Everything You Need to Know About Styes

The typical way your eyelid appears when you have a stye.
There is usually no white head because most styes are inside
the eyelid!  via

If you have had a stye before, you know that you never, ever want to have one again.  The pain, discomfort, and just horrific appearance is enough to make anyone miserable.  If you have a red, sore to touch, and swollen eyelid, then stye is on the top of your list of culprits.

What is a Stye?

A stye (or hordeolum) is an acute bacterial infection of one of the oil glands found within eyelid.  In its active stages, it is painful, red, and feels like a localized tender nodule within the eyelid.  You may be able to see a white head, much like a pimple which is similar in etiology, but many styes form internally inside the eyelid so no head will ever develop.

What to do if you think you have a stye?

If you have an active stye, the best thing you can do is a hot massage.  Use a clean washcloth dipped in hot water, or you can get creative.  Common hot massage tools are to microwave a potato and wrap it in a cloth to prevent burning the eyelid, heat a bag of rice and wrap similarly, or heat up a tea bag.  All of these options retain heat better than a hot cloth will, but just be careful not to burn yourself.  When you have your preferred heated item, then apply it against your closed eyelid and gently massage over the tender area.  Do this as many times a day as you can.  The heat will help to open the clogged oil gland, breaking down the infective materials inside.

If your stye does not resolve with a hot massage in a day, you definitely need to see a doctor.  Your optometrist is trained to make sure that the pain in your eyelid is really a stye and not a different issue, like a viral herpes lesion, or a localized inflammation.  If you do indeed have a stye, your doctor is going to start more aggressive treatment.

Prescription Treatment Options

Augmentin knocks a stye out fast.  Oral medication
tends to work much better than eye drops because
an eye drop can't penetrate very well through the
eyelid skin!  Just watch out for penicillin allergies.
Azithromycin is a better choice in that case; Keflex
typically is fine but can have a cross-sensitivity
so not worth the risk.
via

Most styes are internal-- inside the eyelid, so an eye drop is not going to be a good way of delivering antibiotics to the area.  An oral antibiotic will actually work much better.  I typically use Augmentin or Keflex, since they are both cost effective generics, and don't cause a lot of upset stomach issues.  Your doctor will discuss your medical history and any antibiotic allergies before determining the right oral antibiotic for you!

If there is discharge from the stye draining into the eye, an additional eye drop will be useful in this case.  An oral antibiotic will treat the stye, but all the bacteria that your eye is now being bathed in from the drainage is putting you at risk for an eye infection (instead of just an eyelid one!). Tobramycin or Polytrim drops are a first choice for me.  Again both are generics with good coverage, and tend to have very few antibiotic allergy issues.

Sometimes the eyelid is so swollen (called preseptal cellulitis) it is painful to even open the eye.  In these cases, I will often couple my oral antibiotic with a topical ointment with antibiotic and anti-inflammatory properties.  Tobradex ointment is excellent for this use.  If finances are an issue, generic Maxitrol (neopolydex) ointment is a pretty good substitute.  The added anti-inflammatory coverage can really boost comfort as the antibiotic kills the infection.

Always, always, continue the hot massages, even after you start your doctor's treatment.  You can only help break down the stye faster by continuing to apply heat.

Typically a stye will take no longer than 7-10 days to completely resolve with this treatment, if it is caught early enough.  If left alone too long, a scar tissue may develop inside the lid, called a chalazion.  It will feel like a non-tender, hardened lump or bead inside the lid.  A chalazion is not an infection, and no antibiotics will help.  Keep trying your warm massages to hopefully break the scar tissue down, but in most cases the scar will have to be surgically cut out of the eye to get complete resolution.

What Shouldn't Happen

If you have a stye, there are a few quite scary changes that you need to be on the lookout for.  If you see any of these, please go straight to the ER.  Remember, your eye is directly connected to your brain, so if the bacterial infection breaks through past your eye you could have a life threatening problem!

It is NOT normal for you to have:

-fever
-double vision
-protrusion of the eye forward out of the socket
-vision loss
-severe pain with eye movement

If a orbital cellulitis (inflammation/infection that progresses behind the eye) develops, it requires urgent treatment -- typically injections of antibiotics straight into your blood stream.  While progression of this nature is very rare, styes are common place and I have seen many patients wait until their infection is really at a dangerous point before they decide to seek medical help.  Treating a stye early is key; don't wait until your eye is swollen shut to ask for help!

Do you have issues with styes over and over again?  Head to my next post on the topic of styes-- how to break the cycle of recurring styes!