Can High Cholesterol Cause Eye Hordeolums (Styes)?
No, high cholesterol does not directly cause hordeolums (styes), but there is emerging evidence suggesting a possible association between metabolic syndrome components—including elevated cholesterol—and eyelid inflammation conditions like blepharitis, which is a known risk factor for recurrent hordeolums.
The Evidence Linking Cholesterol to Eyelid Disease
The relationship between cholesterol and eyelid conditions is indirect and relates primarily to blepharitis rather than hordeolums specifically:
Metabolic syndrome components, including elevated total cholesterol, LDL cholesterol, and triglycerides, have been associated with higher rates of blepharitis in observational studies 1.
Patients with increased waist circumference, systolic blood pressure, higher glucose, higher total cholesterol and LDL cholesterol, and higher triglycerides were more likely to have a diagnosis of blepharitis 1.
Interestingly, statin use was associated with a lower risk of blepharitis in population-based studies, suggesting that cholesterol-lowering may have protective effects on eyelid inflammation 1.
However, the guidelines explicitly state that "further research is needed to examine the relationship between cholesterol and blepharitis," indicating this association is not yet definitively established 1.
The Actual Causes of Hordeolums
Hordeolums have well-established causes unrelated to cholesterol:
Hordeolums are typically caused by bacterial infection (usually Staphylococcus aureus) of the eyelid glands, presenting as painful, erythematous nodules at the eyelid margin with rapid onset and acute inflammation 2, 3.
The primary risk factors for hordeolums are bacterial blepharitis, meibomian gland dysfunction, poor eyelid hygiene, and underlying skin conditions like rosacea or seborrheic dermatitis 2, 3, 4.
Children with a history of styes have an increased risk of developing adult rosacea, but this represents a different causal pathway unrelated to cholesterol 1.
Clinical Implications
When evaluating patients with recurrent hordeolums:
Focus on identifying and treating underlying blepharitis, meibomian gland dysfunction, rosacea, and seborrheic dermatitis as these are the established predisposing conditions 2, 3.
Implement regular eyelid hygiene measures, warm compresses, and treatment of underlying skin conditions as prevention strategies 2, 3.
While screening for metabolic syndrome components may be reasonable in patients with chronic blepharitis, there is insufficient evidence to attribute hordeolums directly to hyperlipidemia 1.
Important Distinction: Xanthelasma vs. Hordeolum
Do not confuse hordeolums with xanthelasmas:
Xanthelasmas are superficial fat deposits around the eyelids that ARE associated with hyperlipidemia and familial hypercholesterolemia, and these can regress with aggressive lipid-lowering therapy 5.
Hordeolums are acute infectious/inflammatory lesions that are NOT caused by lipid deposits 2, 3, 4.
Bottom Line for Clinical Practice
Treat recurrent hordeolums by addressing their actual causes—bacterial blepharitis, meibomian gland dysfunction, and poor eyelid hygiene—rather than focusing on cholesterol levels 2, 3, 4. While the metabolic syndrome-blepharitis association is intriguing, it remains investigational and should not change current management of hordeolums 1.