Antibiotic therapy could be amoxicillin, Keflex (cephalexin, Dista), doxycycline or erythromycin. I typically use 500 mg of Augmentin (amoxicillin/clavulanate, SK Beecham) twice daily for 7 to 10 days.HealioNewsOptometryCornea/ExternalDiseaseIssue:September2007ReadnextReadnextReadnextSeptember01,20075minreadSavePrescribeoralantibioticswheninternalhordeoladonotrespondtotopicaltherapyIssue:September2007ADDTOPICTOEMAILALERTSReceiveanemailwhennewarticlesarepostedonPleaseprovideyouremailaddresstoreceiveanemailwhennewarticlesarepostedon.SubscribeADDEDTOEMAILALERTSYou'vesuccessfullyaddedtoyouralerts.Youwillreceiveanemailwhennewcontentispublished.ClickHeretoManageEmailAlertsYou'vesuccessfullyaddedtoyouralerts.Youwillreceiveanemailwhennewcontentispublished.ClickHeretoManageEmailAlertsBacktoHealioWewereunabletoprocessyourrequest.Pleasetryagainlater.Ifyoucontinuetohavethisissuepleasecontactcustomerservice@slackinc.com.BacktoHealioA.Skiptopicaltherapy,chooseoralsElizabethD.MuckleyElizabethD.Muckley,OD,FAAO:Aninternalhordeolumisabacterialinfectionofoneofthemeibomianglandsintheeyelid.Patientscomplainofatenderorpainfulnodule.Staphylococcusspeciesareusuallythemostcommonbacteriatoinfecttheglands.Insomecases,theinfectioncanspreadtothesofttissueoftheeyelidandcauseapreseptalcellulitis.Aftertheinfectionresolves,chronicinflammationcanoftenpersistandcauseagranulomatouschalazion.Theprimarydifferencebetweenachalazionandhordeolumisthatchalaziaarearesultofinflammationandhordeolaorstyesareinfectious.Thesymptomofpaintypicallypointstohordeolum.Inthiscase,thepatienthasapainfulhordeolum.Hotcompressesandtopicalantibiotic/steroids(conservativetherapy)wereinitiated,butthepatient’ssymptomspersisted.Iamnotsurprisedthatconventionaltreatmentdidnotwork.Oftentimes,topicaltreatmentdoesnotpenetratethelidtissueeffectivelywhenitisaninternalhordeolum.Duetothisineffectiveness,manycliniciansarenowskippingtraditional,topicaltherapyandgoingrighttooralantibiotics.Becauseourpatientwasstillcomplainingofpainwithlideryt