![]() ![]() Ī chalazion can mimic an internal hordeolum, and it may be difficult to distinguish between the two at first. These underlying conditions should be addressed to prevent recurrent hordeolum in these patient populations. The provider should also consider underlying causes that can lead to a reoccurrence of hordeola such as blepharitis and rosacea. ![]() Other diagnoses that should be considered are periorbital and orbital cellulitis, chalazion, sebaceous gland carcinoma, and squamous cell carcinoma. While hordeolum is a common presentation, the practitioner should ensure that other manifestations of a painful red eyelid are considered and ruled out during evaluation and treatment. The specimen should be sent to pathology to rule out more serious diseases, including carcinoma. An ophthalmologist should perform the incision and drainage under local anesthesia. Incision and drainage of a persistent abscess may be necessary. If the infection spreads and progresses to a periorbital or orbital cellulitis, systemic antibiotics are required. If the swelling is significant and causing pressure on the cornea, topical steroids can be used for a short duration. A macrolide antibiotic ointment such as erythromycin ophthalmic ointment is often used and has the added benefit of lubrication. This treatment may help to shorten duration and severity. Persistent lesions or larger lesions may require antibiotic therapy. Careful attention should be paid to compresses and massage for the internal hordeolum, as this could cause irritation or deformation to the cornea. Soap may also help to remove bacteria by breaking down cell membranes, and it may also treat an underlying cause of the external hordeolum, blepharitis. Lid massage is intended to help express the purulent drainage from the infected gland. Lid scrubs with saline or mild shampoo (e.g., baby shampoo) that is tear-free and ph-balanced, may promote drainage by clearing debris from the clogged duct. There are no conclusive studies to date, showing that this method alone causes any shortened durations or improved outcomes. Warm compresses are aimed at softening the granulomatous tissue and facilitating drainage. These are often seen as the gold standard. Warm compresses are also of benefit, as is massage to the area. In many cases, the lesions can spontaneously drain without any treatment. Ophthalmology referral is indicated in these situations. Persistent or recurrent painful lumps in the eye may be indicative of carcinoma and require biopsy. Any pain in ocular movements with periorbital swelling and erythema is indicative of orbital cellulitis and requires additional and more aggressive management and treatment. The provider should inquire about any of the predisposing conditions for hordeolum, and these conditions should be addressed and managed in treatment. ![]() The provider should try to locate a pustule, and the eyelids may need to be everted, especially to locate an internal hordeolum. The erythema is localized to the lid of the affected eye. The patient should not report ocular pain, and their extraocular movements should be intact and painless. Visual acuity may be affected if the size of the hordeolum is pressing on the cornea. The patient will usually relay a slow and insidious onset of a painful, red, and swollen eyelid without a history of foreign body or trauma. ![]() A careful history of and physical exam is essential. ![]()
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