11/30/2016

Hordeolum: Background, Pathophysiology, Epidemiology

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Hordeolum
Updated: May 17, 2016
Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel Ing, MD, FRCSC more...

OVERVIEW

Background
A hordeolum is a common disorder of the eyelid. [1] It is an acute focal infection (usually
staphylococcal) involving either the glands of Zeis (external hordeola, or styes) or, less
frequently, the meibomian glands (internal hordeola). [2]
"Hordeum" is Latin for barley, the appearance of which a hordeolum can resemble.

Pathophysiology
There is usually underlying meibomitis with thickening and stasis of gland secretions with
resultant inspissation of the Zeis or meibomian gland orifices. Stasis of the secretions leads to
secondary infection, usually by Staphylococcus aureus. [3] Histologically, hordeola represent
focal collections of polymorphonuclear leukocytes and necrotic debris (ie, an abscess).
Hordeola should not be confused with chalazia, which represent focal, chronic,
lipogranulomatous inflammation of the Zeis or meibomian glands. [4] Chalazia form when
underlying meibomitis results in stasis of gland secretions, and the contents of the glands
(sebum) are released into the tarsus and adjacent tissues to incite a noninfectious inflammatory
reaction. Histologically, chalazia appear as a granulomatous reaction (ie, histiocytes,
multinucleated giant cells) surrounding clear spaces that were once occupied by sebum/lipid
before they were dissolved by the solvents used for tissue processing, hence the term
lipogranuloma.
Essentially, a hordeolum represents an acute focal infectious process, while a chalazion
represents a chronic, noninfectious granulomatous reaction. However, chalazia often evolve
from internal hordeola. [5]

Epidemiology
Frequency
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United States
Hordeola are common in clinical practice, but no data are available on the precise incidence
and prevalence in the United States.
International
No data are available on the incidence and prevalence of hordeola internationally. However,
hordeola are among the most common eyelid lesions in clinical practice.

Race
There is no known racial predilection to developing hordeola.

Sex
There is no sexual predilection to developing hordeola. Both men and women seem to be
equally affected.

Age
Hordeola are more common in adults than in children, possibly because of a combination of
higher androgenic levels (and increased viscosity of sebum), higher incidence of meibomitis,
and rosacea in adults. However, hordeola can occur in children.
Clinical Presentation
References

1. American Academy of Ophthalmology. Eyelids. Ophthalmic Pathology and Intraocular

Tumors. San Francisco, CA: LEO; 2007-2008. 4:
2. American Academy of Ophthalmology. Infectious diseases of the external eye: clinical
aspects. External Disease and Cornea. San Francisco, CA: LEO; 2006-2007. 8:
3. Destafeno JJ, Kodsi SR, Primack JD. Recurrent Staphylococcus aureus chalazia in
hyperimmunoglobulinemia E (Job's) syndrome. Am J Ophthalmol. 2004 Dec.
138(6):1057-8. [Medline].
4. Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. 1999 Aug. 20(8):283-4.
[Medline].
5. Katowitz WR, Shields CL, Shields JA, Eagle RC Jr, Mulvey LD. Pilomatrixoma of the
eyelid simulating a chalazion. J Pediatr Ophthalmol Strabismus. 2003 Jul-Aug. 40(4):2478. [Medline].
6. Raskin EM, Speaker MG, Laibson PR. Blepharitis. Infect Dis Clin North Am. 1992 Dec.
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Hordeolum: Background, Pathophysiology, Epidemiology

6(4):777-87. [Medline].
7. Kiratli HK, Akar Y. Multiple recurrent hordeola associated with selective IgM deficiency. J
AAPOS. 2001. 5(1):60-1. [Medline].
8. Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL. Sebaceous carcinoma of the
eyelids: personal experience with 60 cases. Ophthalmology. 2004 Dec. 111(12):2151-7.
[Medline].
9. Panicharoen C, Hirunwiwatkul P. Current pattern treatment of hordeolum by
ophthalmologists in Thailand. J Med Assoc Thai. 2011 Jun. 94(6):721-4. [Medline].
10. Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum. Cochrane
Database Syst Rev. 2010 Sep 8. CD007742. [Medline].
11. Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum. Cochrane
Database Syst Rev. 2013 Apr 30. 4:CD007742. [Medline].
12. Hosal BM, Zilelioglu G. Ocular complication of intralesional corticosteroid injection of a
chalazion. Eur J Ophthalmol. 2003 Nov-Dec. 13(9-10):798-9. [Medline].
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Contributor Information and Disclosures

Author
Michael P Ehrenhaus, MD Director, Department of Cornea, External Disease & Refractive
Surgery, Assistant Professor, Department of Ophthalmology, State University of New York
Downstate Medical Center
Michael P Ehrenhaus, MD is a member of the following medical societies: American Academy
of Ophthalmology, American College of Surgeons, American Medical Association, American
Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists
Disclosure: Nothing to disclose.
Coauthor(s)
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Hordeolum: Background, Pathophysiology, Epidemiology

Kirk Alexander Sturridge, MD Staff Physician, Department of Ophthalmology, State University

of New York Downstate Medical Center
Disclosure: Nothing to disclose.
Specialty Editor Board
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska
Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical
College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of
Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy
of Ophthalmology, American Ophthalmological Society, American Society of Cataract and
Refractive Surgery, Cornea Society, Contact Lens Association of Ophthalmologists, Eye Bank
Association of America, International Society of Refractive Surgery
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for:
Cornea Society, AAO, OMIC, Aerie, Bausch & Lomb, Bio-Tissue, Shire, TearLab<br/>Serve(d)
as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue.
Chief Editor
Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision
Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children
and Sunnybrook Hospital
Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of
Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American
Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and
Surgeons of Canada, Canadian Ophthalmological Society, North American NeuroOphthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of
Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario
Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society
Disclosure: Nothing to disclose.
Additional Contributors
Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American
Academy of Ophthalmology
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Hordeolum: Background, Pathophysiology, Epidemiology

Disclosure: Nothing to disclose.

Acknowledgements
The authors and editors of Medscape Reference gratefully acknowledge the contributions of
previous author, George Alexandrakis, MD, to the development and writing of this article.
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