What is the treatment for a Hordeolum?

Treatment of Hordeolum

The first-line treatment for hordeolum is warm compresses applied to the affected eyelid for 5-10 minutes, several times daily, combined with gentle eyelid hygiene and massage to help express the obstructed gland. 1

First-Line Management

• Apply warm compresses to the affected eyelid for 5-10 minutes, several 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 contents of the obstructed gland 1
• Discontinue eye makeup use during active infection to prevent further irritation and contamination 1

Second-Line Management

• Topical antibiotics should be considered for moderate to severe cases or when there are signs of spreading infection 1
• Oral antibiotics are reserved for severe cases with spreading infection or systemic symptoms 1
• For persistent cases that do not respond to conservative management, incision and curettage may be necessary after 5-14 days of nonsurgical treatment 2

Special Considerations

• For recurrent hordeola, implement a more aggressive eyelid hygiene regimen and evaluate for underlying conditions such as blepharitis or meibomian gland dysfunction 1
• Consider evaluation for possible sebaceous carcinoma in cases of marked asymmetry, resistance to therapy, or unifocal recurrent chalazia 1
• In pediatric cases, conservative management is often extended and surgical interventions delayed compared to adult cases 2

Important Clinical Pearls

• Avoid squeezing or attempting to "pop" the hordeolum, as this may spread infection 1
• Distinguish between hordeolum (acute infection) and chalazion (chronic, non-infectious inflammation), as management approaches differ 1, 3
• Most hordeola will resolve spontaneously within 7-10 days with proper conservative management 4, 3
• Address moderate to severe blepharitis prior to any intraocular surgical procedures to reduce risk of complications 1

Evidence Quality

• Despite the common nature of this condition, there is a lack of high-quality randomized controlled trials evaluating non-surgical interventions for hordeolum 5, 6
• Current treatment recommendations are based primarily on expert consensus and clinical experience rather than robust clinical trials 1, 5
• Low-certainty evidence suggests that acupuncture with or without conventional treatments may provide short-term benefits for treating acute hordeolum when compared with conventional treatments alone, though this requires further study 4

The management of hordeolum follows a stepwise approach, starting with conservative measures and progressing to more invasive interventions only if necessary. Most cases will resolve with proper application of warm compresses, eyelid hygiene, and gentle massage, making these simple interventions the cornerstone of treatment.