Stye in Eyelid

Is stye Contagious?

"Is this Stye in eye contagious ?" This is a very common question we get asked.

A stye is definitely not contagious.

In other words, if someone with a stye looks at another it's not like this other person is going to get a stye.

Complications of styes

Most of the time a stye subsides and disappears. Sometimes this happens without any treatment. Most of the time however, treatment is necessary. About 20% of the time a stye turns into a chalazion. Chalazions usually have to be treated.

• The skin over the external stye can burst and blood and pus ooze out.
  • Even though this sounds terrible, the pain reduces instantly when this happens. The recovery process speeds up because now the ointment can be applied to the main infected area since all the pus has drained out. Similarly, internal styes can burst internally and lead to oozing out of pus and blood but this occurs internally and one will have to wash the eye or wipe off from the eye. Again this improves the condition almost instantly.
• Recurrent styes can lead to disruption of lash growth.
  • If it's only a single lash it may not be visible. However, when multiple adjacent eyelashes are affected this may be visible.
• Preseptal Cellulitis
  • The infection (Eyelid Cellulitis) of a stye can spread to regions surrounding it. In other words, the abscess can burst within the lid and infection spreads to other parts of the lid. When this happens the entire lid swells and becomes painful and tense. This is also known as preseptal cellulitis or periorbital cellulitis.
• Orbital cellulitis
  • If the preseptal cellulitis spreads further inwards we get a condition called orbital cellulitis. This is a very severe infection and a serious condition and may require hospital admission and IV antibiotics. Its like an orbital abscess and one may also need emergency surgery to drain the pus.

Stye Vs Chalazion

A stye is an acute infection. As mentioned earlier, it is a painful red bump and appears tense. This is because at this time it is like an abscess. There is an active infection in the stye.

However, because of body defences and also the stye treatments, the infection gradually dies down. As it dies down pain and swelling reduce. The skin also gets back its normal appearance.

Sometimes the swelling does not go completely. There is still a small or large lump present in the lid. This painless lump which is a sequela of a stye is called a chalazion.

Things to avoid when you have a stye

When one has a stye the following should be avoided

1. Eye makeup
2. Contact lenses
3. Trying to burst the swelling with a sharp object

Treatment of stye

Stye management includes

1. Hot fomentation - Warm Compresses
   • A clean washcloth is dipped in some warm water. This warm washcloth is then placed on the swelling. The idea is to increase the heat in that area which causes all the blood vessels to dilate. Dilated blood vessels carry more white blood cells to the area and help in fighting the bacterial infection. This is a mainstay of treatment and must be done a few times per day. 
   • Along with this one may take some warm water and mix a gentle soap in the water. Dip an ear bud in the water and gently clean the lid margins so reduce dirt and keep the area clean.
2. Stye eye ointment -
   • This is the second most important part of treatment. One needs to apply an antiobiotic eye ointment on the lid margin like one would apply eyeliner. Some of the antibiotic cream can go in the eye and some will go on the skin outside. That is fine. This should be done twice a day and if not then at least once a day.
3. Stye eye drops
   • When the infection is spreading then one may start antibiotic eye drops also. However, topical antibiotics would not be the first line of treatment.
4. If the stye is not too painful then we also advise a gentle massage on the lump to force the infected material out of the opening. The lesser the infected material the faster the stye will heal and lessen the chance of a chalazion forming.
5. Systemic Antibiotics
   • Sometimes when the stye is very big and it appears that the infection is spreading then one may have to start oral antibiotics to stop that spread. These tablets are taken after food once or twice a day depending on the antibiotic your eye doctor has prescribed.
6. Systemic NSAIDS -
   • These are anti-inflammatory and pain relievers. Sometimes the pain is unbearable and these tablets are required. These are taken as and when needed after food
7. Your eye doctor may pluck out the offending eyelash follicle to aid in the treatment of a stye.
8. No use of Eye Makeup while the stye persists
9. No usage of contact lenses while stye persists

Treatment of a chalazion

A chalazion is a painless lump in the eyelid. It is a sequela of a stye. Usually, a chalazion does not go away and needs to undergo surgical removal. While the chalazion does not cause any harm to the eye it is usually removed for cosmetic reasons.

It is removed by a procedure called incision and curettage. Here, after administering local anesthesia to the region, a small incision is made at the backside of the eyelid. Thus, there is no incision on the skin. The contents of the chalazion are scooped out. The incision is not sutured and the wound heals on its own.

Because of the anesthesia and the procedure some lid swelling persists for a few days.

After the surgery, the patient is asked to apply an antibiotic ointment and continue the hot water fomentation for a few days.

There is no cosmetic deformity after the procedure.

Sometimes steroid injections are given into the chalazion and surgery can be avoided. One must be very careful with this injection because sometimes the bolus of the steroid can stay in the eyelid and cause another set of issues.

Stye prevention

There is a condition called meibomitis. This is nothing but an infection of the meibomian glands. It occurs because of poor hygiene of the eyelid margins. Meibomitis is a precursor to a stye. It thus becomes important to treat meibomitis.

Treatment is somewhat similar to a stye treatment.

1. Hot fomentation - Hot compresses
2. Antibiotic eye ointment
3. Daily lid hygiene - Here one can take some baby shampoo and after mixing it with a little water use a cotton swab or an earbud to dip into the shampoo and clean the lid margin. This will remove the dirt on the lid margin and open up the blocked pores.
4. Eyelight therapy - This is a form of heat therapy which opens up the meibomian glands. One may require a few sittings based on the severity of meibomitis.

Even though we may stop the ointment usage after 1-2 weeks it is important that one continues the hot fomentation for longer periods of time to prevent styes from recurring.

Recurrent styes

Some patients come in with recurrent styes. Usually, these are recurring styes and there is nothing more to them. One should do warm compresses every day so that the styes reduce overall. One may even get multiple styes in a row. Sometimes, however, these are not styes and may point to something more sinister. If a stye is recurring at the same location your eye doctor may suggest a biopsy of the area. This biopsy is suggested because your eye doctor may suspect a malignant eyelid condition. Of course, more often these are benign eyelid lesions but it is important to confirm the diagnosis with a biopsy.

Why is it important to make sure you don't have a stye before cataract surgery?

Cataract surgery is the commonest eye surgery performed worldwide. One of the most dreaded complications of cataract surgery is an eye infection. It's important to rule out styes or chalazion or meibomitis before performing cataract surgery for this very reason. Today, cataract surgery is performed by inserting a lens or an IOL in the eye. If these precautions are taken before surgery cataract surgery remains a very safe procedure to undergo.