Barleycorn

Synonyms

Medical: Hordeolum

Definition

A hordeolum (barleycorn) is an acute bacterial inflammation of an eyelid gland. If several glands are affected at the same time, one speaks of a hordeolosis (several barley grains). Characteristic for the barleycorn (hordeolum) are: Usually there is a central pus point.

The inner barleycorn usually shows more severe symptoms (e.g. conjunctivitis) than the hordeolum externum.

Severe pain in the affected area
Swelling and
A strong redness.
Pus in the eye

A hordeolum externum (outer barley grain) is usually diagnosed quite quickly due to its location on the outer edge of the eyelid. Mostly the diagnosis of the barleycorn is done by a so-called gaze diagnosis, so the doctor knows already at a single glance which problem he is dealing with.

The hordeolum internum (inner barleycorn), however, is only discovered when ectropioning (turning the song to the outside so that the inner conjunctiva becomes visible). As a differential diagnosis (Which other disease is possible?) the hailstone (chalazion) is used, which is insensitive to pressure pain (pressure indolent).

As a rule, a barleycorn heals without problems and spontaneously. To support the healing process, various measures can be taken. In the acute stage, dry heat (e.g. red light irradiation) can cause the pus to break through or encapsulate the barleycorn more quickly, thus accelerating the healing process.

In general, care should be taken not to transport the bacteria with the hands from the diseased eye to the healthy eye. Red light or also infrared light is also called heat radiation. In contrast to conventional white light, the long-wave red light rays penetrate deeper into the skin.

They gently warm up the underlying tissue without damaging the surface of the skin. The slowly rising temperatures in the illuminated region stimulate the local metabolism. The blood circulation increases and the body’s defense cells reach the inflammation faster.

It is not uncommon for the barleycorn to break through pus more quickly and the duration of the disease is shortened! During the red light therapy the eyes must be kept closed. The resulting heat should be pleasant.

As soon as there is a feeling of heat or even pain, the treatment must be stopped immediately! In addition, the minimum distance of about 30cm to the lamp must not be undercut. Detailed information on operation and handling can be found in the manufacturer’s instructions.

Red light lamps are offered for sale in pharmacies or medical supply stores. Warm, dry compresses can also be helpful. However, it is important that no moist compresses (e.g. chamomile tea envelopes) are used.

This is because the damp heat would create an optimal breeding ground for the pathogens of the barley grain: the bacteria spread and more barley grains are formed. The tear film of the human eye has a high fat content. The composition of the tear fluid in a barleycorn is often disturbed because the fat-producing glands are inflamed.

In order to restore the natural balance, eyelid hygiene can be helpful after the barleycorn has subsided. Possible measures include eyelid edge massages, moisturizing eye drops or eyelid edge cleansing.

Red light therapy
Compresses
Eyelid Edge Hygiene

In the case of massive swelling of the eyelid and great tension pain caused by pus in the barleycorn, there is the possibility of a small operation to remedy the situation.

The ophthalmologist opens the barleycorn through a small incision (incision) and the pus can drain off. Note: This incision, no matter how small, should be performed exclusively by the doctor! Faulty scarring can cause permanent disturbances of the eyelid margin like an ectropion.

Under no circumstances should the person affected be allowed to “lay hands” on it himself! When trying to express the barleycorn, similar to a pimple, germs get into the eye. Conjunctivitis and other barleycorns can develop.

The hands also come into contact with the pus and transport germs into the unaffected eye. In very rare individual cases it may be necessary to take antibiotics in tablet form. This is known as “systemic antibiotics“: the drug does not act purely locally on the barleycorn, such as eye ointments, but throughout the body.

Floxal or Refobacin® is suitable for local antibiotic therapy.The ingestion is indicated as soon as the inflammation threatens to migrate to the orbit. In case of a barleycorn, eye ointment can support the healing process. A distinction is made between antibiotic, disinfecting and homeopathic eye ointments.

Without ophthalmologic advice, over-the-counter ointments should be used with caution. General use: Before using eye ointment, affected persons should wash and dry their hands thoroughly. Contact lens wearers must remove their lenses!

Then unscrew the lid of the tube and store it safely. Now it is advisable to place the head slightly in the neck. With one hand pull the lower eyelid of the affected eye slightly downwards.

To protect the sensitive skin around the eyes, a cotton pad or handkerchief can be used. The other hand exerts gentle pressure on the ointment tube and thus applies an ointment strand into the conjunctival sac. For hygienic reasons, it is essential to ensure that the tip of the tube does not come into contact with the eye!

After finishing, affected persons can slowly close and open their eyes. Caution: Immediately after administration of the ointment, vision is impaired: Therefore, no heavy machinery may be operated or participate in road traffic during the first few minutes! After a short time, however, the blurred vision disappears and visual acuity is restored.

Due to its bactericidal properties, antibiotic eye ointment kills pathogens of the barley grain. This accelerates the healing process and prevents the bacteria from spreading. Usually the ointment is given into the conjunctival sac (lower eyelid) several times a day.

Gentamycin is one of the most common active substances and is often combined with the anti-inflammatory dexamethasone. As a rule, affected persons should place a 1 cm long strand of the ointment into the conjunctival sac (lower eyelid) two to three times a day. Antibiotic eye ointment is a prescription-only medication and can therefore only be used on a doctor’s prescription.

Another frequently prescribed antibiotic eye ointment is Floxal eye ointment, Floxal eye drops are also available. Disinfecting eye ointment, on the other hand, is freely available in pharmacies and has a cleansing effect on the barleycorn through the active ingredient bibrocathol. In addition to its antiseptic effect, it often contains so-called secretion-inhibiting ingredients that loosen the adhesions in the affected eye.

There are numerous disinfecting eye ointments available in pharmacies, including Those affected should put an ointment strand of about 0.5 cm length into the conjunctival sac or on the edge of the affected eyelid several times a day. Away from the conventional medical eye ointments, a homeopathic treatment with herbal, freely available ointments can also provide relief. A proven ingredient of such eye ointments is an extract from the Echinacea plant, also called coneflower.

If there is no noticeable improvement after 2-3 days of treatment with Echinacea eye ointment (e.g. Euphrasia eye ointment) or if the symptoms get worse, those affected should nevertheless consult an eye doctor.

Antibiotic eye ointment
Disinfecting eye ointment
Posiformin® 2% eye ointment
Noviform 2% eye ointment
Homeopathic eye ointment

There are some homeopathic remedies that can be used to treat a barley grain in both children and adults. Most are taken in the form of globules.

Different preparations are used depending on the course and stage of the disease. In the beginning, when no pus has collected, belladonna and arnica can help to suppress the development of pus and thus positively influence the course of the disease. These two preparations should be taken as soon as the first swelling and redness of the eyelid is visible.

Further helpful substances are: If the symptoms do not get better and possibly even worse after about 2 days, a doctor should be consulted immediately.

Hepar Sulfuris – for pus formation
Pulsatilla pratensis – for stuck together, inflamed eyelids
Staphisagria, sulfur – when the barleycorn appears again and again
Lycopodium clavatum – Barleycorn near the inner corner of the eye
Graphites – Barley grain on the lower eyelid

In most cases the barley grain is an infection with the bacterium Staphylococcus aureus. This pathogen occurs naturally in various parts of the body.

For example, it is found in the armpit, the nasal vestibule or the hairline on the forehead. The eyelid has several different glands.The so-called Meibom-glands lie rather on the inside of the eyelid, while the so-called Moll and Zeis-glands are adjacent to the eyelashes, thus rather on the outside of the eyelid. If a Meibom gland is now affected by the inflammation, it is called an inner barleycorn (Hordeolum internum).

An external barleycorn (Hordeolum externum) is involved when minor or silica glands are infected. Pus is formed in the eyelid, painful thickening and redness. Usually after about a week the pimple bursts open and the pus is emptied.

Barley pimples often occur in connection with diabetes mellitus (sugar disease). Frequent recurrences (recurrence) also occur with acne (acne vulgaris) or gastro-intestinal diseases. They are also particularly common in cases of frequent inflammation of the eyelid margin or dry eyes.

If barley grains frequently occur or patients sometimes suffer from several inflammations at the same time, this is called hordeolosis. Persons with a weakened immune system are particularly at risk: this includes above all patients with diabetes mellitus (diabetes)! However, the disease pattern can also occur more frequently with high psychological stress (e.g. stress).

Due to a lack of hand hygiene, children in particular often suffer from a grain of barley. Contact lens wearers represent a special risk group. By inserting the lenses, bacteria can easily get into the eye and cause an infection.

Only strict hygienic handling reduces the risk! Eye make-ups are also to be evaluated critically, since, for example, pathogens can reach the edge of the eyelid through the mascara on the eyelashes. Therefore it is recommended to change the mascara every 3-6 months.

The trigger of a barley grain is in most cases an infection with bacteria. In principle, it is therefore one of the contagious diseases, like all diseases with a bacterial basis! However, the risk of infection is rather low, e.g. in contrast to conjunctivitis.

The most common pathogen of the barley grain is Staphylococcus aureus, a widespread bacterium. It is found on many natural surfaces or materials, not infrequently also on human skin or mucous membranes. Typically, children, for example, can become infected with the germs while playing in the sandbox.

Normally the pathogen is harmless and does not cause any complaints. However, if the bacterial density increases rapidly due to favorable conditions, e.g. a weakened immune system or minor injuries, the sensitive balance tilts: formerly harmless staphylococci gain in disease value and cause complaints, such as the barleycorn. Transmission The transmission of bacteria can take place in different ways.

A distinction is made between the so-called direct and indirect infection. In the case of a direct infection, the person affected comes into direct contact with the pathogens: numerous tiny droplets are sprayed into the air by sneezing, coughing or even blowing his nose. People nearby breathe them in and the pathogens enter the body.

The contact infection is also one of the direct routes of infection. Here germs are wiped off by direct contact, e.g. shaking hands. The so-called smear infection plays a major role in the infection with a grain of barley.

Here the infection occurs indirectly by touching a contaminated (soiled) object: Affected persons wash their face and rub the infected eye with a towel. The bacteria get on the surface and settle down. Afterwards, other family members dry their face with the same towel, thus carrying pathogens into their eyes.

There they multiply and lead to a barleycorn. In general, contact between hands and eyes should be strictly avoided in case of illness. It requires some discipline not to touch the itching and burning barleycorn.

Children in particular find it incredibly difficult! This is the only way to prevent pathogens from being transmitted via physical contact (e.g. shaking hands). It is not to be expected that the bacteria “jump” from eye to eye.

So as long as the following rules of conduct are followed, the risk of infection can be almost completely reduced: Avoid eye to hand contact. Wash hands frequently and carefully: Hold hands under running water, rub with soap for 20-30 seconds, rinse thoroughly. Especially before and after touching the eyes!

Strict separation from towels, washcloths etc. Eye ointments and drops may only be used by one person. Do not use eye make-up (mascara, kohl pencil etc.).

Avoid eye and hand contact.
Wash hands frequently and carefully: Hold hands under running water, rub with soap for 20-30 seconds, rinse thoroughly. Especially before and after touching the eyes!
Strict separation of towels, washcloths etc.
Eye ointments and drops may only be used by one person.
Avoid eye makeup (mascara, kohl pencil, etc. ).
Do not wear contact lenses.

After the pus has broken through and the barleycorn (hordeolum) has completely emptied itself, the symptoms usually disappear very quickly.

The barleycorn (hordeolum) is usually a quite harmless bacterial infection. If no complications occur and the pathogens do not spread further, it usually heals by itself. In the course of the disease, swelling and reddening of the eyelid occurs at first.

This can develop within a few days. Afterwards, the accumulation of pus opens up independently in most cases. Normally this happens after about 3 to 6 days.

If strict hygiene is observed and further spreading of the pathogens that are in the pus is prevented, the barleycorn heals without complications. However, if the bacteria are transferred to the eyeball or to the conjunctiva, more extensive inflammation can occur and the course of the disease is much longer. In addition, a weakened immune system can produce several barley grains in succession, which can also delay the healing process.

Normally a barleycorn heals completely without any problems. However, if no treatment takes place, a chronic inflammation of the affected glands can develop over time. In such cases a so-called hailstone (chalazion) is visible in the upper or lower eyelid.

The hailstone is usually not movable, very firm and, unlike the barley grain, completely painless! Mostly hailstones have to be removed surgically. In some disease courses, the infection attacks surrounding regions, such as the conjunctiva (conjunctivitis) or very rarely the eye socket (orbit).

In the event of frequent recurrence, an underlying disease (e.g. diabetes mellitus) should be excluded. In children, the development of a barley grain is much more frequent than in adults. This is due to the child’s immune system, which is not yet fully developed.

The bacteria can thus settle more easily on the eyelid and cause a purulent inflammation. The risk of infection and the spread of the pathogens is also increased in children, because they often rub their eyes with their hands and the bacteria can be passed on. In these cases it is particularly important to pay strict attention to hygiene and to use your own towels and washcloths within a family.

Under no circumstances should the barley grain itself be opened. Since a barleycorn is contagious, care should be taken in kindergarten or school to wash hands regularly and prevent the spread of the pathogens. The child should be presented to a pediatrician who will decide whether the child may visit public institutions and whether antibiotics may be necessary to fight the bacteria.

Antibiotics are used in the form of eye drops or eye ointments. Irradiation with red light can also help to positively influence the course of the disease, as it accelerates the self-opening of the barley grain.