# Hordeolum (Stye) and Blepharitis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: College of Optometrists Clinical Management Guidelines 2021 · Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) · Chloramphenicol 1.0% w/w Antibiotic Eye Ointment SmPC section 4.2 (eMC product 9770) - Verified date: 2026-08 ## Verified against - Chloramphenicol 1.0% w/w Antibiotic Eye Ointment SmPC section 4.2 (eMC product 9770) - Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) ## Treatment metadata - Fusidic acid — eye ## Complete treatment card ```text HORDEOLUM (STYE) AND BLEPHARITIS Sources: College of Optometrists Clinical Management Guidelines 2021 · Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) · Chloramphenicol 1.0% w/w Antibiotic Eye Ointment SmPC section 4.2 (eMC product 9770) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - A contained burning, tender swelling on one eyelid, upper or lower - It sometimes begins as general swelling and redness of the whole lid and only later becomes localised [redness] - Patients often say they have had similar lid lesions before - Pain is mild to moderate and stays over the lump; many also feel grittiness or irritation in that eye - Watering of the eye, light sensitivity, and blurring if the swelling gets in the line of sight [photophobia] - Symptoms come on acutely and run a few days to a week; repeated attacks suggest chronic blepharitis or meibomian gland dysfunction - Contributing factors: poor lid hygiene, rubbing the eyes, blepharitis or meibomian gland dysfunction, eye makeup and contact lenses - Rosacea and diabetes raise the risk, as does low immunity from stress or a recent illness such as a chest cold SIGNS - what you find (10) - A red, tender, localised swelling at the lid margin - External type sits superficially near the lash line in the glands of Zeis or Moll; internal type sits deeper in the tarsal plate meibomian glands - It is tender to touch and may feel boggy if pus has formed, or firm if a chalazion is developing [pus] - Externally it looks like a pustule with slight redness of the lid margin, sometimes with pus discharging [pus · pustules · redness] - Internal ones give wider lid tenderness and redness; everting the lid reveals a small pustule on the conjunctival side [pustules · redness] - There may be mild redness of the bulbar conjunctiva; the sclera stays clear unless infection has spread [redness] - Blocked gland openings or crusting along the lid margin are common where there is blepharitis [crusting] - Vision is normal unless the lid droops mechanically or the swelling blocks the line of sight - A mildly enlarged node in front of the ear can occur with secondary infection, but is rare - Pain and tenderness are the giveaway; a chalazion is painless and chronic, and the sudden onset separates a stye from blepharitis and benign lid lumps TESTS (9) - The diagnosis rests on history and examination - Telling a stye from a chalazion needs only history and examination, with no test adding anything - Swab for Gram stain and culture only if the infection looks atypical or fails to respond, with fungal culture in immunocompromised patients - Harmless bacteria colonise the area, so cultures of the discharge generally do not predict who gets better - Check blood glucose or HbA1c when styes keep coming back or are severe, to catch undiagnosed diabetes - A lipid profile is worth doing in repeated styes or chalazia, since dyslipidaemia feeds meibomian gland dysfunction - Ultrasound biomicroscopy helps with a deep or unusual lid lesion when cancer or an abscess is a concern - CT or MRI is for suspected preseptal or orbital cellulitis, and contrast CT is what separates the two - A lesion that persists or looks unusual and does not clear with standard care needs a biopsy for sebaceous gland carcinoma IF NOT THIS - what else fits (9) - Chalazion: a chronic, painless, firm lump from a blocked meibomian gland, without acute inflammation, often after a stye has settled - Preseptal cellulitis: the whole lid is swollen, red and tender with no discrete lump, no fluctuant pus, and sometimes a low fever - Red flag, orbital cellulitis: the eye protrudes, eye movements are limited and vision changes, usually with high fever and malaise - Sebaceous gland carcinoma: a lump that keeps returning and resists treatment, with lid margin change such as lost eyelashes - Blepharitis: diffuse redness and scaling along both lid margins, with irritation and crusting rather than an acute painful lump - Dermoid cyst: a firm, well-defined, painless and uninflamed lump, usually along the orbital rim - Dacryocystitis: swelling, redness and tenderness at the inner corner over the tear sac, with watering or pus - Herpes simplex gives blisters on the lid; zoster ophthalmicus gives a blistering rash along the trigeminal nerve with crusting and pain - Molluscum contagiosum: dome-shaped pearly papules with a dimple in the centre, painless and not inflamed Source StatPearls "Hordeolum (Stye)" - disease-level clinical article Status traced to the source above 1. FUSIDIC ACID [2nd line] Adult Instil 1 drop of 1% eye drops twice daily x 7 days Peds Ophthalmic infections/conjunctivitis: Children ≥2 years and Adolescents: Refer to adult dosing. Neonates: Not indicated for use in neonatal conjunctivitis. Source Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) Why Topical antibiotic with targeted activity against Staphylococcus aureus, the usual pathogen in hordeola, offered as a second option that is particularly convenient for recurrent styes needing sustained anti-staphylococcal cover. Caution Fusidic acid has targeted anti-staphylococcal activity for recurrent hordeola. Sustained-release formulation requires only twice daily dosing. Clean eyelid margins daily with diluted baby shampoo or lid wipes for underlying blepharitis. Egypt FUTHALM 1% EYE SUSP. DROP 5 ML SIGMA TEC 14.40 EGP OPTIFUCIN 1% VISCOUS EYE DROPS 5 GM AMMAN PHARMACEUTICAL CO - JORDAN > A... 27.00 EGP EFUCISAN 1% VISCOUS EYE DROPS 5 GM ORCHIDIA PHARMACEUTICAL INDUSTRIES 28.00 EGP OJOBLICK 1% VISCOUS EYE DROPS 5 GM EIPICO 28.00 EGP FUSAMIC 1% VISCOUS EYE DROPS 5 GM CHEMIPHARM 36.00 EGP FUCITHALMIC 1% VISCOUS EYE DROPS 5 GM AMIDPHARM > CHEMIPHARM 37.00 EGP OFUSIDIC VISCOUS EYE DROPS 5 ML ORCHIDIA PHAR... 28.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)