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Eyelid infections: outer and inner barley grain (hordeolum)
In view of the clearly visible signs of the disease on the eye and the additional pain, a barley grain is a very unpleasant symptom for those affected. In itself, however, this special inflammation of the eyelid usually takes a harmless course and heals itself after a few days. Healing can be additionally supported by therapeutic measures, but also by various home remedies.
If the grain of barley persists for more than a week, there is a clear increase in inflammation, additional symptoms such as fever or headache and / or repeated eye infections, so urgent medical attention should be sought.
The grain of barley (hordeolum) describes the inflammation of a sebum or sweat gland on the eyelid. If the external minor or Zeis gland is affected, this is referred to in medicine as the external hordeolum, while the internal meibomian gland is referred to as an internal hordeolum. The grain of barley is basically a small abscess on the eyelid and therefore a special form of eyelid inflammation (blepharitis).
The symptoms of the inner and outer barley grain are quite different. Although pressure sensitivity, itchy eyes and pain in the eyelid are typical complaints in both forms, the extent of redness and swelling can vary significantly. And because the internal hordeolum faces inwards, there is an increased risk of complications.
Usually after two to four days, a delimited pus is formed around the affected gland. In the further course, the barley grain finally bursts, so that the pus can drain off and the inflammation slowly subsides. In some people, however, the inflammation spreads, which can result, for example, in conjunctivitis or inflammation of the entire eye (orbital phlegmon).
In some severe courses, sufferers also develop fever, general malaise and swelling of the lymph nodes. A prompt visit to the doctor is strongly advised here. Because veins lead to the brain from the affected region, the causative agents can also trigger further complications, including life-threatening meningitis (meningitis).
The direct cause of the barley grain is the bacterial infection of a sebum or sweat gland on the eyelid. The most common triggers are bacteria from the staphylococcus genus, but other pathogens can also cause the disease. The risk of infection itself can be influenced by various factors. For example, rubbing your eyes with dirty fingers, as is often the case with small children, increases the risk of a grain of barley. Wearing contact lenses or a lot of makeup are also mentioned as predestining factors. In addition, there are existing diabetes diseases and general weakening of the immune system as further risk factors. A medical examination in this direction should therefore be carried out, especially in the event of repeated occurrence.
On the basis of the symptoms, the outer grain of barley is usually easily recognizable even for laypeople. In the internal internal hordeolum, however, a specialist diagnosis is sometimes necessary in order to rule out secretion of the sebum gland (hailstones or chalazion), which can also cause lingitis. A hailstone can be felt as a kind of lump in the eyelid and usually remains painless. In view of the pressure on the eyeball, larger hailstones often have to be removed surgically, which can be done in an outpatient procedure.
The specialist tissue examination also examines the surrounding tissue structures to determine whether the inflammation may spread and to limit the risk of complications.
In principle, it makes sense not to work the eye with your hands during the entire development period and to avoid contact lenses and make-up in order to minimize the entry of other pathogens and to avoid transmission of the infection to other tissue structures. Local treatment with antibiotic ointments and eye drops can also help to limit infection and reduce inflammation.
If the barley grain does not burst on its own, a surgical opening is possible so that the pus can drain off and healing can begin. The procedure is carried out on an outpatient basis under local anesthesia. Attempts to open the barley kernel independently are strongly discouraged, as this can result in considerable complications.
For the healing to start, the barley thorn must first open. Heat treatment is used for this in naturopathy. They are intended to accelerate the opening of the hordeolum so that the pus can drain away. A heat or red light lamp can serve as a heat source, as can warm pads that are produced in naturopathic treatment, for example on the basis of chamomile flowers or linseed. Cushions with fennel water compresses are also used against barley grains.
However, since there is a risk of spreading and further entry of pathogens, strict compliance with hygiene is essential and their use is controversial. The same applies to the traditionally widely used washes, envelopes and eye baths based on eyebright. Sebastian Kneipp, the founder of Kneipp medicine, had recommended such treatments. However, the eyewashes used must be sterile in order not to risk any further entry of pathogens and there is a risk of the spread of existing germs on the surrounding tissue structures. Appropriate caution should be exercised here.
In the field of homeopathy, the active ingredients Pulsatilla, Staphisagria but also Apis, Hepar sulfuris and Silicea are mainly used against the inflammation on the eyelid. Other naturopathic measures often aim at a general strengthening of the immune system in order to minimize the risk of infection in the future. Basically, the prevention of barley grain focuses on eye hygiene and the immune system. (jvs, fp)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Jeanette Viñals Stein, Barbara Schindewolf-Lensch
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- American Academy of Ophthalmology: What Are Chalazia and Styes? (Accessed: 14.08.2019), aao.org
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ICD codes for this disease: H00ICD codes are internationally valid encryption for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.