Barley on the eye, sometimes called a stye, is a common acute infection that occurs on the eyelid. The technical term for this condition is a hordeolum. Hordeum is the Latin word for barley, which a hordeolum can resemble. Hordeola can occur on the upper or lower eyelid, causing tenderness and discomfort.

There are two types of hordeola: external and internal. An external hordeolum occurs at the base of the eyelashes, while an internal hordeolum occurs on the inside of the eyelid.

Symptoms

Symptoms of barley on the eye may include the following:

  • Painful, red, swollen bump on the eyelid.
  • Crusting around the eyelid.
  • Blurred vision.
  • Scratchy eye.
  • Feeling like something is in the eye,
  • Tearing.
  • Light sensitivity.

It can be difficult to differentiate a hordeolum from a similar condition called a chalazion. A chalazion can look similar to a hordeolum, but is usually painless, in contrast to a hordeolum.

Symptoms of a chalazion include:

  • Painless bump on the eyelid, sometimes with redness and swelling,
  • Blurred vision.
  • Scratchy eye.
  • Feeling like something is in the eye.
  • Tearing.

Causes

Hordeola are usually caused by an infection of a gland by the Staphylococcus bacteria.

In external hordeola, the affected glands are either the glands of Zeiss or the glands of Moll.

The glands of Zeiss are sebaceous (oil-producing) structures located at the eyelid margin. The glands of Moll, also known as the ciliary glands, are sweat-producing structures also located at the eyelid margin, and their ducts empty into the eyelash follicle. External hordeola present as a pimple on the outside of the eyelid near the eyelash margin.

In internal hordeola, the affected glands are the meibomian glands. The meibomian glands are sebaceous (oil-producing) structures. Internal hordeola present on the inner eyelid.

In contrast, chalazia are non-infectious. They usually develop as a result of a chronically inflamed oil gland. Inflammatory cells accumulate forming granulation tissue, which is hard and forms the palpable lump on the eyelid.

There are several risk factors for developing barley on the eye:

Contact lens wear. Contact lenses, even when cleaned regularly, harbor bacteria. Wearing contact lenses can therefore contribute to the development of barley on the eye.

Previous stye. A history of previous styes can make a person more prone to developing them again. Sometimes, regular eyelid maintenance is required to prevent the recurrence of barley on the eye. This generally involves lid hygiene and warm compresses with lid massage.

Blepharitis. Blepharitis is an inflammatory condition of the eyelids. Although blepharitis can present as an acute condition, it is generally chronic. Blepharitis is generally caused by an overpopulation or imbalance of bacteria on the eyelids. This overgrowth of bacteria can lead to barley on the eye.

Meibomian gland dysfunction. Meibomian gland dysfunction is an inflammatory condition of the meibomian glands of the eyelids. These glands normally secrete oil into the tear film. In meibomian gland dysfunction, the glands don’t function as they should. They become clogged and more susceptible to infection like hordeola, particularly the internal type.

Rosacea. Rosacea is a chronic inflammatory condition of the skin, causing flushing. Some people with rosacea have involvement of the eyes, called ocular rosacea. Symptoms include dry eyes, meibomian gland dysfunction, and recurrent hordeola or chalazia.

Treatments

Hordeola and chalazia may resolve on their own. There are several things that can speed this process along.

Warm compresses. The application of warm compresses can help to drain a hordeolum or mobilize the granulation tissue of a chalazion. This can be done using a washcloth with warm water. Combining warm compresses with gentle lid massage can be especially helpful. An alternative to warm compresses is the use of a commercially available heat pack. There are several brands available specifically for use on the eyelids. Whether using warm compresses or a heat pack, care will need to be taken to avoid burning the delicate skin of the eyelids.

Eyelid hygiene. Measures to keep the eyelid area clean can be helpful in treating barley on the eye. This is especially true if blepharitis is also present. Various products are commercially available to clean the eyelid region.

Antibiotics. If a hordeolum is not responding to warm compresses, oral antibiotics may be used to treat the infection. Topical antibiotics may be used to prevent the spread of bacteria with drainage of the lesion. These are generally in ointment form and don’t penetrate the lesion very well.

Chalazion-specific treatments. Chalazia can take a long time to go away. If a chalazion is not responding to warm compresses, more invasive treatment may be necessary. A corticosteroid injection may be recommended, or the lesion may be lanced and drained.

Key take-aways

Barley on the eye, otherwise known as a stye, is a common nuisance that can cause eyelid redness and eye discomfort.

Some barleys may resolve on their own, but there are several things that can speed this process along.

The use of warm compresses with lid massage is most commonly recommended to treat the lesion.

If the condition persists, an eye doctor can help to prescribe the most appropriate treatment.

References:

Boyd, K. (2022). Ocular Rosacea. American Academy of Ophthalmology.

Boyd, K. (2021). What Are Chalazia and Styes? American Academy of Ophthalmology.

Bragg, K.J., Le, P.H., Le, J.K. (August 2021). Hordeolum. In: StatPearls. Treasure Island (FL): StatPearls Publishing.

American Optometric Association. Chalazion.

American Optometric Association. Hordeolum (stye).

InformedHealth.org. (2019). Styes and chalazia (inflammation of the eyelid): Overview. Cologne, Germany: Institute for Quality and Efficiency in Health Care.

Stoeckelhuber, M., Stoeckelhuber, B.M., Welsch, U. (2003). Human glands of Moll: histochemical and ultrastructural characterization of the glands of Moll in the human eyelid. Journal of Investigative Dermatolology.

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