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]. 

• Pain

  Over-the-counter pain medications may be used to alleviate pain and tenderness. Contact lenses and eye makeup should never be worn during treatment for a sty. What is the prognosis (outcome) of a sty? A sty is harmless in the majority of cases. [web.archive.org]

  Clinical features include malaise, fever, and painful eyelid with periorbital edema. Any sign of proptosis, chemosis, painful restricted eye movements, diplopia, lagophthalmos, or optic nerve dysfunction warrants further investigation. [oadoi.org]

  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. [symptoma.com]

• Inflammation

  Localized inflammation (vs. involvement of the entire eyelid or surrounding skin) Foreign body sensation in the eye Prior episodes are common. Localized inflammation of the ... The hordeolum should not be expressed. [5minuteconsult.com]

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

  […] hor·de·o·lum ( hōr-dē'ō-lŭm ), A suppurative inflammation of a gland of the eyelid. [Mod. [medical-dictionary.thefreedictionary.com]

  Antibiotics are indicated only when inflammation has spread beyond the immediate area of the hordeolum. Topical antibiotics may be used for recurrent lesions and for those that are actively draining. [emedicine.medscape.com]

• Swelling

  Swelling subsides gradually becoming red, tender, swollen and painful. Swelling subsides gradually over a period of days after the pus is able to drain out. Sometimes it is necessary for your doctor to drain the hordeolum in the office. [epocny.com]

  […] hordeolum The aim of this Cochrane review was to investigate whether treatments such as warm compresses, over‐the‐counter topical medications and lid scrubs, antibiotics, steroids, and lid massages were useful treatments for an internal hordeolum (a swelling [web.archive.org]

  Chief Complaint: Redness, swelling and tenderness of the upper right eyelid for 5 days. History: Approximately 1 year prior to treatment, the patient frequently experienced redness, swelling and pain in his right eye. [sixfishes.com]

  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]

  They continue to swell (~3 days) until they break open and drain. [pedclerk.bsd.uchicago.edu]

• Fever

  Clinical features include malaise, fever, and painful eyelid with periorbital edema. Any sign of proptosis, chemosis, painful restricted eye movements, diplopia, lagophthalmos, or optic nerve dysfunction warrants further investigation. [oadoi.org]

  Because internal hordeola are so rare, they are not usually suspected unless inflammation is severe or fever or chills are present. [merckmanuals.com]

  The review of systems was negative for fever or other current or recent infectious diseases. The pertinent physical exam showed a well-appearing male. Vital signs were normal and growth parameters were 50-90% for age. [pediatriceducation.org]

• Localized Pain

  Symptoms may include: Swelling of the eyelid Redness at the edge of the eyelid Pain over the affected area (localized pain) Tenderness Drainage of yellow fluid The symptoms of a stye may resemble other conditions or medical problems. [chop.edu]

  Symptoms may include: swelling of the eyelid redness at the edge of the eyelid pain over the affected area (localized pain) tenderness drainage of yellow fluid The symptoms of a stye may resemble other conditions or medical problems. [weillcornelleye.org]

• Erythema

  The stye generally appears as a pustule with mild erythema of the lid margin. Pustular exudate may be present. Patients with internal hordeolum present with more diffuse tenderness and erythema of the lid given the relatively larger meibomian gland. [ncbi.nlm.nih.gov]

  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]

  Contact dermatitis with irritation, erythema, and edema. Copyright © VisualDx.com Figure 4. Contact dermatitis with irritation, erythema, and edema. Copyright © VisualDx.com Enlarge Print Figure 5. [aafp.org]

  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]

• Skin Disease

  Various skin diseases that may affect the eyelids also increase the risk of a stye, including seborrheic dermatitis and acne rosacea. These skin conditions may cause blepharitis (eyelid inflammation) with a stye arising thereafter. [healthhype.com]

• Blepharitis

  Blepharitis is an inflammation of the lid margins. Anterior blepharitis affects the area of the lid where the eyelashes attach. Posterior blepharitis affects the inner portion of the eyelid margin that is in contact with the eye. [web.archive.org]

  Patients with rosacea, seborrheic dermatitis, psoriasis, and blepharitis are especially at risk for hordeolum or chalazion. [visualdx.com]

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

• Eye Pain

  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 [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]

• Conjunctival Injection

  Blepharitis is a related condition that involves inflammation of the eyelid margin characterized by erythematous, pruritic eyelids, conjunctival injection, crusting or matting of the eyelids, and occasionally flaking of the eyelid skin. [ncbi.nlm.nih.gov]

• Redness of Eye

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

• Eye Swelling

  When a sty develops, a small area of the upper or lower eyelid or the corner of the eye becomes red, tender, swollen and painful. Swelling subsides gradually becoming red, tender, swollen and painful. [epocny.com]

• Irritability

  Use mild and non-irritating soap or shampoo along with tepid tap water. Do this gently with the eye closed and be careful not to cause damage to the eye. [healthguidance.org]

  Contact dermatitis with irritation, erythema, and edema. Copyright © VisualDx.com Figure 4. Contact dermatitis with irritation, erythema, and edema. Copyright © VisualDx.com Enlarge Print Figure 5. [aafp.org]

  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. Prevention : Good hygiene is the best way to prevent styes and chalazia. [epocny.com]

  The eye may feel irritated or "scratchy." Later symptoms can include swelling, discomfort during blinking of the eye, watering of the eye, and sensitivity to light. [web.archive.org]

  However, the most frequent complication of styes is progression to a chalazion that causes cosmetic deformity, corneal irritation, and often requires surgical removal. [en.wikipedia.org]

• Confusion

  A sty is sometimes confused with a chalazion (see below), which is a cyst or a specific type of scarring (due to chronic inflammation) arising in the meibomian glands of the eyelid. In contrast to a sty, a chalazion is usually painless. [web.archive.org]

  […] of the effectiveness of nonsurgical interventions (including hot or warm compresses, lid scrubs, antibiotics, and steroids) for hordeolum, and controlled clinical trials would be useful. 2 Chalazion and hordeolum are similar in appearance and often confused [oadoi.org]

  Hordeola should not be confused with chalazia, which represent focal, chronic, lipogranulomatous inflammation of the Zeis or meibomian glands. [4] Chalazia form when underlying meibomitis results in stasis of gland secretions, and the contents of the [emedicine.medscape.com]

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