Stye (Hordeolum)

A stye (hordeolum) is an acute, painful abscess of the eyelid caused by bacterial infection, almost always Staphylococcus aureus.

Types

	External Hordeolum	Internal Hordeolum
Gland involved	Follicle of eyelash + glands of Zeis (sebaceous) or Moll (sweat)	Meibomian glands
Location	At the lash line / eyelid margin	Posterior tarsal conjunctival surface (inner eyelid)
Appearance	Small pustule visible at lid margin	Pustule on inner surface of tarsal plate

Pain, edema, and erythema of the eyelid
Localized swelling that may come to a point (pustule)
Usually self-limited
Differentiation from chalazion: a chalazion is a painless, non-mobile lipogranulomatous nodule (blocked meibomian gland, no infection); an early chalazion can look identical to an internal hordeolum

Warm compresses — 10 minutes, 4–5 times/day; encourages spontaneous drainage
Topical antibiotics — erythromycin or bacitracin ointment twice daily × 7–10 days; alternatively moxifloxacin or gatifloxacin drops
Eyelash removal — removing the offending eyelash can be considered for external hordeolum
Systemic antibiotics — if significant surrounding cellulitis develops
Incision & drainage — refer to ophthalmologist if no improvement within 48 hours, or if abscess does not respond to conservative care
Recurrent chalazion in same spot — warrants investigation to exclude underlying carcinoma

Most styes resolve without specific treatment given warm compress support
Do not squeeze or rupture — risk of spreading infection
Watch for spreading erythema beyond the lid → preseptal/orbital cellulitis, which requires systemic antibiotics and urgent evaluation

— Goldman-Cecil Medicine, §391; Tintinalli's Emergency Medicine, §241

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