The following signs and symptoms are commonly present in hordeolum:

• Red lump or papule (similar to a pimple): This small mass represents the accumulation of the inspissated sebum or the inflammatory swelling of the eyelid glands.
• Eyelid pain: Pain occurs due to pressure symptoms of the enlarging pus within the lesion.
• Eyelid swelling: The swelling in the eyelids is caused by the focal inflammation within the glands which may appear singly or multiple.
• Tearing: Tearing is an offshoot of the persistent irritation of the eyelid tarsus to the episclera. The tear formation lubricates the episcleral surface and may wash off the infectious agents from the eyes.
• Crusting around the eyelids: Crusting of the eyelids is due to the chronic inflammatory process that occurs with recurrent blepharitis [6]. 

• Aspiration

  The cataract was removed by aspiration. On the operative findings, the anterior lens capsule inside the pupil margin was ruptured. The iris and posterior lens capsule was intact and no vitreous was found in the anterior chamber. [ncbi.nlm.nih.gov]

• Erythema

  Focal swelling and erythema at the lid margin are seen in this hordeolum. Chalazion. This chalazion shows nodular focal swelling and erythema from meibomian cyst formation. Pain is present during swelling and cyst formation. [doctorsgates.blogspot.com]

  Examination of the right lower lid revealed a roundish raised abscess with surrounding erythema ( Figure 1 ). The raised area was tender on palpation; there was no discharge. The palpebral conjunctiva was normal. [oadoi.org]

  These are usually somewhat painful with erythema and the entire general eyelid may be edematous. Generalized cellulitis can also occur. In 90-95% of cases, Staphylococcus aureus is the cause. [pediatriceducation.org]

• Blepharitis

  Blepharitis. Infect Dis Clin North Am. 1992 Dec. 6(4):777-87. [Medline]. [emedicine.com]

  A sty can develop as a complication of blepharitis (inflammation of the eyelid). [web.archive.org]

• Eye Pain

  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. [skinsight.com]

  Do this gently with the eye closed and be careful not to cause damage to the eye. Pain Killers If the hordeolum is painful then an individual might use paracetamol or other pain killers in order to address the pain. [healthguidance.org]

  Other symptoms commonly associated with a stye include: gritty feeling in the eye eye pain or tenderness eye tearing or leakage swollen eyelid light sensitivity redness and soreness at the edge of the eyelid Although these symptoms are associated with [healthline.com]

• Lagophthalmos

  Any sign of proptosis, chemosis, painful restricted eye movements, diplopia, lagophthalmos, or optic nerve dysfunction warrants further investigation. Chronic or large hordeola may require incision and curettage. [oadoi.org]

• Eye Swelling

  It may cause tearing, light sensitivity and the sensation of having something in the eye. Swelling usually involves only a small area of the lid, but in some cases it can lead to irritation and redness of the whole eyelid. [epocny.com]

• Redness of Eye

  […] of eye and lid Signs External hordeolum Tender inflamed swelling of the lid margin. [college-optometrists.org]

• Renal Insufficiency

  insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy Drug Name Erythromycin (E-Mycin) Description Inhibits bacterial growth, possibly by blocking [web.archive.org]

The diagnosis of hordeolum and other eyelid infection relies heavily on a complete clinical history and thorough physical examination of the eye [7]. Ophthalmologist may use a slit lamps or magnifying lens to meticulously examine the eyelids lesions.

For hordeolum lesions that are non-responsive to medications, eyelid exudates may be gathered for culture and sensitivity testing in the laboratory to guide the attending physician which pathogenic bacteria is present in the infection and what particular antibiotics are they sensitive to.

In the majority of cases of hordeolum, the clinical course will appear to be uneventful and lesions may just resolve spontaneously without treatment. Hordeolum lesions may be massaged for 10 minutes every 6 hours in a day and may be alleviated with warm compress [8]. However, in persistent cases of hordeolum the following treatment modalities may be opted by the attending physician:

• Antibiotic treatment: The use of antibiotic eye drops or topical antibiotic creams may be used to treat persistent cases of hordeolum [9]. However, infectious eye lesions with high risk of spread to contiguous structures may benefit from the use of oral antibiotics. Ophthalmic antibiotic solutions used in hordeolum usually contain neomycin, polymyxcin and gramicidine [10].
• Surgical incision and drainage: In Hordeolum that presents with pressure symptoms and is unable to spontaneously erupt or drain the pus, ophthalmologist surgeon may opt to do a surgical incision and drainage to drain the pus and relieve pressure symptoms of pain in the eyelid. 

Hordeolum is essentially self-limiting but may recur frequently due to poor hygiene. Its clinical outlook remains excellent especially with treatment. Focal and local infection may potentially spread throughout the same eyelid and cause eyelid cellulitis.

Complications

The following clinical conditions are common complications of hordeolum:

• Chalazion
• Cellulitis of the eyelids
• Eyelid ulceration
• Eyelid necrosis [5]
• Cavernous thrombosis
• Acute episcleritis 
• Acute bacterial conjunctivitis

Hordeolum as a focal infection of the eyelids is commonly caused by the transfer of the staphylococcus bacteria to the eyelids via an unwashed hand. Persistent and chronic inflammation of the eyelids referred to as blepharitis causes hordeolum.

The primary control and treatment of the blepharitis may subsequently prevent its occurrence and recurrence. Patients appearing with primary immunologic deficiency or impaired cell mediated immunity like IgM deficiency may present with recurrent hordeolum [2].

There are no available data as to the exact incidence rate of hordeolum in United States and in internationally but it remains to be one of the most common eyelid lesions in clinical practice. There are no known racial and sexual predilection for this eye disorder.

Hordeolum is more common in the adults than in the children because of the relative increase in androgenic function in adults. This androgenic surge increases the viscosity of the sebum from the eyelid glands. Adults have a higher incidence of meibomitis and rosacea than children.

The primary event in the pathophysiology behind the development of hordeolum lies on the secretory stasis of the Meibomian gland and the gland of Zeis. The stasis are due to the orifice obstruction of the gland by dust and dirt, and the relative inspissation of the sebum as a result of low humidity and drying. The stasis of the secretions within the gland invites secondary infection by skin bacteria like Staphylococcus aureus [3].

Hordeolum histology will reveal an acute collection of polymorphonuclear leukocytes and necrotic debris (pus). Internal hordeolum may complicate to a chalazion which is a chronic non-infectious lipogranulomatous inflammation of the Meibomian glands and glands of Zeis [4].

The following tips may prevent the occurrence of Hordeolum and other eye infections:

• Keep the hands clean always: Frequent washing of the hands with antibacterial soaps and warm water can prevent the transmission of germs to the eye. The prudent and occasional use of alcohol based hand sanitizer can sterilize the hands perennially. Always keep the hands away from the eyes.
• Cosmetic care: Discard old cosmetics which are no longer in use to prevent eye and face infections. Cosmetics that were used prior to the onset of a previous hordeolum should no longer be used or should be disposed immediately to prevent point source infection. The sharing of cosmetics with others should always be avoided to prevent transmission of cutaneous and ophthalmic infectious diseases.
• Contact lens care: Contact lenses must regularly be disinfected with a washing solution provided by the ophthalmologist to rid off lingering bacteria. The hands must be washed thoroughly with an alkali soap and disinfected before removing and placing the contact lenses on the eyes. 
• Blepharitis: Any infection of the eyelids like blepharitis must be medically addressed as soon as possible to prevent recurrence and complications like hordeolum and chalazion.

Hordeolum or stye is a common eyelid disorder characterized by an acute focal infection of the eyelid glands [1]. The infection is commonly caused by staphyloccal bacteria involving the glands of Zeis in external hordeolum and the less commonly the glands of Meibomian in internal hordeolum. It usually presents as a red and painful lump around the edge of the eyelid which usually contains pus. In the majority of cases, hordeolum is a self-limiting disease of the eyelids.

Definition

Hordeolum is a common eyelid disorder characterized by an acute focal infection of the eyelid glands.

Cause

Inspissation of the sebum within the glands and local infections cause the disorder.

Symptoms

Common symptoms are eye lump, pain, swelling, tearing and crusting of the eyelids.

Diagnosis

Thorough history and physical examination of the eye are needed to diagnose the condition.

Treatment and follow-up

Topical and oral antibiotics, and surgical incision and drainage of the hordeolum pus. Hordeolum frequently recurs in patients.

1. American Academy of Ophthalmology. Eyelids. In: Ophthalmic Pathology and Intraocular Tumors. 4. San Francisco, CA: LEO; 2007-2008.
2. Kiratli HK, Akar Y. Multiple recurrent hordeola associated with selective IgM deficiency. J AAPOS. 2001; 5(1):60-1.
3. Destafeno JJ, Kodsi SR, Primack JD. Recurrent Staphylococcus aureus chalazia in hyperimmunoglobulinemia E (Job's) syndrome.Am J Ophthalmol.Dec 2004; 138(6):1057-8.
4. Katowitz WR, Shields CL, Shields JA, Eagle RC Jr, Mulvey LD. Pilomatrixoma of the eyelid simulating a chalazion. J Pediatr Ophthalmol Strabismus. Jul-Aug 2003; 40(4):247-8
5. Bârsan S,Georgescu A, Stefăniu C. Eye lid reconstruction after bilateral palpebral complete necrosis after an extensive Pseudomonas aeruginosa infection (infected neonatal hordeolum). Oftalmologia. 2010; 54(3):66-71 
6. Raskin EM, Speaker MG, Laibson PR. Blepharitis. Infect Dis Clin North Am. Dec 1992; 6(4):777-87.
7. Deibel JP, Cowling K. Ocular inflammation and infection. Emerg Med Clin North Am. 2013; 31(2):387-97 (ISSN: 1558-0539)
8. Panicharoen C, Hirunwiwatkul P. Current pattern treatment of hordeolum by ophthalmologists in Thailand. J Med Assoc Thai. Jun 2011; 94(6):721-4.
9. Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum. Cochrane Database Syst Rev. Sep 8 2010; CD007742.
10. Panicharoen C, Hirunwiwatkul P. Current pattern treatment of hordeolum by ophthalmologists in Thailand. J Med Assoc Thai. 2011; 94(6):721-4