Stye

Definition/diagnostic criteria A stye, medically known as a hordeolum, is a common and painful eye condition affecting the eyelid. It typically presents as a localised, inflammatory swelling, either on the outer (external hordeolum) or inner (internal hordeolum) aspect of the eyelid. The primary diagnostic criteria for stye include the presence of a tender, erythematous, and painful nodule on the eyelid, often accompanied by mild swelling and discomfort. The condition is usually self-limiting, with resolution occurring within a few days to a couple of weeks.

Epidemiology Styes are a prevalent ocular condition in the UK, frequently encountered in primary care settings. While exact prevalence figures vary, styes are estimated to affect approximately 1 in 1,000 individuals each year. Although they can occur at any age, styes are most commonly observed in young adults and individuals aged 30-50 years. Risk factors for developing styes include poor eyelid hygiene, meibomian gland dysfunction, and conditions such as blepharitis.

Diagnosis
Clinical features: The diagnosis of a stye is primarily clinical, relying on the characteristic presentation and symptoms. Key clinical features include:

• Pain and tenderness: Patients typically report localised pain and tenderness at the site of the stye, which may worsen with blinking or touching the eyelid.
• Eyelid swelling: The affected eyelid may exhibit mild to moderate swelling, giving it a puffy appearance.
• Erythema: The skin overlying the stye is often red and inflamed.
• Localised nodule: A palpable, firm nodule or pustule is usually present, indicating the site of the infection.

Investigations: In most cases, styes can be diagnosed based on clinical examination alone. However, if there is doubt about the diagnosis or concern about a severe infection, further investigations may be considered. Such investigations might include a culture of purulent material from the lesion or a swab for microbiological analysis to identify the causative organism. Imaging studies are not routinely required for diagnosing styes.

Treatment The management of styes primarily revolves around symptom relief, promoting spontaneous drainage and preventing complications. Key treatment strategies include:

• Warm compresses: Encourage patients to apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times a day. This helps in relieving pain, promoting drainage, and reducing inflammation.
• Eyelid hygiene: Emphasise the importance of maintaining good eyelid hygiene, including gentle lid scrubs and avoiding eye makeup until the stye resolves.
• Topical antibiotics: For persistent or recurrent styes, topical antibiotic ointments (e.g., chloramphenicol) may be considered. These should be applied to the eyelid margin, not directly into the eye.
• Pain relief: Over-the-counter pain relievers, such as paracetamol or ibuprofen, can be recommended for pain management.
• Surgical drainage: In cases where the stye does not improve or worsens after conservative measures, incision and drainage may be necessary.

It is crucial to educate patients on the importance of avoiding squeezing or attempting to pop the stye, as this can lead to complications and worsen the infection.

Prognosis Most styes resolve spontaneously within a few days to a couple of weeks, with appropriate management. Recurrence is possible, particularly if predisposing factors like poor eyelid hygiene are not addressed. Complications, such as the spread of infection to adjacent structures, are rare but can occur if left untreated. In such cases, prompt referral to an ophthalmologist may be required.