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Stye in Eyelid

Oculoplasty eye conditions

Introduction

A stye is a painful, reddish bump of the edge of the eyelid. It is similar to an acne pimple and forms when the oil glands near the eyelashes get blocked and infected. Styes are quite a common condition and most of the time can be managed at home. Sometimes, however, the infection in the stye subsides but the bump remains. This painless bump is known as a chalazion and may need a small procedure at a doctor's clinic to remove it.

What is stye in Hindi 

We see quite a few patients with a stye and it does appear that when we connect their eye condition to a word they have already heard they understand better.  Its called Aanjani in Hindi and is also referred to by the same name in Gujarati.

Types of styes

Each eyelid margin has a row of eyelashes.  The eyelashes arise from a hair follicle.  Just behind the row of eyelashes are tiny openings of meibomian glands.  These meibomian glands are like oil glands or sebaceous glands.  These meibomian glands are located in the Tarsal plate in the eyelid.  The oil secretion from these glands spreads over the tear fluid on the front surface of the eye and prevents evaporation and dryness.

  • External Stye: If the hair follicle gets infected then we get what is known as an external hordeolum. 
  • Internal Stye: If a meibomian gland gets infected then it is known as an internal hordeolum.  

There may be minor differences in the way they appear.  One is more superficial while one is situated a little deeper within the lid.  However, from a patient's point of view, they are both painful bumps in the eyelid.

Stye Causes

Stye in eyelids is caused because of the openings of these oil glands and hair follicles getting blocked.  This blockage can happen because of

  • Dirt on the eyelid
  • Makeup on the eyelid.
  • Poor lid hygiene. 
  • They are caused by organisms found on the skin but the most common bacteria are the staphylococci bacteria.

Location of stye

A stye occurs due to an infection of the

  • hair follicle or
  • meibomian glands of the eyelids. 

The stye could thus be located on either the upper or the lower eyelid and anywhere on it.  Some of our patients say that their swelling is in the corner of the eyelid and thus should not be a stye.  That is not true and a stye can occur anywhere on the eyelid.

Stye Symptoms

The first and most troublesome symptom is pain.  The pain usually starts before the lump is visible.  However many patients notice a yellow dot.  This is the opening of the infected area on the skin.  

Here are some common symptoms

  1. Pain
  2. The appearance of a yellowish spot or white spot on the lid margin
  3. Swelling
  4. Redness or congestion of the skin over and around the swelling
  5. Swelling of the entire eyelid
  6. Discharge coming out of the opening
  7. Skin showing a yellowish area that looks like it's about to burst

 

Stages of chalazion or stye

A chalazion or a stye goes though stages as shown in the pictures below. It starts of as a small swelling which gradually increases. Pain and tenderness also increase as the eyelid swelling increases. It may resolve on its own as in the patient below or may need a small surgery to remove. 
Stye stages
Lid swelling with small pointing opening of stye
Stye stages
Lid swelling increased
Stye stages
Lid swelling further increased along with some bleeding
Stye Stages
Reduction in lid welling and patient feeling better
Stye Stages
Further reduction in lid swelling
Stye Stages
Lid swelling almost gone and patient feeling great

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 a stye

Most of the time a stye subsides and disappears.  Sometimes this happens without any treatment and happens on its own.  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 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 serious condition and may require hospital admission and IV antibiotics. 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

Stye Eye Treatment

Stye management includes

  1. Hot fomentation
    • 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 infection.  This is a mainstay of treatment and must be done a few times a day.  
  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 an eyeliner.  Some of the antibiotic ointment 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 be removed.

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 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
  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 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 it.  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 chalazions 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.

Frequently Asked Questions ?

How much time does this procedure take ?
The stye removal takes about 10-15 minutes. Your total time spent at the hospital could be anywhere between 30 – 45 minutes. As mentioned, the eye is patched after the procedure and you can leave immediately once the procedure is completed.
What is the post surgery care after removal of the stye ?
The eye is patched after the procedure. We instruct our patients to remove the patch 4-5 hours later and start ointments and eye drops. Sometimes we also prescribe certain tablets which help in faster healing.

Usually the swelling completely disappears in a week.
What is the cost of removal of stye ?
The removal of the stye is one in an operation theater. Even though the procedure is small and takes 10-15 minutes we have to use OT time for this procedure.

At Eye Solutions we charge Rs 15000 for this procedure.
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