Stye

A mildly itchy, tender “red bump” on his eyelid concerned a 68-year-old man. Two years earlier, a basal cell carcinoma, which started as a “red bump,” had been removed from his cheek. This lesion had been present for 2 weeks; the patient noted a small amount of discharge at the site in the mornings.

Drs Charles E. Crutchfield III and Humberto Gallego of St Paul were able to allay this patient's fears. They assured him that the eyelid lesion was not another cancer but a hordeolum, or stye.

Hordeola comprise any inflammation or infection of the eyelid margin: those involving the hair follicles of the eyelashes are external hordeola, an internal hordeolum arises in the meibomian glands, and a chronic granulomatous infection of the meibomian glands is termed a chalazion. Staphylococcal infection is the usual cause, but other organisms may be implicated as well. Seborrheic blepharitis, or nonulcerative inflammation of the eyelids, predisposes patients to recurrent hordeola.

Treatment includes application of warm compresses to the eye several times a day until the lesion resolves. Erythromycin ophthalmic ointment may be used concurrently. To prevent recurrences, instruct the patient to regularly clean the eyelashes with warm tap water and dilute baby shampoo or a very mild ophthalmic cleanser.

Follow-up is important. Refractory cases may require an aminoglycoside ophthalmic ointment or an in-office incision and drainage. Internal hordeolum, if untreated, may lead to generalized cellulitis of the eyelid.

This patient's hordeolum healed with treatment. His initial concern about cancer was appropriate, since the differential diagnosis for hordeolum includes eyelid neoplasms.