Hordeolum

It is an acute focal infection (usually staphylococcal) involving either
the glands of Zeis (external hordeola, or styes) or, less frequently,
the meibomian glands (internal hordeola)
Pathophysiology

There is usually underlying meibomitis with thickening and stasis of gland
secretions with resultant inspissation of the Zeis or meibomian gland
orifices. Stasis of the secretions leads to secondary infection, usually
by Staphylococcus aureus. [3] Histologically, hordeola represent focal
collections of polymorphonuclear leukocytes and necrotic debris (ie, an
abscess).

Essentially, a hordeolum represents an acute focal infectious
process, while a chalazion represents a chronic, noninfectious
granulomatous reaction. However, chalazia often evolve from
internal hordeola
Epidemiology
Frequency

United States
Hordeola are common in clinical practice, but no data are available on the
precise incidence and prevalence in the United States.
International
No data are available on the incidence and prevalence of hordeola
internationally.
Race
There is no known racial predilection to developing hordeola.
Sex
There is no sexual predilection to developing hordeola. Both men and women seem
to be equally affected.

therefore. or rosacea. single or multiple. Clinical Presentation History Hordeola essentially represent focal abscesses. However. warm.Age Hordeola are more common in adults than in children. . higher incidence of meibomitis. red lump on the eyelid. a tender erythematous subcutaneous nodule is present near the eyelid margin. and rosacea in adults. If sufficient edema is present. The eyelid lump may also induce corneal astigmatism and cause blurring of vision. These nodules may be unilateral or bilateral. such as a painful. blepharitis. Physical On examination. such as meibomian gland dysfunction. then it may be difficult to palpate a discrete nodule. possibly because of a combination of higher androgenic levels (and increased viscosity of sebum). swollen. The inflammation associated with hordeola may spread to adjacent tissue and cause a secondary preseptal cellulitis. hordeola can occur in children. which may undergo spontaneous rupture and drainage. they will present with features of acute inflammation. The patient often has a past history of similar eyelid lesions or risk factors for hordeola.

Histologic Findings Histopathology of a hordeolum reveals an abscess or a focal collection of polymorphonuclear leukocytes and necrotic tissue. and cultures are not indicated in uncomplicated cases. histopathologic examination is very important in determining the diagnosis. Workup Laboratory Studies The diagnosis is based on history and clinical examination. therefore. Histologically. [3] Patients with chronic blepharitis. especially in patients with a persistent or recurrent lesion. Treatment & Management . chalazia represent a lipogranulomatous inflammatory reaction. meibomian gland dysfunction.Causes Hordeola are associated with S aureus infection. and ocular rosacea are at greater risk of developing hordeola than the general population. Basal cell carcinoma or sebaceous cell carcinoma of the eyelid can be misdiagnosed clinically as a recurrent hordeolum or chalazion.

intralesional steroids. The specimen should be sent for histopathological evaluation to confirm the . and topical antibiotic ointment in the inferior fornix if the lesion is draining or if there is an accompanying blepharoconjunctivitis. and the incision is made through the skin and orbicularis (in the case of external hordeola) or through the tarsal conjunctiva and tarsus (in the case of internal hordeola). Medical therapy for hordeola includes eyelid hygiene (lid scrubs). warm compresses and massages of the lesions for 10 minutes 4 times per day. Surgical Care Incision and drainage is indicated if the hordeolum is large or if it is refractory to medical therapy. Incision and drainage is done under local anesthesia. although unproven.Medical Care Hordeola are usually self-limited. [9. [11] do not seem to be harmful. which may require topical steroids. Systemic antibiotics may be indicated if the hordeola is complicated by preseptal cellulitis. spontaneously improving in 1-2 weeks. the lash can be pulled to enhance drainage. Internal hordeola may occasionally evolve into chalazia. 10] Nonsurgical remedies for hordeolum. If an external hordeolum is centered around a lash follicle. Oral doxycycline may also be added if there is a history of multiple or recurrent lesions or if there is significant and chronic meibomitis. or surgical incision and curettage.

PCE Dispertab may be taken with food. Medication Summary The goals of pharmacotherapy are to treat the infection. and to prevent complications. E.E. base has poorest absorption . possibly by blocking dissociation of peptidyl t-RNA from ribosomes. to reduce morbidity.diagnosis and to rule out a more sinister pathology (eg. PCE.S. 400)  View full drug information Inhibits bacterial growth. Indicated for infections caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections. basal cell carcinoma). Dosage Forms & Strengths tablet   250mg 500mg Dose Range Usual dosage range: 250-500 mg PO q6-12hr or 500 mg q12hr or 333 mg PO q8hr Severe infections: Up to 4 g/day Take on empty stomach if possible. Erythromycin base (Ery-Tab. Antibiotics Class Summary A course of oral antibiotics is indicated if the hordeolum is complicated by preseptal cellulitis. causing RNA-dependent protein synthesis to arrest.

therefore. Adoxa. Usually is well tolerated and provides good coverage for most infectious agents. bacterial growth by binding with 30S and possibly 50S ribosomal subunits of susceptible bacteria. not to exceed 2 g/day Severe infection: 15-50 mg/kg/day PO . May be added if there is history of multiple or recurrent lesions or if there is significant and chronic meibomitis. Augmentin XR. Adult . not to exceed 4 g/day Amoxicillin/clavulanate (Augmentin. Addition of clavulanate inhibits beta-lactamase–producing bacteria. Amoclan)  View full drug information Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Good alternative antibiotic for patients allergic to or intolerant to macrolides. Oracea)  View full drug information Doxycycline inhibits protein synthesis and. Doxycycline (Morgidox. Augmentin ES-600.Pediatric Dosage Forms & Strengths tablet   250mg 500mg Dose Range Mild to moderate infection: 30-50 mg/kg/day PO divided q6-12hr.

delayed-release  40mg (Oracea. Adoxa. Vibramycin. generic) . generic) syrup  50mg/5mL (Vibramycin) oral suspension  25mg/5mL (Vibramycin. generic) 75mg (Acticlate.Dosage Forms & Strengths capsule     50mg (Monodox. generic) 200mg (Doryx) capsule. generic) tablet. generic) 100mg (Adoxa. generic) 150mg (Acticlate. generic) 75mg (Monodox) 100mg (Monodox. generic) 150mg (Adoxa) solution. delayed-release        50mg (Doryx) 60mg (Doryx MPC) 75mg (generic) 100mg (generic) 120mg (Doryx MPC) 150mg (Doryx. reconstituted powder for IV  100mg (Doxy. generic) tablet      20mg (generic) 50mg (Adoxa.

THEN Maintenance: 120 mg PO qDay. 120 mg q12hr recommended Specific Bacterial Infections Typical dosage and frequency: 100 PO q12hr on day 1. then 100 mg PO qDay Severe infections (particularly chronic infections of the urinary tract): 100 mg q12hr is recommended Doryx MPC   240 mg/day divided twice daily PO on first day. or osteomyelitis: 100 mg PO q12hr  CNS infections: 100 mg q12 hr PO/IV with or without rifampin 300 mg PO/IV q12hr  Equivalent dose of Doryx MPC: 120 mg PO BID Brucellosis  Brucellosis due to Brucella species . THEN Maintenance: 100-200 mg/day qDay or divided q12hr PO/IV (IV may be given qDay) Doryx MPC  Mild to moderate infections: 240 mg PO divided q12hr on first day of treatment  Maintenance: 120 mg PO qDay. for more severe infections administer BID (particularly chronic UTI) Bartonella bacilliformis  Bacillary angiomatosis. peliosis hepatitis. bacteremia.periodontal extended-release liquid  10% General Dosage Initial: 200 mg/day divided twice daily PO/IV on first day (IV may be given qDay). in the management of more severe infections (particularly chronic infections of the urinary tract).

doxycycline is an alternative drug in the treatment of the following infections: -Syphilis caused by Treponema pallidum -Yaws caused by Treponema pallidum subspecies pertenue -Listeriosis due to Listeria monocytogenes -Vincent’s infection caused by Fusobacterium fusiforme -Actinomycosis caused by Actinomyces israelii -Infections caused by Clostridium species . culture and susceptibility testing are recommended Escherichia coli Enterobacter aerogenes Shigella species Acinetobacter species Urinary tract infections caused by Klebsiella species Infections when Penicillin is Contraindicated When penicillin is contraindicated. adjunct to fluid and electrolyte replacement Equivalent dose of Doryx MPC is 360 mg PO Other infections include     Relapsing fever due to Borrelia recurrentis Plague due to Yersinia pestis Tularemia due to Francisella tularensis Campylobacter fetus infections caused by Campylobacter fetus Gram-negative bacteria       Because many strains of the following groups of microorganisms have been shown to be resistant to doxycycline.  100 mg PO twice daily for 6 weeks with rifampin or streptomycin Equivalent dose of Doryx MPC: 120 mg PO BID Cholera    Indicated for cholera caused by Vibrio cholerae 300 mg PO once.

1-137 Uncomplicated gonococcal infection of the cervix. then 120 mg PO qDay Respiratory infections    Respiratory tract infections caused by Mycoplasma pneumoniae Psittacosis (ornithosis) caused by Chlamydophila psittaci Indicated for the following microorganisms. urealyticum: 100 mg PO BID x 7 days Syphilis (early): Patients who are allergic to penicillin should be treated with doxycycline 100 mg PO BID x 2 weeks Syphilis >1 year duration: Patients who are allergic to penicillin should be treated with doxycycline 100 mg PO BID x 4 weeks Acute epididymo-orchitis caused by N. June 5. gonorrhoeae or C trachomatis: 100 mg PO BID x least 10 days Equivalent dose of Doryx MPC is 120 mg PO BID . and rectum: Ceftriaxone 250 mg IM once plus azithromycin 1 g PO once (preferred) or alternatively doxycycline 100 mg PO q12hr for 7 days Uncomplicated urethral.Acute Bacteria Rhinosinusitis 200 mg/day PO qDay or divided BID for 5-7 days Respiratory Tract Infections 100 PO q12hr on day 1. then 100 mg PO qDay Doryx MPC: 120 mg PO q12hr on day 1. urethra. endocervical. trachomatis and U. or rectal infection caused by Chlamydia trachomatis: 100 mg PO BID x 7 days Nongonococcal urethritis caused by C. 2015:64(RR3). when bacteriological testing indicates appropriate susceptibility to doxycycline:  -RTIs caused by Haemophilus influenzae  -RTIs caused by Klebsiella species  -Upper RTIs caused by Streptococcus pneumoniae Sexually Transmitted Diseases CDC STD guidelines: MMWR Recomm Rep.

also approved for inclusion conjunctivitis caused by chlamydia trachomatis 100 PO q12hr on day 1. <4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strain Prophylaxis: 100 mg PO qDay. begin taking 1-2 days before travel and continue daily during travel and for 4 weeks after traveler leaves malaria infested area Severe infection (off-label): 100 mg PO/IV q12hr x 7 days with 3-7 days quinidine gluconate Uncomplicated infection (off-label): 100 mg PO q12hr x 7 days with 3-7 days quinine sulfate depending on region Equivalent dose of Doryx MPC is 120 mg . on an empty stomach Chlamydia trachomatis Trachoma caused by Chlamydia trachomatis. dose depends on size. and number of pockets treated Rosacea Oracea: 40 mg PO qAM. although the infectious agent is not always eliminated as judged by immunofluorescence. shape.Periodontal Disease 100-200 mg PO qDay Atridox: Apply subgingivally. then 100 mg PO qDay Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1. then 120 mg PO qDay Anthrax Postexposure prophylaxis: 100 mg PO BID for 60 days Equivalent dose of Doryx MPC is 120 mg PO BID for 60 days Malaria Indicated for prophylaxis of malaria due to Plasmodium falciparum in shortterm travelers (ie.

Intestinal Amebiasis Indicated for adjunctive therapy to amebicides for acute intestinal amebiasis 100 PO q12hr on day 1. then 120 mg PO qDay Infective Endocarditis Suspected Bartonella infection with a negative culture: 100 mg PO BID x 6 weeks in combination with gentamicin and ceftriaxone Positive culture Bartonella infection: 100 mg PO BID x 6 weeks in combination with gentamicin or rifampin Equivalent dose of Doryx MPC is 120 mg PO BID Purulent Cellulitis from Community Acquired MRSA (Off-label) 100 mg PO q12hr for 5-10 days Pediatric Dosage Forms & Strengths capsule   50mg (Monodox. generic) 75mg (Monodox) . and tick fevers caused by Rickettsiae 100 PO q12hr on day 1. then 120 mg PO qDay Rickettsial Infections Indicated for Rocky Mountain spotted fever. rickettsial pox. typhus fever and the typhus group. Q fever. then 100 mg PO qDay Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1. then 100 mg PO qDay Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1.

<45 Kg . generic) 75mg (Acticlate.  100mg (Monodox. delayed-release  40mg (Oracea. generic) 150mg (Acticlate. Vibramycin. generic) syrup  50mg/5mL (Vibramycin) oral suspension  25mg/5mL (Vibramycin. generic) tablet      20mg (generic) 50mg (Adoxa. generic) General Dosing Guidelines ≤8 years: Not recommended for midle-to-moderate infections. generic) 200mg (Doryx) capsule. may cause tooth discoloration and enamel hypoplasia during tooth development >8 years. delayed-release        50mg (Doryx) 60mg (Doryx MPC) 75mg (generic) 100mg (generic) 120mg (Doryx MPC) 150mg (Doryx. generic) tablet. Adoxa. generic) 100mg (Adoxa. reconstituted powder for IV  100mg (Doxy. generic) 150mg (Adoxa) solution.

4 mg/kg PO qDay Initiate treatment 1-2 days prior to travel to endemic area and continue for 4 weeks after leaving the area Severe infection  <45 kg: 2.6 mg/kg PO BID o Less severe infections: 5.3 mg/kg PO divided into 2 doses on day 1. ≤45 kg  100 mg PO q12hr or 50 mg PO q6hr on day 1. anthrax.4 mg/kg/day PO/IV divided q12hr day 1 Maintenance: 2.4 mg/kg/day IV/PO qDay (may divide BID for higher doses)  Doryx MPC o Severe or life-threatening infections (eg. followed by maintenance dose of 120 mg/day. then a maintenance dose of 2.6 mg/kg PO q12hr for 60 days) >8 years (>45kg): 100 mg PO/IV q12hr for 60 days (Doryx MPC: 120 mg PO q12hr for 60 days) Malaria >8 years Prophylaxis    2 mg/kg PO qDay.2 mg/kg PO/IV q12hr for 60 days (change to amoxicillin as soon as penicillin susceptibility confirmed) >8 years (≤45kg): 2.  Load: 4. particularly chronic UTI Anthrax Postexposure prophylaxis ≤8 years: 2. Rocky Mountain spotted fever): 2. not to exceed 100 mg /day Doryx MPC: 2.2-4. followed by maintenance dose of 100 mg/day as single dose or as 50 mg q12hr  Doryx MPC: Doryx MPC: 120 mg PO q12h on day 1.2 mg/kg PO/IV q12hr for 60 days (Doryx MPC: 2. may increase frequency to q12hr for more severe infections.6 mg/kg PO qDay >8 years.2 mg/kg q12hr for 7 days with quinidine gluconate .

Deterrence/Prevention Try to prevent recurrences by minimizing or eliminating risk factors. 2 mg/kg qDay on days 2 and 3. . not to exceed 100 mg/dose. adjunct to fluid and electrolyte replacement Follow-up Further Outpatient Care Patients should be followed within 2-4 weeks of institution of medical therapy to assess response to therapy and need for surgical incision and curettage. such as blepharitis and meibomian gland dysfunction. not to exceed 100 mg dose PO q12hr for 7 days with quinine sulfate Tularemia <45 kg: 2.2 mg/kg. adjunct to fluid and electrolyte replacement Multiple dose: 2 mg/kg PO/IV twice daily on day 1. ≥45 kg (Off label): 100 mg PO/IV q12hr for 7 days with quinidine gluconate Uncomplicated  >8 years: 2. through daily lid hygiene and warm compresses.2 mg/kg PO twice daily for 14-21 days ≥45 kg: 100 mg PO twice daily for 14-21 days Cholera Single dose: 7 mg/kg PO/IV. not to exceed 300 mg/dose. THEN.

. Internal hordeola may occasionally evolve into chalazia. Prognosis Hordeola are usually self-limited and spontaneously resolve within 1-2 weeks. which may require topical or intralesional steroids or even incision and curettage.Complications Large lesions of the upper eyelid have been reported to cause decreased vision secondary to induced astigmatism or hyperopia resulting from central corneal flattening. The resolution is hastened with the use of warm compresses and lid hygiene.