Causes of Eye Styes
Eye styes (hordeola) are primarily caused by bacterial infections of the eyelid glands, with Staphylococcus species being the most common causative organisms. 1
Types of Styes
- Internal hordeolum: Infection of the meibomian glands (oil glands) within the tarsal plate of the eyelid 1
- External hordeolum (stye): Infection of the glands of Zeis or Moll (sebaceous glands associated with eyelash follicles) 2
Primary Causative Organisms
- Staphylococcus aureus: A frequent cause of eyelid infections 3
- Staphylococcus epidermidis: Common skin flora that can become opportunistic pathogens 4
- Other bacteria: Less commonly, other bacterial species may be involved 1
Risk Factors and Contributing Conditions
Eyelid-Related Factors
- Blepharitis: Chronic inflammation of the eyelid margins creates an environment conducive to stye formation 1
- Poor eyelid hygiene: Allows bacterial overgrowth on eyelid margins 1
- Meibomian gland dysfunction: Blockage of oil glands can lead to infection 1
- Previous history of styes or chalazia: Increases risk of recurrence 1
External Factors
- Contact lens wear: Especially with poor hygiene practices or overnight wear 1
- Eye makeup: Can block glands and harbor bacteria 1
- Contaminated eye products: Including expired makeup or solutions 1
Systemic Conditions
- Rosacea: Dermatologic condition that often affects the eyelids 1
- Diabetes mellitus: Increases susceptibility to infections 1
- Immunosuppression: From medications or medical conditions 1
- Atopic dermatitis/blepharoconjunctivitis: Creates inflammation that predisposes to infection 1
Pathophysiology
- Gland obstruction: Initial blockage of the oil gland creates a favorable environment for bacterial growth 1
- Bacterial colonization: Staphylococcal species proliferate in the blocked gland 3
- Inflammatory response: The body's immune response to the infection causes redness, swelling, and pain 1
- Abscess formation: Collection of pus within the infected gland 2
Common Presentation
- Localized eyelid swelling: Focal area of inflammation 1
- Redness and tenderness: Due to inflammatory response 1
- Pain: Often worse when blinking or touching the area 1
- Discharge: May be present as the stye matures 1
- Foreign body sensation: Common complaint from patients 1
Prevention Strategies
- Regular eyelid hygiene: Cleaning eyelid margins with warm compresses and gentle cleansers 1
- Proper contact lens care: Following recommended cleaning and replacement schedules 1
- Avoiding eye rubbing: Reduces transfer of bacteria to eyelid margins 1
- Regular replacement of eye makeup: To prevent bacterial contamination 1
- Management of underlying conditions: Such as blepharitis or rosacea 1
Clinical Considerations
- Differentiation from chalazion: A stye is an acute infection, while a chalazion is a chronic, sterile inflammatory lesion of a blocked meibomian gland 2, 5
- Potential for spread: Untreated styes can sometimes lead to preseptal cellulitis 5
- Recurrence: Some individuals are prone to recurrent styes, suggesting underlying chronic conditions 1