A 35-year-old man presented with discomfort in his left eye. He had experienced eye discomfort for one day and noticed a bump on his lower eyelid when he woke the next day. The bump then enlarged and developed discharge. The patient had no vision changes. He had a history of seasonal allergic rhinitis.

Physical examination revealed a single slightly firm, erythematous lesion on the lower eyelid (Figure 1). The patient's vital signs were normal.

Question

Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

• A. Chalazion.

• B. Hordeolum.

• C. Milia.

• D. Seborrheic keratosis.

• E. Xanthelasma.

Discussion

The answer is B: hordeolum, also known as a stye. A hordeolum develops rapidly (within 12 to 24 hours) and is characterized by local pain, swelling, and erythema. Hordeola are inflammatory lesions of the eyelids that can be external or internal. External hordeola are caused by clogging of the eyelash follicles or Zeis and Moll glands. Internal hordeola are caused by infection or inflammation of the meibomian glands. Staphylococcus aureus is the most common pathogen, but other bacteria can cause hordeola. They can also form without a bacterial source and may be sterile. Hordeola are more common in people with underlying skin conditions of the eyelids, such as rosacea and seborrheic dermatitis. Use of eye makeup, which can be contaminated with bacteria, may also increase the risk of hordeola.