2.10 Hordeolum (Sty)
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agk's Library of Common Simple Emergencies

Presentation
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The patient complains of redness, swelling, and 
pain in the eyelid, perhaps at the base of an 
eyelash (sty or external hordeolum) or deep 
within the lid (meibomianitis or internal 
hordeolum, best appreciated with the lid 
everted) perhaps with conjunctivitis and 
purulent drainage.

What to do:
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- Examine the eye, including visual acuity and 
   inversion of lids (see "[Conjunctival FB]" 
   for technique).
- Show patient how to instill antibiotic drops 
   or ointment (e.g., sulfa, tobramycin, 
   erythromycin, gentamycin) into his lower 
   conjunctival sac and apply warm tap water 
   compresses for 10 minutes per hour or 20 
   minutes four time daily.
- Instruct the patient to return to the ophtha- 
   lmologist or the ED if the problem is not 
   clearly resolving in two days, or if it gets 
   any worse.
- If the abscess does not spontaneously drain 
   or resolve in two days, you may incise it 
   with the tip of a #11 blade or small needle, 
   with the same follow up instructions.

What not to do:
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- Do not miss a periorbital cellulitis, which 
   is a severe infection and requires agressive 
   systemic antibiotic treatment.

Discussion
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The terminology of the two types of hordeolum 
have become confusing. Meibomian glands run 
vertically, within the tarsal plate, open at 
tiny puncta along the lid margin, and secrete 
oil to coat the tear film. The glands of Zeiss 
and Moll are the sebaceous glands opening into 
the follicles of the eyelashes. Both can become 
occluded and superinfected, producing 
meibomianitis (internal hordeolum) or a sty 
(external hordeolum). The ED care of both acute 
infections is the same. A chronic granuloma of 
the meibomian gland is called a chalazion, will 
not drain, and requires excision.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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