What is a Hordeolum (Stye)?
A hordeolum is an acute, painful, purulent (pus-filled) inflammation of the eyelid margin caused by bacterial infection and obstruction of the eyelid's oil-producing glands 1.
Types of Hordeolum
There are two distinct types based on which glands are affected:
External hordeolum (stye): Infection of the Zeis or Moll glands associated with eyelash follicles at the eyelid margin 2, 3
Internal hordeolum: Infection of the meibomian glands located within the tarsal plate (deeper in the eyelid) 2, 4
Clinical Presentation
The key distinguishing features that help identify a hordeolum include 5:
- Redness of the eyelid margin
- Swelling - localized, tender lump
- Pain - this is the hallmark that differentiates it from chalazion
- Acute onset (typically less than 7 days duration)
- May have purulent discharge
Natural Course
Most hordeola are self-limited and resolve spontaneously within approximately one week through spontaneous drainage of the abscess 2, 6. However, complications can occur:
- Spread to adjacent glands and tissues
- Recurrences are very common 2, 6
- If an internal hordeolum remains unresolved, it can develop into a chalazion (chronic lipogranulomatous inflammation without infection) or generalized eyelid cellulitis 2
Differentiation from Chalazion
This distinction is clinically important 3:
- Hordeolum: Acute, painful, purulent, infectious process
- Chalazion: Chronic, typically painless, non-infectious lipogranulomatous cyst from gland obstruction
Associated Conditions
Hordeola are commonly seen in patients with 1:
- Chronic blepharitis (eyelid margin inflammation)
- Meibomian gland dysfunction
- Rosacea
- Recurrent hordeola in children increase risk of developing adult rosacea 1
Important Pediatric Considerations
In children, chronic blepharokeratoconjunctivitis with recurrent hordeola is often unrecognized and can be more severe, potentially leading to corneal complications and amblyopia 1. The presentation can be asymmetric and is frequently confused with herpetic disease 1.