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https://upload.medbullets.com/topic/120513/images/hordeolum..jpg
Snapshot
  • A 35-year-old man presents to his primary care physician with eyelid pain. He denies any trauma to the eye or recent procedures. He had a past medical history of blepharitis a few months prior, where he was treated with antibiotic ointment. Physical examination is noticeable for a small, erythematous, and tender nodule on the upper eyelid. He is recommended warm compresses to the eye and asked to return to clinic in 2 weeks.
Introduction
  • Overview
    • an acute focal infection of the glands of Zeis or meibomian glands
  • Epidemiology
    • demographics
      • more common in adults
    • risk factors
      • meibomian gland dysfunction
      • blepharitis
      • ocular rosacea
  • Pathophysiology
    • thickening and stasis of gland secretions of the gland of Zeis or meibomian gland leads to secondary infection
      • most common organism is Staphylococcus aureus 
Presentation
  • Symptoms
    • painful, warm, enlarged nodule on the eyelid 
  • Physical exam
    • tender and erythematous nodule near the eyelid margin
    • may spontaneously rupture and drain
Studies
  • Histopathology
    • indication
      • in patients with persistent or recurrent lesions
        • can help differentiate from basal cell carcinoma and sebaceous cell carcinoma
    • findings
      • abscess
      • focal collection of polymorphonuclear leukocytes and necrotic tissue
Differential
  • Chalazion
    • differentiating factors
      • it is a chronic, nontender noninfectious granulomatous reaction
      • on histopathology, chalazion shows lipogranulomatous inflammation
Treatment
  • Conservative
    • eyelid hygiene and warm compresses 
      • indication
        • first-line, as hordeolum typically self-resolves in 1-2 weeks
  • Medical
    • systemic antibiotics
      • indication
        • when there is clinical suspicion for a preseptal cellulitis
  • Surgical
    • incision and drainage
      • indication
        • if unresponsive to conservative management or hordeolum is large
Complications
  • Preseptal cellulitis
    • if hordeolum spreads to adjacent tissues
 

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