A 33-year-old man comes to the office due to painful swelling of the right lower eyelid for the past 2 days. He has had no trauma or history of similar symptoms in the past. The patient says he recently visited his niece who was having an upper respiratory tract infection. He has no significant prior medical problems other than occasional episodes of herpes labialis. He is sexually active with his girlfriend who takes oral contraceptives. Temperature is 36.8 C (98.2 F), blood pressure is 130/80 mm Hg, and pulse is 80/min. Examination of the right eye shows localized swelling along the margin of the lower eyelid with associated erythema and tenderness. There is no conjunctival injection or ocular discharge. Visual acuity is normal, and the left eye appears unremarkable. Which of the following is the most appropriate initial management of this patient's current condition?

Question

A 33-year-old man comes to the office due to painful swelling of the right lower eyelid for the past 2 days.  He has had no trauma or history of similar symptoms in the past.  The patient says he recently visited his niece who was having an upper respiratory tract infection.  He has no significant prior medical problems other than occasional episodes of herpes labialis.  He is sexually active with his girlfriend who takes oral contraceptives.  Temperature is 36.8 C (98.2 F), blood pressure is 130/80 mm Hg, and pulse is 80/min.  Examination of the right eye shows localized swelling along the margin of the lower eyelid with associated erythema and tenderness.  There is no conjunctival injection or ocular discharge.  Visual acuity is normal, and the left eye appears unremarkable.  Which of the following is the most appropriate initial management of this patient's current condition?

Quizplus · Accepted Answer

This patient has an external hordeolum (stye). A hordeolum is an acute inflammatory disorder of the eyelash follicle or tear gland and presents as an erythematous, tender nodule at the lid margin. It is often due to infection with Staphylococcus aureus but can be sterile in many cases. A similar process arising in the meibomian gland (internal hordeolum) presents as a tender nodule visible at the palpebral conjunctiva but is less common. hordeolum Within a few days, a minute pustule may appear at the lid margin (pointing), which will then rupture with discharge of pus and relief of pain. Warm compresses are advised to accelerate the process. Following resolution of infection, some patients have a residual granulomatous nodule (chalazion) that regresses slowly over several months. For patients with a persistent hordeolum (eg, >1-2 weeks) or a large chalazion, additional management options include incision and curettage (Choice B). (Choice A) Erythromycin ophthalmic ointment is used for treatment of bacterial conjunctivitis and in the prevention of ophthalmia neonatorum due to Neisseria gonorrhoeae. Topical antibiotics are often prescribed for hordeolum but are usually unnecessary. (Choice C) Preseptal cellulitis is an infection of the eyelid anterior to the orbital septum. It presents with fever and leukocytosis as well as erythema and edema of the eyelid and is treated with oral antibiotics (eg, doxycycline). Preseptal cellulitis (Choice D) Viral keratitis is infection of the cornea due to herpes simplex or varicella zoster virus. Patients have corneal vesicles, opacification, and/or dendritic ulcers. Treatment includes topical ganciclovir or trifluridine. dendritic ulcers Educational objective: An external hordeolum is an acute inflammatory disorder of the eyelash follicle or tear gland and presents as an erythematous, tender nodule at the lid margin. It is often due to infection with Staphylococcus aureus but can be sterile. Initial treatment includes warm compresses.

A 33-Year-Old Man Comes to the Office Due to Painful