Which symptom indicates the need for urgent referral of a hordeolum?

A hordeolum, commonly known as a stye, is typically a localized infection of the eyelid that can present with symptoms such as pain, redness, swelling, and sometimes a discharge. While moderate pain is generally expected with a hordeolum, it alone does not necessarily indicate a need for urgent referral.

Significant preseptal cellulitis, on the other hand, is a more serious complication that can arise from a hordeolum. Preseptal cellulitis involves an infection of the eyelid and surrounding tissues, which may pose a risk for the spread of infection to deeper structures, including the orbit or even the central nervous system. The presence of significant preseptal cellulitis typically warrants urgent evaluation and possibly systemic antibiotics to prevent further complications.

In contrast, lid hygiene refers to practices that help maintain or improve eyelid health; if this is being implemented, it is usually a positive step rather than an indication for urgent referral. Improvement of the eyelid condition would suggest that the hordeolum is resolving, which is not a reason for urgency. Therefore, recognizing significant preseptal cellulitis as an urgent concern when managing a hordeolum is crucial for preventing further complications.