Stye

Stye (Hordeolum)

Definition
A stye is a localized, acute infection or inflammation of the eyelid margin, usually involving the sebaceous glands (Zeis or meibomian) or sweat glands (Moll), leading to a tender, red swelling. It may be external or internal depending on the gland affected.

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Types

• External hordeolum: Infection of glands of Zeis or Moll at the base of an eyelash, appearing on the outer eyelid margin

• Internal hordeolum: Infection of the meibomian gland, deeper within the eyelid, presenting on the inner eyelid surface

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Causes

• Bacterial: Usually Staphylococcus aureus

• Poor eyelid hygiene

• Blepharitis (chronic eyelid inflammation)

• Using contaminated cosmetics or contact lenses

• Hormonal changes and stress (predispose to recurrence)

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Risk Factors

• Chronic blepharitis

• Diabetes mellitus

• Seborrhoeic dermatitis

• Rosacea

• Immunosuppression

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Pathophysiology
Blockage and infection of eyelid gland ducts lead to inflammation, pus formation, and localized swelling.

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Clinical Features

• Sudden onset of painful, red swelling on eyelid margin

• Tenderness to touch

• Localized pustule (external type) or diffuse swelling (internal type)

• Sometimes associated with tearing, light sensitivity, or foreign body sensation

• May discharge pus spontaneously and resolve within days

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Diagnosis

• Clinical diagnosis based on history and examination

• No routine investigations needed unless recurrent or atypical presentation

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Treatment

Self-care Measures

• Warm compresses for 5–10 minutes, 3–4 times daily to promote drainage

• Lid hygiene (gentle cleansing with diluted baby shampoo or commercial lid wipes)

• Avoid squeezing the stye

• Avoid eye makeup and contact lenses until resolved

Medications

• Topical antibiotic ointments (e.g., chloramphenicol 1%) applied to eyelid margin 2–4 times daily if there is secondary bacterial spread or associated blepharoconjunctivitis

• Oral antibiotics (e.g., flucloxacillin 250–500 mg orally four times daily for 5–7 days) for multiple or severe lesions, cellulitis, or recurrent cases

• Analgesics (e.g., paracetamol 500–1000 mg every 4–6 hours as needed; maximum 4 g/day) for pain relief

Procedural Management

• Incision and drainage by an ophthalmologist if large, persistent, or associated with abscess formation

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Complications

• Preseptal cellulitis

• Chalazion (chronic, non-infectious granulomatous lesion)

• Recurrent styes if underlying blepharitis not addressed

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Quick-Reference Clinical Chart — Stye (Hordeolum)

Feature	Details
Definition	Acute infection of eyelid glands causing red, painful swelling
Causes	S. aureus infection, poor hygiene, blepharitis
Symptoms	Pain, redness, swelling, localized pustule, tenderness
Risk factors	Blepharitis, diabetes, dermatitis, rosacea, poor immunity
First-line treatment	Warm compress 5–10 min, 3–4× daily; lid hygiene
Drug therapy (adult dose)	Chloramphenicol 1% ointment 2–4× daily; Flucloxacillin 250–500 mg PO QID × 5–7 days if severe
Adjuncts	Analgesics (Paracetamol 500–1000 mg Q4–6h PRN)
Surgery	Incision and drainage if persistent
Prognosis	Usually resolves within 1–2 weeks with conservative measures