Hordeolum

HORDEOLUM (stye), an acute isolated inflammation of the eyelid glands, limited to one or several glands. Hordeolum can be external and internal. Hordeolum externum arises as a result of suppuration of the sebaceous Zeis gland or the hair follicle of an eyelash. Inflammatory edema of the eyelid is the first symptom of hordeolum; it can also spread to the conjunctiva of the eyeball (chemosis). The eyelids of the other eye sometimes also swell. Upon careful palpation, a more resistant spot is found in the swollen eyelid, which is recognized by strong pain upon touching. It lies near the eyelid margin and corresponds to the inflamed gland. In subsequent days, infiltration increases, the skin reddens, and after three to four days a yellowish point-pustule appears on the margin of the eyelid, which lies directly at the outer edge of the eyelid margin. After the pus breaks through, the inflammatory phenomena quickly disappear. Despite the short duration of the disease, it can be very distressing thanks to strong pain and swelling of the eyelids. As a rule, swelling of the parotid gland on the same side can be noted. Hordeolum internum is rarer than hordeolum externum. It consists in the suppuration of a Meibomian gland and is therefore also called hordeolum meibomianum or meibomiitis. The course of this disease is generally the same as in hordeolum externum, but since the Meibomian glands lie in the tarsal cartilage of the eyelid, it takes more time for the pus to come out. The pus usually breaks through via the excretory duct of the gland, i.e., at the inner margin of the eyelids, or through the conjunctiva. Hordeolum externum and internum essentially represent acute suppuration analogous to acne of the skin. The strong edema, which does not occur with an ordinary skin pustule, is caused by the special anatomical structure of the eyelid. The cause of hordeolum is infection by microorganisms (almost exclusively Staphylococcus aureus) causing suppurative inflammation. Unna (1896) sees the cause in Asperbacilllen, Herxheimer (1907) considers the role of staphylococcus to be secondary, placing autointoxication from the alimentary tract in first place. General causes must include scrofula, anemia, chlorosis, menstrual disorders, and diabetes. Blepharitis and inflammation of the mucous membrane favor the reproduction of bacteria, their penetration into the duct of the glands, and the suppuration of the latter. Treatment of hordeolum: At the beginning of the disease, a warming compress is indicated for the rapid transition of hard infiltration into suppuration. When pus becomes visible, an incision is made for a more rapid cure. In order to prevent new styes, which can appear one after another over the course of several months and are very painful for the patient, it is necessary first of all to pay attention to the state of the eyelids and mucous membrane. In the case of blepharitis and conjunctivitis (see), treatment must be directed against these diseases. Attention should also be paid to the state of the gastrointestinal tract, and constipation should be combated, since the latter is often the cause of styes appearing one after another. In anemia, good results can be obtained from the use of arsenic and iron preparations.

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