Along the upper and lower lids are a number of glands which produce a portion of the eyes tears. These glands include the meibomian glands which produce the oil layer of the tears. Other glandular elements include the glands of Zeiss and Moll. An acute inflammation and/or infection of the eyelid gland (s) is termed a hordeolum, commonly referred to as a stye. A hordeolum can either occur internally inside the lid involving the meibomian glands or can occur externally when the glands of Zeiss or Moll are involved.
Hordeola are characterized by a swollen bump or nodule along the lid margin with redness and tenderness to the touch. Symptoms include a “fullness” feeling and/or a foreign body sensation and occasionally pain. As depicted in the photograph, one can see a red, irritated nodule on this patient’s upper right lid. This is the classic presentation of a stye.
The hallmark treatment of hordeolum/stye is warm compresses and digital massage.
- Warm compresses consist of a clean face cloth under warm to hot water applied to the site of inflammation at least four times daily with gentile pressure applied on the gland with a clean finger.
- The best method we have found to apply heat to the eye area is by using a hard boiled egg. The whole, shelled egg should be wrapped dry in a dry washcloth. As you wrap the egg with the cloth, gather the excess cloth in your fist to make a handle, The egg will fit well against the eye (use a small egg for children), and will hold heat for about 30 minutes, long enough to watch a TV program without running back and forth to the sink. You can reheat the same egg for 15 minutes in boiling water each time you plan to apply the warm compress. (Do not reheat using the microwave). Be careful, without the dry washcloth, the egg will be extremely hot.
- In more involved cases, a topical antibiotic drop and/or ointment may be used. Tobradex® is a combination medication of antibiotic and steroid which is commonly used for this condition. In severe cases which appear to involve large areas of the lid, an oral antibiotic is used to prevent a more serious systemic infection such as preseptal or septal cellulitis.
If a hordeolum is not completely cleared from the gland, the area of inflammation may become encapsulated forming a chalazion. A chalazion is a nodule remnant of a hordeolum without pain and a decrease amount of redness. Chalazion treatment options can include any of the above mentioned but resolution at this stage is less likely with these medications. For cosmetically disfiguring chalazion, the next step of the treatment include either a steroid injection or a minor surgical procedure of incision and curette in which a small incision is made in the roof of the gland and the contents of the glands are scooped out. Hordeola and chalazia can reoccur. One should be concerned if recurrence in the same location occurs. This could be sebaceous cell carcinoma rather then recurrent infection. A biopsy is indicated when the highly malignant sebaceous cell carcinoma is suspected.