What is it, what are the causes and indicated treatments

To fight the sty, just apply a hot wedding ring on the spot. This is the prescription of folk medicine to treat the illness defined by doctors as hordeolum. Characterized by an acute infection at the ends of the eyelids, it actually improves with exposure to heat.

However, experts warn: bringing a hot, unsterilized object to the eyes increases the risk of burns or reinfection, and this should be avoided.

The sty is considered a common eye disease that affects men, women, children and the elderly alike. However, it is more frequent among adults due to the greater viscosity of the secretions produced by the sebaceous and sweat glands, and also among people with blepharitis, acne rosacea, seborrheic dermatitis and even diabetes.

For most of these individuals, the sty is self-limiting, that is, it resolves itself and in a few days. When the condition does not improve or recurs over time, it is necessary to undergo a medical evaluation.

The treatment is simple and boils down to guidelines on hygiene and the application of warm compresses on the spot, which can be combined —or not— with specific medications. For more severe cases, there is also the option of surgical drainage.

Understand what a sty is

It is defined by ophthalmologists as hordeolum, and it is an acute bacterial infection that affects the eyelids. Most of the time, the bacteria most involved in this process is the Staphylococcus aureus, followed by Staphylococcus epidermidis.

Painful, the sty may appear on the lower or upper part of the eyelids, and may also appear on the outer (most common) or inner regions, in the line of the lashes.

Why does it happen?

Your eyelids have three types of glands. Two of them are located in its front part — and are known as Zeiss and Moll; the third, located at the back, is called the meibomian gland.

Together, they are responsible for producing part of the tear film components, whose function is to protect the surface of the eyes.

When the hordeolum is external, it results from infection of the Zeiss and Moll glands; when it is internal, it results from infection of the meibomian gland—which leads to the formation of chalazion, a small, painless nodule.

On the other hand, the manifestation of the sty is characterized by the formation of a reddish little ball (abscess), painful, swollen, with the appearance of a pimple that can break and generate pus.

Other causes and risk factors

The sty can also appear as a consequence of the following conditions:

  • Blepharitis (crust on eyelashes, eyelid skin peeling)
  • Dermatological diseases (such as dermatitis, acne rosacea)
  • eyelid eczema
  • Contact dermatitis
  • Inadequate eye hygiene, especially after using cosmetics
  • Stress
  • hormonal changes
  • Frequent use or sharing of makeup
  • Use of permanent false eyelashes

What is the relationship between the sty and the use of masks?

Ophthalmologist Tatiana Nahas, a specialist in eyelid diseases and Head of the Eye Plastic Service at Santa Casa de São Paulo, says that there has been an increase in sty cases since the need for the use of masks during the pandemic was established.

She explains that the reason for this is that the air expelled through the nose and mouth contains microorganisms and “while we talk, cough or sneeze, the air evaporates, rises towards the eyes and eyelids, and this increases the chances of infection and appearance of the sty”.

Who needs to be more attentive?

Stys can affect men, women, children and even the elderly, but it has been more frequent among people aged 30 to 50 years.

It has also been observed that individuals with chronic diseases are at increased risk for the problem, especially those with blepharitis, seborrheic dermatitis, diabetes and high cholesterol.

Know how to recognize the symptoms

Most of the time the sty presents itself as a small pimple (abscess) with pus (pustula) in one of the margins of the lower or upper eyelids.

The following manifestations are also common:

  • Local swelling (edema)
  • Redness (flushing or erythema)
  • Pain
  • Itching (itching)
  • Crusts or secretion on the eyelashes

When is it time to seek medical help?

Ophthalmologist Maria Cristina Nishiwaki Dantas, a professor at the Department of Ophthalmology at Unifesp, says that, in general, sty frames are self-limited, that is, they resolve spontaneously within a period of 3 to 5 days.

But there are some individuals who have recurrent hordeoli because their associated factor is blepharitis or rosacea, which also need to be treated, precisely to prevent the sty from reappearing. Therefore, in these situations, the doctor suggests that a specialist be consulted for a complete ophthalmological evaluation.

“The same is indicated in cases where the hordeolum is very large. In addition, be aware of a sty that does not improve: it can indicate more serious conditions such as an infection of the orbital tissue (orbital cellulitis), or even a malignant tumor ( carcinoma)”, adds Nishiwaki Dantas.

What to expect from the consultation

The doctor will listen to your complaint, take your health history and even do a complete eye exam.
This practice allows quick observation of the hordeolum and also helps to identify other signs that indicate the presence of blepharitis, rosacea or some other alteration – in the eyelids or eyelashes – that may be responsible for the origin of the sty.

As no additional tests are needed, the diagnosis is clinical.

How is the treatment done?

Whether the sty is external or internal, the therapeutic strategy is identical. The goal of treatment is to speed up recovery and control the infection so that it does not progress. In 90% of cases, the problem is solved by adopting the following measures:

  • Local hygiene – it is recommended to clean the eyelids and eyelashes with the dilution of children’s shampoo, in the morning and at night. There is also the alternative of using appropriate solutions (purchased from a pharmacy) to sanitize these areas. The objective is to gently massage the region, remove all the fatty tissue accumulated on the eyelids and eyelashes and prevent the problem from happening again;
  • Gauze swabs (warm to hot) – they should be positioned over the sty until the region heats up. The idea is to dilate the orifices and soften the secretion to facilitate its drainage, which can be done by gently moving the sty towards the eyelid margin. The more times you do it during the day, the greater the chances of improvement;
  • Medicines – if necessary, the practices described above can be combined with the use of specific ophthalmic ointments or eye drops that contain antibiotics and/or corticosteroids. If these measures do not have the desired effect, the doctor may still indicate the use of antibiotics orally.

“When this clinical treatment fails, the procedure is to adopt surgical drainage, a procedure that empties the purulent content of the obstructed gland, and prevents the infection from spreading to other glands”, adds ophthalmologist Cristina Baracuhy, coordinator of the Service of Plastic Ocular, Orbit and Lacrimal Pathways at HC-UFPE.

What are the possible complications?

Although the sty has the appearance of a pimple, it should never be manipulated with the intention of removing the secretion that has accumulated there. This could not only aggravate the infection, but its symptoms.

On the other hand, the evolution of the sty is generally benign. But there may be concomitant infections by other microorganisms, changes in the eyelashes that lead to changes in the texture of the threads, fall or trichiasis (the eyelashes are born turned inwards), in addition to thickening of the eyelid.

Ophthalmologist Pérola Grupenmarcher Iankilevich, professor at the PUC-PR School of Medicine, says that the most feared and rare complication is the advancement of the infection caused by the sty beyond the eyelids, reaching all tissues around, inside and at the back of the eye.

This condition is known as orbital cellulitis, and its symptoms are eyeball projection and extreme sensitivity to light. “Sometimes, depending on the patient’s health conditions, there is a need for hospitalization for intravenous antibiotic use”, completes the doctor.

Are chalazion and sty the same thing?

No. A sty is an infection of the glands located in the eyelids (external or internal). Chalazion, on the other hand, most often results from blocking the drainage of the meibomian glands. It is an inflammatory process that leads to the formation of a painless nodule (granuloma) in the eyelids. The explanation comes from ophthalmologist Tania Schaefer, president of Soblec (Brazilian Society of Contact Lenses).

Can I pass the sty to someone else?

No. Although it is an eye infection, sty cannot be transmitted to another person or even to the other eye. However, it is possible to have two hordeoli at the same time—on the same eyelid or on a different eyelid.

Experts suggest care that the infection itself does not increase. Be more attentive to hand hygiene, and avoid sharing makeup, towels or a sleep mask.

Can you prevent it?

Yes. And the main measure is to take care of the daily hygiene of the eyelids, eyelashes, contact lenses, in addition to the hands. Also, put the following measures into practice:

  • Use neutral baby shampoo in the morning and evening to wash the eyelids and eyelashes. If you prefer, use gauze or flexible rods to gently massage the region;
  • Avoid sleeping with makeup on, sharing it or using products for this purpose that have expired;
  • Visit a specialist so that he or she can guide you in the treatment of acne rosacea or contact dermatitis that could trigger sty conditions;
  • Talk to the ophthalmologist to recommend the use of anti-allergic eye drops if your eyes are prone to irritation and itching;
  • Make warm compresses more often to avoid clogging. This indication is specific for those who have blepharitis;
  • Prefer to use eyeliner on the outer region of the eyelids. By using it on the inside, you increase the chance of blocking the drainage hole of the eyelid glands;
  • Take extra care in cleaning your lenses and changing your serum if you wear contact lenses;
  • Change the mask when you notice it is wet. Warm and humid environments favor the proliferation of microorganisms;
  • Pay attention to oral hygiene when using masks. By doing this, you reduce the chance of oral bacteria getting into the eye area. If you prefer cloth masks, sanitize them properly.

Sources: Maria Cristina Nishiwaki Dantas, ophthalmologist, professor at the Department of Ophthalmology at Unifesp (Federal University of São Paulo) and specialist at the CBO (Brazilian Council of Ophthalmology); Cristina Baracuhy, ophthalmologist and coordinator of the Ocular, Orbit and Lacrimal Pathways Service at HC-UFPE/Ebserh (Hospital das Clínicas of the Federal University of Pernambuco/Brazilian Company of Hospital Services) and preceptor of the medical residency at the same institution; Tania Schaefer, ophthalmologist, president of Soblec (Brazilian Society of Contact Lenses) and partner of Zeiss; Tatiana Nahas, an ophthalmologist specializing in eyelid diseases and head of the Ocular Plastics Service at Santa Casa de São Paulo; Pearl Grupenmarcher Yankilevich, ophthalmologist and professor at the School of Medicine at PUC-PR (Pontifical Catholic University of Paraná), responsible for the Pediatrics Service at Hospital Pequeno Príncipe (Curitiba). Technical review: Maria Cristina Nishiwaki Dantas and Cristina Baracuhy.

References: Ministry of Health; Willmann D, Guier CP, Patel BC, et al. Stye. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459349/.