Styes and chalazia are infections and inflammations of the tiny oil glands on the eyelids. A sty, or external hordeolum, is a common childhood infection of an oil gland on the surface of the upper or lower eyelids at the base of the eyelash. An internal hordeolum is an infection deeper inside the eyelid.
A chalazion is an inflammation or blockage of the deep oil glands within the eyelid that develops into a small hard mass.
Description
Styes and internal hordeola begin as a red, pimple-like bump on the eyelid. The eye may water and itch, and the eyelid may be swollen and painful. Styes come to a head in about three days when they open and drain. Healing is rapid. Internal hordeola are larger, last longer, and are more painful.
Chalazia develop within the Meibomian glands, or oil glands of the eyelid. There are approximately one hundred of these glands located underneath each row of eyelashes. Obstruction and infection, which often are the result of bacteria, cause the gland and the area around it to swell. Chalazia are slow growing, usually over two to three weeks, and can last several months.
A chalazion first appears as a firm lump under the skin but is usually not painful. If the oil gland is blocked and inflammation spreads beyond the eyelid, the condition can interfere with vision. Sometimes, a chalazion develops after a sty has healed.
Growths on the eyelid that are not red and painful are usually cysts and should be evaluated by a doctor. Sometimes, they are removed. In most cases, they are not.
Transmission
Staphylococcus aureus bacteria are thought to be responsible for most styes. Rubbing the eyes, especially when the sty is oozing pus, can spread the infection along the eyelid and cause other styes. There is also a chance that if transmitted to the face or other parts of the body the bacteria in the sty can cause impetigo, a contagious skin infection.
Demographics
Styes are more common in children than adults. Once a child has one sty, there is an increased chance of the child having another later on. They also seem to recur in children with lowered immune resistance such as children with diabetes. Acne also seems to trigger styes in some adolescents.
Chalazia occur more often in adults than children, and in men more than women. As is the case with styes, having acne seems to predispose some adolescents to having chalazia.
Causes and symptoms
Styes and internal hordeola in children are usually caused by Staphylococcus aureusbacterial infections that are transmitted from a child's eyes and nose. In most cases, the bacteria enter the eye through unwashed hands or contaminated contact lens. Bacteria may live on the eyelids or eyelash hair follicles themselves and begin to grow when the oil gland of a hair follicle becomes blocked.
Symptoms
Styes appear as red bumps on the eyelid and may cause itching or tearing. Sometimes children report feeling as if something is in the eye. Both styes and internal hordeola are usually painful. The eyelid may look red and be swollen. Vision is sometimes blurred, and the eyes may be sensitive to light.
Though chalazia may appear as large unsightly lumps deep within the eyelid, they are usually not painful. On rare occasions, if a chalazion becomes quite big, it can press on the cornea. If the chalazion is on the upper eye lid, it can produce various vision problems including astigmatism, a distortion of the lens that causes fuzzy vision.
When to call the doctor
It is important to call the doctor if the child has a fever, pain in the eye, swelling or redness over the entire eyelid, or a painful sty persists for one to two weeks. It may be necessary to call a doctor if the child experiences no improvement after three days of home care. In addition, if the child experiences vision problems, a doctor should be consulted.
Conjunctivitis, which appears as redness in the white of the eye, is a serious condition that must have a doctor's attention. In most cases, antibiotics or antibiotic ointments are prescribed.
Stubborn chalazia that do not go away within six weeks or continue to enlarge require medical attention. They may need to be removed surgically, using local anesthesia.
Diagnosis
The doctor determines whether a child has a sty by visually examining the appearance of the eyelid. If the bump is hard and is located deep within the eyelid, it probably is a chalazion. For a patient whose sty has not healed with home treatment, the doctor may test the fluid in the eye to determine the type of bacteria present and prescribe treatment accordingly.
Treatment
The usual treatment for styes begins at home with the application of a warm washcloth soaked in fairly warm water. Heat is important to increase the blood supply to the eye, helping the immune system to fight off the infection. It also opens the blocked oil gland and helps remove pus. The water should be hot but not too hot. If a finger cannot remain in the water comfortably, it is too hot. Washcloths should not be heated in a microwave oven. Salt or rosewater may be added to the warm water.
The warm washcloth is applied to the eyelid of the closed eye for 10 to 15 minutes three to four times a day. Relief is usually felt within 24 hours.
The child and the parent should avoid popping the sty as one would a pimple. This can irritate the eyelid further and spread the bacteria. By allowing the style to break on its own and leak out pus, the sty can drain. Daily washing and the use of warm compresses help eliminate the bacteria released by the burst sty.
Some doctors recommend using over-the-counter eye washes, such as Bausch and Lomb Eye Wash or Collyrium Eye Wash, or medicated pads made especially for the eyes to clean around the eyelid. Others suggest washing the eyelid and the eyelash area with a mild soap wash, made from equal parts of baby shampoo and water. The soap is applied by dipping a cotton ball or clean cloth into the soap wash and washing the eye area gently. This action decreases the risk of infection, especially if the child has recurring styes. This procedure also helps prevent further styes.
Sometimes, antibiotic ointment, sulphonimide, or drops are used. Ointment is applied by putting a thin layer over the sty, usually at bedtime. To insert eye drops into the eye of an older child or adolescent, pull the lower lid down to create a pouch and then put the drops into the pouch. For a younger child, the child can lie down and then close his or her eyes. The eye drops are put into the corner of the affected eye closest to the nose. Then, the child should open his or her eyes so that the eye drops can roll into the eye. Ointment or eye drops usually are prescribed after a sty has been lanced.
The doctor may also decide to surgically drain the sty by lancing it. Usually, not all of the pus is removed if there is acute inflammation. Doing that can deform the eyelid. Sometimes, if a single eyelash is involved, it may be removed to promote healing and drainage.
If the infection does not respond to treatment or spreads to other eye areas or to the lymph nodes in front of the ear, the doctor may prescribe oral antibiotics, such as erythromycin, dicloxacillin, or cephalexin.
Internal hordeola are usually just monitored by the doctor. They may need to be opened and drained or may require antibiotics.
Chalazia are given the same treatment as styes.
Until the sty or chalazion is healed, the child should not wear contact lenses and the adolescent should not wear eye makeup.
Alternative treatment
Homeopathic practitioners prescribe oral homeopathic medications that reduce the bacterial growth within the sty and chalazion and thereby heal the inflammation. These medications also eliminate the itching and scaling often experienced along the eyelash line. In addition, homeopathic oral medications are aimed at boosting the immune system. Homeopathic practice usually does not use topical ointments or drops but does recommend using an antibacterial eyewash made from five drops of tincture of goldenseal in a cup of warm water. This is swabbed on the eyelid with a cotton ball. (Since goldenseal can stain, it should be used carefully.)
Prognosis
Most styes heal with minimal treatment in about a week.
Recurring styes may be an indication of a chronic eye infection called Staphylococcus blepharitis. In this condition, the eyelids are crusty, reddened, and swollen. The eyes may itch and burn. The base of the eyelashes may have dry scales that flake like dandruff. This condition can cause loss of eyelashes. Both Staphylococcus blepharitis and recurring styes can cause scarring of the eyelid.
Prevention
Cleaning the eye with a warm washcloth helps prevent the pores from clogging and a sty from forming. Using a mild, soap wash made with baby shampoo and water will also clean the area and help prevent styes from recurring.
Maintaining good hygiene is essential to preventing styes. Not touching or rubbing the eyes with the hands, especially if they are unwashed, can also prevent styes. Providing separate washcloths and towels for each child will keep bacteria from spreading. In addition, teenagers should not share makeup, especially mascara, eyeshadow, and eyeliner. Eye makeup should be replaced at least every six months because bacteria can grow in these cosmetics and cause infection.
Protecting the eyes from dust and air pollution by using safety glasses when doing dusky work outdoors, such as raking leaves, can also help prevent eye infections. These protections are also good when children are working with craft materials or other materials that may produce airborne particles.
Children's contact lens care should be monitored to maintain cleanliness. Bacteria can contaminate contact lenses or be transmitted by lenses when they are removed or inserted into the eyes. This is a common vector for bacterial transmission into the eye.
Stress has been a contributing factor to the formation of styes, especially in children with immune system disorders. Therefore, stress management techniques could help prevent styes from forming.
KEY TERMS
Autoimmune disorder—One of a group of disorders, like rheumatoid arthritis and systemic lupus erythematosus, in which the immune system is overactive and has lost the ability to distinguish between self and non-self. The body's immune cells turn on the body, attacking various tissues and organs.
Chalazion—A condition in which clogging of the Meibomiam gland causes a cyst inside the eyelid.
Conjunctivitis—Inflammation of the conjunctiva, the mucous membrane covering the white part of the eye (sclera) and lining the inside of the eyelids also called pinkeye.
Hordeolum—The medical term for sty, an infection or small abscess formation in a hair follicle of the eyelids.
Sty—An external hordeolum caused by an infection of an oil gland on the eyelid.
Parental concerns
Parents should make sure children wash their hands often and use fresh linens. Contact lenses need to be kept clean and eyes need to be protected when someone is doing dusty chores or art projects. If a child has diabetes
or an autoimmune disorder, good eye hygiene is as critical as monitoring wound healing and foot care.
Neff, A. G., and C. D. Carter. "Benign eyelid lesions." In Ophthalmology, 2nd ed. Edited by M. Yanoof and J. S. Duker. St. Louis, MO: Mosby, 2004, pp. 698–710.
ORGANIZATIONS
National Eye Institute. 31 Center Drive, MSC 2510, Bethesda, MD, 20892–2510. Web site: <www.nei.nih.gov>.
WEB SITES
Lee, Judith, and Gretchyn Bailey. "Styes." All About Vision, 2003. Available online at <www.allaboutvision.com/conditions/styes.htm> (accessed November 30, 2004).
