Hordeolum: symptoms, treatment, causes

Hordeolum: Short overview

  • Definition: Acute purulent inflammation of the eyelid
  • Cause: bacteria that infect certain glands in the eyelids
  • Typical symptoms: reddened, painful and pressure-sensitive lump inside or outside the eyelid
  • Investigations: Gaze diagnosis, slit lamp examination
  • Treatment options: dry heat (red light lamp), possibly antibiotic ointments and drops, antiseptic ointment
  • Complications: Inflammation of the eye socket and/or conjunctiva, eyelid abscess
  • Prevention: ensure adequate hand and eye hygiene

Barleycorn: causes

In most cases, a bacterial infection causes a barleycorn to develop. The exact cause is often staphylococci, more precisely Staphylococcus aureus, a bacterium that settles on the skin and mucous membranes. Less frequently, streptococcus infections cause a barleycorn. These bacterial strains are mainly found in the mouth and throat area.

If these bacteria enter the eye, they can infect certain glands on the eyelids. Thus a grain of barley is formed. Depending on which glands are affected, a distinction is made:

  • inner barley grain (Hordeolum internum): Here so-called Meibom glands are inflamed. These are sebaceous glands on the inner edge of the eyelid. They release a special liquid that mixes with the tear fluid and prevents it from evaporating prematurely.
  • external barleycorn (Hordeolum externum): It is formed due to inflammation of the minor or Zeis glands. These are sweat and sebaceous glands on the eyelid. Outer barley grains are rarer than inner ones.

If a barleycorn occurs more frequently, or even several barleycorns are formed at the same time, physicians speak of hordeolosis. She should always be checked by a doctor. This is often due to a weakened immune system, for example as a result of a previously unrecognized diabetes (diabetes mellitus).

Barleycorn: Risk factors

A weakened immune system favours the development of a barley grain. The weakness of the immune system may be due to stress or another illness. The barleycorn, for example, is a common side effect of diabetes mellitus.

A barleycorn also often occurs in connection with acne.

Since the triggering pathogens in the barley grain are contagious and occur on the skin, a hordeolum can also have its origin in poor hygiene or incorrect care of the eyes. Due to unwashed hands, the pathogens easily get into your eyes when you rub your eyes. Thorough hand washing is therefore an important measure to prevent a grain of barley.

Children are more susceptible to a grain of barley than adults because their immune system is not yet fully developed. The fact that they often play “in the dirt” and then touch each other’s faces may also be a reason for this.

Symptoms: You can recognize a stye by this

A barleycorn causes the sebaceous and sweat glands of the eyelid to become inflamed. This can be seen in a reddened knot at the upper or lower lid edge. Typical barleycorn symptoms are also

  • Feeling of tension
  • intense pain
  • red eyelid
  • swollen eyelid
  • Pressure Sensitivity
  • Suppuration

Depending on which glands are affected by the inflammation, the symptoms appear in different places on the eye.

An inner barleycorn (Hordeolum internum) occurs on the inside of the eyelid and is often not visible from the outside. Only when the eyelid is turned outwards does it become visible.

The affected eyelid is initially swollen and reddened and then thickens. In rare cases, an inner barleycorn also affects the conjunctiva of the eye and can cause conjunctivitis and chemosis.

Inner barleycorn: In the inner barleycorn, the Meibom gland in the eyelid is inflamed. But the other glands can also be affected.

The outer barleycorn (Hordeolum externum) affects the minor or silica glands, which are located at the edge of the eyelid. The typical barleycorn symptoms (swelling and reddening of the eyelid) occur in the lash area in this form. In the beginning, a reddish, painful and pus-filled lump develops, which is easily recognizable externally.

Rarely do barley grains show symptoms such as fever or swollen lymph nodes in front of the ears. If the disease is severe, the inflammation can spread to the orbit (orbital phlegmon) or cause eyelid abscesses.

Even if a barleycorn is quite easy to identify because of its symptoms, you should still see an eye doctor to rule out other eye diseases.

Barleycorn: examinations and diagnosis

Usually a barleycorn on the eyelid heals on its own after a few days. Nevertheless, an examination by a doctor is advisable. In this way, possible complications can often be avoided and other causes of inflammation can be ruled out. Especially if conjunctivitis occurs as a result of a barley grain, further investigations are necessary.

Gaze diagnosis

An external barleycorn on the eye can already be recognized by the doctor by means of a gaze diagnosis: It is indicated by a clearly visible swelling and a reddish, pus-filled knot, similar to a pimple, in the area of the eyelashes.

An inner barleycorn is often not visible at first sight because the glands on the inner edge of the eye are inflamed. In this case, the doctor will carefully fold the eyelid down to examine the inside of the eyelid and, if necessary, identify the site of inflammation.

Slit lamp inspection

In the case of a barleycorn in the eye, the doctor carries out a so-called slit-lamp examination: With the aid of a microscope and a special lamp (slit lamp), the physician can look at the eye in a magnified view. He particularly examines the following structures in the eye:

  • eyelids
  • the edges of the eyelids
  • conjunctiva
  • the tear film
  • the meniscus of tears

Exclusion of other diseases

During his examinations, the doctor must exclude other causes that could be the cause of inflammation of the eye. For example, a grain of barley is very similar and easily confused with a hailstone (chalazion). It is a chronic inflammation of the Meibom gland, which is not purulent and does not hurt. The reason for this is usually a blocked glandular duct.

Barleycorn: treatment

A grain of barley is an annoying and painful thing. The latter in particular can be worrying for those affected and they are unsure what they can do about a grain of barley.

Under no circumstances should you press one of these grains! It can easily happen that the contagious pathogens are carried into the healthy eye, for example, and the inflammation spreads further.

As unpleasant as the barleycorn may be, in most cases it heals by itself. After a few days it opens, the pus flows off and the inflammation subsides. As a rule, no special barleycorn treatment by a doctor is necessary.

However, there are several ways to support and accelerate the healing process of a barleycorn:

Barley grain treatment with dry heat

One way to treat a barleycorn is to apply dry heat locally in the form of red light. You can also do this barleycorn therapy at home.

The barleycorn – more precisely, the closed eye – is irradiated three times a day for ten minutes each time with a red light lamp. The heat from the red light lamp promotes blood circulation to the eye. The barleycorn opens more quickly, so that the pus drains away.

Discuss a red light application with your doctor. He can explain the exact procedure to you. He will also explain to you what you need to know about the use of red light, especially if you are taking medication, or about eye care.

Damp heat is not advisable!

Often the application of moist heat is recommended as barley grain therapy, for example in the form of moist warm compresses or compresses. However, most doctors advise against this. Damp heat favours the further spread of pathogens: The moisture softens the skin and the bacteria can spread more easily.

Barleycorn: treatment with eye ointment and drops

To support barleycorn therapy, your doctor may also prescribe eye ointments or eye drops containing an antibiotic agent. The antibiotics work against the bacteria that cause the barley grain. Often the eye drops are used during the day and the ointment at night. They prevent the inflammation from spreading further.

Such antibiotics in ointment or drop form are very often used for an inner barley grain: here the danger is particularly high that the inflammation spreads to the conjunctiva and the eye socket. This can lead to conjunctivitis (inflammation of the conjunctiva) or inflammation of the eye socket (orbital phlegmon).

A barleycorn treatment with antibiotic-containing tablets is only necessary if the inflammation has already spread.

Sometimes a disinfectant (antiseptic) eye ointment is also applied to a barleycorn, for example with the active ingredient Bibrocathol.

Barleycorn: Operative opening by the doctor

In rare cases, a barleycorn does not open by itself and the inflammation lasts longer. Then a small operation by a doctor (usually an ophthalmologist) is necessary. This opens the barleycorn carefully under local anaesthetic with a small incision so that the pus can drain away.

Barleycorn: Home remedy

Many people use home remedies for a grain of barley. These include warm, moist compresses (with camomile tea, for example) as well as warm compresses and paps. However, doctors often advise caution here. Such household remedies can sometimes do more harm than good. Moist compresses, for example, can soften the skin around the eye and promote the spread of bacteria.

The best “home remedy” for barley grain (and other diseases) is a strong immune system. Because then the pathogens that cause the eye infection have a harder time to multiply. With a healthy, vitamin-rich diet and sufficient exercise you can effectively support your immune system.

Which household remedies against a barleycorn circulate in detail and what you should know about it, you will learn in the article Barleycorn – household remedies

Barleycorn: course of disease and prognosis

The prognosis for a barleycorn on the eye is usually good, the course is unproblematic. In most cases the barleycorn heals by itself: after a few days it opens up and the pus flows off.

Only in rare cases do complications occur with a barleycorn in the eye. The most common ones are:

  • Inflammation of the conjunctiva: A barleycorn can cause conjunctivitis (inflammation of the conjunctiva). Swelling of the conjunctiva (chemosis) is also possible.
  • Inflammation of the orbit: In the case of a severe course of disease, the inflammation can spread to the orbit (orbital phlegmon). But that happens very rarely.
  • Eyelid abscess: In exceptional cases, a barleycorn can also cause eyelid abscesses in severe cases of disease. An abscess is also called a boil or boil.

How to prevent a grain of barley

As a barleycorn is contagious, you should ensure adequate hand and eye hygiene. The pathogens live on skin and mucous membranes and easily enter the eye via the hands. Therefore, wash your hands regularly and do not get dirty hands in your eyes.

Contact lens wearers need to wash their hands particularly thoroughly, as they have to keep their eyes open when inserting and removing the visual aid. Make sure that you always store your contact lenses properly and clean them thoroughly. This prevents infections of the eye like a barleycorn.

If an infection already exists, you should not touch the barleycorn. If you then unconsciously touch your healthy eye with the hand in question, it can also become infected.

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Hello I am Sandra Eades, physician, researcher and author from Australia. I am working currently as researcher for a private institution. I have studied in Britain and Australia, where I currently reside. I write about research topics in the organization of the public health government agencies. For the iMS I write about general medical conditions. I also research scholar sources to provide information to writers of other articles. I also check the citations of scholar papers. Finally, I read other articles before they are published. I am also a mother of three children!