Clinical Topic A-Z Clinical Speciality

Styes (hordeola)

Styes (hordeola)
D017043Chalazion
D006726Hordeolum
EyesInfections and infestations
2010-05-17Last revised in May 2010

Styes (hordeola) - Summary

A stye is an acute, localized abscess situated on the eyelid.

It is usually caused by a staphylococcal infection and can be:

External (appears along the edge of the eyelid, caused by infection of an eyelash follicle or associated gland), or

Internal (occurs on the conjunctival surface of the eyelid, caused by infection of a meibomian gland).

Styes are regarded as a common cause of eyelid infection and are common in people with blepharitis.

Styes are generally self-limiting.

Most external styes drain spontaneously within 3–4 days following pointing and resolve within 1–2 weeks.

Internal styes may take longer to resolve (around 1–3 weeks).

Recurrence is common if any underlying blepharitis is not adequately managed.

Rarely, the infection may spread to neighbouring tissues, which can lead to preseptal cellulitis. A persistent internal stye can develop into a meibomian cyst.

A stye typically presents as an acute, painful, localized eyelid swelling that develops over several days.

The swelling generally affects only one eyelid (although both eyes could be affected).

More than one stye may be present.

If there is associated periorbital cellulitis (causing the eyelid to become very oedematous) the localized swelling may not be obvious.

The onset and course of the infection with an internal stye is usually more prolonged and more painful than with an external stye.

Differential diagnoses of styes include meibomian cyst, contact dermatitis, blepharitis, and orbital cellulitis.

Management of a stye includes:

Reassuring the person that styes are self-limiting and rarely cause serious complications.

Advising that attempts should not be made to puncture the stye.

Advising on conservative treatment (e.g. applying a warm compress to the affected eye till the stye drains or resolves).

Managing any blepharitis to reduce the risk of future episodes of styes.

Offering paracetamol or ibuprofen to relieve pain, if required.

Topical antibiotic should not be prescribed unless there is evidence of conjunctivitis.

For painful external stye one of the following should be considered:

Epilating the eyelash from the infected follicle (to facilitate drainage).

Incising and draining the stye, using a fine sterile needle (if suitable and if the expertise exists to do so).

Hospital admission is required if there is significant preseptal cellulitis and if the person presents with signs and symptoms of orbital cellulitis. Red flags for hospital admission include:

Lid swelling.

Protrusion of the eyeball.

Double vision or impairment of eye movement.

Reduced visual acuity.

Reduced light reflexes or abnormal swinging light test.

Systemically unwell.

Central nervous system signs or symptoms (e.g. drowsiness, vomiting, headache, seizure, or cranial nerve lesion).

When a full eye examination is not possible.

Referral to an ophthalmologist should be made for incision and drainage:

If the stye is persistent and has not responded to conservative treatment.

If an internal stye is particularly large and painful.

Urgent referral should be made if cancer is suspected, e.g. if the stye has an atypical appearance or reoccurs in the same location.

Have I got the right topic?

1months3060monthsBoth

This CKS topic covers the management of styes (also known as hordeola).

This CKS topic does not cover meibomian cysts — for further information, see the CKS topic on Meibomian cyst.

There are separate CKS topics on Blepharitis, Conjunctivitis - allergic, Corneal superficial injury, Dry eye syndrome, Giant cell arteritis, Herpes simplex - ocular, Red eye, and Uveitis.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary health care.

CKS gratefully acknowledges the contribution of the British Association of Dermatologists in the development of this topic.

How up-to-date is this topic?

How up-to-date is this topic?

Changes

Last revised in May 2010

February to May 2010 — this is a new CKS topic. The evidence-base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

Update

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 November 2009.

HTAs (Health Technology Assessments)

No new HTAs since 1 November 2009.

Economic appraisals

No new economic appraisals relevant to England since 1 November 2009.

Systematic reviews and meta-analyses

Systematic reviews published since the last revision of this topic:

Lindsley, K., Nichols, J.J., and Dickersin, K. (2010) Interventions for acute internal hordeolum (Cochrane Review). The Cochrane Library. Issue 9. John Wiley & Sons, Ltd. www.thecochranelibrary.com [Free Full-text]

Primary evidence

No new randomized controlled trials published in the major journals since 1 November 2009.

New policies

No new national policies or guidelines since 1 November 2009.

New safety alerts

No new safety alerts since 1 November 2009.

Changes in product availability

No changes in product availability since 1 November 2009.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

Accurately diagnose styes

Advise appropriate self-care measures for the management of a stye

Refer the person appropriately to secondary care

Background information

Definition

What is it?

A stye (also known as a hordeolum) is an acute, localized abscess situated on the eyelid. It is usually caused by a staphylococcal infection.

Two types of stye can be distinguished:

External stye (also known as an external hordeolum or a common stye)

Appears along the edge of the eyelid.

It is caused by infection of an eyelash follicle or associated gland (sebaceous [Zeis] or apocrine [Moll] gland).

Internal stye (also known as an internal hordeolum or meibomian stye)

Occurs on the conjunctival surface of the eyelid.

It is caused by infection of a meibomian gland (situated within the tarsal plate).

[Carter, 1998; Lederman and Miller, 1999; Skorin, 2002; Peralejo et al, 2008]

Prevalence

How common is it?

Stye is regarded as a common cause of eyelid infection [Skorin, 2002]. However, CKS found no data on the prevalence of styes in the UK.

Risk factors

What are the risk factors?

People with blepharitis are more at risk of styes [The College of Optometrists, 2008].

However, evidence for this risk factor is lacking.

Prognosis

What is the prognosis?

Styes are generally self-limiting.

Most external styes:

Resolve within 1–2 weeks.

Drain spontaneously within 3–4 days following pointing.

An internal stye may take longer to resolve (around 1–3 weeks).

Recurrence is common if any underlying blepharitis is not adequately managed.

[Olson, 1991; Lederman and Miller, 1999; Skorin, 2002; Thunstrom, 2006]

Complications

What are the complications?

Rarely, the infection may spread to neighbouring tissues, which can lead to preseptal cellulitis.

A persistent internal stye can develop into a meibomian cyst (see the CKS topic on Meibomian cyst).

[Lederman and Miller, 1999; Skorin, 2002; Sethuraman and Kamat, 2009]

Diagnosis

Diagnosis of styes (hordeola)

Diagnosis

How do I know my patient has it?

A stye typically presents as an acute, painful, localized eyelid swelling that develops over several days.

The swelling generally affects only one eyelid (although both eyes could be affected).

More than one stye may be present.

If there is associated periorbital cellulitis (causing the eyelid to become very oedematous), the localized swelling may not be obvious.

If the stye is external, the swelling:

Is located at the eyelid margin (upper or lower).

Is usually localized around an eyelash follicle.

Points anteriorly through the skin. A small, yellow, pus-filled spot may be visible.

Is painful on palpation.

If the stye is internal:

The onset and course of the infection is usually more prolonged and more painful than with an external stye.

There is a localized, red swelling on the external eyelid (although the whole eyelid can be affected) that is tender to the touch. An internal stye is usually further away from the lid margin compared with an external stye.

Upon everting the eyelid (which can be extremely painful), there is localized swelling within the tarsal plate.

It usually points toward the conjunctiva (although it can point anteriorly through the skin).

Vision is unaffected.

Basis for recommendation

Basis for recommendation

These recommendations are based on expert review articles and UK and Australian optometry guidelines [Elkington and Khaw, 1988; Olson, 1991; Carter, 1998; Shields, 2000; Greenberg, 2002; Skorin, 2002; QUT, 2005; Thunstrom, 2006; Papier et al, 2007; Peralejo et al, 2008; The College of Optometrists, 2008; Sethuraman and Kamat, 2009].

Differential diagnosis

What else might it be?

The differential diagnosis of styes includes other conditions that cause a swollen, red eyelid.

Meibomian cyst (also known as a chalazion)

This is a chronic inflammatory granuloma that is caused by the obstruction of a meibomian gland; situated on the posterior eyelid.

Unlike an internal stye, palpation of the meibomian cyst generally produces no pain or tenderness.

Although it can be difficult to differentiate clinically between an internal stye and a meibomian cyst, this is not crucial in practice; the initial management is the same. For further information, see the section on Management, and the CKS topic on Meibomian cyst.

Contact dermatitis

The acute phase is often characterized by itch, redness, and vesiculation. The chronic phase is generally characterized by dryness, lichenification (thickening of the skin), and fissuring. For further information, see the CKS topic on Dermatitis - contact.

Check for any history of contact dermatitis, and ask about possible trigger factors (for example, cosmetic use and occupational contact with chemicals).

Atopic eczema

This is a chronic, relapsing, itchy skin condition. It usually starts in infancy and is episodic in nature. The skin lipid barrier is reduced, leading to increased water loss and a tendency towards dry skin.

When the eyelid is affected, pruritus, oedema, erythema, lichenification, fissures, or fine scaling may be evident. Compared with contact dermatitis, atopic eczema is associated with predominant lichenification and fine scaling and less oedema and erythema.

Check for other features consistent with atopic eczema, such as longstanding eczema and localization of eczema to the flexure of the limbs. For further information, see the CKS topic on Eczema - atopic.

Blepharitis

The margin of the eyelid is inflamed, causing it to appear erythematous and oedematous with crusting and telangiectasia. Other symptoms include pruritus, irritation, and burning. For further information, see the CKS topic on Blepharitis.

It can be distinguished from other causes of eyelid inflammation by the presence of soft, oily, yellow scaling (or more rarely, brittle scaling) around the eyelashes.

Dacryocystitis

This is infection of the lacrimal sac.

With acute infection, there is pain, swelling, and redness localized in the medial canthal region (but it may extend to the nose and cheek). With chronic infection, there may be no swelling and redness, but digital pressure applied to the skin over the sac may result in the appearance of pus at the lacrimal punctum.

Rosacea

This can cause acneiform eruptions of the eyelids as well as oedema, erythema, and telangiectasia of the lid margin. The eyelids may appear thickened and irregular. For further information, see the CKS topic on Rosacea.

Herpes zoster infection

Unilateral crops of small vesicles can be seen, along with swelling and erythema. For further information, see the CKS topic on Shingles.

Herpes simplex infection

This can appear as unilateral crops of small vesicles, along with swelling and erythema. For further information, see the CKS topic on Herpes simplex - ocular.

Orbital cellulitis

This is an infection involving the deep soft tissue surrounding the eyeball, located posterior to the orbital septum.

Orbital cellulitis is a medical emergency. It can progress rapidly and can lead to loss of sight and serious cerebral complications (such as meningitis and brain abscess).

Most cases are a consequence of acute or chronic bacterial sinusitis.

Orbital cellulitis usually presents as an acute onset of unilateral eyelid swelling, along with a red and painful eye. It is often associated with severe pain, blurred vision, double vision (diplopia), headache, fever, and systemic malaise.

Preseptal cellulitis (periorbital cellulitis)

This is caused by an infection anterior to the orbital septum.

Causes include trauma and local infection (for example, a stye, impetigo, and dacryocystitis).

Clinical findings do not always correlate with the severity of the condition.

It can be difficult to differentiate between periorbital cellulitis and orbital cellulitis based on clinical observation alone. Both conditions may present with eyelid oedema and erythema.

However, unlike orbital cellulitis, periorbital cellulitis does not cause visual impairment (including decreased visual acuity), limitation of extraocular movement, pain with eye movement, or protrusion of the eyeball (proptosis — displacement of the globe anteriorly from orbital margin).

Malignancy

Basal cell carcinoma

The most common cause of malignancy affecting the periorbital area; it accounts for 90% of all malignant eyelid tumours.

It can appear as a shiny, waxy, pearly nodule with small telangiectasias on the surface and rolled borders.

Squamous cell carcinoma

Less common, contributing to around 5% of eyelid tumours.

Usually presents as a shallow ulcer, often crusting over a reddish base. It has a ridge-like border. Loss of eyelashes and destruction of the surrounding eyelid structure may be seen.

Sebaceous cell carcinoma

A rare and aggressive cancer (1–5.5% of eyelid tumours).

Appearance is variable; and it may mimic other benign conditions (such as a meibomian cyst, wart, or chronic blepharitis).

Melanoma

A rare pigmented eyelid tumour (around 1% of eyelid tumours).

Examine any suspicious pigmented lesions for asymmetry, irregular border, pigmentation, and rapid change in size.

Basis for recommendation

Basis for recommendation

Information on the differential diagnosis is based on expert reviews of eyelid conditions [Papier et al, 2007; Peralejo et al, 2008], periorbital cellulitis [Howe and Jones, 2004], and eye infections [Baum, 1995].

Management

Management

Scenario: Management : covers the management of styes in primary care.

Scenario: Management

Scenario: Management of styes (hordeola)

1months3060monthsBoth

Management

How should I manage a stye?

Reassure the person that styes are self-limiting and rarely cause serious complications.

Symptoms rapidly subside once the stye has ruptured or has been drained.

Advise the person:

To apply a warm compress (for example, using a clean flannel that has been rinsed with hot water) to the affected eye for 5–10 minutes. Repeat three to four times daily until the stye drains or resolves.

To avoid excessively hot compresses (to avoid scalding, particularly in children).

They should not attempt to puncture an external stye themselves.

For painful external styes, consider:

Epilating the eyelash from the infected follicle (to facilitate drainage).

Incising and draining the stye, using a fine sterile needle. This should only be undertaken by suitably experienced healthcare professionals, and may not be practical for all people (for example, young children).

Do not prescribe a topical antibiotic for styes, unless there is evidence of conjunctivitis (for further information, see the CKS topic on Conjunctivitis - infective).

Prescribe or recommend a simple analgesic (such as paracetamol or ibuprofen) to relieve pain, if required.

If the stye does not improve or resolve with conservative treatment, refer the person to an ophthalmologist.

Manage any blepharitis to reduce the risk of future episodes of styes.

For information on management (including eyelid hygiene and the use of eye lubricants), see the CKS topic on Blepharitis.

Basis for recommendation

Basis for recommendation

These recommendations are based on expert review articles, and UK and Australian optometry guidelines [Hudson, 1981; Elkington and Khaw, 1988; Olson, 1991; Carter, 1998; Shields, 2000; Greenberg, 2002; Skorin, 2002; Burns et al, 2004; QUT, 2005; Thunstrom, 2006; Papier et al, 2007; Peralejo et al, 2008; The College of Optometrists, 2008; Sethuraman and Kamat, 2009].

Conservative treatment

Although evidence is lacking, warm compresses are widely recommended by experts to encourage pointing and spontaneous drainage of the stye.

Expert advice varies regarding the frequency of hot compress application — from every 2 hours [Greenberg, 2002] to two to four times daily [Carter, 1998; Shields, 2000; Skorin, 2002] or several times a day [Olson, 1991; QUT, 2005; Mueller and McStay, 2008]. The recommendation to apply warm compresses three to four times a day is supported by most experts.

Given the prognosis of the condition, conservative treatment should be applied until the stye has ruptured (which should occur within 1–3 weeks). Symptoms rapidly subside following rupture.

Symptomatic relief of external styes

The recommendations for epilating the affected hair follicle or incising an external stye are supported by expert opinion [Olson, 1991; Baum, 1995; Skorin, 2002; QUT, 2005; Peralejo et al, 2008; The College of Optometrists, 2008; Sethuraman and Kamat, 2009].

Puncture of an external stye by the person

Two UK case reports highlight serious complications that followed the puncturing of a stye by the person themselves — causing preseptal cellulitis (with necrosis) [Benton and Karkanevatos, 2007] and periorbital necrotizing fasciitis (which can be potentially life-threatening) [Raja et al, 2008].

Consequently, CKS does not recommended that the person punctures their own stye.

Drug treatments that are not recommended

Topical antibiotics for external styes

Expert opinion differs on the reason for prescribing topical antibiotics for a stye. These include treating the stye [Sharma, 1998; Skorin, 2002; Thunstrom, 2006], preventing local complications (such as spread of the infection) [Olson, 1991; QUT, 2005; Papier et al, 2007], and treating secondary infection (for example, in combination with an oral antibiotic for infection that is spreading) [Elkington and Khaw, 1988; Lederman and Miller, 1999; Greenberg, 2002; Peralejo et al, 2008].

However, some experts consider that topical antibiotics do not affect the course of an external stye [Olson, 1991; Sethuraman and Kamat, 2009] and their use for preventing complications and infection is controversial [Mueller and McStay, 2008].

Given the lack of evidence and the self-limiting nature of the condition, CKS does not recommend topical antibiotics for treating external styes.

This recommendation is supported by most CKS expert reviewers.

Topical antibiotics for internal styes

There is no evidence to support their use.

They are regarded as ineffective, given that the infection is located within the eyelid tissue [Olson, 1991; Skorin, 2002].

Oral antibiotics

CKS identified no evidence on the use of oral antibiotics for the treatment of styes.

Oral antibiotics are not recommended for styes (unless there is cellulitis; a rare, but serious complication — see Differential diagnosis and Referral) [Lederman and Miller, 1999; Skorin, 2002].

Non-antibiotic drug treatment and herbal remedies

CKS found no evidence for non-antibiotic drug treatment and herbal remedies or any published expert opinion supporting their use.

Referral

When should I refer a person with a stye?

Admit the person if:

There is significant preseptal cellulitis.

The person presents with signs or symptoms of orbital cellulitis (rare). Red flags for hospital admission include:

Lid (periorbital) swelling.

Protrusion of the eyeball (proptosis).

Double vision (diplopia) or impairment of eye movement (ophthalmoplegia).

Reduced visual acuity.

Reduced light reflexes or abnormal swinging light test.

Systemically unwell.

Central nervous system signs or symptoms (for example drowsiness, vomiting, headache, seizure, or cranial nerve lesion).

When a full eye examination is not possible.

Refer the person to an ophthalmologist for incision and drainage:

If the stye is persistent and has not responded to conservative treatment.

If an internal stye is particularly large and painful (rare for external styes).

Refer urgently if cancer is suspected — for example, if the stye has an atypical appearance or reoccurs in the same location.

Basis for recommendation

Basis for recommendation

These recommendations are based on expert review articles on managing styes [Elkington and Khaw, 1988; Olson, 1991; Greenberg, 2002] and periorbital cellulitis [Howe and Jones, 2004].

Evidence

Evidence

Supporting evidence

Conservative treatment

Evidence on conservative treatment for the management of styes

CKS found no trial-based evidence on the use of hot compresses for the treatment of styes. However, their use is widely supported by experts (see Management for further information).

No other recommended self-care measures were identified.

Topical and oral antibiotics

Evidence on topical and oral antibiotics for treatment of styes

CKS found no trial-based evidence on the use of topical or oral antibiotics for the treatment of styes.

No randomized controlled trials were found.

Two very small non-randomized studies involving topical antibiotics were identified. However, neither study was relevant since they examined nasal application of antibiotics to prevent the recurrence of styes [Copeman, 1958] and post-operative use of antibiotics to reduce complications after incision and drainage [Hirunwiwatkul and Wachirasereechai, 2005]. Given the small size and poor methodological quality of these studies, it is not possible to draw any conclusions.

Non-antibiotic drug treatment

Evidence on non-antibiotic drug treatment for managing styes

CKS found no good evidence to support the use of non-antibiotic drug treatment for styes.

Two small studies of poor methodological quality were identified. However, they involved treatments not available in the UK — yellow mercuric oxide 1% eye ointment (79 participants, no clinical outcomes) [Kastl et al, 1987] and Broncasma Berna injection (not used clinically for styes; published in a letter, involving 12 participants with recurrent styes collected over an 11-year period) [Nakatani, 1999].

Herbal remedies

Evidence on the use of herbal remedies for the treatment of styes

CKS found no evidence on the use of herbal remedies for treating styes.

No trials were found.

One case report on a traditional Malian ointment was found [Willcox et al, 2008].

Search strategy

Scope of search

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of styes (hordeola).

Search dates

Dates not restricted – November 2009

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline and these were adapted for other databases. Further details are available on request.

Chalazion/, chalazion.tw, Hordeolum/ hordeolum.tw, hordeola.tw, stye.tw, meibomian cyst.tw.

Table 1 . Key to search terms.
Search commands Explanation
/ indicates a MeSh subject heading with all subheadings selected
.tw indicates a search for a term in the title or abstract
exp indicates that the MeSH subject heading was exploded to include the narrower, more specific terms beneath it in the MeSH tree
$ indicates that the search term was truncated (e.g. wart$ searches for wart and warts)
Sources of guidelines

National Institute for Health and Care Excellence (NICE)

Scottish Intercollegiate Guidelines Network (SIGN)

National Guidelines Clearinghouse

New Zealand Guidelines Group

British Columbia Medical Association

Canadian Medical Association

Institute for Clinical Systems Improvement

Guidelines International Network

National Library of Guidelines

National Health and Medical Research Council (Australia)

Alberta Medical Association

University of Michigan Medical School

Michigan Quality Improvement Consortium

Royal College of Nursing

Singapore Ministry of Health

Health Protection Agency

National Resource for Infection Control

CREST

World Health Organization

NHS Scotland National Patient Pathways

Agency for Healthcare Research and Quality

TRIP database

Patient UK Guideline links

UK Ambulance Service Clinical Practice Guidelines

RefHELP NHS Lothian Referral Guidelines

Medline (with guideline filter)

Sources of systematic reviews and meta-analyses

The Cochrane Library :

Systematic reviews

Protocols

Database of Abstracts of Reviews of Effects

Medline (with systematic review filter)

EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

NIHR Health Technology Assessment programme

The Cochrane Library :

NHS Economic Evaluations

Health Technology Assessments

Canadian Agency for Drugs and Technologies in Health

International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

The Cochrane Library :

Central Register of Controlled Trials

Medline (with randomized controlled trial filter)

EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Bandolier

Drug & Therapeutics Bulletin

MeReC

NPCi

BMJ Clinical Evidence

DynaMed

TRIP database

Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

Department of Health

Health Management Information Consortium (HMIC)

References

Baum, J. (1995) Infections of the eye. Clinical Infectious Diseases 21(3), 479-486.

Benton, J. and Karkanevatos, A. (2007) Preseptal cellulitis due to Mycobacterium marinum. Journal of Laryngology & Otology 121(6), 606-608. [Abstract]

Burns, T., Breathnach, S., Cox, N. and Griffiths, C. (Eds.) (2004) Rook's textbook of dermatology. Volume four. 7th edn. Oxford: Blackwell Science Ltd.

Carter, S.R. (1998) Eyelid disorders: diagnosis and management. American Family Physician 57(11), 2695-2702. [Abstract] [Free Full-text]

Copeman, P.W. (1958) Treatment of recurrent styes. Lancet 2(7049), 728-729.

Elkington, A.R. and Khaw, P.T. (1988) ABC of eyes. Eyelid and lacrimal disorders. British Medical Journal 297(6646), 473-477. [Free Full-text]

Greenberg, M.I. (2002) Diagnosis: a hordeolum. Emergency Medicine News 24(6), 10. [Free Full-text]

Hirunwiwatkul, P. and Wachirasereechai, K. (2005) Effectiveness of combined antibiotic ophthalmic solution in the treatment of hordeolum after incision and curettage: a randomized, placebo-controlled trial: a pilot study. Journal of the Medical Association of Thailand 88(5), 647-650. [Abstract]

Howe, L. and Jones, N.S. (2004) Guidelines for the management of periorbital cellulitis/abscess. Clinical Otolaryngology and Allied Sciences 29(6), 725-728. [Abstract]

Hudson, R.L. (1981) Treatment of styes and meibomian cysts. Practical procedures. Australian Family Physician 10(9), 714-715. [Abstract]

Kastl, P.R., Ali, Z. and Mather, F. (1987) Placebo-controlled, double-blind evaluation of the efficacy and safety of yellow mercuric oxide in suppression of eyelid infections. Annals of Ophthalmology 19(10), 376-379. [Abstract]

Lederman, C. and Miller, M. (1999) Hordeola and chalazia. Pediatrics in Review 20(8), 283-284.

Mueller, J.B. and McStay, C.M. (2008) Ocular Infection and inflammation. Emergency Medicine Clinics of North America 26(1), 57-72. [Abstract]

Nakatani, M. (1999) Treatment of recurrent hordeolum with Broncasma Berna. Eye 13(5), 692.

Olson, M.D. (1991) The common stye. Journal of School Health 61(2), 95-97.

Papier, A., Tuttle, D.J. and Mahar, T.J. (2007) Differential diagnosis of the swollen red eyelid. American Family Physician 76(12), 1815-1824. [Abstract] [Free Full-text]

Peralejo, B., Beltrani, V. and Bielory, L. (2008) Dermatologic and allergic conditions of the eyelid. Immunology and Allergy Clinics of North America 28(1), 137-168. [Abstract]

QUT (2005) Clinical pathways for optometric management of ocular conditions. ..Northern Territory Government.www.health.nt.gov.au [Free Full-text]

Raja, V., Job, R., Hubbard, A. and Moriarty, B. (2008) Periorbital necrotising fasciitis: delay in diagnosis results in loss of lower eye. International Ophthalmology 28(1), 67-69. [Abstract]

Sethuraman, U. and Kamat, D. (2009) The red eye: evaluation and management. Clinical Pediatrics 48(6), 588-600.

Sharma, S. (1998) Ophthaproblem. Chalazion. Canadian Family Physician 44, 1249. [Free Full-text]

Shields, S.R. (2000) Managing eye disease in primary care. Part 2. How to recognize and treat common eye problems. Postgraduate Medicine 108(5), 83-86. [Abstract]

Skorin, L. (2002) Hordeolum and chalazion treatment. The full gamut. Optometry Today June 28, 25-27. [Free Full-text]

The College of Optometrists (2008) Hordeolum. ..The College of Optometrists.www.college-optometrists.org [Free Full-text]

Thunstrom, V. (2006) Primary eye care for the general practitioner. South African Family Practice 48(7), 27-32. [Free Full-text]

Willcox, M., Bengaly, T., Lopez, V. et al. (2008) Traditional malian ointment for styes. Journal of Alternative and Complementary Medicine 14(5), 461-464.