Internal and External Hordeolum
Definition of a Stye
A stye is the common name for a hordeolum. A stye is an infection (abcess/boil) of one of the tiny oil producing glands inside the eyelid usually caused by staphylococcus aureus bacteria. There are two types of styes, officially called internal hordeolum and external hordeolum.
An internal hordeolum (stye) is a bacterial infection of the meibomian glands inside the eyelids. Internal styes tend to be more severe and occur a little less often than an external hordeolum.
An external hordeolum (stye) is a bacterial infection of the Glands of Zeis and/or Glands of Moll inside the eyelids. This type of stye is more superficial and tends to heal quicker.
A stye can occur on either the upper or lower eyelid.
Causes of a Stye
A stye is usually caused by staphylococcus aureus bacteria which infect the internal sebaceous glands within the eyelids. Styes are common in infants and children but affect people of all ages.
If the pores of the oil glands become blocked by debris or otherwise they tend to develop an infection. The bacteria multiply in the root (follicle) of an eyelash.
A stye may be related to blepharitis, which should be treated regularly to avoid styes.
Possible Signs and Symptoms of a Stye
- A circumscribed defined lump or bump on either upper or lower eyelid
- Localized swelling of the eyelid
- Mild pain in the eyelid and sensitive to touch
- Redness of the affected eyelid
- Possible crusting of the eyelid margins
- Possible burning in the eye
- Eyelid appears droopy
- Mucous or watery discharge in the eye
- Irritation of the eye
- Light sensitivity
- Sensation of a foreign object in the eye
Internal Hordeolum (Stye) tends to come to a point on the underside of the eyelid and has an appearance of general redness on the outside visible part of the eyelid.
An external hordeolum (Stye) comes to a visible point on the outside visible part of the eyelid and may appear yellowish in the center of the swelling which indicates pus formation from the infection.
Treatment of a Stye
Most styes can be treated without medical intervention by applying hot compresses for 10-15 minutes at a time for four times per day. There is some controversy that a warm compress may worsen the swelling and shouldn’t be used for several days. However, the purpose of the warm compress is not to decrease swelling, but rather to open the pores of the tiny oil glands to allow proper drainage so the eye can heal itself. Therefore, we only recommend warm/hot compresses.
Removing an eyelash or two in the center of the bump may help to stimulate drainage of the infection.
Clean the eyelid margin and the entire eyelid with an over the counter eyelid scrub (e.g. SteriLid Eyelid Cleanser or Ocusoft eyelid scrubs) that can be purchased at any pharmacy.
Most styes will heal within 10-14 days.
If the stye does not get better within 3-5 days treatment by an eye doctor is recommended. The doctor may prescribe oral antibiotics such as:
Keflex (cephalexin) 500mg twice per day for seven days for patients who are not allergic to penicillin or cephalosporins.
Option (also if no penicillin allergy) Augmentin (Amoxicillin + Clavulanic acid):
Dose if mild infection -generic Augmentin 500 mg. twice a day for one week
Dose if more severe –generic 875mg Augmentin twice a day for one week
Most severe - 1000mg Augmentin twice a day for one week (not generic)
When the patient has a penicillin or cephalosporin allergy:
Zithromax (azithromycin) in a Z-pak (500mg on day one, followed by 250mg for the next four days) is a good alternative.
OR, if the patient also has allergies to macrolides, we recommend:
Oral fluoroquinolone Levaquin (levofloxacin) at 500mg once daily for 7 days.
Or Cipro (ciprofloxacin) 500-1000 mg once daily for 7 days
Topical eye medicines in most cases offer very little healing since they do not penetrate into the glands. There is some evidence that topical Azithromycin (Azasite) has some penetrating ability. However, it is an expensive medicine and most patients are not happy if it doesn’t heal the hordeolum. The tested and proven treatment would be to use an oral antibiotic, many of which are available generically at a greatly reduced cost.
Complications of a Stye
Use of the above medicines on a timely basis will also prevent an eyelid cellulitis or preseptal cellulitis which is a serious complication of a hordeolum.
If the above medicines are not effective at treating the hordeolum it has probably become a chalazion. Chalazion may resolve without treatment but many require a minor surgery to remove.
Prognosis of Styes
Although styes are usually harmless and complications are rare, styes often recur. Styes normally heal using the treatment described above with no vision complications.
Preventing a stye is primarily a function of improved hygiene around the eyelid area. Regular use of eyelid scrubs (e.g. SteriLid Eyelid Cleanser or Ocusoft Lid Scrubs) will greatly reduce the incidence of stye formation.
There is some evidence that flaxseed oil or fish oil may assist in keeping the oil flowing freely from the glands in the eyelids so they don’t become clogged and susceptible to bacterial infection.
Women should never share cosmetics with others. Women should remove makeup every night before going to sleep and discard old or contaminated eye makeup.