Chalazion and hordeolum are similar in appearance and often confused. Cleveland Clinic Journal of Medicine. May;83(5) Author(s):: Colm . A hordeolum is a common disorder of the eyelid. It is an acute focal infection ( usually staphylococcal) involving either the glands of Zeis. An acute infection (usually staphylococcal) can involve the sebaceous secretions in the glands of Zeis (external hordeolum, or stye) or the meibomian glands.
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Hordeolum is a common, painful inflammation of the eyelid margin that is usually caused by bacterial infection. The infection affects oil glands of the eyelid and can be internal or external. In many cases, the lesion drains spontaneously and resolves untreated; however, the inflammation can spread to other ocular glands or tissues, and recurrences are common.
If unresolved, acute internal hordeolum can become chronic or can develop into a chalazion. External hordeola, also known as styes, were not included in the scope of this review. The objective of this review was to investigate the effectiveness and safety of nonsurgical treatments for acute internal hordeolum compared with observation or placebo.
We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 July The selection criteria for this review included randomized or quasi-randomized clinical trials of participants diagnosed with acute internal hordeolum.
Studies of participants with external hordeolum styechronic hordeolum, or chalazion were excluded. Nonsurgical interventions of interest included the use of hot or warm compresses, lid scrubs, antibiotics, or steroids compared with observation, placebo, or other active interventions.
Two review authors independently assessed the references identified by electronic searches for inclusion in this review. No relevant studies were found. The reasons for exclusion were documented.
No trials were identified for inclusion in this review. Most of the references identified from our search reported on external hordeola or chronic internal hordeola. The few references specific to acute internal hordeolum reported mostly recommendations for treatment or were reports of interventional jouranl series, hordeeolum studies, or other types of observational study designs and were published more than 20 years ago.
We did not find any evidence for or against the effectiveness of nonsurgical interventions for the treatment of hordeolum. Controlled clinical trials would be useful in determining which interventions are effective for the treatment of acute internal hordeolum. Hordeolum is a common, painful inflammation of the eyelid that is usually caused by a bacterial infection.
The infection affects the oil horrdeolum in the eyelid and results in a lump. Often, the infected lump drains and heals by itself with no treatment. However, the infection can sometimes spread to other glands in the eyes and can become long lasting. It can also turn into a cyst known as a chalazion. Hordeolum can be internal on the inside of the eyelid or external on the outside of the eyelid near the eyelashes.
Hordeolum on the outside of the eyelid is known as a stye. Hordeolum also can be acute appearing suddenly and healing in a short time or chronic long lasting ohrdeolum occurring over time.
Common treatments for hordeolum include warm compresses applied at home, available over-the-counter topical medications and lid scrubs, antibiotics or steroids, lid massages, and others.
The purpose of this review hordeoulm to see whether these treatments work.
We included only studies of patients with acute internal hordeolum. We did not include studies of joournal with styes or long-lasting cases of hordeolum.
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We identified no trials for this review, thus no evidence was found for or against the effectiveness of common treatments for hordeolum.
Controlled clinical trials would be useful in showing which treatments help people with acute internal hordeolum. Hordeolum is a common inflammation of the eyelid margin. It presents as a red, painful, swollen furuncle with an acute onset and is usually caused by a staphylococcal infection Mueller ; Peralejo ; Skorin The infection can be internal, affecting the meibomian glands, or external, affecting the glands of Zeis or Moll Wald External hordeola are known more commonly as styes.
In many cases, the lesion drains spontaneously and resolves untreated; however, the infection can spread to other ocular glands or tissues, and recurrences are common. If unresolved, acute internal hordeolum can become chronic or can develop into a chalazion De Jesus ; Hudson ; Mueller ; Rubin Hordeolum is one of the most common diseases of the eye; therefore many people can be affected and many causative factors are known to be related to the disease.
Incidence rates for hordeolum are not available because most cases are not reported. Hordeola tend to occur in younger people but are not limited to any age, gender, or racial group Fuchs ; Lederman ; Roodyn Onset is spontaneous and may be related to lid hygiene, an underlying condition, or a systemic infection Mathew ; Wald Typically, the size of the swelling is a direct indicator of the severity of the infection Lebensohn Internal hordeolum tends to be more painful and longer lasting than external hordeolum Barza ; Fuchs ; Olson ; Wilkie Cases of recurrent hordeolum are usually the result of failure to eliminate bacteria completely rather than resulting from new infections Roodyn Blepharitis Fuchs ; Skorinacne rosacea De Jesustrichiasis, and cicatricial ectropion Moriarty are conditions frequently associated with internal hordeolum.
Most cases of internal hordeolum resolve on their own; therefore people with hordeolum often do not seek professional medical treatment Olson Home therapies, including heated compresses, lid scrubs, and over-the-counter medications, are often employed without consultation with a medical professional.
Interventions for acute internal hordeolum
For times when medical care is sought, a general practitioner or a family physician may be consulted before an ophthalmologist or an optometrist is seen Fraunfelder ; Lebensohn Practice standards for the initial treatment of hordeola are conservative, typically limited to the application of warm compresses several times a day, if any treatment is recommended at all Barza ; Fuchs ; Olson ; Panicharoen ; Sethuraman ; Wilkie A topical antibiotic may be prescribed in conjunction with warm compresses Diegel ; Lebensohn ; Lederman ; Panicharoen ; Wald If the condition is severe and is resistant to topical antibiotics, systemic antibiotics or surgical incision and drainage may be implemented Moriarty ; Mueller ; Panicharoen ; Rubin ; Skorin Nonsurgical treatments for hordeolum include the application of warm or hot compresses, the use of lid scrubs and digital massage, the administration of antibiotics or steroids, or alternative medicine such as acupuncture and autohemotherapy.
Typically, the intent of these interventions is to reduce healing time while relieving the symptoms associated with the lesion. Thus, interventions of interest would be provided during the first week after onset. Beyond one week, it is believed that internal hordeolum may resolve on its own or may require surgical incision and curettage. In addition to resolving the presenting hordeolum, other aims of the interventions are to minimize the risk that the infection may worsen, may spread to other areas, or may become recurrent.
The natural history of acute internal hordeolum generally spans one to two weeks, beginning with the appearance of an abscess and concluding with draining of the abscess. Initial treatments for hordeolum have therefore been aimed at promoting the evacuation of pus from the abscess.
The application of a warm or hot compress may facilitate drainage by softening the granuloma Diegel ; Fuchs ; Moriarty ; Skorin Heated compresses are typically employed for five to 10 minutes several times a day until the hordeolum is resolved.
Lid scrubs consist of mild shampoos or saline solutions and are applied while the affected area is gently massaged.
The theory underlying the use of lid scrubs is that they promote lid hygiene and prepare the physical environment for drainage by clearing debris from the lid margin Driver ; Skorin Creating a clear channel is believed to initiate drainage, similar to the epilation of an eyelash in cases of external hordeolum Hudson Also, ingredients used in shampoos break down bacterial membranes, which further decreases the presence of bacteria at the infection site McCulley Lid scrubs are commonly recommended in the treatment of other ocular bacterial infections, such as blepharitis, and may prevent the spread of infection Avisar In conjunction with lid scrubs, lid massage has been proposed to physically express secretions from the infected glands Driver ; Scobee Antibiotics can be administered locally at the site of infection or may be given systemically.
Most cases of hordeolum are caused by a staphylococcal species; therefore antibiotics should be effective against the bacteria. Application of topical antibiotics may reduce healing time by fighting against the causative bacterial infection and reducing inflammation. Many topical medications include ingredients that relieve the symptomatic pain of internal hordeolum.
Antibiotics can also be applied locally by injection. Systemic antibiotics are sometimes used when local antibiotics are not effective, or when the infection is not localized. Steroids can be applied topically as ointments or eyedrops.
Internal hordeolum has a short journnal therefore as little as one steroid treatment could be effective in reducing healing time and relieving symptoms associated with the inflammation King ; Palva Acute internal hordeolum is a common disease experienced by a wide population.
Although the course of the disease is relatively short, instances of internal hordeolum are painful and bothersome. Furthermore, improper management of the underlying cause of the infection may hordrolum to recurrent infections or to the development of other disease. Despite the common recommendation to employ heated compresses, their efficacy in treating hordeolum has not been systematically reviewed. If heated compresses are indeed sufficient in treating hordeolum, then more rigorous interventions, such as antibiotics or steroids, may not be warranted for initial treatment.
Conversely, comparing the effectiveness and safety of all available interventions, to determine which may be most beneficial to the individual, is also important.
A summary of the evidence should assist patients and professionals in determining preferred methods of treatment. The objective of this review was to investigate the effectiveness and, when possible, the safety of nonsurgical treatments for acute internal hordeolum compared with observation or placebo.
Interventions for acute internal hordeolum
This review was limited to randomized and quasi-randomized clinical trials. We were interested in studies of participants with a diagnosis of acute internal hordeolum. Studies of participants with only external hordeolum styechronic hordeolum, or chalazia were excluded. Nonsurgical interventions were the primary focus of this review. We included trials that compared the use of hot or warm compresses, lid scrubs, antibiotics, or steroids with observation, placebo, or another active intervention for the treatment of acute internal hordeolum.
Complementary and alternative therapies, such as acupuncture and bloodletting, were outside the scope of this review. The primary outcome for this review was the proportion of participants with complete resolution of hordeolum seven days after diagnosis. The seven-day period for resolution was selected because most cases of hordeolum resolve on their own at between one and two weeks.
We also analyzed the proportion of participants with complete resolution of hordeolum after 14 days as a secondary outcome, when these data were available. We planned to report all adverse effects related to the treatment of hordeolum that were reported in the primary studies. Specific journak outcomes of interest included conjunctivitis; eye irritation; discoloration of the eyelid, conjunctiva, and lens; and corneal damage.
In we modified the search strategy to include broader terms related to hordeolum. We reviewed the reference lists from potentially eligible studies to identify further studies. In addition we used the Science Citation Index to search for references that cited potentially eligible studies last searched on 11 Oct with no relevant studies identified. We designated each reference identified from the searches as a relevant, b possibly relevant, or c not relevant for this review.