Cellulitis of the surrounding soft tissues may develop in external or internal eyelid lesions. The external hordeolum becomes localized and often drains anteriorly through the skin near the eyelash line. On slit lamp examination, clinical findings of eyelid margin inflammation are noted in patients with blepharitis and a history of recurrent or multiple chalazia. The exact role of bacterial agents such as Staphylococcus aureus in the pathogenesis of a hordeolum remains unclear. A large cholesterol component has been found in specimens from a chalazion, and studies have reported an association of multiple chalazia with elevated serum cholesterol.
Diagnosis is based on the typical clinical presentation.
Histopathology of a hordeolum reveals an abscess or a focal collection of polymorphonuclear leukocytes and necrotic tissue. Histopathologically, chalazia represent chronic lipogranulomatous inflammatory changes. Clear spaces usually are seen within the granuloma representing the location of tissue lipid. Foreign body giant cells, epithelioid cells, polymorphonuclear leukocytes, macrophages, lymphocytes, and plasma cells also may be present. Medical treatment consists of frequent daily use of warm compresses, eyelid hygiene, and topical anti-inflammatory medication in the acute inflammatory phase.