FFinalistSouthampton · 2027
Ophthalmology
AKT · Ophthalmology/Lids & surface

Hordeolum (stye)

Acute focal infection of a lid gland (external: lash follicle/Zeis-Moll; internal: meibomian gland)

Overview

An acute, painful, localised staphylococcal infection of an eyelid gland. External hordeolum (common stye) points at the lash line (gland of Zeis/Moll); internal hordeolum is an infected meibomian gland pointing on the inner lid. Self-limiting — warm compresses, NOT antibiotics.

Recognise

  • Acute tender red swelling at the lid margin, pointing externally (lash line) or internally (tarsal surface)
  • Localised, comes to a head and discharges; may recur and is associated with blepharitis
  • An internal hordeolum can evolve into a chalazion once the acute infection settles

Red flags

  • Spreading lid erythema/oedema, proptosis, painful or restricted eye movements, fever → periorbital/orbital cellulitis — admit

Differentials & how to tell them apart

Chalazionpainless, firm, rubbery tarsal nodule (chronic, sterile lipogranuloma) — a stye is acutely painful and infected
Preseptal cellulitisdiffuse lid swelling/erythema rather than a discrete pointing lesion
Sebaceous/basal cell carcinomarecurrent at the same site, ulcerated, with lash loss — biopsy
External stye — tender lesion pointing at the lash line

External stye — tender lesion pointing at the lash line

Andre Riemann / Public domain — Wikimedia Commons

Investigations

Clinical. No investigation.

Management

Warm compresses (and epilate the lash / incise-drain an external pointing stye if needed)

  1. 1Reassure (self-limiting). Warm compress 5–10 min 2–4 times daily; avoid eye make-up/contact lenses; do not squeeze. For a painful pointing external stye, epilate the affected lash or incise-and-drain with a sterile needle if expertise allows.Gate: Emergency admission if periorbital/orbital cellulitis; same-day ophthalmology if corneal symptoms, rapid visual loss or a red painful eye — and refer on a cancer pathway if eyelid malignancy is suspected
  2. 2Very large/severe/atypical, recurrent, or diagnostic uncertainty → refer to ophthalmology.
Warm compresses — 5–10 min, 2–4 times daily until it drains — the mainstay
Topical antibiotic — only if associated conjunctivitis or after incision/epilation; not routinely needed

Key points

Painful + acute = stye; painless + chronic firm nodule = chalazion. Both are managed with warm compresses first.

Monitor & prognosis

Resolves over days; recurrent styes → treat underlying blepharitis.

Excellent; self-limiting.

Source: NICE CKS Styes (hordeola)