Introduction Signs and symptoms Causes Treatment Precautions Introduction to Styes :STYE or hordeolum usually is a small swelling on the

outer or inner side of the eyelid. Stye develops from eyelid oil gland or eyelash follicle, excess of oil, bacteria, debris, it is also brought on by stress, but it can also be of another condition called blepahritis. Stye is a small swelling on internal or external side of upper or lower eyelid site. Stye appearance at first sight may be unsightly but it is usually harmless. External stye is an infection of sebaceous gland of zeis . At the base of the eyelashes infection is of the porcine sweat gland. External stye can be seen on the out side of the lid like small red swelling, like pimple. Internal stye is infection of the meibomian sebaceous gland lining in side of the eyelid, also causes red swelling, only redness and swelling under the lid.

Stye
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 eyelidTypes of Eye Styes

External Hordeolum It refers to the stye condition that develops at the base of eyelashes. External Hordeolum is mainly around a hair follicle of the eyelids. Internal Hordeolum It refers to the stye condition that develops as a result of blocked oil glands in the eyelid

Stye Causes
A Stye is the condition in which eyes become infected. The medical name of Stye is hordeolum. In this a boil is seen on the corner or inside of the eyelashes or eyes. It is caused by an infection in the oil producing glands located at the base of eyelashes by the bacteria called staphylococcus. Seborrhea, excess oily discharge from the glands, may lead to stye. This bacterium can easily be found in the nasal passage and easily reach the eyes. This can reach by rubbing the nose and then touching the eye area. The glands which are at the end of the eyelid get infected. It can also occur due to hair follicle at the base of an eyelash. It can also occur due to a complication of blephartis. Blephartis is the medical term for inflammation of the eyelids. It is an inflammation which causes red, irritated, itchy eyelids. It is a very common disorder which may lead to sty. There are many factors which may lead to the infection People use make up but at times they do not remember to remove the make up completely or properly. It is very essential to remove the eye make up properly. At times one may use outdated cosmetics. Poor eye hygiene can also add on to the infection. So one should take care of the eyes properly. Too much of stress can also lead to sty Hormonal changes at times can also be a reason for sty. These causes lead to the eye infection called sty. It is very painful. But by taking proper care we can prevent stye infection. It spreads from one person to the other. Taking preventive measures to stop stye is the best thing because prevention is better than cure.

Complications of Sty
Complications of a sty are rare.

 The infection may spread to other eyelash follicles, leading to multiple styes. A chalazion (a form of scarring of the glands in the eyelid that may include the formation of
cysts) is the most common complication that develops from a sty. they may cause a cosmetic problem.

Chalazia can be large enough to deform the cornea of the eye and interfere with vision, and Other potential complications include a generalized infection (cellulitis) of the eyelid, and
improper drainage of a sty may lead to deformity or disruption of eyelash growth. and only a few instances of such spread have been recorded.

Progression of a sty to a systemic infection (spreading throughout the body) is extremely rare,

PathophysiologyOne of 3 glands is typically acutely infected by the staphylococcal

species in a hordeolum. Meibomian glands secrete sebum, which helps prevent evaporation of the tear film on the eye; when acutely infected, the hordeolum is in appearance due to its deeper position within the tarsal plate. Zeis and Moll glands (ciliary glands) are generally smaller and more superficial and, when infected, give rise to pain and swelling at the root of the eyelash. These hordeola are termed external and are responsible for the classic appearance of a stye.

Chalazia arise when sebum from meibomian glands is released into the tarsal plate, causing a localised inflammatory reaction. This may occur secondary to mechanical obstruction from a hordeolum or from dysfunction of the meibomian gland with subsequent stasis and release of sebum. As such, chalazia represent a more chronic, non-infectious inflammatory reaction. [1] [2] [3] [4] One of 3 glands is typically acutely infected by the staphylococcal species in a hordeolum. Meibomian glands secrete sebum, which helps prevent evaporation of the tear film on the eye; when acutely infected, the hordeolum is termed internal, and is generally less circumscribed in appearance due to its deeper position within the tarsal plate. Zeis and Moll glands (ciliary glands) are generally smaller and more superficial and, when infected, give rise to pain and swelling at the root of the eyelash. These hordeola are termed external and are responsible for the classic appearance of a stye. Chalazia arise when sebum from meibomian glands is released into the tarsal plate, causing a localised inflammatory reaction. This may occur secondary to mechanical obstruction from a hordeolum or from dysfunction of the meibomian gland with subsequent stasis and release of sebum. As such, chalazia represent a more chronic, non-infectious inflammatory reaction. [1] [2] [3] [4] One of 3 glands is typically acutely infected by the staphylococcal species in a hordeolum. Meibomian glands secrete sebum, which helps prevent evaporation of the tear film on the eye; when acutely infected, the hordeolum is termed internal, and is generally less circumscribed in appearance due to its deeper position within the tarsal plate. Zeis and Moll glands (ciliary glands) are generally smaller and more superficial and, when infected, give rise to pain and swelling at

the root of the eyelash. These hordeola are termed external and are responsible for the classic appearance of a stye. Chalazia arise when sebum from meibomian glands is released into the tarsal plate, causing a localised inflammatory reaction. This may occur secondary to mechanical obstruction from a hordeolum or from dysfunction of the meibomian gland with subsequent stasis and release of sebum. As such, chalazia represent a more chronic, non-infectious inflammatory reaction. [1] [2] [3] [4] One of 3 glands is typically acutely infected by the staphylococcal species in a hordeolum. Meibomian glands secrete sebum, which helps prevent evaporation of the tear film on the eye; when acutely infected, the hordeolum is termed internal, and is generally less circumscribed in appearance due to its deeper position within the tarsal plate. Zeis and Moll glands (ciliary glands) are generally smaller and more superficial and, when infected, give rise to pain and swelling at the root of the eyelash. These hordeola are termed external and are responsible for the classic appearance of a stye. Chalazia arise when sebum from meibomian glands is released into the tarsal plate, causing a localised inflammatory reaction. This may occur secondary to mechanical obstruction from a hordeolum or from dysfunction of the meibomian gland with subsequent stasis and release of sebum. As such, chalazia represent a more chronic, non-infectious inflammatory reaction. [1] [2] [3] [4] 1. Management 1. Warm compresses to eye for 15 minutes qid 1. Increases blood supply to area 2. Increases spontaneous discharge 2. Daily cleansing of eyelids 3. Antibiotic ointment to eyelid margin 1. Erythromycin 2. Avoid prolonged use in age under 12 years 1. Blurred vision (Amblyopia risk) 4. Incision, Drainage and Curettage 1. Indications 1. Single gland involvement 2. Failed improvement after 48 hours 2. In-office procedure under local anesthetic 1. May be performed by non-ophthalmologist

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

. Diagnosing Stye

The diagnosis of a stye is based on the location and appearance of the eyelid. Your doctor may also test the fluid in the eye to establish what type of bacteria is present. A chalazion or cyst may be mistaken for a stye.

Eye Stye Home Remedies

As mentioned above, an eye stye will usually take care of itself. Sooner or later, it will rupture and give you an immediate relief from painful symptoms if any at all. As far as self-care of eye stye is concerned, you have to consider certain hygiene issues only. Read on to learn about some popular home remedies to treat eye stye. 1. Applying a hot compress for at least ten minutes can be very helpful. You should repeat this process at least three-four times on a daily basis. It will help you to reduce the pain to a great degree. Within a few days, eye stye will be resolved. Rupture of the eye stye happens a lot earlier due to repeated hot compress, thereby giving you quick relief. 2. Some people prefer to use warm tea bags to deal with eye stye problems. Dip a tea bag in a cup of warm water and place it on top of the stye. Leave the warm tea bag on top of the stye for a few minutes. You will notice that the size of stye begins to reduce drastically when you repeat this procedure. Tea bag has tannic acid inside it. It is due to

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this acid that eye stye shrinks in size. The size of an eye stye may reduce to half of even more than that. You can also use clove spices to deal with eye styes problem. Rub some clove spice in water at first. Now, apply them on top of the eye stye. It can give you an immediate pain relief. Some people prefer to use herbal remedies to deal with an eye stye problem. For example, you can place the pulpy side of a slit aloe leaf on top of the eye stye. Aloe leafs paste is known to have superb healing properties. Take a cup of clean water and add one tablespoon of coriander seeds to it. Boil this mixture. This mixture is a superb eyewash solution. Rinse your eyes at least three-four times a day with this homemade eyewash solution. Alum aid is a very famous home remedy for treating eye stye. You just need to dissolve two-three pieces of alum in a cup of water and use this mixture as eyewash. Rinse your eyes with the mixture few times a day to see quick results. Acacia leaves are also known to cause a healing action. You can prepare a concentrated extract of these leaves. Boil some leaves with a little water. This extract can be used as a compress for the eyelids affected by eye stye.

8. Drainage of a hordeolum
1. Perform drainage with stab incisions at the site of pointing using an 18-gauge needle or a #11 blade. External incisions lead to scarring, so making external eyelid incisions or punctures is inadvisable, unless the hordeolum already is pointing externally. 2. A large abscess may have multiple pockets and require multiple stabs. 3. Internal incisions should be made vertically to minimize the area of cornea swept by a scar during blinking; external incisions should be made horizontally for optimal cosmesis. 4. Hold the lesion with a chalazion clamp. 5. To avoid disrupting normal growth of lashes, do not make incisions along eyelash margins. 6. Leave the incision open with a clean margin. 7. When draining a lesion that points both externally and internally, make the incision internally and as far as possible from the site of external pointing. Combined overlying internal and external drainage increases the risk of later fistulae through the lid. 8. Do not inject local anesthesia directly into the hordeolum; inject along the lid margins in a line above the upper tarsus or below the lower tarsus. 9. Do not attempt to remove all seemingly purulent material if acute inflammation is present; excessive loss of tarsal tissue and lid deformity may result. 9. Hordeola usually are self-limited even without drainage. Most hordeola eventually point and drain by themselves. 10. Warm soaks (qid for 15 min) are the mainstays of treatment. 11. Antibiotics are indicated only when inflammation has spread beyond the immediate area of the hordeolum.

1. Topical antibiotics may be used for recurrent lesions and for those that are actively draining. Topical antibiotics do not improve the healing of surgically drained lesions.[1] 2. Systemic antibiotics are indicated if signs of bacteremia are present or if the patient has tender preauricular lymph nodes. 12. Surgical drainage of pointed lesions speeds the healing process. 1. If the lesion points at a lash follicle, removal of that one eyelash hair may promote drainage and healing. 2. Exercise caution when removing a lash, because removal of multiple lashes may result in disfigurement.

13.

Treatment
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14. 15. 16. Stye on lower part of a person's eye 17. As a part of self-care at home, patients may cleanse the affected eyelid with tap water or with a mild, nonirritating soap or shampoo (such as baby shampoo) to help clean crusted discharge. Cleansing must be done gently and while the eyes are closed to prevent eye injuries.[11] 18. Patients are highly advised to not lance the stye, as serious infection can occur as a result. The infection could spread to the surrounding tissues and areas. 19. Eye stye sufferers should avoid eye makeup (e.g., eyeliner), lotions and wearing contact lenses, since these can aggravate and spread the infection (sometimes to the cornea). 20. Medical treatment can also be provided by a doctor and it is aimed on relieving the symptoms. Pain relievers such as acetaminophen may be prescribed and in some cases, antibiotics may be needed. Antibiotics are normally given to patients with multiple styes or with styes that do not seem to heal, and to patients who also suffer from blepharitis or rosacea. Commonly, the ophthalmologist prescribes oral or intravenous antibiotics, such as doxycycline, only when the infection has spread. Topical antibiotic ointments or antibiotic/steroid combination ointments can also be administered in stye treatment. 21. Alternative treatment: Use warm green tea bags over the affected eye. Pour hot water over green tea bags. Let cool down for five minutes, but make sure water is still hot or warm and place over the eye. When the tea bag becomes cool, dip in the hot water again

and repeat the procedure until the water becomes cool. This method has been shown to reduce or even get rid of styes within 24 hours. Green tea has antinflammatory and antioxidant properties that reduces symptoms associated with the infection. Warm compresses alone may help, but the green tea bag method offers greater fighting power against the infection. This is best done when first signs and symptoms of styes appear. 22. Surgery is the last resort in stye treatment. Styes that do not respond to any type of therapies are usually surgically removed. Stye surgery is performed by an ophthalmologist, and generally under local anesthesia. The procedure consists of making a small incision on the inner or outer surface of the eyelid, depending if the stye is pointing externally or not. After the incision is made, the pus is drained out of the gland, and very small and unnoticeable sutures are used to close the lesion. It is common for the removed stye to be sent for histopathological examination to rule out the possibility of skin cancer.
Treating a Stye:

Warm compresses: Gently press a very warm washcloth against the eyelid for 10 minutes at least 4 times per day. Massage: Gently massage the entire area to speed healing. Antiobiotic ointment, eye drops or pills: Antibiotic ointments or eye drops may help cure the infection. If the skin around it is becoming infected, antibiotic pills may be needed.

Prevention of Sty There are some important tips to prevent eye sty. To prevent eye sty :

Wash your hands after any activity or after going to the bathroom. Avoid touching your eyes as most children do after being tired. Touching with bare hand should be avoided especially if you have sore eyes. Avoid using pressure to drain the eye sty; it will burst on its own. If you try to squeeze the eye sty, infection can seep into the blood stream. Do not pop it like a pimple; it can increase the infection to the other eye also. If you have touched any wound, pimple or boil, wash your hands thoroughly before touching eyes. Use clean disinfected cotton swab or cotton ball to clean areas around eyes to avoid spreading of infection. Use two different cotton swabs for both eyes. Never share your eye make up; facecloth or towel with others as sharing of these personal objects can cause spreading of infection among various people.

When to seek Medical Advice Sometimes, complications may occur from a seemingly innocent problem. Immediately contact your ophthalmologist (a medical doctor who specializes in eye care and surgery) if any of the following problems occur:

The eye is swollen shut. Redness appears around the entire eye. You have any change or disturbance in your vision. Swelling lasts for more than three weeks. The stye or styes come back or bleed. Your eyelashes fall out. The stye is on the bottom eyelid, near the nose. The white part of the eye becomes red. Pus or thick discharge continues to drain from the eye. You have a fever higher than 100.5 F. You have excessive persistent tearing. You have persistent redness of the surface of the eye. You have significant pain. The stye recurs, especially if the stye does so in the same location as a previous stye. You have swelling of the lymph nodes in your neck. You experience double vision.

Concerned Doctor

Ashok Gupta (M.B.B.S, M.S(PGI)) Rajesh Fogla (MBBS, DNB, FRCS, MMed (Ophth)) Surinder Kumar (M.B.B.S) P. Prakash Rao (MBBS, MS, DOMS, MRCOphth(London)) Harish Dulani (MS)
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