Treatment for Internal Hordeolum
The primary treatment for an internal hordeolum is warm compresses applied to the affected eyelid for 10-15 minutes, 4-6 times daily, which helps promote spontaneous drainage and resolution of the infection. 1
Understanding Internal Hordeolum
An internal hordeolum is an acute, painful inflammation of the meibomian gland in the tarsal plate of the eyelid. It differs from an external hordeolum (stye), which affects the glands of Zeis or Moll associated with eyelash follicles.
Treatment Approach
First-line Treatment
- Warm compresses: Apply warm (not hot) compresses to the affected eyelid for 10-15 minutes, 4-6 times daily
- Lid hygiene: Gentle cleansing of the eyelid margins with mild soap or commercial lid scrubs
- Avoid eye makeup: During the acute phase of infection
When to Consider Additional Interventions
If symptoms persist beyond 48 hours or worsen despite conservative treatment:
- Topical antibiotics: May be considered, though evidence for their efficacy is limited 2
- Oral antibiotics: Reserved for cases with spreading infection or systemic symptoms
- Surgical incision and drainage: Consider if the hordeolum does not resolve with conservative measures after 7-10 days
Evidence Limitations
It's important to note that despite the widespread use of these treatments, high-quality evidence supporting specific interventions for internal hordeolum is lacking. Multiple Cochrane reviews (2010,2013,2017) found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 3, 4, 2. Treatment recommendations are largely based on clinical experience and expert opinion.
Potential Complications
If left untreated, an internal hordeolum may:
- Spread to adjacent glands and tissues
- Develop into a chronic condition
- Progress to a chalazion
- Rarely, lead to more serious complications such as preseptal cellulitis 5
Monitoring and Follow-up
- Most internal hordeola resolve spontaneously within 1-2 weeks
- If symptoms worsen (increasing pain, redness, swelling) or spread beyond the eyelid, prompt medical attention is necessary
- Recurrent hordeola may indicate underlying conditions requiring further evaluation, such as blepharitis or metabolic disorders
Prevention Strategies
- Regular eyelid hygiene, especially for those prone to blepharitis
- Avoid touching or rubbing eyes with unwashed hands
- Replace eye makeup regularly (every 3-6 months)
- Properly remove eye makeup before sleeping
While acupuncture has shown some potential benefit in limited studies from China 6, the evidence is of low certainty and not currently recommended as a first-line treatment in standard ophthalmology practice.