The lowly chalazion.

Chalazia are localized cysts of chronic lipogranulomatous inflammation arising from the obstruction of sebaceous glands of the eyelid tarsal plate, including the Meibomian gland (deep chalazion) or Zeis gland (superficial chalazion). This disease entity is differentiated from the hordeolum (stye), an acute purulent localized swelling of the eyelid often associated with an eyelash follicle, Zeis gland, or Moll gland obstruction and infection. Ambiguously, the chalazion, hordeolum, and blepharitis are commonly categorized and described on a continuum in the literature. While it is one of the most common eyelid disorders across all age demographics, the chalazion remains largely understudied and pathophysiological, epidemiological, and therapeutic findings exist fragmented in the literature. We discuss current understandings of the chalazion and provide current best practice guidelines supported by clinical anecdotal evidence.

[Effect of bloodletting at tip of ear with different amounts on pain in patients with early-stage stye: a randomized controlled trial].

OBJECTIVE: To compare the curative effect between bloodletting at tip of ear with different amounts combined with western medication and western medication alone for early-stage stye. METHODS: A total of 108 patients with early-stage stye were randomly divided into a 50 µL group (36 cases, 4 cases dropped off), a 100 µL group (36 cases, 2 cases dropped off) and a western medication group (36 cases, 5 cases dropped off). The patients in the western medication group were treated with levofloxacin eye drops and levofloxacin hydrochloride eye gel. Based on the treatment of the western medication group, the patients in the 50 µL group were treated with 50 µL bloodletting (about 3 drops) at tip of ear while the patients in the 100 µL group were treated with 100 µL bloodletting (about 6 drops) at tip of ear; the bloodletting was given once a day for 3 days. After treatment, the changes of visual analogue scale (VAS) and clinical effect were observed, and the patients were followed up by telephone on the 8th day. RESULTS: After treatment, the VAS score in each group was reduced (P<0.01), and the score in the 50 µL group and 100 µL group was lower than that in the western medication group (P<0.05, P<0.01), and the score in the 100 µL group was lower than that in the 50 µL group (P<0.05). After treatment, the cured rate was 76.5% (26/34) in the 100 µL group, 71.9% (23/32) in the 50 µL group and 51.6% (16/31) in the western medication group, and there were no significant differences among three groups (P>0.05). One week after the onset of the disease, all the patients in the 50 µL group and 100 µL group were cured, and one patient in the western medication group was not cured, and treated with routine surgery. CONCLUSION: Based on the conventional western medication treatment, bloodletting at tip of ear can significantly reduce the pain of stye, and the effect of 100 µL bleeding is better than 50 µL.

Bloodletting at EX-HN6 as an adjunctive therapy to eye drops for stye: A meta-analysis.

BACKGROUND: This study evaluated the effectiveness and safety of bloodletting (BL) at ear-apex (EX-HN6) as an adjunctive therapy to eye drops for stye. METHODS: This study systematically searched electronic databases from inception to March 1, 2020 in PUBMED, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Full-text Database, and WanFang Database. All potential randomized controlled trials (RCTs) investigating the effectiveness and safety of BL at EX-HN6 as an adjunctive therapy to eye drops for stye were included in this study. Study quality of all included studies was assessed by Cochrane Risk of Bias Assessment Tool. RevMan 5.3 software was used for statistical analysis and meta-analysis performance. RESULTS: A total of 11 RCTs, involving 1718 subjects, were included in this study. Results showed that BL at EX-HN6 as an adjunctive therapy to eye drops was superior to the eye drops alone in enhancing total effectiveness rate (risk ratio [RR] 1.21, 95% confidence intervals [CIs] [1.11, 1.32], I = 79%), and total cure rate (RR 1.28, 95% CIs [1.14, 1.43], I = 69%). After removing two studies, results of subgroup analysis still showed significant improvements in total effectiveness rate (RR 1.13, 95% CIs [1.08, 1.18], I = 0%), and total cure rate (RR 1.16, 95% CIs [1.08, 1.24], I = 0%). No data of adverse reactions was reported in primary trials, thus, this study did not analyze adverse reactions of BL at EX-HN6 as an adjunctive therapy to eye drops for stye. CONCLUSION: BL at EX-HN6 as an adjunctive therapy to eye drops may benefit stye. However, high-quality RCTs addressing on this issue is still needed to warrant the findings of this study.

Common inflammatory and infectious conditions of the eyelid.

Patients with infection or inflammation of the eyelid will often first present to their primary care physicians with symptoms such as redness, swelling, tearing, itchiness, or a foreign body sensation. There are a variety of conditions that affect the eyelid which can cause such symptoms, and the exam and history can help a provider differentiate some of the more common conditions. This article will provide a comprehensive review of the background, diagnosis and management of dry eye disease, chalazion, hordeolum (stye), and preseptal cellulitis.

Acupuncture for acute hordeolum.

BACKGROUND: Hordeolum is an acute, purulent inflammation of the eyelid margin usually caused by obstructed orifices of the sebaceous glands of the eyelid. The condition, which affects sebaceous glands internally or externally, is common. When the meibomian gland in the tarsal plate is affected, internal hordeolum occurs, while when the glands of Zeis or Moll associated with eyelash follicles are affected, external hordeolum, or stye occurs. The onset of hordeolum is usually self limited, and may resolve in about a week with spontaneous drainage of the abscess. When the condition is severe, it can spread to adjacent glands and tissues. Recurrences are very common. As long as an internal hordeolum remains unresolved, it can develop into a chalazion or generalized eyelid cellulitis. Acupuncture is a traditional Chinese medical therapy aimed to treat disease by using fine needles to stimulate specific points on the body. However, it is unclear if acupuncture is an effective and safe treatment for acute hordeolum. OBJECTIVES: The objective of this review was to investigate the effectiveness and safety of acupuncture to treat acute hordeolum compared with no treatment, sham acupuncture, or other active treatment. We also compared the effectiveness and safety of acupuncture plus another treatment with that treatment alone. SEARCH METHODS: We searched CENTRAL, Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, Embase, PubMed, Latin American and Caribbean Health Sciences Literature Database (LILACS), three major Chinese databases, as well as clinical trial registers all through 7 June 2016. We reviewed the reference lists from potentially eligible studies to identify additional randomised clinical trials (RCTs). SELECTION CRITERIA: We included RCTs of people diagnosed with acute internal or external hordeola. We included RCTs comparing acupuncture with sham acupuncture or no treatment, other active treatments, or comparing acupuncture plus another treatment versus another treatment alone. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures used by Cochrane. MAIN RESULTS: We included 6 RCTs with a total of 531 participants from China. The mean age of the participants ranged from 18 to 28 years. Four RCTs included participants diagnosed with initial acute hordeolum with a duration of less than seven days; one RCT included participants diagnosed with initial acute hordeolum without specifying the duration; and one RCT included participants with recurrent acute hordeolum with a mean duration of 24 days. About 55% (291/531) of participants were women. Three RCTs included participants with either external or internal hordeolum; one RCT included participants with only external hordeolum; and two RCTs did not specify the type of hordeolum. Follow-up was no more than seven days after treatment in all included RCTs; no data were available for long-term outcomes. Overall, the certainty of the evidence for all outcomes was low to very low, and we judged all RCTs to be at high or unclear risk of bias.Three RCTs compared acupuncture with conventional treatments. We did not pool the data from these RCTs because the conventional treatments were not similar among trials. Two trials showed that resolution of acute hordeolum was more likely in the acupuncture group when compared with topical antibiotics (1 RCT; 32 participants; risk ratio (RR) 3.60; 95% confidence interval (CI) 1.34 to 9.70; low-certainty of evidence) or oral antibiotics plus warm compresses (1 RCT; 120 participants; RR 1.45; 95% CI 1.18 to 1.78; low-certainty of evidence). In the third trial, little or no difference in resolution of hordeolum was observed when acupuncture was compared with topical antibiotics plus warm compresses (1 RCT; 109 participants; RR 1.00; 95% CI 0.96 to 1.04; low-certainty of evidence). One RCT mentioned adverse outcomes, stating that there was no adverse event associated with acupuncture.Three RCTs compared acupuncture plus conventional treatments (two RCTs used topical antibiotics and warm compresses, one RCT used topical antibiotics only) versus the conventional treatments alone. One of the three RCTs, with very low-certainty evidence, did not report the resolution of acute hordeolum; however, it reported that acute hordeolum relief might be higher when acupuncture was combined with conventional treatments than with conventional treatments alone group (60 participants; RR 1.80; 95% CI 1.00 to 3.23). Pooled analysis of the remaining two RCTs, with low-certainty evidence, estimated resolution of acute hordeolum was slightly higher in the combined treatment group compared with the conventional treatment alone group at 7-day follow-up (210 participants; RR 1.12; 95% CI 1.03 to 1.23; I2 = 0%). None of the three RCTs reported adverse outcomes. Among the included RCTs, four participants, two from the acupuncture plus conventional treatments group and two from the conventional treatments alone group, withdrew due to exacerbation of symptoms. AUTHORS' CONCLUSIONS: Low-certainty evidence suggests that acupuncture with or without conventional treatments may provide short-term benefits for treating acute hordeolum when compared with conventional treatments alone. The certainty of the evidence was low to very low mainly due to small sample sizes, inadequate allocation concealment, lack of masking of the outcome assessors, inadequate or unclear randomization method, and a high or unreported number of dropouts. All RCTs were conducted in China, which may limit their generalizability to non-Chinese populations.Because no RCTs included a valid sham acupuncture control, we cannot rule out a potential expectation/placebo effect associated with acupuncture. As resolution is based on clinical observation, the outcome could be influenced by the observer's knowledge of the assigned treatment. Adverse effects of acupuncture were reported sparsely in the included RCTs, and, when reported, were rare. RCTs with better methodology, longer follow-up, and which are conducted among other populations are warranted to provide more general evidence regarding the benefit of acupuncture to treat acute hordeolum.

Non-surgical interventions for acute internal hordeolum.

BACKGROUND: A hordeolum is a common, painful inflammation of the eyelid margin that is usually caused by a bacterial infection. The infection affects oil glands of the eyelid and can be either internal or external. In many cases, the lesion drains spontaneously and resolves without treatment; however, the inflammation can spread to other ocular glands or tissues, and recurrences are common. If unresolved, an acute internal hordeolum can become chronic, or can develop into a chalazion. External hordeola, also known as styes, were not included in the scope of this review. OBJECTIVES: The objective of this review was to investigate the effectiveness, and when possible, the safety, of non-surgical treatments for acute internal hordeola compared with observation or placebo. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register (2016; Issue 12)), MEDLINE Ovid, MEDLINE Ovid Epub Ahead of Print, MEDLINE Ovid In-Process & Other Non-Indexed Citations, MEDLINE(R) Ovid Daily (January 1946 to December 2016), Embase (January 1947 to December 2016), PubMed (1948 to December 2016), Latin American and Caribbean Literature on Health Sciences (LILACS (January 1982 to December 2016)), the metaRegister of Controlled Trials (mRCT; www.controlled-trials.com (last searched 26 July 2012)), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We used no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 December 2016. SELECTION CRITERIA: The selection criteria for this review included randomized or quasi-randomized clinical trials of participants diagnosed with an acute internal hordeolum. Studies of participants with external hordeola (styes), chronic hordeola, or chalazia were excluded. Non-surgical interventions of interest included the use of hot or warm compresses, lid scrubs, antibiotics, or steroids compared with observation, placebo, or other active interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the references identified by electronic searches for inclusion in this review. No relevant studies were found. The reasons for exclusion were documented. MAIN RESULTS: No trials were identified for this review. Most of the references identified through our search reported on external hordeola or chronic internal hordeola. The few references specific to acute internal hordeola reported recommendations for treatment, were reports of interventional case series, case studies, or other types of observational study designs, and were published more than 20 years ago. AUTHORS' CONCLUSIONS: We did not find any evidence for or against the effectiveness of non-surgical interventions for the treatment of an internal hordeolum. Controlled clinical trials would be useful to determine which interventions are effective for the treatment of acute internal hordeola.

[Randomized controlled clinical trials for treatment of external sty with ear-apex blood-letting].

OBJECTIVE: To observe the clinical therapeutic effect of ear-apex blood-letting for external sty. METHODS: A total 102 sty patients were randomized into ear-apex blood-letting group (n = 51) and routine treatment (medication) group (n = 51) according to computer-aided randomization procedure. Ear-apex-bloodletting (5-6 blood drops/time) was performed once daily for 3 times for the patients of blood-letting group. Patients of the medication group were treated by local application of hydrochloric levofloxacin and erycin ointment to the affected eyelid lining. Additionally, local warm compress of the affected eyelid was given to patients of both groups. The therapeutic effect was assessed by measuring the size of the sty swell and visual analogue scale (VAS) was determined for evaluating pain severity changes. The outcomes were analyzed by researchers who did not know the grouping. RESULTS: Comparison between patients of the two groups showed that the difference vahees of the styrize and VAS score between pre- and post-treatment in the ear-apex bloodletting group were significantly bigger than those of the medication group on day 3, 5 and 7 after treatment (P<0.05). The cure rates of the blood-letting group and medication group were 64.7% and 41.2%, 90.2% and 62.7%, 94. 1% and 80.4%, respectively on day 3, 5 and 7 after the treatment. The therapeutic effects of blood-letting were significantly superior to those of the medication group in relieving external sty (P<0.05). CONCLUSION: Ear-apex blood-letting therapy for external sty is effective in relieving pain, reducing the size and shortening the duration of disease.

Interventions for acute internal hordeolum.

BACKGROUND: Hordeolum is a common, painful inflammation of the eyelid margin that is usually caused by bacterial infection. The infection affects oil glands of the eyelid and can be internal or external. In many cases, the lesion drains spontaneously and resolves untreated; however, the inflammation can spread to other ocular glands or tissues, and recurrences are common. If unresolved, acute internal hordeolum can become chronic or can develop into a chalazion. External hordeola, also known as styes, were not included in the scope of this review. OBJECTIVES: The objective of this review was to investigate the effectiveness and safety of nonsurgical treatments for acute internal hordeolum compared with observation or placebo. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to July 2012), EMBASE (January 1980 to July 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to July 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 July 2012. SELECTION CRITERIA: The selection criteria for this review included randomized or quasi-randomized clinical trials of participants diagnosed with acute internal hordeolum. Studies of participants with external hordeolum (stye), chronic hordeolum, or chalazion were excluded. Nonsurgical interventions of interest included the use of hot or warm compresses, lid scrubs, antibiotics, or steroids compared with observation, placebo, or other active interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the references identified by electronic searches for inclusion in this review. No relevant studies were found. The reasons for exclusion were documented. MAIN RESULTS: No trials were identified for inclusion in this review. Most of the references identified from our search reported on external hordeola or chronic internal hordeola. The few references specific to acute internal hordeolum reported mostly recommendations for treatment or were reports of interventional case series, case studies, or other types of observational study designs and were published more than 20 years ago. AUTHORS' CONCLUSIONS: We did not find any evidence for or against the effectiveness of nonsurgical interventions for the treatment of hordeolum. Controlled clinical trials would be useful in determining which interventions are effective for the treatment of acute internal hordeolum.

Ocular inflammation and infection.

Ocular inflammation and infection may involve any part of the eye and surrounding tissue. A complete examination, including visual acuity, extraocular movements, pupillary response, slit lamp examination, and fluorescein staining, is often required to establish the diagnosis. Pain relief may be achieved with oral analgesics and cycloplegics. In most cases, prompt follow-up is required.