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Disease

• Acute (bacterial) infection of the meibomian glands (hordeolum internum) or zeis glands (hordeolum externum)
• palpable nodule on the eyelids, usually painful, reddening

Management

• high self-healing rate, application of warm compresses 4x/day with light massage (with hot/cold packs, alternatively black tea bags, warm flannel), eyelid hygiene
• Fucithalmic gel (Fusidic acid) 2x/day for 2-3 weeks
  • Alternatively: Maxitrol ointment (Dexamethason, Neomycin, Polymyxin-B-sulfat) 3x/day or Tobradex ointment (Tobramycin, Dexamethason) 3x/day (max. 2 weeks, Cave: IOP rise!)
• In case of recurrent hordeola:
  • eyelid hygiene
  • Minocin Acne p.o. 50mg 2x/d for 1 week, then 1x/d for 5 weeks (take approx. 1h before meals).
    • Contraindication: renal and hepatic insufficiency, pregnancy, children under 8 years of age
  • Alternatively: azithromycin p.o. 110mg 1-0-0 for 4-6 weeks

Differential diagnoses

• Chalazion: chronic granulomatous inflammationory reaction, not painful
• Preseptal cellulitis: in case of pronounced eyelid swelling

Sources

• Eyewiki Stye
• The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7. Edition (2016)
• Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8. Edition(2015)