How are hordeolum (stye) drained?

Updated: Oct 08, 2019
  • Author: Michael J Bessette, MD, FACEP; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Answer

Drainage of a hordeolum is performed as follows:

  • Perform drainage with stab incisions at the site of pointing using an 18-gauge needle or a #11 blade. External incisions lead to scarring, so making external eyelid incisions or punctures is inadvisable, unless the hordeolum already is pointing externally.

  • A large abscess may have multiple pockets and require multiple stabs.

  • Internal incisions should be made vertically to minimize the area of cornea swept by a scar during blinking; external incisions should be made horizontally for optimal cosmesis.

  • Hold the lesion with a chalazion clamp.

  • To avoid disrupting normal growth of lashes, do not make incisions along eyelash margins.

  • Leave the incision open with a clean margin.

  • When draining a lesion that points both externally and internally, make the incision internally and as far as possible from the site of external pointing. Combined overlying internal and external drainage increases the risk of later fistulae through the lid.

  • Do not inject local anesthesia directly into the hordeolum; inject along the lid margins in a line above the upper tarsus or below the lower tarsus.

  • Do not attempt to remove all seemingly purulent material if acute inflammation is present; excessive loss of tarsal tissue and lid deformity may result.

Hordeola usually are self-limited even without drainage. Most hordeola eventually point and drain by themselves.


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