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Stye

A stye, also known as a hordeolum, is an acute bacterial infection of the eyelid margin1 that affects the eyelash roots and/or the glands located into the eyelid edges1.

Styes are among the most common eyelid lesions in clinical practice. They are not serious but may be rather painful until they heal2,3.

Styes are frequently confused with chalazia, which is also a lump on the eyelid but do not result from an infection4. More information on chalazia can be found in this fact sheet.

causes

What can cause a stye?

A stye is caused by bacteria, mainly staphylococcal1, which are normally present on the skin and are responsible for most skin infections.

stye

Styes are mostly external, involving the infection of an eyelash root and its associated oil glands (glands of Zeiss and Moll)1. Less frequently, styes may be internal, with the infected part being a Meibomian gland (another kind of oily gland)1.

Some risk factors favor the development of styes, such as1,5:

  • Hygiene issues: insufficient hygiene of contact lenses, insufficient hand hygiene, improper eye makeup removal, or using eye makeup that is old or contaminated, rubbing the eyes too often,
  • Local underlying conditions: chronic dry eye disease, blepharitis, inflammation or infection of the eyelids, rosacea, seborrheic dermatitis,
  • General illnesses such as diabetes or an immune deficiency, that encourages infection.

Some people are prone to repeated styes.

symptoms

What are the symptoms of a stye?

Styes are small abscesses: therefore, an external stye will present as a red lump at the base of an eyelash. A small pus spot can appear at the center of the bump4.

Internal styes are less obvious, and may appear as a mere red, swelling of the eyelid.

Stye is usually very painful, and in addition, there may be a feeling of something in the eye or itching or an oversensitivity to light4.  Vision should not be affected3.

The eye may be watery or there may be crustiness along the eyelids edge4.

A stye usually only affects 1 eye, but it’s possible to have more than one at a time and on both eyes3.

At times, the abscess bursts and, in external styes, a small amount of pus is visibly released from the lump, while in internal styes, pus exude on the inner surface of the eyelid, and may be unnoticed6.

diagnostic

How to diagnose a stye problem?

The diagnosis is based on history and clinical examination2, and no diagnostic tests are required or useful1.

treatment

What treatments are available for styes?

A stye is usually a self-limiting condition with spontaneous resolution occurring within 1 or 2 weeks11,2.

Both internal and external styes are treated similarly1. Warming and gentle cleansing of the affected eyelid are the best treatment. Warmth helps the stye to come to a head, rupture and spontaneously drain7.

Painkillers help reduce the pain.

Antibiotics applied directly to the eye are sometimes prescribed to treat styes, but they usually provide little or no help, as most styes tend to resolve by themselves. Sometimes, oral antibiotics are given if the infection is spreading in the surrounding tissues7.

For an external stye, centered around a lash follicle, the lash can be pulled to enhance drainage2, but this must be done only by a health professional with appropriate antiseptic measures to avoid infection spreading3. If the stye is large or if it is refractory to medical therapy, incision and drainage under local anesthesia, performed by an ophthalmologist, may be considered2.

A chalazion is also a lump on the eyelid, and sometimes very alike a stye, but a chalazion does not involve an infection.

A stye comes from an infection of an eyelash root or of a gland and is usually redder and much more painful than a chalazion, which is a painless swelling that grows slowly.
In most cases, yes, one can manage a stye without medical help, as styes usually resolve spontaneously.

To reduce the swelling and help the stye heal, you can use clean compresses soaked in warm water or a heating mask and hold them against the affected eye for 5 to 10 minutes, 2 to 4 times a day.

To relieve the pain, you can take over-the-counter painkillers.

You shall not try to burst a stye or remove an eyelash by yourself. This can spread the infection3, and if necessary, must be performed by healthcare professionals.

You shall avoid wearing contact lenses and eye make-up until the stye has burst and healed.
You should ask medical advice if the stye is very painful or very swollen, or if it does not get better within a few weeks, or if your vision is affected.
You shall first undergo an eye and general health check-up, to make sure that you do not have risk factors that would favor the styes, such as blepharitis, rosacea, diabetes…

Then, eyelid cleansing must be included in your daily routine: remove eyelid and face makeup thoroughly before bedtime, clean the eyelids with specific eyelid gentle scrubs or wipes.
As styes come from a bacterial infection, one could reckon that they are contagious.

But actually, they are not: the bacteria that are responsible for styes are normally present on the skin of all humans. Thus, the infection that induces the stye is promoted by local conditions that allow an excessive growth of these bacteria, such as inflammation caused by contact lenses, blepharitis or rubbing your eyelids.

In general, don’t hesitate to ask your pharmacist for advice if you have any eye symptoms.

On the other hand, if you experience one or more of these symptoms, you should see an eye specialist as a matter of urgency; -Moderate,-Severe pain, -Intense sensitivity to light, -Decreased vision, -Flashes of light, -Dark spots, -Sensation of a foreign object in the eye, -Trauma (injury, contusion, acid burn etc.), -Persisting or worsening symptoms despite appropriate treatment.

  1. Willmann D, Guier CP, Patel BC, et al. Hordeolum (Stye) [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459349/
  2. Ehrenhaus MP. Hordeolum. Medscape. https://emedicine.medscape.com/article/1213080-overview
  3. NHS – Stye – https://www.nhs.uk/conditions/stye/
  4. Difference Between a Stye and a Chalazion? Causes, Symptoms, Treatment. American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/what-are-chalazia-styes#chalazion
  5. American Optometric Association. Hordoleum. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/hordeolum?sso=y
  6. Baharestani S & Sweeney AR. Stye. Eyewiki, American Academy of Ophthalmology. https://eyewiki.aao.org/Stye
  7. Allen RC. Chalazion and stye (hordoleum). MSD Manual. https://www.msdmanuals.com/home/eye-disorders/eyelid-and-tearing-disorders/chalazion-and-stye-hordeolum
  8. Malka T. Isa stye contagiuous ? K Health. https://khealth.com/learn/stye/is-it-contagious/
  9. Lipner M. Verywell health. https://www.verywellhealth.com/are-eye-styes-contagious-5093169

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