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