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  • A 10-year-old girl with a red bump and swelling on the lower eyelid

    What is your diagnosis?

    The diagnosis is...

    Teenager with red bump on lower eyelid margin

    The image is consistent with a diagnosis of a hordeolum (also known as a stye). 

    • A hordeolum is an acute purulent inflammation of a gland within the eyelid, analogous to a pimple on the skin.
    • Hordeola can be categorized by location:
      • External: inflammation of an eyelash follicle (or associated gland of Zeis or Moll)
      • Internal: inflammation of a meibomian gland
    • Risk factors include:
      • Poor hygiene: such as frequent touching of the face without handwashing, or improper makeup removal
      • Chronic conditions: such as diabetes, seborrheic dermatitis, meibomian gland disease, blepharitis, or rosacea

    What is the role of the primary care or emergency medicine physician?

    • Provide conservative treatment, such as using warm compresses, washing the eyelid with a gentle soap, and possibly adding topical antibiotics.
    • Follow up with the patient in a few days or weeks to ensure that the patient is appropriately responding to treatment.
    • Refer the patient to an ophthalmologist:
      • if concerned for other conditions such as cellulitis or sebaceous cell carcinoma (in adults) 
      • if the stye is large or chronic (chronic styes are also known as

    What is the role of the ophthalmologist?

    • Perform a slit-lamp examination.
    • Monitor the patient for possible preseptal cellulitis.
    • Assess for and rule out other conditions on the differential such as sebaceous cell carcinoma (in adults), cellulitis, or cysts.
    • Perform incision and drainage for larger styes or chalazia.

    What is the treatment?

    • Conservative treatment:
      • frequent warm compress use
      • washing the eyelid with a gentle soap
      • antibiotic (+/- steroid) ointment (this requires monitoring of eye pressure)
    • For non-resolving styes (chalazia):
      • incision and drainage
    • Oral antibiotics may be needed if there is secondary infection of the eyelids (preseptal cellulitis)

    Learn more: Ophthalmology resources for medical students