Medical Author : Patricia S. Bainter, MD
Medical Editor : William C. Shiel Jr., MD, FACP, FACR
What is a sty (stye)?
A sty is a bump that forms on or in the eyelid as the result of a blocked gland. The word sty can also be spelled stye. There are two distinct types of styes: hordeolum and chalazion. Each has different causes and treatments.
A hordeolum is a blockage of one of the sweat glands found in the skin of the lid and base of the eyelashes, or one of the small sebaceous glands found at the base of the eyelashes. Sebaceous glands secrete sebum, a waxy, oily material.
A chalazion is a blockage of a meibomian gland, which is a special sebaceous gland unique to the eyelids. These glands form a single row in each lid, with the body of the gland located inside the eyelid, and the opening located at the rim of the lid, posterior to the lashes. They secrete an oily material onto the surface of the eye, preventing the water layer of tears from evaporating too rapidly from the eye's surface between blinks. Therefore, poorly functioning meibomian glands can lead to dry eye symptoms.
What causes a sty?
Styes occur when a gland in or on the eyelid becomes plugged or blocked. This can occur if the gland's opening is obstructed by scar tissue or a foreign substance (makeup, dust), or if there is thickening of the substance produced by the gland, causing the material to flow sluggishly or not at all.
What are the risk factors for a sty?
Obstruction of the gland's opening can result from scar tissue following infections, burns, or trauma. Foreign substances such as makeup and dust can also clog the gland's opening if not properly washed away.
Sluggish outflow of the sebum from the meibomian glands is commonly seen in a chronic inflammatory condition called meibomian gland dysfunction (also commonly called meibomitis). Meibomian gland dysfunction is frequently associated with acne rosacea on the cheeks and nose, but it can also be seen alone.
What are sty symptoms and signs?
The first signs and symptoms of a sty are usually redness, tenderness, and pain in the affected area. The eye may feel irritated or "scratchy." Later signs and symptoms may include
- discomfort during blinking of the eye,
- watering of the eye
- sensitivity to light.
A common sign of a sty is a small, yellowish spot at the center of the bump that represents pus rising to the surface.
How is a sty diagnosed?
The doctor will examine the lids to locate the opening of the plugged gland. This helps to distinguish between a hordeolum and a chalazion. Also, the doctor will look for signs of scar tissue, foreign bodies, or underlying chronic meibomitis to determine the cause.
In addition, the doctor will look for any signs that the gland may have become infected. It is particularly important to identify infection that has spread from the gland to the neighboring skin, tissue around the eye, or the eye itself.
What is the treatment for a sty?
A noninfected hordeolum will resolve on its own. Warm compresses may help soften the material in the gland, easing the drainage of the gland's contents. Squeezing or cutting the hordeolum can cause the skin to become scarred.
A noninfected chalazion similarly will resolve on its own, though over a much longer period of time. A small chalazion may resolve within weeks, while larger ones may resolve over the course of a year.
The most conservative treatment is application of frequent warm compresses. Steroids can be injected into the lesion, often resulting in a speedier resolution. However, this carries a small risk of bleeding/bruising, depigmentation/thinning of the skin, scar, pain, and in very rare cases, loss of vision.
Finally, the chalazion can be incised and drained. This is the most invasive method and is reserved as a last resort by most eye doctors. The eyelid is anesthetized, and a clamp is placed around the chalazion. The eyelid is everted, and the meibomian gland is incised from the back surface of the eyelid, avoiding cutting the skin on the front surface. The waxy sebum is "scooped" out of the gland with a special curette. This "debulking" of the gland's contents may be sufficient to shrink the chalazion; however, there is risk that the chalazion may recur, particularly if the underlying cause is not addressed.
If either type of sty appears infected, oral antibiotics may be necessary. This is particularly important if the infection is spreading along the skin (cellulitis) or spreading into the orbit (orbital cellulitis). Orbital cellulitis is considered an emergency, as rapidly spreading infection can threaten a person's vision and even a person's life and can require intravenous antibiotics.
In some situations, the infection spreads to the eye itself. Depending on what the eye doctor finds on careful slit lamp examination of the eye, topical antibiotics (drops or ointment) might be sufficient.
Treatment of the underlying cause of the sty is also important to prevent recurrence.
Are home remedies effective for a sty?
The best home remedy is to apply a warm compress as often as possible. It is important to remember that a chalazion may take months to resolve completely.
What is the prognosis for a sty?
A hordeolum may resolve in a matter of days, while a chalazion may take months. Both types of styes should resolve completely once the plugged gland drains. If an infection sets in, medical treatment will be necessary.
Recurrence is likely if chronic underlying conditions aren't addressed. In the case of meibomitis, your eye doctor will likely recommend daily cleansing of the eyelids and eyelashes with a gentle soap (such as baby shampoo). Increased intake of omega-3 fatty acids in the diet or from supplements may also help improve the flow of the sebum. Small doses of oral doxycycline are prescribed for acne rosacea and meibomitis in some patients.
Is it possible to prevent a sty?
The best prevention is to keep the eyelids and eyelashes clean. A diet high in omega-3 fatty acids is associated with improvement of meibomian gland function.
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