Stye (Hordeolum and Chalazion) in Adults: Condition, Treatments, and Pictures – Overview

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Images of Hordeolum (Stye) and Chalazion

Overview

A stye (hordeolum) is a local, acutely inflamed growth (swelling, lesion) of the eyelid. They can occur at the lid margin or farther up the lid on either the inner (tarsal) side or the outer (skin) side of the lid. A chalazion is the chronic form of a stye, and its cellular makeup is different than that of a stye.

Both the meibomian and sebaceous oil glands of the lid can be involved in this process, which begins with a blockage of the normal openings of these glands, leading to the swelling. Typically, there is bacterial contamination.

Who’s at risk?

Styes and chalazions are extremely common. You are more likely to have this problem if you have:

• Dry skin problems
• Blepharitis
• Acne rosacea
• Poor lid hygiene
• Incomplete removal of eye makeup
• Outdated or infected cosmetics
• Increased stress
• Hormonal changes

Signs and Symptoms

One should be suspicious of having a stye when there is the rather rapid development of a pus-filled bump (pustule) or swelling on the edge of the eyelid or on the lid itself. Chalazions are more of a rounded lump and are harder in consistency.

Some of the things you may experience include:

• Pain
• Redness of the eye
• Discharge from the swelling
• Tenderness to touch
• Tearing
• Very mild blurring of vision
• Burning sensation
• Scratchy feeling in the eye
• Drooping of the eyelid
• Crusting of the eyelid edges

Self-Care Guidelines

Apply frequent (4–6 times daily) very warm compresses until there is no more drainage from the stye or chalazion. The compresses must be hot enough to help drain the growth yet not so hot as to burn the very delicate eyelid skin. It usually takes 7–10 days, at most, for the problem to resolve. Good lid hygiene is also mandatory. Over-the-counter ointments or drops have no treatment value.

Note: Recurring styes or chalazions without other related factors suggest possible serious disease. With the start of very warm compresses, the growth may get larger temporarily before draining.

When to Seek Medical Care

You should seek medical advice if:

• The eyelids are swollen shut.
• There is no improvement after using frequent very warm compresses for 10–14 days.
• There is pus or very thick drainage from the eye.
• Pain or tenderness is increasing despite compresses.
• The swelling is increasing beyond the first 2–3 days.
• The eyelid is hot to the touch.
• You develop a fever.
• Recurrences are frequent, especially at the same location.
• Progressive vision changes are experienced, including double vision.

Treatments Your Physician May Prescribe

Treatment may involve any or all of the following:

• Surgical incision and drainage
• Injection of steroid into the growth
• Antibiotic ointments
• Antibiotic drops
• Oral antibiotics (especially if there is possible lid infection suspected)
• Treatment for underlying/contributing conditions such as dandruff, acne rosacea, psoriasis, etc.

Trusted Links

MedlinePlus: Eye Diseases
MedlinePlus: Eyelid Disorders
Clinical Information and Differential Diagnosis of Hordeolum (Stye) and Chalazion

References

Kanski JJ, Nischal KK, eds. Ophthalmology: Clinical Signs and Differential Diagnosis. pp. 17, 91. Philadelphia: Mosby, 1999.

Yanoff M, Duker JS, eds. Ophthalmology. 2^nd ed, pp. 708-709. St. Louis, MO: Mosby, 2004.

Sty/Stye (Hordeolum): Symptoms, Causes, Treatments

Overview

A sty is a red, painful bump that forms either on or inside the eyelid near the edge of the eyelashes.

What is a sty?

A sty (sometimes spelled “stye”) is a red, painful bump that forms either on or inside the eyelid near the edge of the eyelashes. A sty that appears on the outside of the upper or lower eyelid, the more usual location, is called an external sty. A sty that appears on the inside of the upper or lower eyelid is called an internal sty. A sty can look like an acne pimple.

The medical term for a sty is a hordeolum.

A sty is similar to another bump that occurs in the eyelid called a chalazion. A chalazion is a bump that usually occurs farther back on the eyelid. Unlike a sty, a chalazion is usually not painful and is not caused by a bacterial infection. Instead, a chalazion occurs when the opening of the oil-producing glands in the eyelid becomes clogged. Treatment for both conditions, however, is similar.

Symptoms and Causes

What causes a sty?

A sty is caused by a bacterial infection in the oil-producing glands in the eyelid. Oil-producing glands line the eyelids and help lubricate the surface of the eye.

What are the signs and symptoms of a sty?

Signs and symptoms of a sty include:

• Painful red bump along the edge of the upper or lower eyelid near the base of the eyelashes
• Swelling of the eyelid (sometimes the entire eyelid)
• Crusting along the eyelid
• Sensitivity to bright light
• Sore, scratchy eye
• Tearing of the eye
• A feeling that there is something in the eye

Diagnosis and Tests

How is a sty diagnosed?

A sty is usually diagnosed by a visual exam of the eyelid.

What are the risk factors for developing a sty?

Styes are very common. Anyone can get a sty. However, you may be more likely to get a sty if you:

• Have had a sty before
• Have blepharitis (an inflammation of the eyelids)
• Have certain skin conditions, such as acne rosacea or seborrheic dermatitits
• Have diabetes
• Have dry skin
• Are experiencing hormonal changes
• Have high lipid levels (“bad” cholesterol)

Management and Treatment

What are the treatments for a sty?

A sty usually will disappear on its own in a few days. However, to reduce the pain and swelling, a sty can be treated at home with self care. Treat as follows:

• Apply a warm washcloth to the eyelid. Apply for 10 to 15 minutes at a time, 3 to 5 times a day. Rewarm washcloth as needed by soaking it in warm water. Wring out excess water, then reapply to the eyelid.
• Gently wipe away eyelid drainage with mild soap such as Johnson’s baby shampoo and water, or eyelid wipes (available in drug stores).

Also follow these tips:

• Do not squeeze or pop a sty.
• Do not rub or touch your eyelid.
• Do not wear makeup or contact lenses until the area has fully healed.

A sty that does not improve within 48 hours of self care may require medical treatment by a doctor. Treatments given by doctors include:

• In-office incision (under local anesthesia) to drain the sty
• Antibiotic ointment to apply to the eyelid or antibiotic eye drops. Sometimes antibiotic pills are prescribed if there is infection of the area surrounding the eye or after incision and drainage of an internal sty.
• Steroid injection into the sty to reduce the swelling in the eyelid

Prevention

Can styes be prevented?

The best way to prevent a sty is by practicing good hygiene around your face and eyes, including:

• Wash your hands thoroughly and often and especially before touching your face and eyes.
• Wash your hands before and after removing contact lenses. Clean contacts with disinfectant and lens cleaning solution. Discard daily wear or other “limited use” lenses on the schedule recommended by your eye doctor.
• Wash your face to remove dirt and/or makeup before going to bed.
• Throw away all old or expired makeup. Replace mascara and eye shadow every 2 to 3 months. Never share or use another person’s makeup.

Living With

When should I see my eye doctor about a sty?

See your eye doctor if:

• Your eye is swollen shut due to the swelling in the eyelid
• Pus or blood is leaking from the bump
• Pain and/or swelling increases after the first 2 to 3 days
• Blisters have formed on your eyelid
• Your eyelid feels hot
• Your vision has changed
• Styes keep recurring. If this happens, a biopsy (a small piece of the sty) may need to be taken to rule out other more serious problems.

Eye Stye | Causes and Treatment

What is an eye stye?

Dr Sarah Jarvis MBE

The medical name for a stye is hordeolum (or hordeola if there are more than one). Styes are a very common type of infection of the eyelid. They usually develop quite quickly, over a few days. Usually only one eye is affected, although you can develop more than one stye at a time, even on the same lid. There are two types of stye: external styes (the common type) and internal styes (which are quite uncommon).

External

stye (external hordeolum)

This is the common type of stye. Technically it is an external stye; however, it is often just called a stye. It appears along the edge of the eyelid, due to infection in the root (follicle) of an eyelash. It may start off as a small red lump but, as it develops into a collection of pus (a little abscess), it looks like a yellow pus-filled spot. The edge of the eyelid around it becomes reddened and swollen, and the lid is painful.

External stye

Internal

stye (internal hordeolum)

An internal stye arises when a type of gland in the main part of the eyelid (meibomian gland) becomes infected. The infection comes to a head on the inner surface of the eyelid, against the eyeball, so that from the outside it is visible only as a swelling. Internal styes may be painful, although often they cause a dull aching in the eyelid, sometimes with the sensation of a lump.

Internal stye

What causes a stye?

Eye with upper eyelid stye

Most styes usually occur for no obvious reason, although if your eyelids are itchy or rubbed a lot this may make an external stye more likely. The usual germ (bacterium) that causes the infection is called Staphylococcus aureus. It is a common germ that is often found on healthy skin. It usually does no harm. However, it can occasionally get into the skin, where it causes infections such as spots, abscesses, and styes.

Some people have an eyelid condition called blepharitis. This is an inflammation of the eyelids in which they can become swollen, dry and itchy. Blepharitis can make you more prone to developing styes. See separate leaflet called Blepharitis for more information.

Anatomy of the eye

When you look at an object you see it because light reflects off the object and enters your eye….

How to treat a stye

• Styes often need no treatment. The ‘head’ usually bursts within 3-4 days.
• Hot compresses may help to ease soreness and draw the pus to a head.
• You should avoid contact lenses and eye make-up until it resolves.
• Taking antibiotics (ointments or medicines) is not recommended.

It is sensible to discard mascara and eyeliners that you used along the edge of your eyelid as the stye was forming. Options to speed up resolution of the stye are:

No treatment

Often, no treatment is necessary. Once a ‘head’ has formed on a stye, most burst within 3-4 days, with the tiny amount of pus draining away and leaving no further problem.

Hot compresses

These may help to ease soreness and draw the pus to a head. You can do this yourself: Hold a clean flannel, which has been dipped in hot water and squeezed dry, gently but firmly against the closed eye. Do this for 5-10 minutes, 3-4 times a day. (The water should be hot; it should be comfortable and not scalding.) Eventually the stye will ‘pop’ and drain – but do not be tempted to try to pop it yourself. You may make things worse by injuring the delicate eyelid, or by spreading infection deeper into the tissues.

Epilation of the eyelash

This is a treatment for an external stye. It means that the eyelash is plucked out. Epilation is briefly uncomfortable but it can help the infection from the hair follicle to drain.

Incision and drainage of an external stye

A health professional can perform this procedure, which is a treatment for an external stye. It is like lancing a boil. A sterile needle (or perhaps a scalpel) can be used to open the stye and drain the pus. You should not attempt this yourself, as you might spread the infection to the eyelid, with serious consequences.

Drainage of an internal stye

This procedure involves using an injection of local anaesthetic to numb your eyelid, which must be flipped ‘inside out’ in order to expose the stye before it can be scraped out. Very occasionally this procedure is done under general anaesthetic, as it is uncomfortable and children, in particular, do not tolerate it. After this procedure, antibiotic eye drops are usually given.

Are styes contagious?

To reduce the chance of the infection spreading:

• Don’t share facecloths/flannels or towels with anyone whilst you have a stye.
• Always wash your hands after touching the affected eyelid.
• Avoid eye make-up or contact lenses until the infection has settled.

Are there any complications?

Most styes are very minor infections that clear without any treatment and cause no problems. Styes do not affect your vision.

Sometimes the stye doesn’t go away, and can turn into a cyst called a chalazion. If this happens it doesn’t look particularly red and it doesn’t hurt. However, you will have a lump on your eyelid.

Very occasionally the infection can spread. It may spread to the surface of the eye, causing conjunctivitis, which may need antibiotic ointment or drops to clear the infection. Alternatively the infection can spread around the eyelid, causing it to become more red and swollen. If this happens you should see your GP as you may need antibiotic tablets.

An extremely rare complication is the infection spreading to involve the whole eyelid and tissues surrounding and behind the eye. The eyelid may be very swollen and red, it may hurt or be impossible to open the eye and you may have a lot of pain and a high temperature (fever). Sometimes the eyeball is pushed forwards so that it bulges, and you may be very sensitive to the light. If you develop this type of complication, which is called orbital cellulitis, you need to see a medical professional urgently. Treatment of orbital cellulitis is with antibiotics, usually given into a vein (intravenously) via a drip, in hospital.

What Causes a Stye and the Best Ways to Get Rid of One Featuring Singh

A stye is a swollen, painful red bump on your eyelid.

• Styes are caused by infected oil glands on your eyelids, which form a red bump that resembles acne.
• Poor hygiene, old makeup, and certain medical or skin conditions can increase your risk for styes.
• To get rid of a stye, you can gently wash your eyelids, use a warm compress, and try antibiotic ointments.
• This article was medically reviewed by Jason R. McKnight, MD, MS, a family medicine physician and clinical assistant professor at Texas A&M College of Medicine.
• Visit Insider’s homepage for more stories.

A stye is a red bump that forms on the eyelid and can look and feel like a big pimple. This bump often feels swollen and painful to the touch. Styes are basically like acne that occurs on the eyelid, says Amy Lin, MD, an ophthalmologist at the University of Utah Health.

Though styes can happen to anyone, there are certain behaviors that increase your risk. Here’s what you need to know about the main causes of styes, how to prevent them, and what to do if you have one.

What causes a stye

Styes are caused by infected oil glands in your eyelids. These oil glands prevent tears from evaporating too quickly and drying out your eyes, but these glands can also become infected with bacteria.

There’s one particular bacterium that leads to stye infections: Staphylococcus aureus. According to Tina Singh, MD, an ophthalmologist at Duke Eye Center, it’s one of the most common bacteria on the skin, eyelids, and eyelashes, and can clog the oil glands.

While the bacterium is found in 20 to 30% of human nasal cavities without harm, you can also pick it up by touching surfaces infected with it, and S. aureus can become a pathogen itself when it gets under the skin, causing skin infections.

There a few reasons why people tend to get styes:

• Poor hygiene.  Rubbing your eyes when you haven’t washed your hands can lead to styes. “We carry a lot of bacteria on our hands, and that’s easily transmissible to our eyelids and eyelashes,” Singh says. Improper contact lens hygiene can also lead to styes, as it puts bacteria closer to the eyelids, so it’s important to disinfect contact daily. “We don’t recommend sleeping with contacts as well because bacteria love moist, dark environments,” she says.
• Chlorine or sweat. “People should rinse their eyelids after getting out of a pool,” Singh says, in addition to hot tubs, as there are chlorine-resistant bacteria that can cause eye infections. If you sweat from exercise or other activities, she says you should wash your eyelids after, as sweat and oil can clog the eyelid’s oil glands and lead to infection.
• Makeup. “Lash extensions really attract a lot of dirt and bacteria, which can clog the [oil] glands,” says Singh. “And makeup is the same way. Makeup really attracts a lot of dirt and bacteria,” which can lead to oil gland infections on the eyelid and cause styes. The Cleveland Clinic recommends replacing eye makeup every six months to avoid an overgrowth of stye-causing bacteria.
• Skin conditions. “Some people with acne have a condition called rosacea, which can actually affect the eyes and can make them prone to have more styes,” Lin says. Rosacea affects about 13 million Americans, and it involves broken blood vessels under the skin which can produce small, pus-filled bumps. The condition can occur on the eyes as well, called ocular rosacea, which can lead to blocked oil glands around the eyes. Seborrheic dermatitis can also increase your risk of styes, which is a chronic inflammatory skin condition that can lead to eyelid swelling and oily secretions.
• Medical conditions. Both Lin and Singh say that blepharitis can increase the risk of developing styes. Blepharitis causes eyelid inflammation and can often lead to excessive tearing, light sensitivity, redness of the eye, and a feeling like there’s something in your eye. The condition also makes your eyelids prone to infection, which can lead to styes. High blood sugar can also cause a production of molecules that suppress immune defenses, so those with uncontrolled diabetes are more prone to infections, and may have a higher risk for styes.

How to get rid of a stye

“Some people have a tendency to get styes,” Lin says, which could be due in part to the aforementioned poor hygiene, makeup, or medical conditions. “So if you’ve had styes in the past, you are more prone to get styes in the future. It doesn’t really confer any resistance.”

If styes keep recurring, you might consider treating it with antibiotic ointment, eye drops, pills, or even a steroid injection, according to the Cleveland Clinic.

To prevent getting styes in the first place, it’s imperative to practice proper lid hygiene. Washing your whole face isn’t enough, Singh says, and so you instead have to target your eyelids to get rid of styes.

Singh recommends washing your eyelids with baby shampoo (it’s designed to be less harmful on your eyes) and warm water to clean along lash margin where styes tend to form.

If you’ve still developed a stye, though, there are ophthalmologist-recommended ways to safely get rid of them.

“Really, the best way is lots of warm compresses over the eyelids,” says Lin. “Adding heat can get the oil glands to unclog and get them to release their oils naturally.”

To do a warm compress, according to the American Academy of Ophthalmology, you should:

• Take a clean washcloth and soak it in hot water. Wring it out so that it’s not dripping.
• Hold it to your eyelid for 10 to 15 minutes. If the cloth gets cold, warm it up again by dipping it in warm water.
• Do this three to five times a day.

“It’s not recommended to try and squeeze [a stye],” Lin says. “Because that could actually cause us to get more inflamed and actually get worse.” Instead, she says to let a stye run its course of about two to three weeks, using warm compresses to expedite the healing process.

While styes will typically clear up on their own, Singh notes that you should see a doctor if your stye causes vision problems. While a stye won’t affect your eyeball, it can become so swollen it droops down into your eyesight.

Article originally appeared in Business Insider Singapore

Styes | Eye Infection | Internal and External Hordeolum

Styes – Diagnosis, Treatment, Signs and Symptoms

Definition of a Stye

A stye is the common name for a hordeolum.  A stye is an infection (abcess/boil) of one of the tiny oil producing glands inside the eyelid usually caused by staphylococcus aureus bacteria.  There are two types of styes, officially called internal hordeolum and external hordeolum.

An internal hordeolum (stye) is a bacterial infection of the meibomian glands inside the eyelids.  Internal styes tend to be more severe and occur a little less often than an external hordeolum.

An external hordeolum (stye) is a bacterial infection of the Glands of Zeis and/or Glands of Moll inside the eyelids.  This type of stye is more superficial and tends to heal quicker.

A stye can occur on either the upper or lower eyelid.

Causes of a Stye

A stye is usually caused by staphylococcus aureus bacteria which infect the internal sebaceous glands within the eyelids.  Styes are common in infants and children but affect people of all ages. 

If the pores of the oil glands become blocked by debris or otherwise they tend to develop an infection.  The bacteria multiply in the root (follicle) of an eyelash.

A stye may be related to blepharitis, which should be treated regularly to avoid styes.

Possible Signs and Symptoms of a Stye

• A circumscribed defined lump or bump on either upper or lower eyelid
• Localized swelling of the eyelid
• Mild pain in the eyelid and sensitive to touch
• Redness of the affected eyelid
• Possible crusting of the eyelid margins
• Possible burning in the eye
• Eyelid appears droopy
• Mucous or watery discharge in the eye
• Irritation of the eye
• Light sensitivity
• Sensation of a foreign object in the eye

Internal Hordeolum (Stye) tends to come to a point on the underside of the eyelid and has an appearance of general redness on the outside visible part of the eyelid.

An external hordeolum (Stye) comes to a visible point on the outside visible part of the eyelid and may appear yellowish in the center of the swelling which indicates pus formation from the infection.

Treatment of a Stye

Most styes can be treated without medical intervention by applying hot compresses for 10-15 minutes at a time for four times per day.  There is some controversy that a warm compress may worsen the swelling and shouldn’t be used for several days.  However, the purpose of the warm compress is not to decrease swelling, but rather to open the pores of the tiny oil glands to allow proper drainage so the eye can heal itself.  Therefore, we only recommend warm/hot compresses.

Removing an eyelash or two in the center of the bump may help to stimulate drainage of the infection.

Clean the eyelid margin and the entire eyelid with an over the counter eyelid scrub (e.g. SteriLid Eyelid Cleanser or Ocusoft eyelid  scrubs) that can be purchased at any pharmacy.

Most styes will heal within  10-14 days.   

If the stye does not get better within 3-5 days treatment by an eye doctor is recommended.  The doctor may prescribe oral antibiotics such as:

Keflex (cephalexin) 500mg twice per day for seven days for patients who are not allergic to penicillin or cephalosporins.

Option (also if no penicillin allergy)  Augmentin (Amoxicillin + Clavulanic acid):

     Dose if mild infection -generic Augmentin 500 mg. twice a day for one week

     Dose if more severe –generic 875mg Augmentin twice a day for one week

    Most severe – 1000mg Augmentin twice a day for one week (not generic)

When the patient has a penicillin or cephalosporin allergy:

Zithromax (azithromycin) in a Z-pak (500mg on day one, followed by 250mg for the next four days) is a good alternative.

OR, if the patient also has allergies to macrolides, we recommend:

Oral fluoroquinolone Levaquin (levofloxacin) at 500mg once daily for 7 days.

Or Cipro (ciprofloxacin) 500-1000 mg once daily for 7 days

Topical eye medicines in most cases offer very little healing since they do not penetrate into the glands.  There is some evidence that topical Azithromycin (Azasite) has some penetrating ability.  However, it is an expensive medicine and most patients are not happy if it doesn’t heal the hordeolum.  The tested and proven treatment would be to use an oral antibiotic, many of which are available generically at a greatly reduced cost.

Complications of a Stye

Use of the above medicines on a timely basis will also prevent an eyelid cellulitis or preseptal cellulitis which is a serious complication of a hordeolum.

If the above medicines are not effective at treating the hordeolum it has probably become a chalazion.  Chalazion may resolve without treatment but many require a minor surgery to remove.

Prognosis of Styes

Although styes are usually harmless and complications are rare, styes often recur. Styes normally heal using the treatment described above with no vision complications.

Preventing Styes

Preventing a stye is primarily a function of improved hygiene around the eyelid area.  Regular use of eyelid scrubs (e.g. SteriLid Eyelid Cleanser or Ocusoft Lid Scrubs) will greatly reduce the incidence of stye formation.

There is some evidence that flaxseed oil or fish oil may assist in keeping the oil flowing freely from the glands in the eyelids so they don’t become clogged and susceptible to bacterial infection.

Women should never share cosmetics with others. Women should remove makeup every night before going to sleep and discard old or contaminated eye makeup.

Stye Pictures | EyeStyeTreatment.org

Home » Stye pictures. Types of stye.

Contents of this article:

Eye stye, photos of which can be seen below, is an inflammatory process that occurs in the sebaceous gland of the hair follicle, or in lobule of meibomian gland. It can occur on both the lower and on the upper eyelid, as well as behind it.

Internal stye, pictures:

External stye, pictures:

Types of stye

There are different types of eye stye, pictures of which you can see in this article. Among them, there are:

• External stye. This is an acute inflammation of the eyelash hair follicles or sebaceous glands, located next to them. The first symptoms of external stye are redness and swelling of the eyelid.
• Internal stye. The pictures of it are presented in the article. It is a meibomian gland inflammation. It can be identified with a little pushing of eyelid. There will be redness and swelling on the inside of an eyelid, and after a few days there will be a capsule filled with purulence. In 2-4 days the stye capsule bursts, and putulence comes out.

Stye on a child’s eye, photos:

Children are not immune from stye. This is due to the fact that in adolescence years there is a violation of the secret product that is produced by the sebaceous glands. In addition, children do not always follow the rules of personal hygiene, and touch their eyes with dirty hands. All this lead to the eyelid stye, a picture of which you can see above.

Stye is not a dangerous disease, but if not properly treated, it can cause serious consequences.

Despite the fact that the stye is a common disease, not all people clearly imagine what it looks like. Eye stye, photos of which can be found in this article, can be different. If you have enough information, you can define the correct diagnosis, as well as to find the right ways to get rid of the disease.

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Stye vs. Stye

One of the greatest things about being an optometric educator is the constant challenge of young, inquisitive minds. While may old, weathered practitioners like ourselves may sometimes “just know” how to manage certain conditions, clinicians-in-training often need to understand the “why” of therapeutic interventions. And so, when a student recently questioned our traditional, conservative management for hordeola, commonly referred to as a “stye,” we decided it was time to review the literature and consider the why of our ways.

Hordeola represent acute bacterial infection and subsequent abscess formation of the eyelid’s sebaceous glands.^1-3 Two forms are recognized clinically: 

1. External hordeola, which involve the more superficial Zeis glands situated at the base of the lashes.
2. Internal hordeola, which affect the deeper meibomian glands within the tarsal plate.^1-3 

Most often, hordeola present as tender or painful eyelid papules with associated erythema of the involved skin. External hordeola, if large or superficial enough, may demonstrate purulent material within the gland through thinning of the overlying epidermis. When this occurs, the hordeolum is “pointing.” Internal hordeola create a more diffuse eyelid swelling due to the infected gland expanding within the tarsus, although the presentation is still consistent with a firm, tender subcutaneous nodule. Pointing may also be seen with internal hordeola, but because of its deeper location, the lesion must be of substantial size and severity before this occurs. Additionally, internal hordeola pointing can occur at either the skin or conjunctival surface.¹

Traditional Therapy

Historically, we were taught that most hordeola are self-limiting, and do not require aggressive therapy. The use of heated compresses, applied for five to 10 minutes several times a day with concurrent digital massage can hasten pointing and subsequent drainage of the abscess. Topical antibiotic ointments may be prescribed for associated blepharitis, but typically will not achieve sufficient concentrations in deeper lid tissue to eliminate the infection; hence, these agents are considered to be of little benefit. We were cautioned against attempting to express or “pop” a hordeolum (unless it was superficial and already pointing). Such vigorous manipulation can be extremely painful for the patient, but more importantly it can potentiate the spread of infection to adjacent glands and tissue, resulting in a more serious preseptal cellulitis. Should secondary chalazia (granulomatous formation within the meibomian gland following resolution of the infectious hordeolum) develop, intralesional corticosteroid injection or surgical incision and curettage can be performed.

Reviewing the Literature

In an attempt to gather more unbiased, peer-reviewed and evidence-based information on this topic, we conducted a PubMed search using the term “hordeolum.” Only 26 English-language articles were published in the last 10 years and, of those, only seven were review articles. This paucity of reports on relatively common clinical entities is often the rule, rather than the exception. Many conditions are regarded as so familiar and straightforward that they simply do not warrant much scientific attention in true clinical studies.

To gain additional perspective about the current prevailing attitudes toward hordeolum management, we resorted to referenced works on known medical websites, such as Medscape, EyeWiki, Merck Manual and Family Practice Notebook.^4-8 While these sources do not offer the most rigorous scientific evidence, they do provide information regarding expert opinion and practice, presented below.

Conservative Therapies

Most current resources for both internal and external hordeola advise the use of warm or hot compresses in five to 20 minute durations, two to four times daily.^4-8 One report recommended concurrent massage of the hordeolum.⁵ A few sources mentioned daily eyelid and lid margin cleansing for associated blepharitis.^5,8 Interestingly, a recent meta-analysis of 944 potentially relevant references found no credible evidence regarding the effectiveness of the aforementioned treatments for acute internal hordeolum.^1,3 The authors concluded that, while warm compresses and lid scrubs are not unsafe, they show no measurable benefit as compared with simple observation.³

Medical Treatment

Investigators advocate topical antibiotic ointments for cases of external hordeola, primarily as a prophylactic measure to protect against infection of adjacent glands.¹ The majority of medical websites we surveyed also suggest topical antibiotic (or combination antibiotic-corticosteroid) ointment as a potential option, primarily for hordeola that are actively draining.^4-6,8 

However, one source specifically states “topical antibiotics are usually ineffective” in the treatment of internal hordeola.⁷ 

All of the websites except one advocated the use of oral antibiotics (e.g., dicloxacillin or erythromycin 250mg PO QID) in recalcitrant cases, recurrent hordeola or in those with suspected preseptal cellulitis.^4,5,7,8  

Surgical Management

In cases of external hordeola, mechanical epilation of the associated lash follicle may allow spontaneous drainage of the affected gland.^1,4 Incision and drainage of acute hordeola is generally not advocated as a first-line therapy; however, it may be advantageous in cases where: 

1. The hordeolum is pointing at the time of initial presentation.
2. The hordeolum proves refractory to more conservative medical therapy.^1,5,7-10  

Incision and drainage of external hordeola may be performed at the slit lamp using topical anesthesia and an 18-gauge or 20-gauge needle. 

Incision and drainage of internal hordeola requires a local anesthetic delivered by injection to the involved eyelid. It is customary to employ a stab incision with a #11 blade, ideally using a transconjunctival approach, to avoid potential scarring of the external lid.^4,6 A topical antibiotic should be applied to the incision site for 24 hours following the procedure. 

We also routinely advocate a course of oral antibiotics if surgical incision and drainage is performed for internal hordeola, as this procedure has the potential to liberate pathogenic bacteria into surrounding tissue and also the bloodstream.

Aged Wisdom

From time to time, it’s important to review and reconsider our therapeutic approaches, even to the most seemingly mundane and straightforward ocular conditions. Medical science often advances faster than we realize, leaving us citing and employing outdated and dogmatic management strategies. Fortunately, in the case of acute hordeola, it would seem that our instinctive philosophies based on 50+ years of combined practice experience aren’t too far off the mark. To summarize:  

1. Hot compresses are still widely advocated, although little scientific evidence demonstrates a benefit in acute hordeola cases.
2. Topical antibiotics appear to be equivocal in these cases, in both recommendation and effect. 
3. Oral antibiotics are strongly recommended for recalcitrant or severe cases of hordeola. 
4. Surgical incision and drainage may likewise beindicated in hordeola that have reached advanced stages. 

90,000 fast home treatment

Barley is a disease of the eyelid, which is characterized by inflammation in the hair follicle of the eyelash or in the sebaceous gland near its bulb. The medical name of the pathology is hordeolum. It causes discomfort, since a swollen eye with barley looks unattractive and is accompanied by painful sensations when moving the upper or lower eyelid. Pathology can manifest itself regardless of age – both in an adult and in a child.The disease usually affects one eye.

The appearance of barley on the eye occurs unexpectedly. When the inflammatory process develops rapidly, patients are interested in what to do in such a situation. Immediate treatment required. This violation should not be treated as a temporary inconvenience. Its occurrence indicates that the body’s immune forces are reduced.

Causes and symptoms

Gordeolum is caused by a bacterial infection.In most cases, it is Staphylococcus aureus, a gram-positive bacterium that can persist on the skin and mucous membranes.

Various factors provoke the appearance of barley on the eye:

• hypothermia of the body, weakened immunity, vitamin deficiency;
• non-observance of the rules of hygiene of the eyes and eyelids;
• stressful conditions, lack of adequate rest, healthy sleep;
• infectious diseases or the recovery period after them;
• the presence of other problems with the organs of vision – conjunctivitis, blepharitis;
• Elevated blood lipids.

The use of low-quality cosmetics or wearing contact lenses can also become factors provoking a violation, but they are not the root cause of the pathological process.

The main symptoms of pathology:

• itching and burning of the eyelid, increased lacrimation;
• Sensation of a foreign object under the eye;
• redness, swelling, hardening of the lower or upper eyelids;
• Pain when touching the injured area and when blinking;
• pus in the form of a yellowish head on the swelling;
• sometimes – inflammation of the nearest lymph nodes, fever.

Is barley contagious

For those around him, he is not dangerous, but only if basic hygiene rules are observed. The risk of infection usually occurs in young children. Due to their age, they do not yet understand the importance of hygiene and therefore often suffer from bacterial infections. Infection is possible with the use of the patient’s cosmetics. But in general, isolation of an adult or a child suffering from hordeolum is not required.

The causative agents of the disease are found in the pus located in the sac of barley.There are no bacteria on the surface. But there is usually little pus inside, so even bursting barley is not dangerous. In 80% of cases, the abscess breaks out at night when the patient is asleep. Purulent masses, if they get anywhere, then on a person’s face, his pillow, bed linen. The infection does not spread further.

Types and stages of development of Gordeolum

By localization, the lesions can be of the following types:

• Outdoor barley . More common statistically.The infectious and inflammatory process is localized at the edge of the eyelid, since the infection settles in the sebaceous gland of Zeiss or in the ciliary bulb.
• Internal stye on the eye . It has another name – meibomite. It is caused by the penetration of pathogenic microorganisms into the passage of the meibomian glands located on the back of the eyelid margin.

By type, there are:

• Hot barley . It is characterized by the classic development of the disease, the infection is localized in the ciliary pocket – the bulb or Zeiss gland.With therapy, it takes about a week.
• Cold barley (chalazion, meibomian cyst) . The inflammatory process affects the meibomian glands. It develops very slowly. It takes 1-2 months to recover. In the presence of very large barley, it can be quickly removed.

The inflammation goes through the stages:

• Formation of a purulent rod . A slight reddish swelling causes discomfort when moving for centuries.
• Formation of an abscess . The patient’s condition at this stage can only be alleviated by medication.
• Pus breakthrough. Does not indicate recovery, but the patient becomes much better. During this period, you need to keep your eyes clean and use prescribed medications, ointments.

How to quickly cure barley

When barley appears on the eye, how to treat it depends on the stage of development of the infection. If you take action at the initial stage, it is likely that the inflammation will not spread and the swelling will go away in 1–2 days.For this:

• Treat the problem area with an antiseptic. Medical alcohol is suitable, which is diluted with water in a 1: 1 ratio, a solution of brilliant green or iodine, and calendula tincture.
• Perform dry preheat. To do this, heat sea salt or any cereal in a pan. You can use a hard-boiled egg. The selected heat source is wrapped in a clean cloth and applied to the inflamed area until the compress has cooled.

If the inflammation does develop, it is better to consult a doctor, since barley must be treated with medications.Purulent masses must come out of the affected area. If this did not happen naturally, it is impossible to squeeze out the abscess so as not to infect the blood and other organs. In such cases, the ophthalmologist makes a puncture under sterile conditions. There is no scar left from him.

To destroy bacteria, use drops from barley in adults – Tobrex, Albucid, Levomycetin, Vigamox, Gentamicin. They are buried 3-5 times a day. It is important not to allow the bottle to touch the eye.

A quick treatment for barley at home is ensured by combining drops with antibacterial ointments.The latter are laid at night, as they can temporarily reduce vision. But when purchasing them at a pharmacy, be sure to specify that you need drugs specifically for the eyes. Many of these drugs are also produced for the skin, the content of active substances in them is higher, which can harm the visual apparatus. These include Tetracycline, Synthomycin, Hydrocortisone, Erythromycin, Maxitrol.

How long the barley passes depends on the type of pathology. The internal one has to be treated longer than the external one – it takes from 1 month to fully recover.

Preventive measures

Prevention includes following the recommendations:

• Strengthening the immune forces . This should always be done, not only with the threat of hordeolum or in the offseason. It is recommended to drink vitamins, give preference to fresh vegetables and fruits, move more, be outdoors, observe the daily routine.
• Timely elimination of ophthalmic disorders . If you have a tendency to eye diseases, you should regularly visit an ophthalmologist.Self-diagnosis and self-medication usually contribute to the transition of pathology to a chronic form.
• Compliance with hygiene standards . You need to have your own personal towel, wash your hands with soap, change bed linen every 1-2 weeks, do not use other people’s cosmetics.
• Developing the habit of not touching the eyes . It is not worth doing this even in an ordinary state, when a person is not worried about any problems. This rule also applies to the face – you should not touch it during the day with unwashed hands.

Simple preventive measures will avoid inflammation and keep your eyes healthy.

90,000 causes, symptoms and treatment in adults 9,0001

In this article we will tell you:

When we are healthy, our sebaceous glands secrete a fatty secretion. It moisturizes the mucous membrane of the eye, facilitates the movement of the eyelids during blinking. When the ducts of the meibomian gland are blocked, ocular chalazion may develop.This tumor-like formation looks like a nodule. Most often, pathology occurs in people over 30 years old. Chalazion does not threaten human life. In addition to painful sensations, it most often causes cosmetic discomfort.

Reasons for the appearance of chalazion

Chalazion on the eye develops as a pathological process. It can be provoked by various factors:

• unsanitary conditions in the room, lack of hygiene;
• weakened immune system of the body;
• misuse of contact lenses;
• stress, depression, disturbed psycho-emotional state;
• hypothermia;
• vitamin deficiency as a result of improper diet;
• untreated barley;
• Surplus of cosmetics on eyelids and eyelashes.For example, a chalazion of the upper eyelid may appear in women who wear false eyelashes;
• chronic forms of blepharitis;

90,013 skin diseases;

• oncology;
• hormonal disruptions, including diabetes mellitus;
• blockage of the bile ducts.

Symptoms and diagnostics of chalazion

Usually, the inflammatory process begins smoothly and gradually turns into a chronic form.A person discovers seals by accident. For example, if the lower eyelid chalazion begins, then it can be easily confused with barley. Both diseases manifest themselves in the same way with redness and swelling of the eyelid. Barley occurs due to purulent inflammation of the tissues of the gland, while chalazion is the result of a blockage of the duct. It affects the inside of the eyelid and is in close contact with the conjunctiva of the eye. But pathology can develop precisely because of untreated barley.

The clinical picture of chalazion formation is as follows:

• a lump grows on the eyelid;
• there is a slight soreness, swelling, the mucous membrane of the eye turns red;
• the tumor becomes mobile, outwardly resembles a small pea.

If we let the process take its course, then:

• visual acuity is impaired;

90,013 items lose their outlines;

• the cone grows up to 1 cm in diameter;
• the temperature may rise, tearing may increase, and itching may appear in the eyelids.

When the formation develops into a cyst, it accumulates pus and spontaneously opens up. If you do not seek the help of a specialist, the pus left under the eyelid can cause the appearance of new seals.Inflammation can be easily avoided if chalazion treatment is started early.

Usually, an ophthalmologist recognizes the disease by examining the inflamed eyelid externally. If the upper eyelid is affected, the doctor twists the eyelid to see a lump. As a rule, local edema of the conjunctiva is observed. When the affected eyelid moves, it blinks less often than it does from a healthy eyelid. If there is a suspicion of adenocarcinoma, the ophthalmologist prescribes a histological examination.Often, additional examination methods are required with an already established diagnosis. These include analysis of blood, urine and feces, culture for staphylococcal infection, enzyme immunoassay and scoring immunogram, tests for venereal infections. The ophthalmologist can additionally appoint a consultation with an immunologist, dermatologist and parasitologist.

Chalazion treatment

In the early stages of the disease, the doctor will tell you how to treat chalazion and prescribe conservative treatment.It includes the use of antibacterial drops, prednisolone and dexamethasone ointments, dry warm compresses on the eyelid area. Massage of the eyelid area can be used to remove viscous lipid secretions.

If the size of a pea does not exceed 4 mm, the doctor prescribes phytotherapy and physiotherapy: electrophoresis, laser heating, UHF. The therapy helps to enhance the activity of the body’s defense cells. When such treatment does not help, the doctor uses steroid hormones to help dissolve the chalazion.

If the pathological process has gone far, visual function has been impaired or relapses have occurred, you will have to contact a surgeon for the treatment of chalazion. Eyelid surgery is indicated when the nodule size is more than 5 mm. The surgeon opens the swelling and scrapes out its cavity. To reduce pain and to avoid relapses, the doctor often operates with a laser. Removal of the chalazion of the upper eyelid or lower eyelid takes about half an hour and is performed on an outpatient basis under local anesthesia.In the postoperative period, it is recommended to lay an antibiotic eye ointment behind the eyelid. It is advisable to visit an ophthalmologist in a week for a second examination.

Prevention of chalazion

If you do not want the development of this pathology or want to avoid its recurrence, engage in timely prevention. Chalazion does not threaten you if you:

• eat right;
• Observe personal hygiene: do not touch your eyes with dirty hands, thoroughly wash off your makeup;
• strengthen the immune system;
• change the solution on time in case of using contact lenses, observe the period of their wearing;
• Treat tonsillitis and caries in a timely manner;
• do not disturb your sleep patterns;
• avoid stress and overwork;
• Do not smoke and drink alcohol in moderation;
• As a preventive measure, massage the eyelids.

The reasons for the appearance of chalazion are quite diverse. A variety of this disease can be both single and multiple. Therefore, it is important not only to engage in the prevention of the disease, but also generally adhere to a healthy lifestyle.

90,000 Blepharitis – Latvijas Amerikas acu centrs

Inflammation of the edges of the eyelids or blepharitis.

Blepharitis, or inflammation of the edges of the eyelids, is a common disease in everyday life, which is equally common in women and men.The chance of developing blepharitis increases with age and the average age of patients is about 50 years.

Plaksta mala bez iekaisuma – Edge of the eyelid without inflammation
Plaksta malas apsartums un tūska – Redness and swelling of the edge of the eyelid
Zvīņveida aplikums – Scaly plaque
Bakteriāla24 infection

Types of blepharitis

There are different types of blepharitis.Anterior blepharitis affects only the skin and ciliary follicles and is most commonly caused by bacteria and the toxins they produce. In turn, posterior blepharitis is more severe, since it also affects the lining of the eyelid, and this causes changes in the work of the eyelid glands and their clogging.

The development of chronic blepharitis can be promoted by smoking, chemical gases, polluted air, etc., as well as general diseases such as skin disease – rosacea, allergic dermatitis, psoriasis and the like.Blepharitis is more common in people suffering from diseases of the digestive system, imbalances in thyroid hormones and impaired immunity.

Plaque on eyelashes

Clogging of the meibomian glands

Redness and swelling of the eyelid margin

What are the symptoms of blepharitis?

Usually blepharitis manifests itself in the form of: redness of the eyelids and eyes, a burning sensation or a foreign object in the eye, discharge from the eyes, plaque on the eyelashes and in the corners of the eyes, photophobia or even blurred vision.In severe and prolonged cases, there is also a thickening of the eyelid margin and peeling of the skin.

In the case of chronic blepharitis, these symptoms may be constant or periodically become less pronounced, and recover over time.

How is blepharitis diagnosed?

The diagnosis of the disease is based on the patient’s complaints and the microscopic picture of the eye. In some cases, eyelashes are taken for analysis to diagnose ciliary mites, or a smear from the eyelid is taken for microbiological analysis.

How is blepharitis treated?

Treatment is based on regular cleaning and hygiene of the eyelid margins. Drug therapy is necessary only in cases where an infection is added to the disease. Systemic antibiotics are more often prescribed for posterior blepharitis, as well as for patients with reduced immunity or with an aggressive bacterial infection.

How to perform eyelid hygiene in case of blepharitis?

Eye health improves the use of warm compresses, which are applied to the eyelids.Heat acts on the clogged glands at the edges of the eyelids, and the fatty layer in them becomes more fluid and begins to stand out better. Instead of compresses, you can also use special hot-cold glasses, which can be purchased from specialized medical institutions and which are also available at the Latvian American Eye Center.

It is possible to carry out mechanical cleaning of the edges of the eyelids – remove plaque, as a result clogged glands open. The edges of the eyelids are cleaned with special wipes or cotton swabs and baby shampoo.It is important to cleanse the edge of the eyelid, not the skin or conjunctiva. Cleansing should be gentle so as not to injure the edge of the eyelid.

In the case of posterior blepharitis, eyelid massage is a good tool to restore eye health. The eyelid massage can be done gently by massaging the eyelid with your finger towards the eyelashes.

After performing the above procedures, a little antibacterial ointment prescribed by your doctor can be applied to the edges of the eyelids. Typically, the ointment is used within two weeks.Be sure to consult with an ophthalmologist about the need for long-term use of the ointment. After acute symptoms have subsided and if necessary, your doctor will prescribe a disinfectant ointment or gels that can be used for a long time.

In all cases of blepharitis, moisturizing of the eye surface is required.

What else can you do to help?

Given the widespread prevalence of the disease, the medical industry is looking for new ways to help patients with chronic blepharitis.Fast and modern help for chronic inflammation of the eyelid margins or blepharitis, which is also available at the Latvian American Eye Center – eyelid hygiene using the new generation BlephEx equipment. The device is a pen-like instrument with a “micro-sponge” at the end, which, rotating around its axis, cleans both the edges of the eyelids and eyelashes from plaque and old skin cells, as well as microbes.

Benefits of eyelid hygiene with BlephEx:

– the procedure lasts 10-15 minutes;

– painless procedure;

– cleansing plaque from the edges of the eyelids and eyelash roots;

– ensuring access of medicines to the site of inflammation;

– improving the functioning of the glands of the eyelids;

– Sterile, disposable cleaning tips are used during the procedure.

Various versions of warm eye compresses

Cleaning the edge of the eyelids with a cotton swab

Cleaning the eyelids with Blephex

Edge of the eyelid before and after cleaning with Blephex

90,000 Barley (disease) is … What is Barley (disease)?

Barley ( hordeolum ) – acute purulent inflammation of the hair follicle of the eyelash or Zeiss sebaceous gland, which is located near the bulb of the eyelashes.There is also a so-called. internal barley , when the meibomian gland lobule becomes inflamed. Symptoms of both forms are inflammation and swelling of the edge of the eyelid, redness, soreness. Barley is caused by a bacterial infection (in 90-95% of cases – Staphylococcus aureus ^[1] ) and is most often observed with weakened immunity (for example, after colds).

Course of the disease

Painful, limited swelling, edema, reddening of the eyelid conjunctiva appear at the edge of the eyelid.After 2-4 days, a yellowish head forms at the top of the swelling, upon opening which pus with particles of dead tissue appears. Several barley may appear.

In some cases, headaches, fever, enlargement of the nearest lymph nodes are possible. Extrusion of pus is contraindicated; such an attempt can lead to the spread of infection towards the orbit with the appearance of phlegmon of the orbit, thrombosis of the cavernous sinus of the brain, meningitis, and even death is possible.

Meibomit

A similar clinical picture is observed with inflammation of the meibomian glands – the so-called internal barley, or meibomite , in which, however, the inflammation develops less acutely. Internal barley (meibomite) opens into the conjunctival sac. Sometimes chalazion develops after it – a chronic inflammation of the cartilage around the meibomian gland. The skin is not adhered to form, painless. A purely cosmetic defect worries.

Risk factors

Risk factors for the development of barley are general hypothermia, decreased immunity, vitamin deficiency, endocrine disorders and chronic diseases of the gastrointestinal tract.An important place is occupied by the condition of the eyelids: the presence of demodicosis, blepharitis.

Prevention

The main prevention of barley on the eye is, first of all, the observance of the rules of personal hygiene. You should try not to touch or rub your eyes with dirty hands. Use individual cosmetics and personal hygiene products (towels, wash tampons, etc.). Also, human immunity plays an important role.

Treatment

At the beginning of the process, lubricating the skin of the eyelid at the site of infiltration with 70% ethyl alcohol or 1% alcohol solution of brilliant green 3-5 times a day, which often allows to stop the further development of the disease.Instillations of 20-30% sodium sulfacyl solution, 10% sodium sulfapyridazine solution, 1% penicillin solution, 1% erythromycin solution, 0.1% dexamethasone solution, 0.3% prednisolone solution, 1% hydrocortisone emulsion 3-4 times day. Lubrication of the skin of the eyelid in the area of ​​infiltration and laying for the eyelids of ointments containing sulfonamides and antibiotics, 1% yellow mercury ointment.

Compresses and wet lotions are not recommended, since wetting the skin leads to its maceration and the penetration of infection into the openings of the excretory ducts of other sebaceous glands, which can give a recurrent course of inflammation.

With an increase in body temperature and general malaise, you should consult a doctor to decide whether to prescribe antibiotic therapy. If an abscess forms, surgery may be required.

The outlook is generally good. Timely active treatment of barley and associated diseases avoids the development of complications. Patients suffering from recurrent barley should be carefully examined in order to identify possible etiological and predisposing factors. ^[2]

Notes

90,000 Barley in a child – causes, symptoms, diagnosis and treatment

Barley in a child is a limited accumulation of pus in the hair follicle of the eyelash and associated sebaceous glands of Zeiss, less often in the lobules of the meibomian glands embedded in the thickness of the cartilage of the eyelids. The clinical picture of the disease in a child is characterized by painful edema and hyperemia of the eyelid, the formation of an abscess at the root of the eyelash (external barley) or on the inside of the eyelid (internal barley), followed by opening and release of pus.The diagnosis of barley in a child is established on the basis of a general examination of the eye and eyelids under natural and lateral lighting. With barley in a child, cleansing and disinfection of the infiltrate, the use of eye drops and ointments with antibacterial action, and, if necessary, surgical opening of the abscess are shown.

General information

Barley in a child is an acute local purulent-inflammatory process that affects the hair follicle of the eyelash with the Zeiss sebaceous glands, and sometimes the large meibomian glands of the tarsal-conjunctival plate.Barley in children is often found in the clinical practice of pediatrics and pediatric ophthalmology.

Barley in a child

Causes

Barley in a child is an acute local infectious process caused by bacterial microflora, mainly (90-95%) Staphylococcus aureus. Infection of the cavity of the hair sac of the eyelashes and ducts of the sebaceous glands with the development of barley can occur if the child does not follow the rules of personal hygiene, touching and combing the eyelids with dirty hands, using a dirty towel, as well as when wearing contact lenses, swimming in a polluted reservoir.

Infection in the ducts of the sebaceous glands contributes to the clogging of their excretory canals and stagnation of secretions, which aggravates the inflammation. The development of purulent-inflammatory processes on the skin of a child is facilitated by insufficient maturity of immunity and a weakening of protective mechanisms that occurs against the background:

Barley in a child often accompanies other eye lesions (staphylococcal blepharitis, conjunctivitis, dysfunction of the meibomian glands), complicates the course of seborrheic dermatitis in adolescence , acne vulgaris, furunculosis, demodicosis.With HIV infection, there is a chronic course of barley and other bacterial skin infections in children.

Pathogenesis

Distinguish between external and internal, single and multiple, one- and two-sided barley in a child. External barley in a child is detected more often, it is characterized by a purulent focus on the edge of the outer musculocutaneous plate of the eyelid in the root zone of the eyelashes. With internal barley (meibomitis) in a child, purulent inflammation develops in the thickness of the cartilaginous plate of the upper or lower eyelid with the exit of the abscess on its internal mucous surface, directly adjacent to the eyeball.Formed barley in a child is an accumulation of polymorphonuclear leukocytes and tissue necrosis, i.e. abscess.

Symptoms of barley in a child

The clinical picture of barley in a child is characterized by an acute onset and a rapid increase in symptoms. The formation of external barley begins with the appearance of hyperemia and edema in a limited area of ​​the eyelid in the growth zone of the eyelashes. The child complains of soreness when blinking and touching the site of inflammation, tingling and itching.The eyelid swells and hardens, which leads to a narrowing of the palpebral fissure, sometimes – to the inability to open the eye. The inflammatory infiltrate rapidly increases in size, and on days 2-3, as a result of purulent fusion, an abscess with a yellowish head at the roots of the eyelashes is formed.

After 1-2 days, barley spontaneously breaks out with the release of purulent contents and necrotic tissue particles. In a child, the resolution of barley can occur much faster due to the habit of frequently rubbing the eyes.After opening the barley, the child’s soreness, swelling and hyperemia of the eyelid decreases, by the end of the week the signs of inflammation disappear. In severe cases and with multiple barley, the child may be disturbed by headache, fever, general weakness, accompanied by an increase in the parotid and submandibular lymph nodes (lymphadenitis).

With internal barley (meibomitis) in a child, inflammation develops less acutely, edema and hyperemia become more noticeable with eversion of the eyelid, redness and irritation of the conjunctiva of the eye may occur.With internal barley in a child, the abscess is opened from the inner surface of the eyelid into the conjunctival sac. After spontaneous resolution of internal barley, granulation growths of the eyelid mucosa may appear. With a decrease in the child’s immunity and the presence of foci of chronic infection, inflammation of the eyelids can acquire a protracted course with periodic relapses of barley.

Complications

Squeezing out the contents of barley in a child is unacceptable, since it is dangerous to spread a purulent infection with the development of phlegmon of the orbit, thrombophlebitis of the orbital eyelids, thrombosis of the cavernous sinus, in rare cases – purulent meningitis with a risk of death.Barley in a child can turn into a chronic non-infectious lipogranulomatous inflammation of the sebaceous glands of the eyelid – chalazion.

Diagnosis of barley in a child

Diagnosis of barley in a child is established by a pediatric ophthalmologist based on the results of a general examination of the eye and eyelids in natural light and by the lateral illumination method. Biomicroscopy of the eye with internal barley in a child makes it possible to establish the expansion of the mouths of the meibomian glands.

To identify the causes of the recurrent course of barley in a child, a comprehensive examination is carried out with the involvement of a pediatric immunologist, pediatric dermatologist, pediatric gastroenterologist, pediatric endocrinologist.Barley in a child is differentiated with chalazion, dacryocystitis, cysts and tumors of the eyelids. Appointed:

• general analysis of blood and urine,
• determination of blood sugar,
• bacteriological examination of a smear from the conjunctiva (to isolate the pathogen and its sensitivity to antibiotics),
• analysis of feces for eggs of worms,
• study of eyelashes for demodicosis,
• study of the immunological status.

Treatment of barley in a child

Conservative therapy

At the first signs of barley in a child, you should immediately contact a pediatric ophthalmologist. With an uncomplicated course, barley in a child responds well to treatment and usually goes away in 7-10 days. In most cases, with barley in a child, local conservative therapy is carried out.

1. At the beginning of the development of the inflammatory process, cleaning and daily disinfection of the eyelids is performed: treatment with a decoction of chamomile, calendula, extinguishing the infiltrate with 70% ethyl alcohol, 1% solution of brilliant green.
2. Before the breakthrough of the head of barley, the child is prescribed thermal procedures for the inflammation focus (dry heat, UFO, UHF), which increase blood flow and natural drainage.
3. Instillations are made in the conjunctival sac of eye drops containing antiseptics (solution of sodium sulfacil), antibiotics (solution of chloramphenicol, ciprofloxacin), glucocorticosteroids (solution of dexamethasone).
4. Ointment applications of erythromycin and tetracycline ointments under the eyelid continue after opening the barley in the child.

To prevent the infection from spreading deeper when opening the barley, care must be taken that the child does not rub his eyes with his hands. In the case of the development of general symptoms (fever, malaise), antipyretic, sulfa or antibacterial drugs are indicated.

Surgical treatment

Surgical treatment is required for large external and internal barley, which does not respond to conservative treatment. Under local anesthesia, the child’s barley is opened, followed by daily postoperative treatment of a purulent wound and antibacterial therapy.With a recurrent course of barley, the child is prescribed vitamins, immunomodulators, autohemotherapy.

Forecast and prevention

With accurate and adequate treatment, the prognosis of barley in a child is usually favorable: in most cases, complications do not develop, cure occurs in 1-2 weeks.

Prevention of the development of barley in a child includes hardening, good nutrition, walking in the fresh air, hygiene, sanitation of chronic foci of infection.In case of recurrence of barley in a child, a thorough examination is necessary in order to identify and eliminate etiological and predisposing factors.

90,000 causes, symptoms and treatment in an article by an ophthalmologist Yu. V. Nezhibovskaya

Date of publication September 14, 2020 Updated April 26, 2021

Definition of the disease. Causes of the disease

Chalazion is a chronic inflammation of the cartilage of the eyelid ^[3] . It is accompanied by the appearance of a small pea-shaped formation on the edge of the eyelid, sometimes redness or swelling is observed.It is often mistaken for barley. It is not life threatening and usually does not lead to serious consequences.

Chalazion or Barley?

Few have passed such a nuisance as barley or chalazion for the century. Everyone who has encountered these diseases knows that, despite their small size, they can cause a lot of inconvenience.

To understand how chalazion differs from barley, it is necessary to turn to anatomy.

The structure of the eyelids contains cartilage, which is more pronounced in the upper eyelid.In the thickness of the cartilage are the oblong meibomian glands, which produce a hydrophobic (fatty) component of the tear film. Their ducts open into the inter-marginal space: if you move the lower eyelid, then along the edge you will see small openings of these ducts.

With chronic inflammation of the glands (meibomite), their excretory ducts are blocked. As a result, the contents are collected in the thickness of the eyelid, forming a seal – chalazion (hail) ^[2] .

Barley is acute purulent inflammation, which can be localized in the Zeiss gland, eyelash hair follicle (outer barley) or meibomian gland lobules (inner barley).The last type of barley differs clinically only in that the process is concentrated not from the outside, but from the inside of the eyelid ^[4] .

In general, chalazion is usually larger and less painful than barley. But one thing can always lead to another: barley can ultimately cause chronic painless chalazion, while chalazion can fester and develop into acute purulent inflammation.

Why there is a chalazion

There is no definite answer to this question.According to some studies, impaired passage of the secretion of the meibomian glands may be associated with diabetes mellitus, stomach or duodenal ulcers, allergic diseases, rosacea, seborrheic dermatitis or hypercholesterolemia (increased blood cholesterol concentration) ^{[17] [18]} 19] ^{[20] [21] [22]} . At the same time, it is impossible to argue that it is these diseases that contribute to the emergence of chalazion: they can accompany inflammation of the cartilage of the eyelid, proceeding in parallel.

Chalazion is also associated with acne and chronic blepharitis – a group of diseases accompanied by inflammation of the eyelid margins. Parasitic and infectious diseases include leishmaniasis, tuberculosis and frequent viral infections ^{[3] [5] [7]} .

As a side effect, chalazion may occur in patients receiving Bortezomib (Velcade®) for the treatment of cancer ^[6] .

In children, the development of chalazion is sometimes associated with congenital immunodeficiencies (eg, hyperglobulinemia E), as well as viral conjunctivitis and inadequate eyelid hygiene ^[1] .

Some doctors hypothesize that chalazion is caused by demodex skin mites. They are present in small quantities on the skin of all people, and their active reproduction and the emergence of demodicosis really accompany the development of chalazion ^{[13] [23]} . But it is impossible to say unequivocally that it is Demodex that causes chalazion, since there are no convincing clinical data ^[5] . Most likely, these processes arise due to the same factors that are not fully established and proceed in parallel.

The clinical picture of demodicosis is often observed in elderly patients, as well as in people with weakened immunity, changes in the refractive power of the eye (farsightedness or astigmatism), metabolic disorders, rosacea and seborrhea. The disease can also occur in children with chronic diseases of the lungs and digestive tract, but their role has not yet been proven ^{[5] [10]} .

Do they often get sick with chalazion?

There are no exact epidemiological data on the incidence, but it is known that barley and chalazion are very common diseases.In adults, they are more common than in children – this is associated with the action of androgens on sebum (sebum). However, it should be noted that inflammatory eye diseases in children occupy one of the leading places in the structure of ophthalmological problems in childhood. According to Professor Yu. F. Maychuk, they account for more than 40% of outpatient oculist visits and up to 50% of cases of hospitalization ^[12] .

Among the adult population, people 30-50 years old are more susceptible to the disease, both men and women equally ^{[2] [15]} .

If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous to your health!

Symptoms of chalazion

The most common complaint of chalazion is a local subcutaneous mass, usually in the upper eyelid region. It is often visible to the naked eye. The size can be as small as a pea, or reach a very significant size.

Chalazion is prone to spontaneous opening and resorption within 2-8 weeks, although in some cases it can disturb the patient for longer than ^[16] .With a slow development of inflammation, the chalazion is painless, welded to the underlying layer, but can roll slightly under the fingers, the skin above it is often not inflamed, it can be raised or deformed ^[4] . In the case of an acute development of the disease, redness of the skin, swelling and pain appears at the site of the compaction.

The presence of fever and deterioration of the general condition are not characteristic of chalazion. There are no changes in the internal structures of the eye, visual functions, as a rule, do not suffer, but sometimes, as a result of damage to the cornea, astigmatism can be observed ^[16] .

Pathogenesis of chalazion

Chalazion is formed as a result of obstruction (blockage) of the meibomian gland. It is a mass of granulation tissue with chronic inflammation (with lipid-saturated lymphocytes and macrophages). Unlike chalazion, barley is primarily acute inflammation , which is associated with necrosis and pus formation.

Due to its structural features, chalazion is otherwise called granuloma. On its histological sections, a deep cutaneous or subcutaneous purulent lipogranulomatous formation surrounded by a pseudocapsule is found.It contains neutrophils, plasma cells, lymphocytes, histiocytes and giant cells that indicate inflammation ^[1] .

It is not easy to describe all the mechanisms of the development of a chalazion because of the variety of reasons for its appearance. As a rule, they are associated with impaired microcirculation and the development of inflammation. For example, diabetes mellitus increases blood glucose levels. This condition leads to changes in microcirculation and nutritional problems in the tissues. As a result, the healing process slows down, secondary infections join.

Classification and stages of development of the chalazion

Depending on the depth of the lesion, the chalazion can be superficial (inflammation in the meibomian gland) and deep (inflammation in the cartilage of the eyelid). Clinically, they do not differ in any way.

Also distinguish:

• large single chalazion;
• chalazion, not amenable to conservative (drug) treatment;
• multiple chalazions ^[2] .

Abscessing chalazion – pyogenic granuloma should be included in a separate category.This is an acute process, accompanied by suppuration (abscess formation). It develops due to constant inflammation and infection. At the same time, the chalazion increases, the skin in its area turns red and swells, and touching it causes acute pain.

Complications of chalazion

Large chalazion (the size of large beans or half a century), especially located in the center of the upper eyelid, can cause visual impairment. For example, a mechanical effect on the cornea, which the patient feels like a rolling ball, leads to constant pressure and a change in its shape.As a result of this, astigmatism develops: vision decreases, objects are bifurcated or seem bent, a person begins to confuse letters similar in writing ^[5] .

Progressive growth of chalazion can lead to disfigurement of the eyelids: fibrosis of the cartilage followed by inward twisting of the eyelid, the appearance of uneven edges and eyelid baldness (loss of eyelashes) ^{[24] [25]} . If the curvature can be corrected surgically, then it is extremely difficult to restore the correct growth of the eyelashes.

There are also, although quite rare, severe complications of chalazion (for example, preseptal cellulitis – inflammation of the subcutaneous fatty tissue of the orbit). Such complications are mainly observed in patients prone to atopic, non-standard reactions of the body ^[5] . Severe pain and lacrimation appear, body temperature rises, vision is noticeably reduced. The skin around the eye becomes red, and the swelling increases. Often, many patients cannot open their eyes on their own.In these cases, medical assistance is required in a hospital setting ^[8] .

Diagnostics of the chalazion

A standard ophthalmological examination is quite informative, therefore, additional diagnostic methods are usually not required. The patient must specify the following information:

• whether there are vision problems;
• Whether episodes of acute viral infections have occurred;
• what is the immune status;
• Whether there are chronic diseases, acute skin infections, tuberculosis or oncology;
• whether there were injuries or surgical interventions;
• Whether the patient has been exposed to drugs, toxins, or allergens.

It is possible to carry out an ultrasound examination (ultrasound) of the chalazion for a qualitative assessment of the inflammatory process. This method allows you to clarify its localization, size, structure and relationship with the surrounding tissues. However, in clinical practice, ultrasound of chalazion is not widely used ^[9] .

Since the development of chalazion is not associated with bacteria, there is no need to perform bacteriological inoculation. It may be required only if an infection is suspected.It is advisable to conduct a histological examination only in cancer patients with suspicion of tumor metastasis, in all other cases this examination can be considered redundant ^[10] .

Differential diagnosis with internal barley is carried out on the basis of inspection. However, during the first two days, these diseases may not differ in any way. Barley can be suspected when body temperature rises, chills and severe inflammation in the eyelid region ^[16] .

In elderly people, a group of oncological diseases can be disguised as “endless” (chronic) chalazion: squamous cell carcinoma, seborrheic or microcystic carcinoma. In immunocompromised patients undergoing chemotherapy, the work of the meibomian glands is sometimes disrupted (their secret changes). This leads to the development of meibomite and blepharitis, which contribute to the appearance of chalazion. However, this cannot exclude the possibility of metastasis in the eyelid ^[11] . Therefore, the diagnosis of “chalazion” in people with malignant tumors requires increased attention.

Treatment of chalazion

Diseases of the eyelids are most often treated on an outpatient basis. The treatment is quite lengthy (it can take up to several months) and requires patience and careful performance of the procedures from the patient.

In adults, small chalazions dissolve in about two weeks using local combined preparations (with an antibacterial and anti-inflammatory component). At the same time, warm compresses and hygienic massage of the eyelids are prescribed. However, such conservative treatment helps in 50% of cases ^{[2] [5]} .

General (systemic) antibiotic therapy is indicated in the case of primary or secondary infection or in the development of severe purulent inflammation. Also, systemic antibiotic therapy is indicated when chalazion is combined with blepharitis, rosacea or acne ^[5] .

There are suggestions that to reduce the risk of recurrence, treatment of chronic blepharitis and chalazion should be carried out in conjunction with a gastroenterologist, under the control of blood glucose levels ^[7] . Based on this, doctors recommend eliminating sugar if the patient abuses it, as well as excluding spicy, fatty and fried ones for those who have problems with the work of the gastrointestinal tract.However, this practice does not have a convincing evidence base.

If, in addition to chalazion, the patient is diagnosed with demodicosis, treatment can be aimed at eliminating its cause. With a low number of individuals of skin mites, etiotropic therapy is not carried out ^{[10] [13]} .

If no positive dynamics is observed with conservative treatment, adult patients are prescribed an intralesional steroid injection – an injection of an anti-inflammatory drug into the chalazion under local anesthesia.The steroid reduces the inflammation in the cartilage and the size of the formation, sometimes the chalazion disappears completely. The injection can be used alone or in combination with topical combination drops or ointments.

Intralesional steroid injections are believed to be as effective as surgical treatment of chalazion. However, the introduction of steroids often (in 2% of cases) leads to serious complications: loss of vision, atrophy of subcutaneous fat and skin depigmentation ^{[26] [27]} .

Surgical treatment is actively used. It is carried out with unsuccessful conservative therapy. The operation is simple, performed on an outpatient basis, under local anesthesia. The incision can be made both from the skin side and from the mucosal side. A special fenestrated clamp is applied to the eyelid, the cavity is opened, cleaned, after which an aseptic bandage is applied, and the patient is allowed to go home. He is prescribed local treatment in the form of antibacterial drops or ointment. Sutures are rarely applied.

Bruising may occur after eyelid surgery. It occurs when a clamp is applied, is more often a cosmetic defect and disappears after two weeks. To reduce its size, dry cold compresses are used, but only if, during the diagnosis, the patient does not have a malfunction of the meibomian glands. Otherwise, cold compresses can lead to blockage of the ducts with meibum and the formation of new chalazions.

Due to their age, surgical intervention in children is accompanied by some difficulties, therefore, the operation is often performed in a hospital setting under general anesthesia.

Forecast. Prevention

The prognosis is favorable. Relapse is possible if the capsule is incompletely destroyed during the operation, and chalazion in this case may occur in the same place. Often, the re-development of the disease is due to the general condition of the body and other diseases of the eyelids.

To avoid the formation of a chalazion, it is important to follow the basic rules for the care of the eyelids:

• Self-massage of the eyelids to eliminate blockage of the glands.
• Cleansing the eyelids with warm compresses and special cosmetics in the form of a cream or gel.Instead of eyelid hygiene gels, you can use diluted baby shampoo, various soap options. These funds improve the outflow of the secretion of the meibomian glands, cleanse the eyelids from scales and impurities.
• Physiotherapy with LipiFlow for more effective cleansing and passage of the secretions of the meibomian glands. The principle of operation is based on warming up the eyelids (40.5 ° C) and soft pulsation, which stimulates the outflow of secretion from the meibomian glands and their cleansing. Well suited for patients with chronic blepharitis, the complication of which is very often chalazion ^{[5] [14]} .

• The use of foods containing essential unsaturated fatty acids (shellfish, salmon, tuna, herring, fish oil, etc.), or the use of preparations Omega 3 and Omega 9 ^[5] .

To prevent relapses of chalazion, it is recommended to humidify the air, eat a balanced diet, observe the rules of personal hygiene, massage the eyelids and take care of the skin, choose the right soft contact lenses and observe the mode of wearing them. Also, for the skin of the face and eyelids, adequate sleep, moderate exposure to the sun and protection from ultraviolet radiation, exercise and fresh air are always beneficial.

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