Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Hordeolum
HORDEOLUM
A hordeolum, or “sty,” is a localized infection of a sebaceous gland of the eyelash follicle.
I. Etiology: Causative organism is usually S. aureus.
II. Incidence: Occurs frequently in children.
III. Subjective data
A. Localized swelling, tenderness, and inflammation of margin of eyelid
B. May complain of a bump or pimple on eyelid
C. Generally unilateral
D. Visual acuity not affected
IV. Objective data
A. Localized erythema, edema, and pain near the lid edge
B. Abscess may point at lid margin.
C. May have purulent drainage along lid margin
D. Recurrent lesions may be associated with blepharitis or seborrheic dermatitis.
V. Assessment
A. Diagnosis is made by clinical picture of erythema, pain, and swelling.
B. Differential diagnosis
1. Chalazion: A chronic granulomatous infection of the meibomian gland that is relatively painless and may resolve with treatment for Hordeolum.
2. Conjunctivitis: Conjunctival erythema; mucopurulent discharge; foreign body sensation; no localized swelling
3. Blepharitis: Chronic scaling and discharge with matting of the eyelashes; not localized
VI. Plan
A. Hot, moist compresses for 15 to 20 minutes every 2 to 3 hours
B. Thoroughly cleanse eyelashes with Johnson’s Baby Shampoo or CIBA Eye Scrub.
C. Topical antibiotic ointment
1. Ciloxin 1% ophthalmic ointment: For children over 2 years of age,
1⁄2 inch into conjunctival sac tid for 2 days, then bid for 5 days or
2. 10% Sodium Sulamyd Ophthalmic ointment (sodium sulfacetamide) 4 to 5 times daily during acute stage
D. Assess visual acuity. Children with a refraction error may rub eyes repeatedly, causing irritation and resulting in secondary infection.
VII. Education
A. For moist compresses, use a soft cloth and water as warm as child can tolerate.
B. Medication
1. To instill ophthalmic ointment, gently pull down lower lid, and apply a thin ribbon of ointment.
2. Side effects to ointment are rare, but call back immediately if child complains of burning or stinging.
3. Vision may be blurred temporarily following administration of ointment.
4. Ointments are preferable to drops because they cling to the eye for about 3 hours, as opposed to drops, which are washed away after a few minutes.
5. If a parent is unable to apply the ointment in the cul-de-sac, instruct them to apply a strip to the lower lid. The petrolatum base will melt, and medication will get into the eye. Also, once the ointment is applied, the child will rub the eyes and distribute it in the eye.
C. Use thorough handwashing technique after soaks and instillation of medication to prevent spread.
D. Keep fingers away from eyes.
E. Never squeeze a sty.
F. Inflammation generally subsides after 5 to 6 days.
G. Continue treatment for several days following resolution of lesions.
VIII. Follow-up
A. Return immediately if symptoms worsen.
B. Return in 48 hours if no response to treatment.
C. Return if lesion becomes larger and points.
D. Return in 6 days if lesion is not resolved.
E. Return for evaluation if problem is recurrent.
IX. Complications
A. Conjunctivitis
B. Cellulitis
X. Consultation/referral
A. If lesion is well-localized to assess need for incision and drainage
B. No response to treatment after 48 hours
C. Lesion not resolved after 6 days
D. Recurrent styes: May indicate immunologic deficit or systemic disease (e.g., diabetes)
E. Cellulitis: May require systemic antibiotics