Everyone at any age has the potential to develop a stye. In fact, eye styes so common that they affect more than 75% of people, at least once or twice in their lifetime.
Most styes clear up on their own within a week, but they can be a painful bother that wears down on the eyelid and may temporarily affect vision. In this article, we will be discussing eye styes in depth.
Understanding what a stye is, the causes and risk factors, treatment and prevention, will help you deal with it the next time that uncomfortable bump comes up.
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What is a stye?
A stye, also known as a sty, is a localised infection on the edge of the upper or lower eyelid. It is usually tender, reddish, swollen and filled with yellow pus like a pimple. The eyes may be watery, and in most cases, vision is not affected. A stye forms because of a blocked gland or hair follicle on an eyelid.
There are two different types of styes, each with different causes and approaches in management (1)
- A hordeolum is a blockage of one of the sweat glands or sebaceous glands at the base of the eyelashes or eyelids. Sebaceous glands secrete sebum (an oily or waxy substance) to lubricate and waterproof the skin and hair while sweat glands discharge sweat through their tiny ducts on the surface of the skin.
A hordeolum can be external or internal. External hordeolum is the commonest, and it occurs next to the eyelash while internal hordeolum appears on the underside of the eyelid.
- A chalazion is a blockage of a special type of sebaceous gland known as a meibomian The openings of meibomian glands form a single row on the rim of each eyelid while the body is inside the eyelid.
Both of them begin as a painful, red, swelling on the eyelid. With time, a chalazion becomes a small non-tender nodule on the center of the eyelid, while a hordeolum remains a tender swelling localized to the eyelid margin. For the two of them, spontaneous improvement is possible, but a chalazion takes longer and may require an incision to speed up healing.
What causes a stye?
The cause of most styes (more than 95%) is usually a bacterial infection, by a bacterium known as Staphylococcus aureus. (2) A stye can also be as a result of obstruction by a foreign substance such as makeup, dust, or scar tissue. The blockage causes material to flow very slowly or not at all, resulting in a swelling.
What are the risk factors of a stye?
Certain factors may increase the likelihood of developing a stye. They include:
- Meibomian gland dysfunction and acne rosacea increase the risk of meibomian gland obstruction. Meibomian gland dysfunction is the leading cause of dry eye syndrome. It is a condition in which there is blockage of meibomian glands, so they do not secrete enough oil into the eyes. Acne rosacea is a chronic skin condition that causes persistent redness in the central part of the face. Blood vessels on the nose and cheek region swell and become visible as swollen red bumps.
- A history of a stye (they tend to reoccur)
- Touching eyes with dirty hands
- Failure to disinfect lenses or putting them on with unwashed hands
- Not consistently removing eye makeup overnight
- Using old, expired or contaminated eye cosmetics
- Chronic inflammation of the eyelid (blepharitis)
- Stress and hormonal changes
What are the signs and symptoms of a stye?
Signs and symptoms of a stye include:
- Sudden onset of pain, redness, and swelling (pimple-like) on the eyelid
- Puffy appearance of the eyelid
- Foreign body sensation, especially when blinking
- Thick discharge or crusty material on the eyelid or lashes if the stye is draining
- Blurred vision if the stye is draining thick pus that spreads over the eye’s surface
- If the meibomian gland is involved, there will be sensation of a dry eye. This is because the meibomian gland is responsible for secreting oil on the surface of the eye, to prevent quick evaporation of the layer of tears that is responsible for lubrication.
- Also, there may be tearing or sensitivity to light
Is a stye contagious?
A stye by itself is not contagious. However, the bacteria that cause it can be passed from one person to another or from one part of the body to the other.
The stye-causing bacteria lives on the skin and mucous membranes of the body, meaning we all have it. Normally, it does not cause problems when on these external surfaces but when it gets to the eyelids or broken skin, it causes an inflammatory reaction. In most instances, the bacteria enter the eyes when we rub them with dirty hands. For this reason, children are the most affected.
The bacteria can be passed to another person through sharing face towels, pillowcases, bedsheets or washcloths. However, the bacteria may not necessarily manifest as a stye when passed to a second person.
What are the treatment options for a stye?
Majority of styes resolve well with simple home treatments. Some take a few days while others go for a week or even months, especially if a meibomian gland is affected. If a stye does not improve or worsens within a week, a doctor’s opinion should be sought. Also, if the stye affects vision, the bump becomes too painful, bleeds, reoccurs, or the eyelid becomes red, one should seek professional help.
Simple home treatment methods include
Applying warm compressions to the stye for 10 to 15 minutes three to four times daily speeds up the healing process. This can be done by using a clean warm (not hot) cloth, or microwaveable eye masks available in most drug stores. The warmth will allow the stye to open, drain and resolve on its own.
Squeezing, popping or cutting of styes at home should absolutely be avoided. It can lead to scarring and puts the eye at risk of worse infections.
2.Keeping the eyelid clean
Every morning after waking up, use a cotton ball, pre-moistened eyelid pads that can be purchased in a drug store, washcloth, or makeup remover pad to cleanse the eyelids. Use non-irritating soap or tear-free baby shampoo then rinse with warm water and gently pat dry with a clean towel.
The towel should not be shared with other people or used for other body parts. Cleansing should be done gently with the eyes closed, to avoid eye injuries.
3.Salt water rinse
Another option is to use a saline solution. Add a pinch of salt to two tablespoons of warm water. Soak a washcloth in the solution then wipe the stye with it three to four times daily. The solution acts as an antiseptic. It draws water out of the bacteria causing it to get dehydrated and eventually kills it.
Take a tea bag (chamomile, black or green tea), soak it in warm water then let it cool off a bit. Gently place it on the affected eyelid (with the eyes closed) for about 5 to 10 minutes.
Tea contains antibacterial agents known as tannins. (3) They act on the bacteria, reduce pain and swelling. The warmth and steam from the tea bag also provide relief by softening the skin surrounding the stye, to let it drain naturally at a faster rate.
5.Castor, tea tree or almond oil
Put some drops of the oil of your choice on a cotton ball then place it on the stye twice a day. You can also apply the oil on the external margins of the eyelid and allow it to stay on overnight. The oils soothe the irritation and may reduce the swelling and inflammation.
Additional points to note on home treatments
Proper handwashing with soap and running water should be done before and after touching the stye.
It is necessary to stop using makeup until the stye is healed. It can cause more clogging and hence, delay the healing process. You may also consider discarding make up applicators that have been contaminated.
Contact lenses should also be avoided until the stye has healed. They can aggravate and spread the infection to the inner parts of the eye. Instead, use glasses.
Stubborn styes that do not go away after a week or affect vision require the attention of a healthcare professional.
Antibiotic-containing eyedrops, gels or ointments may be prescribed in some circumstances such as when there are multiple styes, blepharitis, or acne rosacea.
Over the counter analgesics such as ibuprofen and acetaminophen are useful in reducing the pain and discomfort caused by the stye. Painkillers can be used both alongside medical and home care treatment.
Incision and drainage may be done as a last resort for styes that do not respond to other types of treatment, or for a chalazion that lasts longer than two weeks. (4) The procedure is done by an ophthalmologist, oculoplastic surgeon or a doctor that deals with reconstructive surgery. It is done under local anaesthesia or general anaesthesia for kids. It takes about 15 to 20 minutes to perform, with no need for an overnight stay at the hospital.
The doctor begins by injecting a numbing medication into the eyelid then proceeds to make a small incision on the swelling. He/she then drains the collected material within the nodule. There is no stitching required; all the doctor needs to do after the surgery is to put a pressure patch on the eye. However, if the stye was large, small sutures might be used to close the lesion. The removed stye material is then sent for further laboratory examination, to find out the causative microorganism or investigate the possibility of skin cancer. Antibiotic cream or eye drops are prescribed for a week, to prevent infection at the incision site. (5)
After the procedure, the eye may remain swollen for the next 1 to 2 days, and some slight bleeding may be noted on the pad. If fresh bleeding is observed, gently press the pad and do not wipe away the clot that forms. If the bleeding continues, then seek medical help. The eye should take two to three days to heal completely.
Can styes be prevented?
Maintaining eyelid hygiene is the single best method to reduce the likelihood of styes. Clean eyelids at least twice per day, (in the morning and before bedtime), especially if you wear makeup or have blepharitis.
Avoid sharing washcloths, face towels, and cosmetics. Also, replace cosmetics every six months.
Proper handwashing goes a long way in preventing not only styes but also many other infections. It is like a “do it yourself vaccine” that cleanses pathogens that cause disease. Thorough handwashing is especially crucial for those handling contact lenses.
Use of flaxseed or fish oil helps in keeping oil flowing freely from the eyelid glands, so they don’t clog and become susceptible to bacterial infections.
Complications of an eye stye
Complications of eye styes are rare. The infection may spread to tissues around the eye, causing periorbital cellulitis. Periorbital cellulitis or preseptal cellulitis is an infection of the eyelid that surrounds the skin anterior to the septum. It differs from a stye in that it is larger and does not have clear margins. (6)
Another potential complication is deformity or disruption of growth of eyelashes due to scarring, after surgical intervention.