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hordeolum internum

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This is an acute inflammation of the Meibomian glands; the infection is in the tarsal plate and the skin is not primarily involved. Usually, it is due to staphylococcal aureus (1).

Presentation is abrupt with pain, redness and swelling. The reaction tends to be more severe than in an external stye. A red velvety area with a central yellow spot may be seen on the conjunctival surface through which pus will later discharge. It may point to the skin or to the conjunctival surface (2).

The upper eye lid is commonly involved and the inflammation may reach the adjacent glands or the contralateral eye lid (1).

The gland may be blocked and swell to leave a residual cyst - a meibomian cyst or chalazion.

Most of the lesions will enlarge and drain spontaneously on the conjunctival side of the eyelid. Warm compresses can be applied to facilitate drainage (3).

Infected cysts are treated with topical antibiotics e.g. fusidic acid eye drops. In severe cases oral antibiotic treatment may be required e.g. flucloxacillin if not penicillin allergic.

Chalazions can be treated by surgical incision into the tarsal gland followed by curettage of the glandular material and glandular epithelium. A vertical incision is preferred to avoid cutting across the meibomian glands; a horizontal incision is indicated if the hordeolum is pointing to the skin so as to minimise scar formation.

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