It is a common disorder of the glands of the eyelids. Hordeolum is Latin for barley as it resembles cereal grains. Eyelids have many types of glands in them that are important for oily and watery secretions. These secretions are necessary to maintain the moisture in the eye, lubricate the eye, and wash off any debris with tears. Two important types of these glands are the Meibomian glands and the glands of Zeis and Moll. Thus, the hordeolum is also of two types, internal hordeolum, and external hordeolum.
The disorder affects men and women equally. However, a hordeolum is more often found in adults than children. The possible reason for the higher prevalence among adults is a combination of many factors, such as the higher levels of sex hormones, increased viscosity of sebum (oily secretions), higher incidence of meibomitis, and acne rosacea. However, hordeola can occur in children as well.
1. External Hordeolum
It is an infection of one of the glands of Zeis or Moll present at the margins of your eyelids and an eyelash follicle. In its early stages, you may feel a tender, raised bump on the margins of your eyelids. You may mistake it for a pimple. It is painful to touch and points anteriorly through the lid margin, almost always involving a lash in its center. It commonly affects young adults and children.
What Causes External Hordeolum?
External hordeolum occurs when the opening of a gland gets clogged with thick oil, bacteria, or dead skin. As a result, bacteria and other substances start to build up in the gland. It leads to infection of the gland and the resultant pus secretion from it. Hordeolum externum usually contains an eyelash in its center. The bacteria is usually staphylococcus which is present in the nose and skin. Many factors may increase the risk of developing an external hordeolum, such as:
- Although no age is immune to a hordeolum, an external hordeolum is more common in young adults and children.
- Habitual rubbing of the eyes or fingering the eyelids and nose and transferring the nose bacteria to the eyelid margins.
- Poor hygiene of the eyes or eyelids in particular.
- Excessive intake of carbohydrates and alcohol
- Eye strains due to muscle imbalance or problems with eyesight (refractive errors).
- Chronic infection of the eyelid margins and diabetes mellitus increase recurrence of external hordeolum.
- It may alternate with boils on the neck, carbuncle, or acne, indicating a decreased immunity to certain bacteria.
What Are The Symptoms Of External Hordeolum?
If you have external hordeolum, you may experience the following symptoms:
- A red bump on the margin of the eyelid
- Gritty feeling or foreign body sensation in the eye
- Tenderness or even pain in the eye
- Watery discharge from the eye (lacrimation)
- Swelling of the eyelids
- Pus secretion from the bump
- Photophobia (photosensitivity)
- The blurring of the vision as eyelids move down due to the weight of the hordeolum (ptosis)
- The pain subsides with the evacuation of the pus
How Is External Hordeolum Diagnosed?
The diagnosis is usually made with the physical examination of the bump. The site of origin of the bulge is crucial in determining the type of hordeolum. Sometimes, the lump on the eyelid is not an external hordeolum rather a chalazion. It is difficult to differentiate between the two, though. But the two have a different history and presentation, enabling your doctor to distinguish between the two easily. No tests are required.
What Is The Prognosis Of External Hordeolum?
External hordeolum is usually a harmless condition. Recurrences are common, though, as many factors increase the risk for developing an external hordeolum. It usually takes three days to reach its mature form containing pus. After which, it bursts and resolves in a week or two. It may persist in case the immune system is weak. So treatment can speed up the resolution.
What Is The Treatment For External Hordeolum?
Hordeolum is not a serious health concern. It usually lasts for a week or two and goes away! You can speed up the recovery with home remedies. However, if your problem persists for a longer duration, you should see a doctor!
Hordeolum Externum Home Remedies
Following home remedies can help you get rid of your hordeolum problem!
- Warm-compression:
As with any inflammation, warm compression is very effective. To do this, soak a clean washcloth in warm water; and get rid of the excess water so that it is not dripping. Then place the warm cloth over the affected eyelid and don’t try to squeeze or compress the bump. A warm compress helps drain the pus naturally, decrease swelling and reduce pain. Do this for an average of ten minutes, four to five times a day.
- Clean your eyelid with baby shampoo or mild soap!
Sometimes the pus involves the entire eyelid, and it gets difficult to open your eye in the morning or after the drainage of pus. Sometimes, the pus may take the form of crust. Don’t be harsh on your eyelids when removing this pus and cleaning your eyes. Use a clean washcloth with baby shampoo or mild soap to wipe off your eyelid.
- Massage Your Eyelid:
Massaging your eyelid promotes drainage: However, your hands must be clean and stop massaging if it hurts.
- Avoid wearing make-up!
You can irritate your eye and delay the healing, or even worse, transfer the infection to the other eye.
- Avoid touching or rubbing your eyes!
Your fingers are one of the dirtiest parts of your body. They contain the most bacteria and other infectious microbes. So, keep your hands away from your eyes so that you don’t transfer any staphylococcus bacteria from your nose and skin to your eyes.
- Take Anti-inflammatory pain medications!
Over-the-counter non-steroidal anti-inflammatory drugs such as ibuprofen relieve pain and inflammation and speed up the recovery.
- Stop Wearing Contact Lenses:
If you wear contact lenses, you should stop wearing them until the hordeolum resolves. You can switch to eyeglasses in the meantime. And after the problem goes away, you should wear new contact lenses to protect yourself from the previous infection.
If these options don’t seem to work for you, or you have recurrent episodes of external hordeolum, talk to your doctor! They may be an ophthalmologist or a dermatologist (if you have associated skin problems). Along with the options mentioned before, your doctor will recommend the following:
- Pull off the eyelash present in the hordeolum to aid in drainage of the pus. It relieves pain and promotes healing.
- Rarely, your doctor may recommend a small incision with a small knife to the hordeolum to increase drainage.
- Antibiotic eye drops—applied three to four times a day—and antibiotic ointment—applied at night before going to bed.
- Your doctor may also recommend oral antibiotics to control the spread of infection.
- If you have a recurrent external hordeolum, your doctor may ask for some tests to diagnose underlying problems, such as diabetes.
What Are The Complications Of External Hordeolum?
Hordeolum does not cause any complications. It resolves within a week or two. However, recurrent cases may flatten the cornea and impair the vision.
2. Internal Hordeolum
It is the second type of hordeolum that is an infection of the Meibomian gland and usually occurs secondary to a chalazion. Since the upper lid has more Meibomian glands, it affects it the more. Although not as common as a hordeolum externum, it is more severe. It is because the Meibomian glands are present in the dense fibrous tissue of the eyelids. However, their openings are at the lid margin.
What Causes An Internal Hordeolum?
It occurs when the opening of a meibomian gland gets clogged, and the sebaceous content of the gland begins to build up. Thus, the gland gradually increases in size. This condition is known as a chalazion, and it is not an infection. However, sometimes, bacteria get into the enlarged gland and cause acute infection. This infection secondary to a chalazion is known as an internal hordeolum. Other predisposing factors are similar to the internal hordeolum.
What Are The Symptoms Of An Internal Hordeolum?
All the symptoms of an internal hordeolum are similar to the external hordeolum. However, an internal hordeolum has the following distinguishing signs and symptoms:
- Pain is worse due to the depth of the gland.
- An internal hordeolum is seen by everting the eyelid.
- Bump and tenderness are usually away from the lid margins.
- The pus point is usually present on the inside of the eyelid rather than on the lid margins. It is rarely present on the lid margins or through the skin of the eyelid.
- The conjunctiva on the inside of the eyelid is more hyperemic (red)
What Is The Treatment Of Internal Hordeolum?
Treatment of hordeolum internum is also similar to hordeolum externum. If the condition does not resolve with conservative options, your doctor may treat it with a surgical incision to drain the pus out and speed up the recovery. A vertical incision is preferred when the pus points on the conjunctival side.
However, if the pus points through the skin, a horizontal incision is given as it heals with minimum scarring and is cosmetically better. After the incision, your doctor may scrape away glandular content and epithelium as well.
Internal hordeolum may also cause similar complications as an internal hordeolum.
Frequently Asked Questions about hordeolum
Is A Hordeolum Contagious?
No, a hordeolum is not contagious. You can not get a hordeolum from another person. Nor can you transfer it to someone around you. However, it is possible that your second eye may get a hordeolum as well. It occurs when your fingers transfer the bacteria from the affected eye to the other.
What is the initial stage of hordeolum?
During the initial stages, a hordeolum does not contain any pus. The gland gradually increases in size due to the build-up of bacteria and other content. In a day or two, your immune system attacks the bacteria and destroys them. In the process, some of the white blood cells die and turn into white pus. It is the mature stage of a hordeolum. It takes about three days to reach this purulent stage. After which, the raised bump bursts and releases the pus. From this point onward the healing begins. Depending upon the status of your overall health, the resolution occurs in a week or two.
Can I pop/express a hordeolum?
No, you can not express a hordeolum. Expressing a hordeolum increases the risk of spreading the infection to the other eye. Just improve your eyelid hygiene and follow the recommended home remedies or the advice of your doctor!
What happens during hordeolum surgery?
Surgery is the last resort to get rid of a hordeolum and is only performed when hordeolum does not go away with conservative measures. Surgery to remove a hordeolum is an outpatient procedure. It only takes 15 to 30 minutes and can be performed in a doctor’s office. During the procedure, the doctor injects a numbing agent into the eyelid. Depending upon the type of your hordeolum, they make a small incision in the bump and drain the pus from it. The doctor may also scrape away the internal lining of your gland to clean it thoroughly.
If you have a hordeolum externum, the doctor will make a small incision at the margins. However, if you have a hordeolum internum, the incision would be either on the conjunctival side of the eyelid or the outer side. If the pus points on the conjunctival side, a vertical incision is preferred. However, your doctor will make a horizontal incision if the pus points through the skin. It is because a horizontal incision heals quicker with minimal scarring and is cosmetically better.
Can I wear contact lenses during a hordeolum?
You can not wear contact lenses during a hordeolum. Contact lenses may irritate your hordeolum and delay healing. It can also trap bacteria underneath and prolong the problem or you may transfer the infection to the other eye. Thus, wearing contact lenses during a hordeolum is not a good idea. You should switch to glasses in the meantime and buy a new pair of lenses once your hordeolum goes away.