A 35-year-old woman presented with a tender nodule on the upper eyelid along with crusting and erythema to both eyelids (Figure 13-1). The upper eyelid had a large external hordeolum. When the lower eyelid was inverted, an internal hordeolum was also present. The physician recommended that she apply warm moist compresses to her eyelids 4 times a day. Her hordeola resolved within 7 days.

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 United States, but often stated to be more common in school-age children and adults 30 to 50 years old.
  
• In one study of school-age children in Brazil, the prevalence of chalazion was found to be 0.2% and that of hordeolum was 0.3%.1

Hordeolum (Acutely Tender Nodule in the Eye)

• Infection in the meibomian gland (internal hordeolum), often resolves into a chalazion (Figure 13-1).
  
• Infection in the Zeiss or Moll gland (external hordeolum) (Figures 13-2 and 13-3).
  
• Staphylococcus aureus is the causative agent in most cases.

Chalazion

• 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 13-4).
  
• Reaction can cause acute tenderness and erythema, which then resolves into a chronic nodule (Figure 13-5).