Stye (hordeolum)

Background

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

External stye

Internal stye

Clinical Features

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

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

Diagnosis

• Clinical diagnosis, based on history and physical exam

Management

• Warm compresses
• Antibiotics
  • Consider oral antibiotics (with staph coverage) if patient has concurrent periorbital cellulitis (rare)
  • Little evidence that topical antibiotics are helpful

Disposition

• Discharge
  • Refer to ophtho if does not improve within 1-2 weeks

See Also

• Chalazion