What are the symptoms and features of Hordeolum (stye)?

Symptoms and Features of Hordeolum (Stye)

A hordeolum presents as a painful, erythematous nodule at the eyelid margin with rapid onset and signs of acute inflammation, often with purulent discharge, and is frequently associated with bacterial blepharitis. 1

Types of Hordeolum

• External hordeolum (stye): Affects the glands of Zeis or Moll associated with eyelash follicles 2
• Internal hordeolum: Affects the meibomian gland in the tarsal plate 2

Clinical Presentation

• Painful, erythematous nodule at the eyelid margin 1
• Rapid onset with signs of acute inflammation 3
• May have purulent discharge 1
• Can occur on either upper or lower eyelid 3
• Often associated with bacterial blepharitis 1
• Localized swelling and redness 3
• Acute inflammatory process with characteristic rapid onset (distinguishing it from chalazion, which has gradual onset) 3, 1

Associated Symptoms

• Ocular discomfort 4
• Foreign body sensation 5
• Tearing 5
• Itchiness may be present 5
• Mild to moderate pain 3

Natural History

• Often self-limited, with spontaneous drainage and resolution within approximately one week 2
• Can spread to adjacent glands and tissues if severe 2
• Recurrences are common 2
• If unresolved, an acute internal hordeolum can become chronic or develop into a chalazion 2

Risk Factors and Associations

• Blepharitis (inflammation of the eyelid margin) is a common predisposing factor 4
• Meibomian gland dysfunction may contribute to development 4
• History of styes in children is associated with increased risk of developing adult rosacea 4
• Systemic conditions like rosacea may predispose to hordeolum development 4
• Use of certain medications (e.g., isotretinoin, dupilumab) may increase risk 4
• Contact lens wear, particularly with giant papillary conjunctivitis, may be associated with increased risk 4
• Components of metabolic syndrome may be associated with higher risk for blepharitis, which predisposes to hordeolum 4

Warning Signs Requiring Further Evaluation

• Marked asymmetry, resistance to therapy, or unifocal recurrent lesions 6, 1
• Eyelid margin distortion, lash loss (madarosis), or ulceration 3, 1
• Unilateral chronic blepharitis unresponsive to therapy 3, 1
• Recurrence in the same location, especially in elderly patients (raises suspicion for sebaceous carcinoma) 3, 1

Differential Diagnosis

• Chalazion: Painless nodule within the tarsal plate with visible meibomian gland obstruction on eyelid eversion, associated with gradual onset 3, 1
• Sebaceous carcinoma: May mimic recurrent hordeolum or chalazion, especially in elderly patients 6, 3
• Preseptal cellulitis: More diffuse eyelid inflammation and swelling 5

Complications

• Spread of infection to adjacent ocular glands or tissues 2
• Development into a chalazion if unresolved 2
• Generalized eyelid cellulitis in severe cases 2
• Cosmetic deformity of the eyelid 3

Common Pitfalls in Diagnosis

• Failure to distinguish between hordeolum (acute infection) and chalazion (chronic, non-infectious inflammation) 6
• Missing underlying chronic blepharitis that predisposes to recurrent hordeola 6
• Overlooking sebaceous carcinoma in cases of recurrent unilateral disease resistant to therapy 6

Understanding these symptoms and features of hordeolum is essential for accurate diagnosis and appropriate management, particularly to distinguish it from other eyelid conditions and to identify cases requiring further evaluation.