Stye (hordeolum)

Background

• External - arises from blockage and infection of (sebaceous) Zeis or Moll (sweat glands)
• Internal - arises from blockage and infection of meibomian glands

Clinical Features

• Pustule accompanied by pain, edema, and erythema of the eyelid

Differential Diagnosis

Periorbital swelling

Proptosis

• Normal IOP
  • Orbital cellulitis
  • Orbital pseudotumor
  • Orbital tumor
• Increased IOP
  • Retrobulbar abscess
  • Retrobulbar emphysema
  • Retrobulbar hemorrhage
  • Ocular compartment syndrome
  • Orbital tumor

No proptosis

• Periorbital cellulitis/erysipelas
• Dacryocystitis (lacrimal duct)
• Dacryocele/Dacryocystocele
• Dacryostenosis
• Dacryoadenitis (lacrimal gland)
• Allergic reaction
• Nephrotic Syndrome (pediatrics)

Lid Complications

• Blepharitis (crusts)
• Chalazion (meibomian gland)
• Stye (hordeolum) (eyelash folicle)

Other

• Subperiosteal abscess
• Orbital abscess
• Cavernous sinus thrombosis
• Conjunctivitis
• Contact dermatitis
• Herpes zoster
• Herpes simplex
• Sarcoidosis
• Granulomatosis with polyangiitis

Treatment

• Warm compresses x15min QID
• Abx
  • Consider oral abx (w/ staph coverage) if pt has concurrent preorbital cellulitis (rare)
  • Little evidence that topical abx are helpful

Disposition

• Refer to ophtho if does not improve within 1-2wk or hardens into a chalazion

See Also

• Chalazion