What is the treatment for Hordeolum?

Treatment of Hordeolum

Start with warm compresses applied for 5-10 minutes several times daily combined with eyelid hygiene, as this conservative approach resolves most cases within 5-14 days without need for antibiotics. 1

First-Line Conservative Management

Warm compresses are the cornerstone of treatment:

• Apply to the affected eyelid for 5-10 minutes, 3-4 times daily 1, 2
• This increases blood circulation, relieves pain, and promotes spontaneous drainage 1
• After applying compresses, perform gentle massage of the affected area to help express the obstructed gland 1

Eyelid hygiene is essential:

• Clean eyelid margins with mild soap or commercial eyelid cleansers 1
• This addresses the underlying bacterial blepharitis that frequently accompanies hordeolum 1, 2

Critical patient instructions:

• Never squeeze or attempt to "pop" the hordeolum, as this spreads infection 1
• Discontinue eye makeup during active infection 1

When to Add Antibiotics

Topical antibiotics should be considered for moderate to severe cases or when signs of spreading infection are present 1, though the evidence base for their effectiveness is notably weak and based primarily on expert consensus 2. Most cases resolve spontaneously with conservative management alone within 5-14 days 2.

• Topical antibiotic drops or ointment may be prescribed to protect against secondary bacterial infection 2
• The antibiotic choice should account for normal eyelid and conjunctival flora 2

Oral antibiotics are reserved for:

• Severe cases with spreading infection 1
• Presence of systemic symptoms 1

Timeline for Escalation

Pursue conservative treatment for 5-14 days before considering surgical intervention 3. If no improvement occurs after 48 hours of appropriate therapy, consider modifying the treatment approach 1.

Management of Recurrent Hordeola

For patients with recurrent hordeola, implement a more aggressive eyelid hygiene regimen and evaluate for underlying conditions:

• Chronic blepharitis 1
• Meibomian gland dysfunction 1
• Rosacea 1
• Seborrheic dermatitis 2

Regular eyelid hygiene and treatment of underlying skin conditions serve as prevention strategies 2.

Red Flags Requiring Further Evaluation

Consider sebaceous carcinoma in cases with:

• Marked asymmetry 1
• Resistance to therapy 1
• Unifocal recurrent chalazia 1
• Recurrence in the same location, especially in elderly patients 4, 2
• Eyelid margin distortion or lash loss (madarosis) 4
• Unilateral chronic blepharitis unresponsive to therapy 4, 2

Evidence Quality Note

The evidence for hordeolum treatment is remarkably weak. Two Cochrane reviews found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 5, 6. Current recommendations are based primarily on expert consensus from the American Academy of Ophthalmology rather than high-quality clinical trials 1, 2.

Common Pitfalls to Avoid

• Failing to distinguish between hordeolum (acute infection requiring warm compresses) and chalazion (chronic, non-infectious inflammation that may require different management) 1, 4
• Missing underlying chronic blepharitis that predisposes to recurrent disease 1, 4
• Overlooking sebaceous carcinoma masquerading as recurrent unilateral hordeolum 1, 4
• Prescribing antibiotics routinely when conservative management alone is typically sufficient 2, 6