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Patient Story

A 5-year-old girl presented with a tender nodule on the lower eyelid for 3 days (Figure 10-1). The clinician diagnosed an external hordeolum (stye) and recommended that the mother apply warm moist compresses to the affected eyelid 4 times a day. Her hordeolum resolved within 7 days.


A. External hordeolum on the lower eyelid of a 5-year-old girl. B. Close-up showing eyelid swelling. (Used with permission from Richard P. Usatine, MD.)


A hordeolum is an acute painful infection of the glands of the eyelid, usually caused by bacteria. Hordeola can be located on the internal or external eyelid. Internal hordeola that do not completely resolve become cysts called chalazia. External hordeola are commonly known as styes.


Stye (external hordeolum).


  • Unclear incidence or prevalence in the US, but often stated to be more common in school-age children.

  • In one study of school-age children in Brazil, the prevalence of chalazion was found to be 0.2 percent and that of hordeolum was 0.3 percent.1

Etiology and Pathophysiology

Hordeolum (Acutely Tender Nodule in the Eye)

  • Infection in the meibomian gland (internal hordeolum), often resolves into a chalazion (Figure 10-1).

  • Infection in the Zeiss or Moll gland (external hordeolum) (Figures 10-2 and 10-3).

  • Staphylococcus aureus is the causative agent in most cases.


External hordeolum (black arrow) and an internal hordeolum (white arrow). (Used with permission from Richard P. Usatine, MD.)


External hordeolum with disruption of the normal contour of the eyelid. (Used with permission from Richard P. Usatine, MD.)


  • Meibomian gland becomes blocked, often in a patient with blepharitis.

  • Blocked meibomian gland’s duct releases gland contents into the soft tissue of eyelid.

  • Gland contents cause a lipogranulomatous reaction (Figure 10-4).

  • Reaction can cause acute tenderness and erythema, which then resolves into a chronic nodule (Figure 10-5).


Chalazion viewed from internal eyelid showing the yellow lipogranulomatous material. (Used with permission from Richard P. Usatine, MD.)


Chalazion present for 4 months on the upper eyelid of a young girl with minimal symptoms but cosmetically unappealing. (Used with permission from Richard P. Usatine, MD.)

Risk ...

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