Hordeolum: Internal and External Treatment

Infectious Diseases of the Eye

Internal Hordeolum

• Definition: Inflammation of the meibomian gland
• Symptoms: Pain, swelling, and redness of the eyelid
• Treatment:
  • Hot compresses on the eye
  • Oral antibiotics
  • Remaining nodule removal by an ophthalmologist

External Hordeolum

• Definition: Inflammation of the Zeis gland or Moll's gland
• Symptoms: Pain, swelling, and redness of the eyelid
• Treatment:
  • Hot compresses to increase blood supply and aid spontaneous drainage
  • Epilating eyelash associated with the infected hair follicle
  • Topical antibiotics

Dacryocystitis

• Definition: Inflammation of the lacrimal sac
• Causes: Obstruction of the nasolacrimal duct, Staphylococcal/Streptococcal infections
• Symptoms: Acute dacryocystitis presents with subacute pain, redness, swelling of the medial canthus, and epiphora
• Treatment:
  • Hot compresses
  • Oral antibiotics (flucloxacillin or amoxicillin/clavulanate)
  • Incision and drainage may be considered if pus points and the abscess is about to drain spontaneously

Canaliculitis

• Definition: Inflammation of the canaliculus
• Causes: Actinomyces, anaerobic bacteria that grow in obstructed canaliculi
• Symptoms: Unilateral epiphora, chronic mucopurulent conjunctivitis
• Treatment:
  • Topical antibiotics (Ciprofloxacin)
  • Canaliculotomy involving a linear incision into the conjunctival side of the canaliculus

Peri-Orbital Cellulitis

• Definition: Infection of the soft tissue behind the orbital septum
• Causes: Staphylococcus aureus, Streptococcus pyogenes, sinus infections, local spread, hematogenous spread
• Symptoms: Rapid onset of severe malaise, fever, pain, and visual impairment
• Complications: Ocular (exposure keratopathy, raised intraocular pressure, occlusion of the central retinal artery/vein), intracranial (meningitis, brain abscess, cavernous sinus thrombosis)
• Treatment:
  • Hospital admission with frequent ophthalmic and ENT assessment
  • Antibiotic therapy
  • Surgical intervention may be considered

Bacterial Conjunctivitis

• Causes: Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Moraxella catarrhalis, Neisseria gonorrhoeae, Chlamydia trachomatis
• Symptoms: Acute onset of redness, grittiness, burning, and discharge
• Signs: Diffuse conjunctival injection, intense papillary reaction, discharge (initially watery, later mucopurulent)

Ophthalmia Neonatorum

• Causes: Sexually transmitted pathogens (Chlamydia trachomatis, Neisseria gonorrhoeae) from infected maternal birth canal
• Symptoms: Redness, swelling, and discharge in newborns

Blepharitis

• Definition: Inflammation of the eyelid margins
• Causes: Bacterial (Staphylococcus), seborrheic blepharitis
• Symptoms: Burning, grittiness, and mild photophobia with remissions and exacerbations

Trachoma

• Definition: Chronic follicular kerato-conjunctivitis caused by Chlamydia trachomatis
• Epidemiology: Associated with poverty, overcrowding, and poor hygiene
• WHO's SAFE strategy: Surgery, Antibiotics, Face washing, Environment improvement

This quiz covers the management of internal and external hordeolum, including treatment options and procedures.