PANCE Blueprint EENT (7%)

Hordeolum (ReelDx + Lecture)

REEL-DX-ENHANCED-REGISTERED

11 y/o with a red, swollen lesion on the eyelid

Patient will present as → a 15-year-old male with pain, redness, and swelling of the upper eyelid for the last 3 days. There are no visual changes or photophobia. Examination reveals a tender, erythematous, and outward-pointing edema of the right eyelid.

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Hordeolum = Stye = Painful and “Hot”- think “H” for Hot = Hordeolum

  • The patient will present with a painful, warm (hot), swollen red lump on the eyelid (different from a chalazion, which is painless)
  • There may be tearing, photophobia, and a foreign body sensation
  • They are usually caused by staphylococcus aureus
  • Hordeolum are infections of the glands of the eyelid, while a chalazion is a sterile, chronic inflammation that results from a blocked meibomian gland. A complication of a stye is that it may progress to a chalazion
Stye02

Red, Painful and "Hot" = Hordeolum

The diagnosis is clinical

Warm compress and topical antibiotics

  • A hordeolum that does not respond to hot compresses can be incised with a sharp, fine-tipped blade
  • Systemic antibiotics (e.g., dicloxacillin or erythromycin 250 mg PO QID) are indicated when cellulitis accompanies a hordeolum

Question 1
A 25-year-old woman presents with a painful, red swelling on the upper eyelid that developed over the past two days. She reports a similar episode six months ago. Which of the following is the most common causative agent of this condition?
A
Herpes simplex virus
Hint:
More commonly associated with ocular herpes, not hordeolum.
B
Staphylococcus aureus
C
Pseudomonas aeruginosa
Hint:
Not a typical cause of hordeolum.
D
Chlamydia trachomatis
Hint:
Associated with trachoma and inclusion conjunctivitis, not hordeolum.
E
Candida albicans
Hint:
Not a common causative agent of hordeolum.
Question 1 Explanation: 
Staphylococcus aureus is the most common causative agent of hordeolum (stye). It typically infects the eyelid margin or lash follicle, leading to the acute onset of a painful, red swelling on the eyelid.
Question 2
Which of the following best differentiates between a Chalazion and a Hordeolum?
A
Chalazion: Acute infection of a meibomian gland, typically painful and located at the eyelid margin
Hint:
A chalazion results from the blockage and inflammation of a meibomian gland but is typically not as acutely painful as a hordeolum and is often located away from the eyelid margin.
B
Hordeolum (Stye): Chronic granulomatous inflammation of a meibomian gland, usually painless and located away from the eyelid margin
Hint:
This description incorrectly characterizes a hordeolum as a chronic and painless condition, which is more indicative of a chalazion.
C
Chalazion: Chronic granulomatous inflammation of a meibomian gland, typically painless and located away from the eyelid margin
Hint:
This is a correct description of a chalazion, but it does not match the patient's presentation of an acutely painful lesion.
D
Hordeolum (Stye): Acute infection of a meibomian gland or Zeis gland, typically painful and located at the eyelid margin
E
Both conditions are essentially the same and differ only in duration
Hint:
This statement is incorrect as chalazion and hordeolum have distinct clinical features and etiologies.
Question 2 Explanation: 
A hordeolum, commonly known as a stye, is an acute infection of the meibomian gland or Zeis gland, resulting in a painful, red, and swollen lump at the eyelid margin. A chalazion results from the blockage and inflammation of a meibomian gland but is typically not as acutely painful as a hordeolum and is often located away from the eyelid margin.
Question 3
A 20-year-old university student presents with an acutely painful swelling on her upper eyelid diagnosed as a hordeolum. What is the most appropriate initial treatment for this condition?
A
Systemic antibiotics
Hint:
Typically reserved for cases with significant cellulitis or systemic symptoms.
B
Warm compresses and lid hygiene
C
Steroid injection
Hint:
Not a standard treatment for hordeolum.
D
Surgical incision and drainage
Hint:
Considered if the hordeolum does not resolve with conservative treatment.
E
Antiviral medication
Hint:
Used for viral infections, not applicable for a bacterial infection like a hordeolum.
Question 3 Explanation: 
The most appropriate initial treatment for a hordeolum is warm compresses and lid hygiene. Warm compresses help in promoting drainage and resolution of the stye, while lid hygiene helps in preventing recurrence.
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References: Merck Manual · UpToDate

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