Hordeolum

Hordeolum or stye can cause symptoms such as itching, irritation, redness, inflammation, and a swollen lump containing yellow pus in the center of an acne-like pimple. Hordeolum can occur on both the outer (external hordeolum) and inner eyelid (internal hordeolum) near the edge of the upper and lower eyelids. Initial signs of hordeolum are swelling, redness, pain, and tenderness over the affected area.

Causes of hordeolum

Hordeolum or stye is caused by bacterial infection of the sebaceous (Zeis) glands, sweat (Moll) glands or meibomian glands of the eyelid. The risk of hordeolum increases, particularly in patients with a history of meibomian gland dysfunction (MGD) and blepharitis. Staphylococcus aureus bacteria is the most common pathogen.

Risk factors of hordeolum

• MGD or obstruction of sebaceous or sweat glands of the eyelid
• Blepharitis or chronic inflammation of the eyelids
• History of hordeolum or stye
• Immune system deficiencies states
• Rubbing or touching eyes with unsanitary hands.
• Wearing unsanitary contact lenses
• Incomplete removal of eye makeup

Can hordeolum resolve without treatments?

Typically, hordeolum can subside and heal. Within 4-5 days after the abscess flare-up, it may rupture and shrink without specific treatment. The patient may apply a warm compress or use a clean cloth moistened with warm water to compress and massage the hordeolum area for approximately 10-15 minutes and repeat 4-5 times a day to help drain the pus and facilitate drainage.

However, the infection may recur if the pus does not drain adequately. Therefore, attention to cleanliness and hygiene is essential. If the symptoms do not improve within 48 hours or the area of inflammation continues to expand, see an ophthalmologist promptly.

Potential risks of recurrent hordeolum

If the abscess does not shrink or dwindle, it may form a hard lump and the pus get trapped in the eyelid, potentially increasing the risk of re-infection. In severe cases, the infection could spread to the cheek. Therefore, patients should have a consultation with an ophthalmologist for proper treatment.

Hordeolum treatment by an ophthalmologist

If you have a very painful hordeolum with extensive inflammation, the eyelid is swollen shut, or a blurry vision, you should urgently make an appointment to see an ophthalmologist. The doctor will examine, diagnose, and prescribe topical medications, such as eye drops or ointment, and may prescribe oral antibiotics if the infection is severe or a lot of pus accumulates.

To drain the pus, the ophthalmologist will lance open the abscess and scrape the pus inside the eyelid (incision and curettage) to remove it. An ophthalmologist should be the one who makes the hordeolum incision for wound cleanliness and safety. It also prevents the possible eyelids deformity, which can negatively affect your appearance, while helping the inflammation to a speedy recovery and preventing hordeolum from recurring.

Pre-incision suggestions for patients with hordeolum

• Stop anticoagulation medicine such as warfarin or aspirin before the incision. 
• On the day of the hordeolum incision, clean your face and wash your hair thoroughly, refrain from applying creams or ointments, and use makeup.
• Avoid dusty areas where pollution is intense.

Post-incision suggestions for patients with hordeolum

• Typically, the ophthalmologist will apply an eye pad after the procedure to keep the wound sterile and prevent dust from entering the eyes. Patients can remove the eye pad after 12-24 hours or as advised by the ophthalmologist.
• After removing the eye pad, the patient can take the prescribed medicine as instructed by the ophthalmologist. If the patient experiences fever or pain, take a Paracetamol every 4-6 hours. 
• Do not rub your eye if it is irritated.
• On the next day, clean the eye with a clean cloth or cotton pad moistened with warm water. Wring it dry before thoroughly and gently wiping the eye.
• Refrain from wearing contact lenses.
• Patients given antibiotics prescriptions should finish the course of the antibiotics, including the topical eyedrops, for at least seven days or as prescribed by the ophthalmologist.
• Avoid touching the eye directly with unsanitary hands. Always wash your hands to maintain hygienic conditions. 
• If there are abnormal symptoms such as severe eye pain; swollen, bruised eyelids; red eyes; or blurred vision, please reach out to a doctor as soon as possible.

How to prevent your eyes from hordeolum or stye?

• Avoid rubbing your eyes with unclean hands.
• Regularly maintain cleanliness around the eyes and face.
• Always clean up your cosmetics and contact lenses before reuse every time.
• Maintain lid hygiene with a warm compress and massage the eyelid if there is coexisting MGD.

Hordeolum is not as troubling as you may think

Hordeolum or stye is curable and not contagious. It commonly happens from a variety of factors. However, the best way to prevent hordeolum or stye is to maintain cleanliness to reduce the risk of bacterial infection, which is the leading cause of hordeolum. However, if you experience an early symptom of hordeolum, you should make an appointment with an ophthalmologist to get early treatment for your eye’s health and well-being.