Can a hordeolum (stye) spread from one eye to the other?

Can a Hordeolum Spread from One Eye to the Other?

Yes, a hordeolum (stye) can spread from one eye to the other through bacterial transmission, particularly when proper hygiene measures are not followed. 1

Mechanism of Transmission

A hordeolum is an acute, painful inflammation of the eyelid margin usually caused by bacterial infection of the oil glands. Transmission between eyes can occur through:

• Direct contact transmission via fingers or hands touching the infected eye and then touching the uninfected eye
• Contaminated items such as washcloths, towels, or pillowcases
• Improper hygiene practices during treatment of the initial hordeolum

Risk Factors for Spread

Several factors increase the risk of spreading infection from one eye to the other:

• Poor hand hygiene
• Sharing personal items (towels, washcloths, pillows)
• Touching or rubbing eyes frequently
• Using contaminated eye makeup or applicators
• Continuing to wear contact lenses during an active infection
• Immunocompromised state

Prevention of Spread

To prevent the spread of infection from one eye to the other:

1. Practice proper hand hygiene:

   • Wash hands thoroughly with antimicrobial soap and water before and after touching the affected eye 1
   • Avoid touching or rubbing either eye unnecessarily

2. Use separate items for each eye:

   • Use separate clean washcloths, cotton balls, or pads for each eye
   • Avoid sharing towels, pillowcases, or other personal items 1
   • Replace pillowcases and towels frequently during an active infection

3. Apply proper treatment techniques:

   • When applying warm compresses, use separate compresses for each eye
   • Apply compresses to the unaffected eye first, then the affected eye
   • Discard used materials properly

4. Discontinue contact lens wear until the infection resolves completely 2

5. Discard and replace eye makeup that may have been contaminated

Treatment Approach

The American Academy of Ophthalmology recommends the following treatment approach for hordeolum 2:

1. First-line treatment:

   • Warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily
   • Gentle eyelid cleansing with diluted baby shampoo or commercial eyelid cleanser
   • Gentle massage to promote drainage

2. Second-line treatment (if signs of blepharitis or risk of secondary infection):

   • Add topical antibiotic ointment (bacitracin or erythromycin) to eyelid margins 1-2 times daily

3. Third-line treatment (for moderate to severe cases):

   • Consider combination antibiotic/steroid topical treatment

Special Considerations

• Immunocompromised patients require more aggressive treatment and closer monitoring 2
• Patients with rosacea are more prone to developing hordeola and may need more intensive management 2
• Children with recurrent hordeola should be evaluated for possible underlying conditions 2

When to Seek Medical Attention

Seek medical attention if:

• No improvement after 7 days of home treatment
• Spreading redness or swelling beyond the eyelid
• Fever or systemic symptoms
• Vision changes
• Recurrent hordeola (may indicate underlying conditions)

By following proper hygiene practices and appropriate treatment protocols, the risk of spreading a hordeolum from one eye to the other can be significantly reduced.