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United States
Hordeola are common in clinical practice, but no data are available on the
precise incidence and prevalence in the United States.
International
No data are available on the incidence and prevalence of hordeola
internationally.
Race
There is no known racial predilection to developing hordeola.
Sex
There is no sexual predilection to developing hordeola. Both men and women seem
to be equally affected.
Age
Hordeola are more common in adults than in children, possibly because of a
combination of higher androgenic levels (and increased viscosity of sebum), higher
incidence of meibomitis, and rosacea in adults. However, hordeola can occur in
children.
Clinical Presentation
History
The eyelid lump may also induce corneal astigmatism and cause blurring of
vision.
The patient often has a past history of similar eyelid lesions or risk
factors for hordeola, such as meibomian gland dysfunction,
blepharitis, or rosacea.
Physical
Causes
Workup
Laboratory Studies
Histologic Findings
Medical Care
Surgical Care
Incision and drainage is done under local anesthesia, and the incision is
made through the skin and orbicularis (in the case of external hordeola) or
through the tarsal conjunctiva and tarsus (in the case of internal hordeola).
The specimen should be sent for histopathological evaluation to confirm the
diagnosis and to rule out a more sinister pathology (eg, basal cell
carcinoma).
Medication Summary
Antibiotics
Class Summary
tablet
250mg
500mg
Dose Range
Usual dosage range: 250-500 mg PO q6-12hr or 500 mg q12hr or 333 mg PO q8hr
Severe infections: Up to 4 g/day
Take on empty stomach if possible; PCE Dispertab may be taken with food; base
has poorest absorption
Pediatric
Dosage Forms & Strengths
tablet
250mg
500mg
Dose Range
Mild to moderate infection: 30-50 mg/kg/day PO divided q6-12hr; not to exceed 2
g/day
Severe infection: 15-50 mg/kg/day PO ; not to exceed 4 g/day
Doxycycline inhibits protein synthesis and, therefore, bacterial growth by binding with
30S and possibly 50S ribosomal subunits of susceptible bacteria. May be added if
there is history of multiple or recurrent lesions or if there is significant and chronic
meibomitis.
Adult
capsule
syrup
50mg/5mL (Vibramycin)
oral suspension
tablet
20mg (generic)
50mg (Adoxa, generic)
75mg (Acticlate, Adoxa, generic)
100mg (Adoxa, generic)
150mg (Acticlate, generic)
tablet, delayed-release
50mg (Doryx)
60mg (Doryx MPC)
75mg (generic)
100mg (generic)
120mg (Doryx MPC)
150mg (Doryx, generic)
200mg (Doryx)
capsule, delayed-release
10%
General Dosage
Initial: 200 mg/day divided twice daily PO/IV on first day (IV may be given
qDay), THEN
Maintenance: 100-200 mg/day qDay or divided q12hr PO/IV (IV may be
given qDay)
Doryx MPC
Bartonella bacilliformis
Cholera
Gram-negative bacteria
Periodontal Disease
100-200 mg PO qDay
Atridox: Apply subgingivally; dose depends on size, shape, and number of
pockets treated
Rosacea
Indicated for prophylaxis of malaria due to Plasmodium falciparum in shortterm travelers (ie, <4 months) to areas with chloroquine and/or
pyrimethamine-sulfadoxine resistant strain
Prophylaxis: 100 mg PO qDay; begin taking 1-2 days before travel and
continue daily during travel and for 4 weeks after traveler leaves malaria
infested area
Severe infection (off-label): 100 mg PO/IV q12hr x 7 days with 3-7 days
quinidine gluconate
Uncomplicated infection (off-label): 100 mg PO q12hr x 7 days with 3-7
days quinine sulfate depending on region
Equivalent dose of Doryx MPC is 120 mg
Intestinal Amebiasis
Indicated for Rocky Mountain spotted fever, typhus fever and the typhus
group, Q fever, rickettsial pox, and tick fevers caused by Rickettsiae
100 PO q12hr on day 1, then 100 mg PO qDay
Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1, then 120 mg
PO qDay
Infective Endocarditis
Pediatric
Dosage Forms & Strengths
capsule
syrup
50mg/5mL (Vibramycin)
oral suspension
tablet
20mg (generic)
50mg (Adoxa, generic)
75mg (Acticlate, Adoxa, generic)
100mg (Adoxa, generic)
150mg (Acticlate, generic)
tablet, delayed-release
50mg (Doryx)
60mg (Doryx MPC)
75mg (generic)
100mg (generic)
120mg (Doryx MPC)
150mg (Doryx, generic)
200mg (Doryx)
capsule, delayed-release
Doryx MPC
o
Severe or life-threatening infections (eg, anthrax, Rocky
Mountain spotted fever): 2.6 mg/kg PO BID
o
Less severe infections: 5.3 mg/kg PO divided into 2 doses on
day 1, then a maintenance dose of 2.6 mg/kg PO qDay
>8 years, 45 kg
Postexposure prophylaxis
8 years: 2.2 mg/kg PO/IV q12hr for 60 days (change to amoxicillin as
soon as penicillin susceptibility confirmed)
>8 years (45kg): 2.2 mg/kg PO/IV q12hr for 60 days (Doryx MPC: 2.6
mg/kg PO q12hr for 60 days)
>8 years (>45kg): 100 mg PO/IV q12hr for 60 days (Doryx MPC: 120 mg
PO q12hr for 60 days)
Malaria
>8 years
Prophylaxis
Severe infection
<45 kg: 2.2 mg/kg q12hr for 7 days with quinidine gluconate
Uncomplicated
>8 years: 2.2 mg/kg; not to exceed 100 mg dose PO q12hr for 7 days
with quinine sulfate
Tularemia
Single dose: 7 mg/kg PO/IV; not to exceed 300 mg/dose; adjunct to fluid
and electrolyte replacement
Multiple dose: 2 mg/kg PO/IV twice daily on day 1; THEN, 2 mg/kg qDay on
days 2 and 3; not to exceed 100 mg/dose; adjunct to fluid and electrolyte
replacement
Follow-up
Complications
Large lesions of the upper eyelid have been reported to cause decreased
vision secondary to induced astigmatism or hyperopia resulting from central
corneal flattening.
Prognosis