Internal Hordeolum (Stye): Symptoms, Complications, Treatment, and More

An internal hordeolum is an infection in a gland inside or under the eyelid. You usually notice it because it feels like an irritant in your eye, such as an eyelash or a piece of dirt.

They are caused by bacterial infections.

Healing time usually takes about two weeks, and the infection typically drains on its own. If it does not drain after two weeks, schedule a trip to the doctor.

Introduction

A hordeolum (also known as a stye) is an infection in a gland in the edge of your eyelid. Hordeola can be external (on the outside part of the eyelid) or internal (inside or under the eyelid).

Internal hordeola cannot be seen without careful examination of your eye. They may rub against the inside of your eye and cause you to feel like something is stuck there.

Internal hordeola usually go away without medical treatment in around two weeks. You can speed up your healing time by keeping your eye clean and applying a warm, moist compress to your eye several times a day.

If your hordeolum does not drain within two weeks, make an appointment with your doctor for further treatment. 

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Risk Factors for Internal Hordeolum

You are more likely to develop an internal hordeolum if you: 

• Had had one before
• Wear contact lenses
• Have other inflammation or infections in the eye area
• Have certain systemic health conditions, such as rosacea or diabetes

Symptoms

Symptoms of an internal hordeolum include:

• Swelling, tenderness, or redness of the eyelid
• Tearing and crusting around the eyelid
• Sensitivity to bright light
• Feeling like there is something stuck in your eye

Symptoms can point to many other eye conditions as well. Be sure to see your doctor to confirm your diagnosis if your hordeolum does not seem to be responding to home care.  

Causes

Internal hordeola are caused by bacterial infections. Staphylococcus aureus (staph) bacteria are the most common culprits, but other types of bacteria can cause this problem as well. 

Many internal hordeola happen due to poor hygiene. Not washing your face regularly and thoroughly allows the bacteria to build up around your eye glands, eventually causing them to develop an infection. 

You can also cause an internal hordeolum by using old or contaminated eye makeup. Sharing eye makeup with others is especially risky. This behavior can spread bacteria from person to person, even if the person you are sharing with does not appear to have an eye infection. 

Diagnosis

Internal hordeola are diagnosed through simple visual inspection. Your doctor will examine your eye for redness and swelling. Your doctor may also shine a bright light on the edge of your eyelid to get a better look at your gland openings and determine if one of them is blocked. 

In some cases, your doctor may also ask about your eye health, general health, and family history. This helps them rule out other eye conditions that present similarly to internal hordeola but require different treatment. 

Treatment

Most internal hordeola will go away without medical treatment. When the infection subsides, the hordeola will break open and the pus inside it will drain away. 

You can help your hordeolum drain faster by:

• Placing a warm, moist compress on your eye for five to 10 minutes. Do this three to six times a day.
• Gently applying an over-the-counter lid scrub to the affected eye.
• Not wearing eye makeup or contacts lenses until your hordeolum has drained. 
• Avoiding touching your face and eyes. 

Do not attempt to squeeze or puncture your hordeolum yourself. If the swollen area does not drain on its own, your doctor may lance it for you using sterile tools. 

If your symptoms do not get better with home care, you may need to apply an antibiotic cream to the area to help your body fight the infection. Do not use antibiotic creams that not prescribed to you for this purpose. Not all of them are safe to use near your eyes, and applying the wrong kind may make the problem worse. 

Some hordeola require surgery to remove. This is rare, but it is more common when you have had multiple hordeola in the same place.

Complications

There are few complications associated with internal hordeola. 

In rare cases, the infection that caused the problem may spread to the rest of the eye. If this does happen, the infection will need more aggressive treatment to keep it under control.

If the internal hordeolum damages the lens of the eye, it may cause you to develop astigmatism in that eye. This is very rare and should not be a major concern for most patients. 

Internal hordeola may also come back after successful treatment, especially if your eye hygiene does not improve. Hordeola that recur this way are more likely to need medical treatment than first-time infections. 

Prevention

To prevent internal hordeola:

• Do not share eye makeup with other people. You do not know who may pass bacteria to you. 
• Replace your eye makeup every three months. This will ensure that any bacteria in the makeup does not have a chance to grow. 
• Practice good contact lens hygiene. Always handle your contact lenses with clean hands and store them in their case when you are not using them. 
• Do not wear contacts lenses or eye makeup overnight. This irritates the eyes and promotes bacterial growth. If you wear makeup, be sure to clean your eyes thoroughly before bed. 
• Be on the lookout for signs of blepharitis (eyelid infection). If you are diagnosed with this condition, follow your doctor’s prescribed treatment and get it under control as soon as possible. 

When to Call Your Doctor

If your internal hordeolum does not go away in two weeks, it may need professional treatment. Consult your doctor and follow their advice. They will examine you in person to confirm the diagnosis before laying out the next steps for your care.

Frequently Asked Questions

How is an internal hordeolum treated?

An internal hordeolum usually goes away on its own with basic home care. If this does not produce the desired results, you may need to get a prescription for special antibiotic cream from your doctor. If your hordeolum still does not respond to treatment, you may need surgery to remove it. 

How do you drain an internal hordeolum?

You can drain an internal hordeolum by applying a warm, moist compress to the affected area several times a day. If you keep the area clean, your body will fight off the infection and the hordeolum will eventually burst and expel its pus. 

Do not try to drain an internal hordeolum by squeezing, poking, or lancing it yourself. If your hordeolum does not go away on its own, you will need to see your doctor for further treatment. 

How long does a hordeolum last?

Most internal hordeola heal within two weeks. If yours lasts longer, call your doctor. You may require further treatment. 

References

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2. Hordeolum (Stye). (2022). Johns Hopkins Medicine.

3. Styes and Chalazia. (August 2020). University of Michigan Health.

4. Hordeolum (stye). (2022). American Optometric Association.

5. Styes in Children. (2022). University of Rochester Medical Center.

6. Chalazion and Hordeolum: Adult & Pediatric. (December 2019). Saskatchewan Registered Nurses Association.

7. Sty. (July 2020). Mayo Clinic.

8. Differential Diagnosis of the Swollen Red Eyelid. (July 2015). American Family Physician.

9. Styes and Chalazia. (August 2020). MyHealth Alberta.

10. Styes and Chalazia. (August 2020). HealthLink BC.

11. Surgery for Stye. (2022). NYU Langone Health.

12. What Are Styes and Chalazia? (November 2021). American Academy of Ophthalmology.