External Hordeolum (Stye): Causes, Stages, and Treatment

Definition: An acute suppurative inflammation of the lash follicle and its associated glands of Zeis or Moll.

Etiology

1. Predisposing Factors

• Age: Common in children and young adults (though no age is a bar).
• Eye Strain: Often due to muscle imbalance or refractive errors.
• Habits: Habitual rubbing of the eyes or fingering of the lids and nose.
• Local Factors: Chronic blepharitis.
• Systemic/Metabolic: Diabetes mellitus (usually associated with recurrent styes), chronic debility, excessive intake of carbohydrates, and alcohol.

Clinical Features

Symptoms

• Acute pain associated with swelling of the lid.
• Mild watering and photophobia.

Signs (Clinical Stages)

Stage	Characteristics
Stage of Cellulitis	Localised, firm, red, tender swelling at the lid margin associated with marked oedema. Usually single, occasionally multiple.
Stage of Abscess Formation	Visible pus point on the lid margin in relation to the affected cilia.

Treatment Protocol

• Conservative: Hot compresses 2-3 times a day (especially useful in the cellulitis stage).
• Pus Evacuation: Epilate the involved cilia when the pus point is formed.
• Surgical: Incision is rarely required (only for a large abscess).
• Topical Therapy: Antibiotic eye drops (3-4 times a day) and eye ointment (at bedtime) to control infection.
• Systemic Therapy:
  • Anti-inflammatories and analgesics to relieve pain and reduce oedema.
  • Systemic antibiotics for early control of infection.

Clinical Pearl: In recurrent styes, always try to find out and treat the associated predisposing condition (like Diabetes or Refractive errors).