Treatment of Hordeolum
Warm compresses are the first-line treatment for hordeolum, applied to the affected eyelid for 5-10 minutes several times daily to increase blood circulation, promote drainage, and relieve pain. 1
First-Line Management
- Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to increase blood circulation, promote drainage, and relieve pain 1
- Clean the eyelid margins with mild soap or commercial eyelid cleansers to maintain hygiene 1
- Perform gentle massage of the affected area after applying warm compresses to help express the obstructed gland 1
- Avoid squeezing or attempting to "pop" the hordeolum as this may spread infection 1
- Discontinue eye makeup use during active infection to prevent contamination 1
Second-Line Management
- Consider topical antibiotics for moderate to severe cases or when there are signs of spreading infection 1
- Reserve oral antibiotics for severe cases with spreading infection or systemic symptoms 1
- For cases that do not respond to conservative treatment within 7-14 days, consider referral for incision and curettage 2
Management of Recurrent Hordeola
- Implement a more aggressive eyelid hygiene regimen for recurrent hordeola 1
- Evaluate for underlying conditions such as blepharitis or meibomian gland dysfunction that may predispose to recurrence 1
- Consider addressing moderate to severe blepharitis prior to intraocular surgical procedures to reduce risk of complications 1
Special Considerations
- Distinguish between hordeolum (acute infection) and chalazion (chronic, non-infectious inflammation) to guide appropriate treatment 1, 3
- Consider sebaceous carcinoma in cases of marked asymmetry, resistance to therapy, or unifocal recurrent chalazia 1
- For pediatric patients, extend conservative management and delay surgical interventions when possible 2
Evidence Limitations
- Despite the widespread use of conservative treatments for hordeolum, there is limited high-quality evidence supporting specific interventions 4, 5
- Cochrane reviews have found no randomized controlled trials evaluating the effectiveness of non-surgical interventions for acute internal hordeolum 4, 5
- Most treatment recommendations are based on clinical experience and expert consensus rather than robust clinical trials 1
The management of hordeolum primarily focuses on symptom relief and resolution of the infection through conservative measures. While surgical intervention is rarely needed, persistent or recurrent cases may require further evaluation to rule out more serious conditions.