Clinical Solutions: Stye

THE CASE:A middle-aged woman presents with a localised, painful eyelid swelling. A small pus-filled spot is visible on the eyelid margin.

Stye (hordeolum) on patient's upper eyelid (Photograph: SPL)
Stye (hordeolum) on patient's upper eyelid (Photograph: SPL)

What are styes?
A stye is an abscess of the eyelid, usually caused by a staphylococcal infection. External styes result from infection of an eyelash follicle or associated gland and internal styes result from infection of a meibomian gland (situated within the tarsal plate).

Is this a stye?
External styes are located at the eyelid margin. The swelling is usually located around an eyelash follicle and points anteriorly through the skin.

If the stye is internal, there is a localised swelling of the external eyelid which is usually located further away from the lid margin compared with an external stye.

When the eyelid is everted, a localised swelling of the tarsal plate is visible. Internal styes may point towards the conjunctiva - although they can point anteriorly through the skin.

How long do styes take to resolve?
External styes resolve within one to two weeks. Once they have pointed they usually drain spontaneously within three to four days. Internal styes may take up to three weeks to resolve.

What treatment should be recommended?
Advise the woman to apply a warm compress (a clean flannel rinsed in hot water) to the affected eye for 5-10 minutes and repeat three to four times a day until the stye resolves or drains.

Prescribe or recommend simple analgesia, such as paracetamol, if required. If the stye is external and painful, consider epilating the eyelash from the infected follicle.

Alternatively, consider incising and draining the stye using a fine sterile needle. Advise the woman not to puncture the stye herself. Only prescribe a topical antibiotic if there is evidence of conjunctivitis.

Evidence
There is a lack of trial evidence on the management of styes and these recommendations are based on expert opinion from review articles1-4, UK guidelines5, Australian guidelines6, and CKS expert reviewers.

Given the lack of trial evidence and the self-limiting nature of the condition, CKS does not recommend topical antibiotics for managing uncomplicated styes. This recommendation is supported by most CKS reviewers.

References
1. Olson, MD. The common stye. J Sch Health 1991; 61(2): 95-7.

2. Papier A, Tuttle DJ, Mahar TJ. Differential diagnosis of the swollen red eyelid. Am Fam Physician 2007; 76(12): 1,815-24.

3. Peralejo B, Beltrani V, Bielory L. Dermatologic and allergic conditions of the eyelid. Immunol Allergy Clin North Am 2008; 28(1): 137-68.

4. Skorin L. Hordeolum and chalazion treatment. The full gamut. Optometry Today 2002: 25-7.

5. The College of Optometrists. Hordeolum. The College of Optometrists. 2008 www.college-optometrists.org

6. Queensland University of Technology. Clinical pathways for optometric management of ocular conditions. Northern Territory Government. www.health.nt.gov.au

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