infectious

Hordeolum (Stye) and Blepharitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

College of Optometrists Clinical Management Guidelines 2021 · Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) · Chloramphenicol 1.0% w/w Antibiotic Eye Ointment SmPC section 4.2 (eMC product 9770)

Verified against2 documents

Chloramphenicol 1.0% w/w Antibiotic Eye Ointment SmPC section 4.2 (eMC product 9770)
Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

A contained burning, tender swelling on one eyelid, upper or lower
It sometimes begins as general swelling and redness of the whole lid and only later becomes localised [redness]
Patients often say they have had similar lid lesions before
Pain is mild to moderate and stays over the lump; many also feel grittiness or irritation in that eye
Watering of the eye, light sensitivity, and blurring if the swelling gets in the line of sight [photophobia]
Symptoms come on acutely and run a few days to a week; repeated attacks suggest chronic blepharitis or meibomian gland dysfunction
Contributing factors: poor lid hygiene, rubbing the eyes, blepharitis or meibomian gland dysfunction, eye makeup and contact lenses
Rosacea and diabetes raise the risk, as does low immunity from stress or a recent illness such as a chest cold

Signs — what you find (10)

A red, tender, localised swelling at the lid margin
External type sits superficially near the lash line in the glands of Zeis or Moll; internal type sits deeper in the tarsal plate meibomian glands
It is tender to touch and may feel boggy if pus has formed, or firm if a chalazion is developing [pus]
Externally it looks like a pustule with slight redness of the lid margin, sometimes with pus discharging [pus · pustules · redness]
Internal ones give wider lid tenderness and redness; everting the lid reveals a small pustule on the conjunctival side [pustules · redness]
There may be mild redness of the bulbar conjunctiva; the sclera stays clear unless infection has spread [redness]
Blocked gland openings or crusting along the lid margin are common where there is blepharitis [crusting]
Vision is normal unless the lid droops mechanically or the swelling blocks the line of sight
A mildly enlarged node in front of the ear can occur with secondary infection, but is rare
Pain and tenderness are the giveaway; a chalazion is painless and chronic, and the sudden onset separates a stye from blepharitis and benign lid lumps

Tests (9)

The diagnosis rests on history and examination
Telling a stye from a chalazion needs only history and examination, with no test adding anything
Swab for Gram stain and culture only if the infection looks atypical or fails to respond, with fungal culture in immunocompromised patients
Harmless bacteria colonise the area, so cultures of the discharge generally do not predict who gets better
Check blood glucose or HbA1c when styes keep coming back or are severe, to catch undiagnosed diabetes
A lipid profile is worth doing in repeated styes or chalazia, since dyslipidaemia feeds meibomian gland dysfunction
Ultrasound biomicroscopy helps with a deep or unusual lid lesion when cancer or an abscess is a concern
CT or MRI is for suspected preseptal or orbital cellulitis, and contrast CT is what separates the two
A lesion that persists or looks unusual and does not clear with standard care needs a biopsy for sebaceous gland carcinoma

If not this — what else fits (9)

Chalazion: a chronic, painless, firm lump from a blocked meibomian gland, without acute inflammation, often after a stye has settled
Preseptal cellulitis: the whole lid is swollen, red and tender with no discrete lump, no fluctuant pus, and sometimes a low fever
Red flag, orbital cellulitis: the eye protrudes, eye movements are limited and vision changes, usually with high fever and malaise
Sebaceous gland carcinoma: a lump that keeps returning and resists treatment, with lid margin change such as lost eyelashes
Blepharitis: diffuse redness and scaling along both lid margins, with irritation and crusting rather than an acute painful lump
Dermoid cyst: a firm, well-defined, painless and uninflamed lump, usually along the orbital rim
Dacryocystitis: swelling, redness and tenderness at the inner corner over the tear sac, with watering or pus
Herpes simplex gives blisters on the lid; zoster ophthalmicus gives a blistering rash along the trigeminal nerve with crusting and pain
Molluscum contagiosum: dome-shaped pearly papules with a dimple in the centre, painless and not inflamed

SourceStatPearls "Hordeolum (Stye)" - disease-level clinical article

Presentation findings are traced to the source above.

FUSIDIC ACID

2nd line

Formeye

Adult dose and duration

Instil 1 drop of 1% eye drops twice daily x 7 days

Paediatric dose

Ophthalmic infections/conjunctivitis: Children ≥2 years and Adolescents: Refer to adult dosing. Neonates: Not indicated for use in neonatal conjunctivitis.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph)

Why

Topical antibiotic with targeted activity against Staphylococcus aureus, the usual pathogen in hordeola, offered as a second option that is particularly convenient for recurrent styes needing sustained anti-staphylococcal cover.

Cautions

Fusidic acid has targeted anti-staphylococcal activity for recurrent hordeola.
Sustained-release formulation requires only twice daily dosing.
Clean eyelid margins daily with diluted baby shampoo or lid wipes for underlying blepharitis.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FUTHALM 1% EYE SUSP. DROP 5 ML	SIGMA TEC	14.40 EGP
OPTIFUCIN 1% VISCOUS EYE DROPS 5 GM	AMMAN PHARMACEUTICAL CO - JORDAN > ADM FOR TRADING & PROJECTS-EGYPT	27.00 EGP
EFUCISAN 1% VISCOUS EYE DROPS 5 GM	ORCHIDIA PHARMACEUTICAL INDUSTRIES	28.00 EGP
OJOBLICK 1% VISCOUS EYE DROPS 5 GM	EIPICO	28.00 EGP
FUSAMIC 1% VISCOUS EYE DROPS 5 GM	CHEMIPHARM	36.00 EGP
FUCITHALMIC 1% VISCOUS EYE DROPS 5 GM	AMIDPHARM > CHEMIPHARM	37.00 EGP
OFUSIDIC VISCOUS EYE DROPS 5 ML	ORCHIDIA PHARMACEUTICAL INDUSTRIES > ORCHIDIA	28.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.