Recurrence is common. Symptoms, Signs, and Diagnosis External hordeolum usually begins with pain, redness, and tenderness of the lid margin followed by a small, round, tender area of induration. Lacrimation, photophobia, and a foreign-body sensation may be present. Though usually localized, edema may be diffuse. The abscess soon ruptures, with discharge of pus and relief of pain.
Internal hordeolum involving one of the meibomian glands is more severe and very rare.
Pain, redness, and edema are more localized. Inspection of the conjunctival side of the lid shows a small elevation or yellow area at the site of the affected gland. Spontaneous rupture is rare, and recurrence is common. An internal hordeolum is deeper and can be seen through the conjunctiva. Successful lacrimal duct irrigation rules out dacryocystitis.