Multiple Bilateral Hordeloums with Pyogenic Granulomas in an 8 month old twin

Title Multiple Bilateral Hordeloums with Pyogenic Granulomas in an 8 month old twin
Author, Co-Author Alicia Feis
Topic Binocular Vision/Pediatrics
Program Number
Ballroom A-B
Midwestern University, Arizona College of Optometry

INTRODUCTION: A Hordeloum is a common bacterial infection that causes a painful inflamed eyelid margin.  It results in an abcess formation on the sebacesous glands of the lids and is most commonly caused by a Staphylococcal infection.  The exact incidence of hordeolums is not known, as many cases are not reported.  Commonly used treatment options include warm compresses, lid scrubs, topical and oral medications as well as surgical excision.1 

CASE REPORT: An 8 month old Hispanic female was referred to the clinic for pustular nodules on all 4 lids.  She was previously treated with oral Augmentin, erythromycin ointment and warm compresses 2 weeks prior. The patient was born after her identical twin with a history of seasonal allergies but no known drug allergies. VA’s showed fixate and follow in both eyes, pre-auricular nodes were negative and she shows no signs of a fever. Anterior segment bilaterally showed copius amounts of pus, swollen red upper and lower eyelids with crusting on the lids and lashes.  Her eyelashes were matted shut blocking the visual pathway and two pyogenic granulomas were noted on the right and left eyelids. The bulbar, palpebral conjunctiva and cornea were unremarkable. She also had small red bumps in the perioral region with no other skin lesions on the rest of her body.  She was diagnosed with contact dermatitis and multiple hordeloums. She was taken off erythromycin and placed on polytrim prior to surgical excision.  After a successful excision the anterior segment was unremarkable and facial red bumps in the perioral region were gone.  An ocular exam ruled out deprivation amblyopia or posterior ocular health abnormalities. Cultures yielded Staphylococcus Aureus. It was recommended that she obtain testing for any immunoglobulin or zinc deficiencies.

CONCLUSION: Although rare, multiple hordeloums can present in a young infant that mimic signs of a more severe underlying bacterial etiology.  Culturing and further testing in all cases is warranted.2,3   

Affiliation of Co-Authors