Definition

Hordeolum is a medical term for a commonly known condition, a stye. It is a small lump on the eyelid resembling a pimple, typically caused by a bacterial infection. Hordeolum is categorized into two types based on the infection's location: external hordeolum (located on the outside of the eyelid) and internal hordeolum (located on the inside of the eyelid). Generally, styes are not serious and do not cause visual impairment.

Causes

Hordeolum is divided into two types based on the cause and location of the infection:

• External Hordeolum (Stye)

This occurs on the outside of the eyelid and is caused by a Staphylococcus bacterial infection in the Zeis or Moll glands located at the base of the eyelashes, affecting both upper and lower eyelids. It commonly occurs in children and adolescents.

• Internal Hordeolum

This type occurs on the inner eyelid due to an infection of the Meibomian glands, which function as sweat glands to keep the eyelid surface lubricated. Internal hordeolum usually appears on the upper eyelid and is more painful than external hordeolum as the lump points inward and presses on the eye.

While styes are not directly transmitted through eye contact, the risk of contracting a sty increases if you come into contact with someone who has recently touched or rubbed an infected eye and then touch your own eyes without washing your hands first.

Risk Factor

While hordeolum can affect anyone, certain groups and histories are at higher risk of this condition if they have:

• Prior history of hordeolum
• Other accompanying skin diseases
• Diabetes or dyslipidemia
• Poor eye hygiene, such as habits of improper makeup removal or using contaminated cosmetics
• Improper care or use of contact lenses, including dirty lenses, handling lenses without washing hands, sleeping with contact lenses, reusing disposable lenses, and using expired lenses

Symptoms

Signs and symptoms of a stye include:

• A small lump on the upper or lower eyelid
• Painful, reddish, and warm lump on the eyelid
• Watery eyes and sensitivity to light
• Itchy eyes

A hordeolum does not cause impaired vision or other visual disturbances. Symptoms typically subside on their own or with over-the-counter medications within 2 to 3 days

Diagnosis

The diagnosis of hordeolum is based on clinical findings from a history of symptoms and a physical examination. No additional tests are usually required.

The doctor will inquire about patients’ complaints and history of prior similar illnesses, diabetes or dyslipidemia, use of facial makeup, or other skin diseases. A physical examination of the eyes will be performed to check for redness, swelling, or lumps on the eyelids. In cases of internal hordeolum, the eyelid may be pulled outward (eversion method) to inspect the inner part of the eyelids. The doctor might also perform a visual acuity examination, although hordeolum does not typically affect visual acuity unless there are complications, such as corneal damage.

Hordeolum is generally easily distinguished from other conditions but may need differentiation from other similar diseases:

• Chalazion: It is caused by inflammation and blockage of glands in the eye, often a complication of hordeolum, persisting for more than 2 weeks.
• Preseptal cellulitis: An infection of the eyelid and surrounding soft tissue, accompanied by decreased vision, inflammation of the eye membrane, red eyes, and possibly upper respiratory tract infection symptoms.
• Basal cell carcinoma: A type of skin cancer presenting as small lumps on the eyelids that bleed easily, often associated with unexplained weight loss and lumps that grow or multiply over time.

Management

The following simple methods can help treat styes:

• Eyelid hygiene

Regularly clean the edge of the eyelid, using a cotton bud moistened with diluted baby shampoo.

• Warm compress

Apply a warm compress to the eye for 10-15 minutes, 2-4 times a day, using a towel soaked in warm water.

• Avoid contact lenses

Refrain from using contact lenses while you have a sty.

• Pain relievers

Take over-the-counter pain relievers like paracetamol to relieve eye pain.

If these methods do not help, consult a doctor to get your eyes checked. They may prescribe topical antibiotics or anti-inflammatory medications in the form of ointments or eye drops. If the lump persists despite medication, a minor surgical procedure may be necessary to drain the pus.

Complications

A stye that does not heal can develop into a chalazion, which refers to a blockage of the eyelid glands resulting in a permanent lump or cyst. Additionally, the infection can spread to the tissue around the eyelid, leading to preseptal cellulitis.

Prevention

To prevent hordeolum, adopt healthy lifestyle changes focused on eye hygiene:

• Maintain cleanliness of your face, scalp, eyebrows, and hands.
• Wash your hands with soap and warm water or use an alcohol-based hand sanitizer before touching your eyes or contact lenses.
• Use a thin layer of eye makeup or none at all, and remove it thoroughly.
• Keep contact lenses clean and free of infection.

The most common cause of styes is the application of cosmetic makeup, particularly around the eyes. Pay attention to the expiration date. Each makeup product has a different longevity and must be replaced at the right time. Here are the guidelines that can be followed:

• Mascara should be changed every 3 to 6 months
• Liquid eyeliner should be changed every 3 months
• Pencil eyeliner should be changed every 2 to 3 months

When to See a Doctor?

Generally, stye is harmless and does not affect vision. However, consult a doctor if you experience any of the following symptoms:

• Fever
• Blurred vision
• Styes persist for more than 2 weeks
• Swelling and redness spreading to the forehead or other parts of the face
• Bleeding lumps or styes
• Increasingly painful and enlarging lumps

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