What are the interventions for hordeolum?

Treatment of Hordeolum

Warm compresses applied to the affected eyelid for 5-10 minutes several times daily are the first-line treatment for hordeolum. 1

First-Line Management

• Apply warm compresses to the affected eyelid for 5-10 minutes, 4-6 times daily to increase blood circulation, promote drainage, and relieve pain 1
• Clean the eyelid margins with mild soap or commercial eyelid cleansers to remove debris and reduce bacterial load 1
• Perform gentle massage of the affected area after applying warm compresses to help express the obstructed gland contents 1
• Avoid squeezing or attempting to "pop" the hordeolum as this may spread infection 1
• Discontinue eye makeup use during active infection to prevent further irritation and contamination 1

Second-Line Management

• Consider topical antibiotics for moderate to severe cases or when there are signs of spreading infection beyond the immediate area 1
• Reserve oral antibiotics for severe cases with spreading infection or systemic symptoms such as fever or significant periorbital cellulitis 1
• For recurrent hordeola, implement a more aggressive eyelid hygiene regimen and evaluate for underlying conditions such as blepharitis or meibomian gland dysfunction 1

Surgical Management

• If the hordeolum does not respond to conservative treatment within 7-10 days, consider incision and curettage 2
• Note that adding antibiotic ophthalmic solution after incision and curettage has not been shown to be more effective than placebo 2
• Recent evidence suggests that antibiotics (topical or oral) do not improve resolution rates for hordeola when added to conservative measures 3

Special Considerations

• For recurrent hordeola, evaluate for underlying conditions such as blepharitis, meibomian gland dysfunction, or immunocompromised states 1
• Consider evaluation for possible sebaceous carcinoma in cases of marked asymmetry, resistance to therapy, or unifocal recurrent chalazia 1
• Address moderate to severe blepharitis prior to intraocular surgical procedures to reduce risk of complications 1

Evidence Quality and Gaps

• Cochrane reviews have found no high-quality randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 4, 5
• Low-certainty evidence suggests acupuncture with or without conventional treatments may provide short-term benefits for treating acute hordeolum compared to conventional treatments alone 6
• A recent study found that antibiotics are frequently prescribed for hordeola (36.5% of cases) despite evidence that they do not improve resolution rates 3

Common Pitfalls

• Failing to distinguish between hordeolum (acute infection) and chalazion (chronic, non-infectious inflammation) 1
• Missing underlying chronic blepharitis that predisposes to recurrent hordeola 1
• Unnecessary prescription of antibiotics, which has not been shown to improve outcomes compared to warm compresses and lid hygiene alone 3
• Failure to consider sebaceous carcinoma in cases of recurrent unilateral disease resistant to therapy 1