What is the treatment for an internal hordeolum?

Treatment of Internal Hordeolum

The first-line treatment for internal hordeolum consists of warm compresses and eyelid hygiene, with topical antibiotics added for moderate to severe cases. 1

Initial Management

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to promote drainage of the infected meibomian gland 1
• Perform gentle eyelid massage during warm compress application to help express the meibomian glands 1
• Use eyelid cleansing with mild soap or commercial lid scrubs to reduce bacterial load on the eyelid margin 1
• Consider artificial tears to improve ocular surface comfort if there is associated dry eye 1

Pharmacological Management

• For moderate to severe cases, apply topical antibiotic ointment (such as bacitracin or erythromycin) to the eyelid margin 1
• Avoid long-term use of topical corticosteroids, as they should be applied for no more than 7 days to prevent thinning of perianal and anal mucosa 1
• Oral antibiotics are generally reserved for cases with spreading infection or systemic symptoms 1

Follow-up and Progression

• Most internal hordeola will resolve within 1-2 weeks with conservative treatment 2, 3
• If symptoms worsen or fail to improve within 1-2 weeks, reassessment is recommended 1
• For persistent internal hordeolum that does not respond to conservative treatment, it may develop into a chalazion requiring additional interventions 2, 3

Special Considerations

• Patients with recurrent hordeola should be evaluated for underlying conditions such as blepharitis or meibomian gland dysfunction 1
• A complete ocular surface examination is important for patients with chronic, recurrent hordeola that are unresponsive to standard treatment 1
• In children, chronic blepharokeratoconjunctivitis with recurrent hordeola is often unrecognized and requires prompt treatment to prevent complications 1

Surgical Management

• Surgical incision and drainage is typically reserved for large, painful hordeola that do not respond to conservative treatment 2, 3
• If an internal hordeolum persists despite appropriate treatment, it may require evaluation to rule out malignancy, especially in cases with marked asymmetry or resistance to therapy 1

Evidence Limitations

• There is a lack of high-quality randomized controlled trials specifically evaluating treatments for acute internal hordeolum 2, 3
• Most treatment recommendations are based on clinical experience and expert opinion rather than robust clinical evidence 2, 3