External stye

This is the most common form of stye. It is essentially a staphylococcal infection of a lash follicle possibly involving the glands of Zeis - small, modified sebaceous glands at the base of the eyelashes - or the glands of Moll - modified sweat glands near the base of the eyelashes. It corresponds to a boil of the skin elsewhere.

Pain, redness and swelling of the lid margin (2)

• initially, the whole of the lid may be affected; soon, the swelling becomes localised, and a yellow, pus filled lesion may be seen near the lid margin (at the base of the effected eyelash) associated with an eyelid (2)
• localised tenderness on palpation of the eye lid
• associated preseptal cellulites may be present (2)

Majority will resolve spontaneously or the abscess will rupture discharging purulent material resulting in rapid subsiding of symptoms (2). Other useful therapeutic interventions include

• heat (warm compresses) applied several time a day will aid in spontaneous drainage of the lesion (3)
• topical antibiotic ointment (e.g. fusidic acid eye drops) may prevent a subsequent staphylococcal infection from a lash lower down
• in severe cases oral antibiotic treatment may be required e.g. flucloxacillin if not penicillin allergic
• less frequently required management options include:
  • epilation of the affected eye lash which extends from the involved lesion will assist in an effective drainage channel (3)
  • for resistant lesions, incising and draining with a sterile needle or a blade (3)

Reference:

• (1) Elton M. Ocular conditions from A to Z (ii). The pharmaceutical journal 2007;278
• (2) Northern Territory Government of Australia , Department of Health and Families 2005. Clinical pathways for optometric management of ocular conditions
• (3) Association of Optometrists. Optometry Today 2002.  Hordeolum and chalazion treatment The full gamut