This guideline last updated 09/05/2022 10:12:20

Differential diagnosis

• Preseptal cellulitis
• Haematoma of eyelid
• Acute dacryocystitis
• Chalazion (blockage of Meibomian gland with cyst formation)
• Sebaceous cell carcinoma

Possible management by Optometrist

Treatment

• In the case of external hordeola, it may help to remove the lash associated with the infected follicle
• Consider course of antibiotic drops or ointment (e.g. Chloramphenicol) in the presence of copious muco-purulent discharge suggestive of associated bacterial conjunctivitis
  • Ask if allergic to Chloramphenicol
    • If not, supply Chloramphenicol 1% eye ointment 3 times daily for a week
    • If allergic to Chloramphenicol, or pregnant, supply Fucidic acid 1% liquid gel twice a day for a week
  • PoM In severe cases, e.g. with associated pre-septal cellulitis, consider management with systemic antibiotics (possible co-management with GP)
    • POM Co-amoxiclav 500/125 mg every 8 hours for 7 days then review
  • • If allergic to penicillin, then POM Erythromycin 500 mg 4 times a day for 5–7 days then review

Advice

• Most resolve/discharge spontaneously
• Traditional remedies such as hot spoon bathing and/or warm compresses may relieve symptoms
• Advise patient to return/seek further help if symptoms persist

Management Category

• Normally no referral
• Rarely, refer for incision in cases that do not discharge (commoner with internal hordeolum)

Possible management by Ophthalmologist

• Incision