HWN Suggests

The Swollen Eyelid

The general initial treatment is the same for both hordeola and chalazia. This includes warm soaks 3-4 times daily for 10-15 minutes. Topical antibiotics have not been shown to hasten resolution. However, in severe or recurrent cases of pyogenic hordeola, there is some literature to suggest that a course of oral antibiotics may be beneficial (such as erythromycin or dicloxicillin). Establishing follow-up with ophthalmology is recommended if these lesions do not improve with conservative therapy, as they may need evaluation for possible incision and drainage or steroid injections.

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 A Nefarious Character with an Agenda

The stye is a nefarious character with an agenda. It starts off by slowly enlarging over the patient's lid, and it can consume other portions of the face if not treated appropriately. Patients may present to the ED on the fifth day or later when the enlarged lid starts to impair their vision. Occasionally, patients have associated facial swelling, tenderness, or even a preseptal cellulitis. Distinguishing the signs of these complications is imperative for proper treatment. It may be difficult to discern the emergent eye from the urgent eye from the "it-can-wait" eye. You will feel confident about draining an eye lid abscess after reading this post, and you can add one more magic ace to your deck.

 An Eyelid Lump

They are generally clinically indistinguishable – both are acute or chronic eyelid lumps associated with tenderness and eyelid swelling. If it’s particularly hot and red it may be more likely to be a stye/ hordeloum.

 Stye vs. Stye

Historically, we were taught that most hordeola are self-limiting, and do not require aggressive therapy. The use of heated compresses, applied for five to 10 minutes several times a day with concurrent digital massage can hasten pointing and subsequent drainage of the abscess. Topical antibiotic ointments may be prescribed for associated blepharitis, but typically will not achieve sufficient concentrations in deeper lid tissue to eliminate the infection; hence, these agents are considered to be of little benefit.

Articles of Interest

Chalazion, Hordeolum, and Stye – Diagnosis and Treatment

Most hordeola and chalazia are managed as outpatient.

Eyelid Swelling

Chalazia generally are a form of sterile inflammation secondary to obstruction, and tend to be larger but less painful then hordeolums, which are caused by purulent infection of the cilium. It may be difficult to differentiate a chalazion from a hordeolums clinically.

Hordeolum (Stye) & Chalazion

In general, hordeola are acute, infected, and painful lesions at the rim of the eyelid. Chalazia are subacute or chronic, noninfected, and generally less painful lesions on the conjunctival side of the eyelid.

What To Do If You Have A Stye

DO use warm compresses for 10-15 minutes at a time, 3-5 times a day...