Stye

A stye is a bump that forms on or in the eyelid as a result of a blocked gland. The word "stye" can also be spelled “sty.” There are two distinct types of sties: hordeolum and chalazion. Each has different causes and treatments.

A hordeolum is a blockage of one of the sweat glands found in the skin of the eyelid and the base of the eyelashes, or one of the small sebaceous glands found at the base of the eyelashes. Sebaceous glands secrete sebum, a waxy, oily material.

A chalazion is a blockage of a Meibomian gland, which is a special sebaceous gland unique to the eyelids. These glands form a single row in each lid, with the body of the gland located inside the eyelid, and the opening located at the rim of the lid, posterior to the lashes. 

They secrete an oily material onto the surface of the eye, preventing the water layer of tears from evaporating too rapidly from the eye's surface between blinks. Therefore, poorly functioning Meibomian glands can lead to dry eye symptoms.

A stye may not be very large, but it can be very painful, and nowadays, no one would want that unwanted addition to appear on their face and spoil their looks. But one should be aware that a stye is quite common, even though it may not be pleasant. A stye is very rarely linked with any other medical condition and it generally goes away within a week or two, but some people are not patient enough to wait for it to go away naturally. 

The first sign of a stye is a small, yellowish spot at the center of a bump that develops as pus expands in the area. A stye can occur inside the eyelid or around the eye. In some cases, it can occur near the edge of the eyelid and can be confused with a boil or a small pimple. Some people can have multiple sties at the same time, while others have only one at a time.

Other stye symptoms may include:

• A lump on the top or bottom eyelid that appears red in color
• Localized swelling of the eyelid
• Localized pain
• Redness
• Tenderness
• Crusting of the eyelid margins
• Burning in the eye
• Droopiness of the eyelid
• Scratchy sensation on the eyeball (itching)
• Blurred vision
• Mucous discharge in the eye
• Irritation of the eye
• Light sensitivity
• Tearing
• Discomfort during blinking

A stye is not contagious since it is an inflammation, which does not pass from person to person. 

A stye is usually caused by an infection from staphylococcus bacteria. These bacteria often live on the skin without causing any harm.

An external stye (on the outside of the eyelid) may be caused by one of the following:

• An infection of an eyelash follicle (a small hole in the skin that an individual eyelash grows out of)
• An infection of the sebaceous (Zeis) gland: This gland is attached to the eyelash follicle and produces an oily substance called sebum, which lubricates the eyelash to prevent it from drying out.
• An infection of the apocrine (Moll) gland: This sweat gland empties into the eyelash follicle; the fluid joins the tear film that covers the eye and prevents the eye from drying out.

An internal stye is caused by an infection of the Meibomian gland. These glands are found on the eyelids and produce an oily liquid, which makes up part of the tear film that covers the eye.

Blepharitis

A stye can sometimes be a complication of another condition called blepharitis. Blepharitis causes the rims of the eyelids to become inflamed (red and swollen). This can result in symptoms such as:

• Burning or sore eyes
• Crusty eyelashes
• Itchy eyelids

Blepharitis can be caused by a bacterial infection, or it can be a complication of a skin condition, such as rosacea (a long-term condition that causes spots and redness on the face).

If you have chronic (long-term) blepharitis, you may be at an increased risk of developing sties.

Diagnosis of a stye is made on the basis of:

• An ophthalmologist will ask questions about whether one has had any injury or previous eye problems or surgeries. Frequently, a history of similar symptoms is useful, so be sure to tell the ophthalmologist if you have previously experienced them. One's eyelid and facial hygienic habits, along with any cosmetic usage, are also useful information.

• The eyes and eyelids will be examined, including the underside of the eyelid. An ophthalmologist may use a slit lamp (a microscope-like device with a powerful light) to examine the eye.
• X-rays and blood work are not usually useful, unless an ophthalmologist is concerned an infection may have spread from the eyelid to the eye socket. In this case, a CT scan of the eye socket may be required.

Treatment methods for sties vary depending on the type. A non-infected hordeolum will resolve on its own. Warm compresses may help soften the material in the gland, easing the drainage of the gland's contents. Squeezing or cutting the hordeolum can cause the skin to scar.

Similarly, a non-infected chalazion will resolve on its own, though over a much longer period of time. A small chalazion may resolve within weeks, while larger ones may resolve over the course of a year.

The most conservative treatment is an application of frequent warm compresses. Steroids can be injected into the lesion, often resulting in a speedier resolution. However, this carries a small risk of bleeding/bruising, depigmentation/thinning of the skin, scarring, pain, and, in very rare cases, loss of vision.

Finally, the chalazion can be incised and drained. This is the most invasive method and is reserved as a last resort by most eye doctors. The eyelid is anesthetized, and a clamp is placed around the chalazion. The eyelid is everted, and the Meibomian gland is incised from the back surface of the eyelid, avoiding cutting the skin on the front surface. 

The waxy sebum is “scooped” out of the gland with a special curette. This “debulking” of the gland's contents may be sufficient to shrink the chalazion; however, there is a risk that the chalazion may recur, particularly if the underlying cause is not addressed.

If either type of stye appears infected, oral antibiotics may be necessary. This is particularly important if the infection is spreading along the skin (cellulitis) or spreading into the orbit (orbital cellulitis). Orbital cellulitis is considered an emergency, as a rapidly spreading infection can threaten a person's vision and even their life, and may require intravenous antibiotics.

In some situations, the infection spreads to the eye itself. Depending on what the eye doctor finds from a careful slit lamp examination of the eye, topical antibiotics (drops or ointment) might be sufficient.

One can also try ointments available over the counter. To use these ointments, one should pull open the lid of the affected eye and apply around a small quarter-inch of ointment inside the eyelid. One should not use topical steroids for the stye, since they may cause certain side effects. Also, check the label of the ointment, since it should be used exclusively for the eye rather than as a general ointment. There is some evidence that antibiotic eye drops work best for external sties.

Treating the underlying cause of the stye is also important to prevent recurrence.

Good hand and facial washing may prevent sties from forming or coming back.

Upon awakening, application of a warm washcloth to the eyelids for one to two minutes may be beneficial in decreasing the occurrence of sties by liquefying the contents of the oil glands of the eyelid, thereby preventing blockage. 

This can also be performed at bedtime on a nightly basis.

All cosmetics and cosmetic tools should be kept clean and protected from the environment. Do not share makeup or eye cosmetic tools, such as eyelash curlers. 

Makeup should be thrown away when it becomes old or contaminated.

Some studies suggest oral flaxseed supplementation may help prevent the occurrence of sties.

The homeopathic remedies suggested for a stye include:

• Tea bags
• Raspberry leaf
• Goldenseal
• Chamomile
• Eyebright
• Echinacea

Most sties go away on their own in five to seven days. Other recommendations for sties include:

• Apply warm compresses four to six times a day for about fifteen minutes at a time to help the drainage. Keep the eyes closed when applying the warm compresses.
• Gently scrub the eyelid with tap water or with a mild, nonirritating soap or shampoo (such as baby shampoo). This may help with drainage. Close the eyes as you scrub so you do not injure them.
• Do not squeeze or puncture the stye; a more serious infection may occur as a result.
• Discontinue the use of eye makeup as well as eye lotions and creams, as they may be contaminated with the bacteria from the infection.
• Stop wearing contact lenses while a stye is present, because the infection may spread to the cornea with the continued use of contact lenses.

Below is a detailed description of some of the home remedies one can use to get rid of sties in a natural way:

• Warm compresses: If left alone, a stye will go away on its own. But if you do not want to see that small boil on your face and instead want a quick healing process, you can try warm compresses. To do so, first, take a clean piece of washcloth and wet it in warm water. Drain out the water from the cloth or wring it so there is no water dripping, then place it on your eye with the stye. This process can be done several times a day for about fifteen minutes each time. While carrying out the warm compress session, one can re-wet the cloth so that the warmth is maintained. One should ensure the temperature of the water is always checked, as hot water should not be used since it can lead to burns on the skin. Using warm compresses encourages drainage and at the same time speeds up the healing process.
• Taking care of the eyelid: It is very important to take proper care of the eyelids. This should be done to treat as well as prevent the prevalence of sties, since bacteria leads to their occurrence. It is always recommended to gently wash your eyelid with warm water and mild soap or a cleanser. If your hands are not clean, avoid rubbing your eyes. Some studies recommend the use of coriander liquid to cleanse the eye. Note that the coriander liquid should be cool, not hot. Coriander is very helpful in healing sties, since it has antibacterial properties.
• Skip the use of makeup and contact lenses: While one is patiently waiting for the stye to go away, it is best to avoid the use of makeup and wearing contact lenses until the stye is completely healed. Instead, one can wear glasses until the infection is gone entirely. Contact lenses are known to get contaminated with bacteria that cause sties, so the lenses can worsen the existing condition. Hence, once the stye is healed completely, it is best to wear a new pair of contact lenses rather than using the old ones, since it can bring back the infection. Replacing makeup is also advisable, especially mascara. This should be done after six months or less, since there are chances of bacteria growing in the makeup, leading to contamination. As a rule of thumb, one should go to bed without makeup on the face for the sake of optimal health. Hence, makeup on the face and eyes should be completely removed with the help of a cotton swab.
• Provide some cooling effect: If you have a stye, applying something cool and refreshing on the eyelids can make it less troublesome by reducing the inflammation to a certain extent. To provide the perfect cooling effect, one can place slices of cool cucumber on the eyelids. Doing so will help reduce the inflammation and irritation caused by the stye. Keep the cucumber in the refrigerator for some time, then remove it and cut a few slices and place them on the problem area for about ten minutes. If one does not have a cucumber handy, potatoes can also work well.
• Green or black tea: Similar to using warm compresses, one can also use warm tea bags, to be placed on the stye for early recovery. Mostly, a black tea bag is recommended, since black tea is excellent in reducing inflammation. It is also comprised of natural antibacterial properties. If not a black tea bag, then a green tea bag would also work well. So, perhaps now you won’t tend to throw away that tea bag in the morning; rather, it can be placed on the stye after its use. Note that the tea bag should not be hot, or else it could worsen the condition. Also, the tea bag should not be dripping with water, only slightly moist. You can leave the tea bag over the affected eye for about five to ten minutes. Once done, do not store the tea bag for reuse again; it should be thrown away.

There are several complications associated with a stye. The most frequent complication of hordeolum is progression to a chalazion that causes cosmetic deformity, corneal irritation, or the need for surgical removal.

Complications from improper drainage are disruption of lash growth, lid deformity, or lid fistula.

Generalized eyelid cellulitis may develop if an internal hordeolum is untreated.

Precautions

Visit the doctor if you experience any of the below:

• The stye does not show signs of improvement even after a couple of days
• The stye condition worsens after waiting a few days
• There is severe pain in the eye instead of only the eyelid
• The eye condition has worsened, has turned red in color with swelling, such that it is difficult to open the eyes
• Apart from the stye, if you have trouble with your vision
• The swelling and redness has extended beyond the eye to the cheeks and other parts of the face
• One experiences common occurrences of sties, since they can be linked to other medical conditions, such as cellulites, conjunctivitis, or blepharitis

Prognosis

The swelling in the stye usually lasts for no more than three to four days. Eventually, after a few days, the stye will break open and drain the fluid. The healing of the stye will take another seven to ten days with the help of simple home remedies. Sties are not considered very serious, but, yes, they tend to be pretty irritating.