Hordeolum (Stye)

Excerpt

A stye or hordeolum is a common problem involving the eye seen in primary and urgent care settings. Styes are manifestations of upper or lower eyelid infection. Classically, the lesion appears as a small pustule along the eyelid margin. Hordeola may be differentiated from a chalazion, which tends to involve less inflammation and follows a more chronic course.

A hordeolum involves an acute, localized infection of the sebaceous glands of the eyelid. The lesion often becomes a red, swollen, and tender nodule, typically near the eyelid margin. Styes are categorized into external hordeola, involving the glands of Zeis or Moll, located at the base of the eyelashes, and internal hordeola, affecting the deeper meibomian glands within the tarsal plate.

Styes are a common condition across all age groups, primarily caused by Staphylococcus aureus. Self-limiting, untreated, or improperly managed styes usually lead to complications, such as chalazia, preseptal cellulitis, and, rarely, orbital cellulitis.

The anatomy of the eyelid plays a crucial role in the development of styes:

1. Glands of Zeis: Sebaceous glands at the base of eyelash follicles. These glands may develop external hordeola (see Image. External Hordeolum of the Upper Eyelid).

2. Glands of Moll: Modified sweat glands near the eyelash follicles that may also develop external styes.

3. Meibomian glands: Sebaceous glands embedded in the tarsal plate that produce the lipid layer of the tear film. These glands are often blocked or infected in internal hordeola.

4. Orbital septum: A fibrous barrier separating the superficial and deep structures of the orbit, helping to prevent the deeper spread of infection.

Styes generally develop over a few days due to gland blockage and subsequent bacterial colonization. In most cases, the lesion progresses to form a small abscess, draining spontaneously or resolving with conservative treatment. Untreated or recurrent styes may evolve into a chalazion, a chronic, noninfectious granulomatous lesion.

Styes can spread in different ways, potentially leading to complications if not properly managed. In localized hordeola, the infection remains confined to the affected gland and surrounding eyelid tissues. If untreated, the infection can progress to preseptal cellulitis, involving the tissues around the eye. In rare cases, the infection may cross the orbital septum and cause orbital cellulitis, which requires urgent medical intervention. Recurrent styes are often linked to underlying conditions such as blepharitis, rosacea, and diabetes.