A 28-year-old woman presents with a painful, tender swelling on the upper eyelid margin that has been present for 3 days. On examination, there is localized erythema and edema at the lid margin with a small pustule pointing outward. She denies any vision changes or systemic symptoms. What is the most likely diagnosis?

Explanation

## Clinical Diagnosis: External Hordeolum **Key Point:** An external hordeolum (external stye) is an acute suppurative inflammation of the glands of Zeis or Moll at the eyelid margin, presenting with localized pustule pointing outward. ### Distinguishing Features | Feature | External Hordeolum | Internal Hordeolum | Chalazion | |---------|-------------------|-------------------|----------| | **Location** | Eyelid margin (anterior) | Eyelid margin (posterior/conjunctival) | Lid margin or away from margin | | **Onset** | Acute (2–5 days) | Acute (2–5 days) | Chronic (weeks to months) | | **Pointing** | Points outward (skin surface) | Points inward (conjunctiva) | No pointing; painless | | **Pain** | Severe, localized | Moderate to severe | Minimal to none | | **Pustule/Discharge** | Visible pustule on skin | Visible on conjunctiva | Lipid-filled nodule | | **Gland Involved** | Glands of Zeis/Moll (sebaceous) | Meibomian glands | Meibomian glands (lipogranuloma) | **Clinical Pearl:** The key distinguishing feature in this case is the **pustule pointing outward** at the lid margin with acute onset and severe pain — pathognomonic for external hordeolum. **High-Yield:** External hordeolum is caused by *Staphylococcus aureus* infection of the anterior eyelid glands; it is self-limited and typically resolves with warm compresses and topical antibiotics within 1–2 weeks. ### Management - Warm compresses (4–6 times daily, 10–15 minutes) - Topical antibiotics (chloramphenicol or gentamicin eye drops) - Oral antibiotics if systemic signs present - Spontaneous drainage or incision and drainage if needed - Avoid squeezing or manipulation **Mnemonic:** **EXTERNAL = Points outward** — External hordeolum points out through the skin; internal hordeolum points inward through the conjunctiva.