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What is Stye (Hordeolum)?
A stye (medically known as a hordeolum) is a small, painful, red lump that develops on the inner or outer edge of the eyelid. It closely resembles a pimple or boil and can cause the affected eye to water; the eyelid and/or the eye itself may become visibly red and swollen.
A stye usually affects only one eye, although multiple styes on the same eyelid or simultaneous involvement of both eyes is possible. Importantly, vision is not typically affected by a stye. Any change in visual acuity should prompt immediate medical evaluation.
Styes are caused by a bacterial infection of the sebaceous (oil-producing) glands of the eyelid. These glands secrete sebum, the oily substance that protects and lubricates the skin and eyelashes.
In most cases, a stye resolves spontaneously within a few days to a couple of weeks. To reduce discomfort in the meantime, the following measures are recommended:
- Warm, moist compresses applied to the closed eyelid
- Gentle cleansing of the eye area with a mild, fragrance-free soap or sterile saline-soaked gauze
The following should be avoided:
- Squeezing or pressing the stye: this can spread the infection
- Scratching or rubbing the eyelid
- Wearing contact lenses until the stye has fully resolved
- Applying eye makeup to the affected area
In more severe or persistent cases, a doctor may perform surgical drainage, a minor in-office procedure to release the accumulated pus and accelerate healing.
Stye or Chalazion? How to Tell the Difference
A chalazion is another common cause of eyelid swelling and is frequently confused with a stye. Understanding the key differences helps guide appropriate management:
| Feature | Stye (Hordeolum) | Chalazion |
|---|---|---|
| Pain | Typically painful and tender | Usually painless (unless secondarily infected) |
| Onset | Acute, rapid onset | Slower, more gradual development |
| Location | Eyelid margin (near lash line) | More commonly on the inner surface of the eyelid, away from the margin |
| Cause | Bacterial infection (usually Staphylococcus) | Obstruction of a Meibomian gland (no primary infection) |
| Resolution | Often drains and resolves within 1–3 weeks | May persist for weeks to months; occasionally requires surgical removal |
A stye can sometimes evolve into a chalazion if the infection resolves but the gland remains blocked. If you are uncertain about your diagnosis, always consult a healthcare professional.
Causes
The vast majority of styes are caused by Staphylococcus aureus, a bacterium that commonly lives harmlessly on the skin. Under certain conditions, such as poor eyelid hygiene, compromised immune function, or existing eyelid disease, these bacteria can proliferate and infect the delicate glands of the eyelid margin.
There are two anatomical types of stye, classified by their location:
External Styes
An external stye develops along the outer edge of the eyelid, near or at the base of the eyelashes. It is the more common form and may be caused by infection of one of three structures:
- The eyelash follicle: the small skin opening (pore) from which each individual eyelash grows.
- The gland of Zeis: a small sebaceous gland attached directly to the eyelash follicle. It produces sebum to lubricate and protect the lash.
- The gland of Moll, a modified apocrine sweat gland that drains into the eyelash follicle, has a secretion that contributes to the tear film coating the eye surface and slowing tear evaporation.
External styes typically appear as a visible, red, tender lump at the eyelid margin and may develop a yellow “head” of pus as they mature.
Internal Styes
An internal stye develops on the inner surface of the eyelid (the conjunctival side), caused by infection of a Meibomian gland. The Meibomian glands are a row of specialized sebaceous glands embedded within the tarsal plate of each eyelid (approximately 25 in the upper lid and 20 in the lower lid); they produce meibum, an oily secretion that forms the outermost lipid layer of the tear film, stabilizing it and preventing evaporation.
Internal styes are generally more painful than external styes and may not be visible from the outside without everting (turning over) the eyelid. They tend to carry a slightly higher risk of progressing to a chalazion.
Blepharitis
In some cases, a stye represents a complication of blepharitis, a common, chronic inflammatory condition of the eyelid margins. Blepharitis causes the eyelid edges to become persistently red, thickened, and inflamed, and produces symptoms such as:
- Burning or stinging sensation in the eyes
- Crusty or greasy eyelashes, particularly upon waking
- Itching along the eyelid margin
- A gritty, “foreign body” sensation in the eye
- Excessive tearing or dry eyes
Blepharitis itself may be caused by bacterial overgrowth on the lid margin, dysfunction of the Meibomian glands, or be associated with skin conditions such as rosacea or seborrhoeic dermatitis.
Chronic blepharitis is a significant risk factor for recurrent styes and should be managed proactively to prevent future episodes.
Risk Factors
The risk of developing a stye is increased by the following factors:
- Touching the eyes with unwashed hands: the most common route of bacterial inoculation
- Handling contact lenses without proper hand hygiene or disinfection of the lenses
- Sleeping with eye makeup on: residual mascara and eyeliner can clog eyelid gland openings
- Using expired or contaminated cosmetics: old mascara and eyeliner are frequent reservoirs of bacteria
- Sharing eye makeup or applicators with other people
- A history of blepharitis: chronic lid margin inflammation predisposes to gland obstruction and infection
- Rosacea: this chronic facial skin condition is strongly associated with Meibomian gland dysfunction and recurrent styes
- Diabetes mellitus or other conditions that impair immune function
- Previous styes: once affected, some individuals are prone to recurrence
Symptoms
The classic presentation of a stye includes:
- A red, tender, raised lump on the eyelid margin or inner lid surface, resembling a pimple or small boil
- Pain and tenderness to touch, which may range from mild to quite severe
- Eyelid swelling: localized or, in more severe cases, affecting the entire eyelid
- Tearing (epiphora): excessive watering of the affected eye
- A sensation of grittiness or a foreign body in the eye
- Sensitivity to light (photophobia) in some patients
- A visible yellow or white pustule (pus-filled head) may develop at the center of the lump as the infection matures. This signals that the stye may be close to draining spontaneously
In most cases, symptoms are confined to the eyelid and do not affect vision. Any visual disturbance must be reported to a doctor promptly.
When to See a Doctor
Most styes are self-limiting and can be managed effectively with home remedies. However, you should contact your doctor if:
- You are unsure of the diagnosis: other conditions (e.g., chalazion, orbital cellulitis, eyelid tumors) can mimic a stye
- You experience changes in vision, such as blurred vision or double vision (diplopia)
- The stye does not begin to improve within 48 hours of starting home treatment
- Redness and swelling spread beyond the eyelid, involving the cheek or other parts of the face (this may indicate preseptal cellulitis, a more serious infection)
- You develop fever or feel generally unwell
- The stye is unusually large, very painful, or affecting a child
- You have a history of recurrent styes; investigation of an underlying cause (e.g., blepharitis, rosacea, diabetes) is warranted
Complications
The vast majority of styes resolve without any complications. However, in a minority of cases, the following may develop:
Chalazion (Meibomian Cyst)
A persistent internal stye may evolve into a chalazion. This is also known as a Meibomian cyst or tarsal cyst. A chalazion forms when the infected gland eventually clears the bacteria, but the gland duct remains blocked, leading to a chronic, sterile granulomatous inflammation of the gland.
Key features of a chalazion:
- Usually painless unless secondarily infected
- Appears as a firm, round, non-tender nodule within the eyelid, often visible as a lump on the inner lid surface
- Can persist for weeks to months
- Warm compresses applied regularly can help soften the hardened gland secretions and promote spontaneous resolution
- Surgical excision under local anesthesia is the definitive treatment when the chalazion fails to resolve. It is a simple, safe, outpatient procedure
- Intralesional corticosteroid injection is an effective alternative to surgery in selected patients
Preseptal Cellulitis
If the bacterial infection spreads beyond the immediate area of the stye into the surrounding eyelid and periorbital tissues, it can cause preseptal cellulitis (also called periorbital cellulitis).
This is a more serious condition characterized by:
- Diffuse redness and swelling of the entire eyelid and surrounding skin
- Warmth and tenderness of the periorbital area
- Possible mild fever and malaise
Preseptal cellulitis is treated with oral antibiotics (typically amoxicillin-clavulanate or cephalosporins) and requires prompt medical attention. It must be distinguished from the more severe and potentially sight- and life-threatening orbital cellulitis, which involves infection posterior to the orbital septum. Orbital cellulitis presents with proptosis (eye protrusion), restricted eye movement, and high fever.
Treatment and Therapy
A stye frequently improves on its own, particularly when it ruptures spontaneously and drains the accumulated pus (do not attempt to force this manually). Most styes resolve within 1 to 3 weeks.
Warm Compresses and Home Remedies
Warm, moist compresses are the most effective first-line treatment and the cornerstone of stye management:
How to apply a warm compress:
- Soak a clean, soft cloth or sterile gauze pad in comfortably warm water (avoid excessive heat, especially in children)
- Wring out the excess water and place it gently over the closed eyelid
- Hold for 5 to 10 minutes
- Repeat 3 to 4 times per day until the stye resolves or drains
The warmth encourages the gland to open, liquefies the thickened secretions, promotes blood flow to the area, and facilitates natural drainage of pus; after this, symptoms typically improve rapidly.
Additional hygiene measures:
- Keep the eyelid area clean and free of crusts, using sterile saline-soaked gauze or commercially available eyelid cleansing wipes
- Avoid contact lenses and eye makeup until the stye has completely healed
- Do not share towels, pillowcases, or washcloths with others while the stye is active
Pain Relief
If the stye is causing significant pain or discomfort, over-the-counter analgesics can provide effective relief:
- Paracetamol (acetaminophen) is the preferred first choice for pain relief and is suitable for all ages with appropriate dosing
- Ibuprofen, an NSAID that provides both pain relief and anti-inflammatory effects
Important: Always read the package leaflet carefully and use the correct dose for age and weight.
Do not give aspirin to children under 16 years of age due to the risk of Reye’s syndrome.
Medical Procedures
If home treatment is insufficient or the stye is particularly large or painful, your doctor may perform one or more of the following procedures:
- Removal of the adjacent eyelash: If the stye originates from an infected eyelash follicle, removing the involved lash can relieve pressure and promote drainage
- Incision and drainage (I&D): Using a fine, sterile needle or scalpel, the doctor makes a small incision in the stye to drain the pus. This is a quick, safe procedure performed under local anesthesia in a clinic setting
- Referral to an ophthalmologist is recommended when:
- The stye fails to respond to initial treatment
- An internal stye is particularly large or painful
- The stye is recurrent or associated with significant Meibomian gland dysfunction
Never attempt to squeeze, pop, or drain the stye yourself, as this can push the infection deeper into the eyelid tissue and lead to more serious complications.
A note on antibiotics: Systemic or topical antibiotics are not routinely recommended for uncomplicated styes. Current evidence does not support their use in straightforward cases, as most styes resolve without antibiotic therapy. Antibiotics ARE indicated in the presence of preseptal cellulitis, concurrent conjunctivitis, or in immunocompromised patients.
Managing Associated Eye Conditions
If a stye occurs in the context of other underlying eye conditions, targeted treatment of the primary condition is essential:
- Conjunctivitis: If bacterial conjunctivitis coexists, your doctor may prescribe antibiotic eye drops
- Blepharitis: Careful eyelid hygiene, including daily lid margin scrubs using a cotton bud dipped in diluted baby shampoo or a dedicated eyelid cleanser, is the cornerstone of blepharitis management and helps prevent stye recurrence
- Rosacea or seborrhoeic dermatitis: Appropriate dermatological management of the underlying skin condition reduces the risk of Meibomian gland dysfunction and recurrent styes
Prevention
Practicing good eye hygiene significantly reduces the risk of developing a stye. Key preventive measures include:
-
Wash your hands frequently: use warm water and soap or an alcohol-based hand sanitizer, and avoid touching your eyes with unwashed hands
-
Replace eye cosmetics regularly: discard mascara and eyeliner every 3 months, as bacteria accumulate in these products over time
-
Never share eye makeup or applicator brushes with other people
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Always remove eye makeup before sleeping; sleeping with mascara or eyeliner on clogs the eyelid gland openings and significantly increases infection risk
-
Maintain clean contact lenses: wash your hands thoroughly before handling lenses and follow your eye care professional’s instructions for cleaning and disinfection. Replace lenses and lens cases as recommended
-
Use warm compresses regularly: if you have a history of recurrent styes or blepharitis, daily warm compresses help keep eyelid glands open and functioning normally, preventing blockage
-
Manage underlying blepharitis: follow your doctor’s recommended eyelid hygiene routine consistently if you have chronic blepharitis
-
Avoid rubbing your eyes, particularly when outdoors or in dusty environments
Frequently Asked Questions
What is the difference between a stye and a chalazion, and how can I tell them apart?
A stye (hordeolum) is an acute bacterial infection of an eyelid gland or eyelash follicle. It develops rapidly, is typically painful and tender, and is located at or near the eyelid margin. A chalazion is a chronic, sterile inflammatory cyst caused by blockage of a Meibomian gland. It develops more slowly, is usually painless (unless secondarily infected), and tends to appear as a firm, smooth lump on the inner surface of the eyelid. A stye may evolve into a chalazion if the gland remains blocked after the infection clears.
Can I use antibiotic or corticosteroid eye drops for a stye without a prescription?
No. Using antibiotic or corticosteroid eye drops without a proper diagnosis and medical supervision is not recommended. Corticosteroid drops in particular can mask signs of infection, increase intraocular pressure, and with prolonged use, increase the risk of cataracts and glaucoma. Without confirming the diagnosis, self-treating with these medications can worsen the condition or lead to serious complications. Always consult a healthcare professional before using prescription-strength eye medications.
How long does a stye last?
Most styes begin to improve within a few days and fully resolve within 1 to 3 weeks. Recovery is often faster if the stye drains spontaneously. If the stye does not improve after 48 hours of warm compress treatment, or if it worsens, medical evaluation is warranted.
Is a stye contagious?
The bacteria that cause styes (Staphylococcus aureus) can be transferred from person to person through direct contact or shared items (towels, pillowcases, makeup). However, styes themselves are not highly contagious under normal circumstances. Basic hygiene, such as not sharing personal items and washing hands frequently, is sufficient to protect close contacts.
Sources and Bibliography
- NHS: Stye, causes, symptoms and treatment (licensed under the Open Government Licence)
- Mayo Clinic: Sty (Stye): Symptoms and Causes
- Deibel JP, Cowling K. Ocular inflammation and infection. Emergency Medicine Clinics of North America. 2013;31(2):387–397.
- Lindsley K, Nichols JJ, Dickersin K. Non-surgical interventions for acute internal hordeolum. Cochrane Database of Systematic Reviews. 2017.
- American Academy of Ophthalmology: Stye (Hordeolum): Diagnosis and Treatment. www.aao.org
