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. SUMMARY A hordeolum is an acute focal infection of the glands of Zeis or meibomian glands Diagnosis is made on the clinical exam finding of a painful, erythematous eyelid nodule Treatment involves eyelid hygiene and warm compresses, as hordeola typically self-resolve surgical incision and drainage is indicated if the hordeolum is unresponsive to conservative management Epidemiology Demographics more common in adults Risk factors meibomian gland dysfunction blepharitis ocular rosacea ETIOLOGY 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 eyelid tissues