1.9 Hordeolum (Stye)

Date of last review: Due to be updated

Differential diagnosis

Preseptal cellulitis
Haematoma of eyelid
Acute dacryocystitis
Chalazion (blockage of Meibomian gland with cyst formation)
Sebaceous cell carcinoma

Possible management by Optometrist

Treatment

In the case of external hordeola, it may help to remove the lash associated with the infected follicle
Consider course of antibiotic drops or ointment (e.g. Chloramphenicol) in the presence of copious muco-purulent discharge suggestive of associated bacterial conjunctivitis

Ask if allergic to Chloramphenicol

If not, supply Chloramphenicol 1% eye ointment 3 times daily for a week
If allergic to Chloramphenicol, or pregnant, supply Fusidic acid 1% liquid gel twice a day for a week

PoM In severe cases, e.g. with associated pre-septal cellulitis, consider management with systemic antibiotics (possible co-management with GP)

POM Co-amoxiclav 500/125 mg every 8 hours for 7 days then review

If allergic to penicillin, then POM Erythromycin 500 mg 4 times a day for 5–7 days then review

Advice

Most resolve/discharge spontaneously
Traditional remedies such as hot spoon bathing and/or warm compresses may relieve symptoms
Advise patient to return/seek further help if symptoms persist

Management Category

Normally no referral
Rarely, refer for incision in cases that do not discharge (commoner with internal hordeolum)

Possible management by Ophthalmologist

Incision

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