Background
A hordeolum, commonly known as a stye, is an acute infection of the eyelid, typically caused by staphylococcal bacteria. [1, 2] It can be classified as either external, affecting the glands of Zeis or Moll, or internal, involving the meibomian glands. [3] The term "hordeolum" is derived from the Latin word for barley, reflecting its appearance. Most cases are external and arise from the obstruction and infection of an eyelash follicle, often linked to blepharitis. Internal hordeola result from meibomian gland infections, and cellulitis may sometimes occur alongside hordeola.
Pathophysiology
There usually is 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. [4] Histologically, hordeola represent focal collections of polymorphonuclear leukocytes and necrotic debris (ie, an abscess).
Hordeola should not be confused with chalazia, which represent focal, chronic, lipogranulomatous inflammation of the Zeis or meibomian glands. [5] Chalazia form when underlying meibomitis results in stasis of gland secretions, and the contents of the glands (sebum) are released into the tarsus and adjacent tissues to incite a noninfectious inflammatory reaction. Histologically, chalazia appear as a granulomatous reaction (ie, histiocytes, multinucleated giant cells) surrounding clear spaces that were once occupied by sebum/lipid before they were dissolved by the solvents used for tissue processing, hence the term lipogranuloma.
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. [6]
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. However, hordeola are among the most common eyelid lesions in clinical practice.
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.
Age
Hordeola are more common in adults than in children, possibly because of a combination of higher androgenic levels (and increased viscosity of sebum), higher incidence of meibomitis, and rosacea in adults. However, hordeola can occur in children.
