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Figure 3. Fluorescein Angiogram done on a patient with suspected atypical ON, showing bilateral late disc hyperfluorescence in mild papillitis. Laboratory Testing Patients with internal hordeolum present with more diffuse tenderness and erythema of the lid given the relatively largermeibomian gland. Diagnosis may be made by everting the lid to reveal a small pustule of the conjunctival surface. Thephysical exam may appear very similar to an external hordeolum in cases when the gland is infected but without obstruction. Treatment for both internal and external hordeolum is the same, so differentiation of the two is not of significant clinical importance.

Hoorbakht H, Bagherkashi F. Optic neuritis, its differential diagnosis and management. The open ophthalmology journal. 2012;6:65. The prognosis depends on the underlying etiology. As noted above, the visual loss in typical ON usually recovers and the most common etiology is MS. In atypical ON however the prognosis depends upon the underlying etiology. Infectious (e.g., Herpes Zoster, Lyme Disease, Syphilis, Tuberculosis, Dengue, mumps, and West Nile Virus, Tuberculosis, Hepatitis B, Rabies, Tetanus, Meningitis, Anthrax, Measles, Rubella.) Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg [Am] 56: 1391–1396Three different glands within the eyelid are implicated in the pathogenesis of hordeolum when they become infected by S. aureus. Infection of Zeis and Moll glands (ciliary glands) causes pain and swelling at the base of the eyelash with localized abscess formation. Termed external hordeolum, these produce the typical appearance of a stye with a localized pustule of the eyelid margin. The meibomian glands are modified sebaceous glands that are found in the tarsal plate of the eyelids. Theyproduce an oily layer on the surface of the eye that helps to maintain proper lubrication of the eye. When a meibomian gland becomes acutely infected, it results in an internal hordeolum. Due to its deeper position within the eyelid, internal hordeolahave a less defined appearance than external hordeolum. Optic disc swelling is seen on fundoscopy in one-third of patients during the active phase. In the absence of observable papillitis, signs and symptoms of ON are usually sufficient to establish the diagnosis of retrobulbar neuritis.

Other testing as it relates to your differential diagnosis (e.g., Lyme, Tuberculosis, Bartonella, etc.) Although it occurs very uncommonly, an untreated stye may evolve into a localized cellulitis of the eyelid and surrounding skin. Periorbital, or rarely, orbital cellulitis, may ensue if progression of the infection is allowed to occur. Any worsening erythema and edema beyond a localized pustule should be monitored closely for cellulitis, which may require systemic antibiotics. For infections that are not well localized, blood tests including a complete blood count (CBC) with differential and blood cultures may be needed, in addition to an orbital CT scan if orbital cellulitis is a possibility. Brattström H (1964) Shape of the intercondylar groove normally and in recurrent dislocation of the patella. Acta Orthop Scand Suppl 68:1–148Malik A, Ahmed M, Golnik K. Treatment options for atypical optic neuritis. Indian journal of ophthalmology. 2014 Oct;62(10):982.