Management of Hordeolum and Chalazion

Andrew D. Munro, MD, MA

DISEASE DESCRIPTION

Focal enlargement and swelling of the eyelid is typically due to two oft-confused conditions, chalazia and hordeola.
A chalazion (from the Greek chalaza or “hailstone”) usually presents as a firm and painless nodule with a slow onset (Figure 14.1).
- A chalazion represents a sterile inflammatory process that is thought to originate from the extrusion of lipid molecules into the perimeibomian gland tissues.
- These molecules provoke a granulomatous response in the body.
A hordeolum (from the Latin hordeum or “barley”) typically features an acute onset with pain and redness along the eyelid margin (Figure 14.2).
- A hordeolum is an infective process, typically of staphylococcal origin, that generates a pyogenic inflammatory reaction.
- Infection involving a gland of Zeis is referred to as an external hordeolum, and is the most common presentation.
- Infection of a meibomian gland is known as an internal hordeolum.
  
  FIGURE 14.1. Chronic chalazia of bilateral upper and lower lids.
  
  FIGURE 14.2. Hordeolum of the left upper eyelid.
  
  FIGURE 14.3. Basal cell carcinoma of the left lower eyelid.
Recurrence, atypical appearance, and/or a history of international travel should prompt consideration of alternative diagnoses. Basal cell carcinoma (Figure 14.3), sebaceous cell carcinoma (Figure 14.4), trachoma, leishmaniasis, tuberculosis, and/or immunodeficiency may mimic the appearance of chalazia.

MANAGEMENT OPTIONS

Lesions that have been present for less than a week or two will often respond to warm compresses and antibiotic-steroid ointment.

An extended course of low-dose doxycycline (20-50 mg daily for 30 days) may prevent new lesions in patients with recurrent or multiple chalazions. Although frequently used to treat patients with meibomian gland dysfunction and blepharitis, oral antibiotics have not been proven to be effective in large-scale randomized prospective studies.