Gordeolum is a limited purulent process on the eyelids that develops when the hair follicle of the eyelash or sebaceous gland is infected. The gordeolum on the eye is manifested by painful local swelling and hyperemia of the edge of the eyelid, followed by the formation of an abscess. Diagnosis of barley is based on an external examination and, as a rule, does not require additional instrumental techniques. In the initial stage of barley, the inflammatory focus is extinguished with ethyl alcohol, instillations of albucide, applications of eye ointments, UHF, quartz are carried out; in the stage of suppuration, the opening of barley on the eye by an ophthalmologist is shown.
H00.0 Gordeolum and other deep inflammation of the eyelids
Gordeolum is the most common eyelid disease in clinical ophthalmology. According to statistics, 80% of the population encounters barley on the eye during their lifetime. The disease occurs more often in children and adults aged 30-50 years. Gordeolum is characterized by acute purulent inflammation caused by bacterial infection and developing in the hair sac of the eyelash and the adjacent sebaceous gland. It should be remembered that gordeolum on the eye is not just a cosmetic problem, but a disease that, with independent treatment, can lead to severe purulent-septic complications or chronization of the process. Under the guise of barley, other diseases of the eyelids can hide – chalazion, cysts, tumors of the eyelids.
The cause of barley is bacterial infection, in 90% of cases – Staphylococcus aureus. In some cases, the root cause of barley may be a microscopic mite demodex, living on eyelashes, or fungi. Penetration of microorganisms into the cavity of the sebaceous gland or hair sac leads to blockage of the excretory duct opening into the follicle, inflammation of the walls of the cavities and accumulation of purulent secretions. Infection in the hair follicle and the cavity of the sebaceous gland contributes to non-compliance with hygiene rules:
- wiping your face with a dirty towel,
- the habit of rubbing your eyes with your hands, combing your eyelids,
- prolonged visual tension,
- the use of low–quality cosmetics, contaminated brushes, applicators for applying makeup, etc.
Often, gordeolum accompanies the course of other eye diseases – blepharitis, conjunctivitis, and also occurs when contact lenses are used and stored incorrectly. To the development and recurrence of barley predispose:
- chronic diseases (diabetes mellitus, seborrhea, hyperlipidemia, furunculosis, gastrointestinal diseases, worm infestation);
- oily skin;
- vulgar acne;
- stress, reduced immunity, general exhaustion;
- deficiency of vitamins A, B and C;
- HIV infection;
- contamination of the room or atmospheric air.
According to the number of ulcers, the gordeolum on the eye can be single or multiple, occur on one or both eyes. Multiple recurrent barley occurs when an infection spreads from one hair follicle to another and is usually observed in weakened patients. According to localization, there are:
- External gordeolum occurs most often and is an abscess on the ciliary edge of the eyelid, from the outside.
- Internal gordeolum (meibomitis) develops in the thickness of the eyelid with infection of the meibomian glands and inflammation of the cartilaginous plate of the eyelid. Chronic meibomitis leads to the development of chalazion.
The development of barley usually occurs acutely, in a short time. First, itching of the edge of the eyelid appears, then hyperemia and local swelling develop, which is accompanied by pain at rest and when pressing on the inflamed focus. Sometimes the swelling of the eyelid is so pronounced that the patient cannot open the eye. The formation of multiple barley on the eye is accompanied by common symptoms: fever, headache, malaise, swelling of the parotid and submandibular lymph nodes.
After 2-3 days, a pustule – purulent head appears in the area of the inflammatory focus; at the same time, the pain subsides. Upon self-opening of barley, purulent contents are released from it, after which all symptoms gradually regress. Usually, the purulent-inflammatory process in barley takes about one week.
The internal gordeolum is located inside the eyelid, deep in the cartilage. It is defined when the eyelid is turned out as local hyperemia and conjunctival edema. After 2-3 days, as the barley matures, yellowish pus shines through the mucous membrane. Spontaneous opening of the internal barley occurs from the conjunctiva. In the future, leaf-like granulations often grow on the mucous membrane of the eyelid.
The contents of ripe barley should never be squeezed out on their own. Otherwise, infection may enter the subcutaneous veins of the face, and through them – into the deep veins of the eye socket. In the future, multiple abscesses of the eyelid, phlegmon of the eye socket, thrombophlebitis of the orbital eyelids may develop, and in particularly severe cases, purulent meningitis and sepsis with a fatal outcome.
Untreated gordeolum leads to chronic infection and recurrence of inflammation; a complication of internal barley may be chalazion, requiring surgical treatment.
If barley appears on the eye, it is advisable to consult an ophthalmologist. Usually, the recognition of internal or external barley is carried out by visual inspection of the eye with the eyelids turned out in side lighting. Additional ophthalmological diagnostics is not required in most cases. Differential diagnosis of barley is carried out with chalazion, dacryoadenitis, cysts and tumors of the eyelids. With often recurrent barley , it can be prescribed:
- consultations with other specialists (endocrinologist, gastroenterologist, dermatologist)
- determination of blood and urine glucose, glucose tolerance test
- examination of eyelashes for demodex and feces for helminth eggs
- bacteriological examination of a smear from the conjunctiva to identify the causative agent of barley
- blood culture for sterility.
Treatment is local, mainly conservative. At the first manifestations (itching, redness of the eyelid), it is recommended:
- treat the problem focus 2-3 times a day with 70% ethyl alcohol, iodine or diamond green.
- to instill into the conjunctival cavity a solution of sulfacetamide or antibiotics,
- to lay eye ointments with antimicrobial action (levomycetin, tetracycline, erythromycin).
- at the stage of barley ripening, the use of dry heat, physiotherapy procedures – quartz tube, UHF are shown.
It is strictly forbidden to apply wet compresses, as this can cause the formation of new abscesses. After the spontaneous breakthrough of barley, instillation of eye drops containing sulfacetamide or ciprofloxacin and the laying of antibacterial eye ointments behind the eyelid continue. If the gordeolum on the eye is accompanied by general symptoms, it is necessary to prescribe antibiotics orally or intramuscularly.
In some cases (with a large external abscess, meibomitis, the absence of the expected effect of treatment), an autopsy of barley is performed in an ophthalmological office. In the future, daily postoperative treatment of the eyelid, local or systemic antibiotic therapy is carried out. With chronic inflammation of the eyelid, they resort to eyelash epilation.
In the case of the recurrent nature of barley on the eye, autohemotherapy, UFO, vitamin therapy, restorative measures are prescribed. When chalazion is formed, its removal by injection or surgery is indicated.
Prognosis and prevention
Following the recommendations and proper treatment, the gordeolum on the eye passes without consequences. In the process of treating barley, women should refrain from using cosmetics. With independent treatment of barley, it is necessary to wait for its maturation and spontaneous opening. The extrusion of the abscess can lead to severe local (infection of subcutaneous fat of the eyelids and eye sockets) or generalized (meningitis, sepsis) complications.
Prevention of barley should include the identification and elimination of predisposing factors, strengthening immunity, proper nutrition, compliance with hygiene rules and contact lens care requirements, refusal to use low-quality cosmetics, etc.