From the Guidelines
The diagnosis is likely hordeolum (stye), an infection of the eyelid gland, and management should include continued warm compresses and topical antibiotic ointment. The patient presents with right eyelid swelling and drainage, which started this morning, and denies any eye pain or vision changes. The improvement with warm compresses is typical, as heat increases blood flow to the area, promoting drainage and resolution of the infection, as suggested by the dry eye syndrome preferred practice pattern 1. Management should include:
- Continued warm compresses applied to the affected eyelid for 10-15 minutes, 4 times daily until resolution
- Topical antibiotic ointment such as erythromycin 0.5% or bacitracin applied to the eyelid margin 2-3 times daily for 7-10 days
- Avoiding eye makeup and contact lenses until the infection resolves
- Considering oral antibiotics such as dicloxacillin 250-500mg four times daily or cephalexin 500mg twice daily for 7 days if symptoms worsen or don't improve within 48-72 hours. The patient's SVT history is not directly relevant to this condition but should be noted in her overall management. Hordeolum typically results from bacterial infection (commonly Staphylococcus) of either the meibomian gland (internal hordeolum) or the gland of Zeis or Moll (external hordeolum). The guidelines for managing SVT 1 are not directly applicable to this condition, as the patient's current symptoms are related to an eyelid infection rather than a cardiac issue.
From the Research
History of Present Illness (HPI)
- The patient is a 25-year-old female with a past medical history (PMH) of supraventricular tachycardia (SVT) who presents with acute onset of right eyelid swelling and drainage, starting this morning.
- She denies any eye pain or vision changes.
- The patient reports that warm compresses helped alleviate her symptoms this morning.
Differential Diagnosis
- Based on the patient's symptoms, possible diagnoses include:
- Blepharitis, which is characterized by eyelid inflammation and can be treated with warm compresses and antibiotics 2.
- Hordeolum or stye, which is a well-defined mass at the lid margin 3.
- Chalazion, which is a mass within the midportion of the lid 3.
- Preseptal or orbital cellulitis, which are important to identify and treat, and can be differentiated from each other based on the presence or absence of vision changes and ophthalmoplegia 3.
Management
- The patient's symptoms improved with warm compresses, which is consistent with the treatment of blepharitis 2, 4.
- Topical azithromycin ophthalmic solution 1% has been shown to be effective in treating posterior blepharitis, especially when combined with warm compresses 4.
- Oral antibiotics may also be considered for the treatment of chronic blepharitis, although the evidence is very uncertain and further trials are needed to provide high-quality evidence 5.