Stye (Hordeolum): Symptoms, Causes & Treatment

What Is a Stye?

A stye is a temporary inflammation or blockage in one of the eyelid's oil glands. It is similar to getting acne on your eyelid, causing a painful red bump that can appear on the outer edge of the eyelash line (external stye) or inside the eyelid (internal stye). Styes vary in size and are not contagious.

A stye, medically known as a hordeolum, develops when bacteria (most commonly Staphylococcus aureus) infect an oil-producing gland in the eyelid. The infection triggers inflammation, causing the characteristic painful, swollen bump. The body's immune response to this localized infection creates the redness, tenderness, and swelling that characterize a stye.

The eyelid contains many tiny oil glands called meibomian glands along with sebaceous glands associated with eyelash follicles. These glands normally secrete oils that form the outer lipid layer of the tear film, helping to prevent tear evaporation and keeping the eye's surface lubricated. When one of these glands becomes blocked, the accumulated oil creates an ideal environment for bacterial growth, leading to infection and inflammation.

Understanding the anatomy helps explain why styes form where they do. The meibomian glands are located deep within the eyelid tissue, while the glands of Zeis and glands of Moll are associated with eyelash follicles near the lid margin. When the deeper meibomian glands are affected, an internal stye (internal hordeolum) forms, which tends to be more painful and may point toward the inner surface of the lid. When the more superficial glands are affected, an external stye (external hordeolum) develops along the eyelash line, often with a visible white or yellow head.

External Stye vs. Internal Stye

There are two main types of styes, distinguished by their location on the eyelid. An external stye appears on the outer edge of the eyelid along the lash line. It occurs when the glands of Zeis (sebaceous glands) or glands of Moll (sweat glands) at the base of an eyelash become infected. External styes are more common and typically visible as a small pimple-like bump with a yellow or white head near the lashes.

An internal stye develops inside the eyelid when a meibomian gland becomes infected. These styes are generally more painful than external styes because they press against the eyeball. The swelling may be visible on the outer eyelid, but the actual infection point is on the inner surface of the lid. Internal styes may take longer to heal and are more likely to develop into a chalazion if not properly treated.

How Common Are Styes?

Styes are extremely common eye conditions that most people experience at least once during their lifetime. While precise prevalence data is limited, ophthalmologists report that styes are among the most frequently seen eyelid disorders in clinical practice. They can occur at any age but are particularly common in adults between 30 and 50 years old. Styes occur with equal frequency in men and women, and there are no significant differences in prevalence across ethnic groups.

Certain populations have higher stye rates, including people with chronic blepharitis (eyelid inflammation), those with skin conditions like rosacea or seborrheic dermatitis, and individuals who frequently touch their eyes or have poor eyelid hygiene. People who wear contact lenses may also be at slightly increased risk, particularly if proper lens hygiene is not maintained.

What Are the Symptoms of a Stye?

The main symptoms of a stye include a painful red bump on the eyelid, tenderness and warmth at the affected area, eyelid swelling, a gritty sensation as if something is in the eye, and sometimes crusting along the eyelid margin. You may also experience increased tearing and light sensitivity.

Stye symptoms typically develop gradually over a day or two and then become more pronounced. The initial sign is often a feeling of irritation or tenderness at the edge of the eyelid, which many people describe as a sensation similar to having an eyelash caught under the lid. This discomfort progresses to localized swelling and redness as the infection develops.

The characteristic bump of a stye usually becomes visible within 24-48 hours of symptom onset. For external styes, this appears as a small, pimple-like swelling along the lash line, sometimes with a visible yellow or white center where pus has accumulated. For internal styes, the bump may not be directly visible but causes a noticeable swelling of the eyelid that can sometimes be seen from the outside.

Pain levels vary depending on the stye's size and location. External styes tend to be less painful than internal styes, though both can cause significant discomfort, especially when blinking or when the affected area is touched. The pain is typically described as a dull, throbbing ache that may intensify during the first few days before gradually subsiding as the stye begins to heal.

Common Symptoms Include:

• Painful red bump: A tender, localized swelling on the eyelid margin or within the lid itself
• Eyelid swelling: The affected eyelid may become puffy and swollen, sometimes significantly
• Tenderness and warmth: The area around the stye feels tender to touch and may be warm
• Gritty sensation: A feeling as though something is in the eye, especially when blinking
• Crusting: Dried discharge may accumulate along the eyelashes, particularly after sleep
• Excessive tearing: The eye may water more than usual as a response to the irritation
• Light sensitivity: Some people experience mild photophobia with styes

Timeline of Symptoms

The symptoms of a stye follow a relatively predictable pattern. During the first 2-3 days, inflammation is typically at its worst, with maximum swelling, redness, and pain. This is the acute phase when the body's immune system is actively fighting the infection. Many people notice that their stye feels particularly uncomfortable during this period.

After the acute phase, the stye typically begins to drain, either spontaneously or with the help of warm compresses. When an external stye drains, you may notice a small amount of pus coming from the white or yellow head. After drainage, symptoms rapidly improve, with swelling and pain decreasing significantly within 24-48 hours. The complete healing process usually takes one to two weeks, though the visible redness may persist slightly longer.

A Lump That Doesn't Go Away

Sometimes a stye begins as a tender, painful bump but then transitions into a firm, painless lump that persists for weeks or even months. This occurs when the initial infection resolves but the blocked gland remains obstructed, resulting in a chalazion. Unlike the acute stye, a chalazion is typically not tender but may cause irritation because it rubs against the eye or causes eyelashes to turn inward against the cornea.

If a lump on your eyelid has been present for more than six months and continues to cause problems, it may need to be surgically removed. This is a minor procedure performed under local anesthesia, typically taking only 10-20 minutes. Your healthcare provider can assess whether surgery is necessary based on the size of the chalazion and the degree of symptoms it causes.

What Can I Do at Home to Treat a Stye?

The most effective home treatment for a stye is applying warm compresses for 10-15 minutes, four times daily. The warmth helps open the blocked gland and promotes drainage, speeding up healing. You should also keep your eyelids clean, avoid wearing contact lenses during active infection, and never squeeze or attempt to pop the stye.

Home treatment for styes focuses on two main goals: promoting drainage of the blocked gland and preventing secondary infection. The cornerstone of treatment is warm compress therapy, which has been used for centuries and remains the most effective first-line intervention for uncomplicated styes. Heat softens the hardened oils blocking the gland, allowing them to flow more freely and helping the stye to drain naturally.

Proper technique for warm compress application is important for maximum benefit. The compress should be warm but not hot enough to burn the delicate eyelid skin. Most people find that water heated to about 40-45°C (104-113°F) is comfortable and effective. The compress should be applied for a minimum of 10 minutes per session, as shorter durations may not provide sufficient heat penetration to soften the blocked oils effectively.

Consistency is crucial for warm compress therapy. Applying the compress four times daily provides the best results, though even twice-daily application can be beneficial. Many people find it convenient to incorporate compress therapy into their morning and evening routines, adding additional sessions as time permits. With consistent treatment, many styes show significant improvement within 3-4 days.

Step-by-Step Warm Compress Instructions

1. Wash your hands thoroughly with soap and water before touching your eye area to prevent introducing additional bacteria.
2. Prepare the compress by soaking a clean washcloth or cotton pad in warm (not hot) water. Wring out excess water so it's damp but not dripping.
3. Apply to the closed eyelid gently, making sure the warmth covers the entire stye area.
4. Massage gently while holding the compress. For upper eyelid styes, massage from top to bottom toward the lash line. For lower eyelid styes, massage from bottom to top.
5. Rewarm as needed when the compress cools to maintain therapeutic temperature for the full 10-15 minutes.
6. Repeat at least 4 times daily until the stye heals completely.

Some people prefer using commercial warm eye masks, which can maintain heat longer than a wet washcloth. Microwaveable eye masks designed for dry eye treatment work well for styes and can provide consistent warmth for the recommended duration. However, always follow the product instructions and test the temperature before applying to the eye to avoid burns.

If the Stye Drains

When a stye ruptures and releases pus, this is actually a positive sign that healing is progressing. You may notice a small amount of yellowish or whitish discharge on your eyelashes or around the stye site. When this occurs, gently clean the eye and eyelid with warm water, being careful not to rub or spread the discharge. You can then continue with warm compress therapy until all symptoms resolve.

It's important to maintain good hand hygiene after cleaning a draining stye. While styes themselves are not contagious, the bacteria in the discharge can potentially cause infection if transferred to the other eye or to another person. Wash your hands thoroughly after any contact with the stye or eye area, and avoid sharing towels or washcloths during this time.

What to Avoid

• Never squeeze, pop, or attempt to drain a stye: This can push bacteria deeper into the tissue, spread the infection, and potentially cause serious complications including cellulitis.
• Avoid wearing contact lenses: While your stye is active, wear glasses instead. Contact lenses can irritate the eye and may become contaminated with bacteria.
• Don't wear eye makeup: Cosmetics can further block glands and harbor bacteria. Discard any eye makeup you used before the stye developed, as it may be contaminated.
• Avoid rubbing your eyes: Rubbing can worsen inflammation and spread bacteria to other areas.

When Should You See a Doctor for a Stye?

Most styes don't require medical treatment, but you should see a doctor if your stye persists for more than two weeks, if your entire eyelid becomes very swollen, red, and painful, if you develop fever, if the swelling extends beyond your eyelid to your face, or if you experience vision changes. Recurring styes also warrant medical evaluation.

While the vast majority of styes resolve on their own with simple home care, certain situations require professional medical evaluation. Understanding when to seek care can help you avoid potential complications while also avoiding unnecessary medical visits for conditions that will heal spontaneously.

The primary concern with styes is the possibility of the infection spreading beyond the gland to the surrounding eyelid tissue or, rarely, to deeper structures. Signs that may indicate spreading infection include increasing redness and swelling that extends beyond the immediate stye area, fever, or feeling generally unwell. These symptoms warrant prompt medical attention, ideally within the same day.

Persistent styes that don't improve with two weeks of warm compress therapy may benefit from medical intervention. In some cases, a healthcare provider may prescribe antibiotic ointment or drops to help clear the infection. For styes that remain after conservative treatment or that have developed into chalazions causing persistent symptoms, minor surgical drainage may be recommended.

Seek Immediate Medical Care If:

• Your entire eyelid becomes severely swollen, red, and painful - This may indicate preseptal cellulitis, an infection of the eyelid tissue that requires antibiotic treatment.
• Swelling extends to your cheek or other parts of your face - Spreading infection beyond the eyelid is a concerning sign.
• You develop a fever - Fever suggests systemic infection requiring medical treatment.
• You experience vision changes - Any effect on your sight warrants immediate evaluation.
• Pain becomes severe - While styes are uncomfortable, severe pain may indicate a more serious condition.

Schedule a Routine Appointment If:

• Your stye hasn't improved after 2 weeks of home treatment
• A lump remains after the acute symptoms resolve and persists for more than 6 months
• You experience recurring styes frequently
• The stye is affecting your vision (e.g., a large stye pressing on the eye)
• You're unsure whether you have a stye or a different condition

How Are Styes Treated Medically?

Medical treatment for styes may include prescription antibiotic ointment to clear bacterial infection and lubricating eye drops to relieve discomfort. For persistent styes that don't respond to conservative treatment, a minor surgical procedure called incision and drainage may be performed under local anesthesia.

For most uncomplicated styes, the treatment recommendations from healthcare providers mirror home care advice: warm compresses and good eyelid hygiene. However, when a stye is particularly severe, slow to improve, or has developed complications, additional medical treatments may be beneficial.

Topical antibiotic ointments such as erythromycin or bacitracin may be prescribed for styes that appear infected or are slow to heal. These ointments are applied directly to the eyelid margin, typically 2-4 times daily. While there is some debate in the medical literature about whether topical antibiotics significantly speed healing for uncomplicated styes, they may help prevent secondary infection and are generally safe to use.

Oral antibiotics are rarely necessary for simple styes but may be prescribed when there is evidence of spreading infection (preseptal cellulitis) or in patients with compromised immune systems. Common choices include dicloxacillin, cephalexin, or amoxicillin-clavulanate, typically taken for 7-10 days. If you are prescribed oral antibiotics, it's important to complete the full course even if symptoms improve before the medication is finished.

Surgical Treatment

When a stye (or the chalazion it has become) persists despite conservative treatment and continues to cause problems, surgical drainage is the definitive treatment. This minor procedure, called incision and curettage, is performed under local anesthesia in an outpatient setting. The procedure typically takes only 10-20 minutes.

During the procedure, the eyelid is numbed with an injection of local anesthetic. For internal styes and chalazions, the eyelid is everted (turned inside out) and a small incision is made on the inner surface of the lid, where the cyst contents are drained and the cyst wall is scraped out. This approach leaves no visible scar. For external styes, the incision may be made on the outer eyelid surface at the site of pointing.

Recovery from surgical drainage is quick, with most patients experiencing only mild discomfort for a day or two. You may be given antibiotic ointment to apply for several days after the procedure. The success rate for surgical treatment is high, though in some cases the lesion may recur, requiring repeat treatment.

What Causes Styes?

Styes are caused when bacteria, usually Staphylococcus aureus, infect a blocked oil gland in the eyelid. Risk factors include blepharitis (chronic eyelid inflammation), rosacea, dry eyelids, previous styes, touching your eyes frequently, poor makeup hygiene, and improper contact lens care.

The root cause of a stye is bacterial infection of an eyelid gland, but several underlying factors can predispose someone to developing styes. Understanding these causes and risk factors can help with both treatment and prevention strategies.

Staphylococcus aureus is responsible for approximately 90-95% of styes. This bacterium commonly lives on human skin without causing problems, but when it gains access to a blocked gland, it can multiply rapidly in the accumulated oils, triggering an infectious inflammatory response. Less commonly, other bacteria or even viruses may be involved.

Gland blockage is the critical factor that allows infection to take hold. Oil glands can become blocked when their secretions thicken due to various factors, when dead skin cells accumulate around the gland opening, or when inflammation causes the gland duct to narrow. Once blocked, the accumulated oils provide an excellent growth medium for bacteria.

Risk Factors for Developing Styes

Blepharitis is the most significant risk factor for styes. This chronic condition causes inflammation of the eyelid margins, leading to thickening of gland secretions, bacterial overgrowth, and frequent gland blockages. People with blepharitis often experience recurring styes and may benefit from ongoing lid hygiene measures to prevent flare-ups.

Rosacea is a skin condition that commonly affects the face and can also involve the eyes (ocular rosacea). People with rosacea often have dysfunction of the meibomian glands, making them more susceptible to styes and chalazions. The inflammatory nature of rosacea also contributes to eyelid margin problems.

Dry eye syndrome can contribute to stye formation in several ways. When the eyes are chronically dry, the meibomian glands may not function properly, leading to thickened secretions and gland blockages. Additionally, people with dry eyes tend to rub their eyes more frequently, which can introduce bacteria to the lid margin.

Other risk factors include:

• Previous styes: Having had styes in the past increases your risk of developing them again
• Touching your eyes frequently: This can transfer bacteria from your hands to your eyelids
• Not removing makeup thoroughly: Makeup residue can block glands and harbor bacteria
• Using old or contaminated eye makeup: Bacteria can grow in makeup products over time
• Contact lens hygiene issues: Poor lens care can contribute to bacterial load around the eyes
• Skin conditions: Acne, seborrheic dermatitis, and other skin conditions affecting oil glands
• Stress and fatigue: These factors may weaken immune response and contribute to infections

How Can You Prevent Styes?

You can help prevent styes by maintaining good eyelid hygiene, including daily warm compresses if prone to recurrence, washing hands before touching your eyes, removing makeup thoroughly before bed, replacing eye cosmetics regularly, and managing underlying conditions like blepharitis or rosacea.

Prevention strategies for styes focus on reducing bacterial load on the eyelids, preventing gland blockages, and addressing underlying conditions that predispose to stye formation. For people who experience frequent styes, consistent preventive measures can significantly reduce the frequency of flare-ups.

Daily eyelid hygiene is the cornerstone of stye prevention. This includes washing the eyelids with a gentle cleanser during your daily face-washing routine, paying particular attention to the lash line where bacteria and debris tend to accumulate. Some people benefit from using commercial lid scrubs or baby shampoo diluted with water to clean the lid margins.

Warm compress therapy isn't just for treating existing styes—regular use can help prevent them by keeping the oil glands functioning properly. For people prone to recurring styes, applying warm compresses for 5-10 minutes daily can help maintain proper gland drainage and prevent blockages from developing.

Prevention Tips for Dry Eyelids

If you tend to have dry eyelid skin, which can contribute to gland dysfunction, applying a moisturizing eye ointment along the lid margin can help. Several over-the-counter products are specifically designed for this purpose. These ointments help maintain the health of the eyelid skin and may reduce the frequency of styes.

Prevention Tips for Blepharitis

People with chronic blepharitis are at highest risk for recurring styes and benefit most from consistent preventive measures. In addition to daily lid hygiene and warm compresses, your doctor may recommend specific treatments such as antibiotic ointments used periodically, omega-3 fatty acid supplements, or specialized treatments like intense pulsed light (IPL) therapy or thermal pulsation devices.

Prevention Tips for Skin Conditions

If you have acne, rosacea, or seborrheic dermatitis, managing these conditions can help reduce stye frequency. Work with your dermatologist to optimize treatment of your skin condition, and let them know if you're experiencing frequent styes so they can adjust your treatment plan accordingly. Regular use of lubricating eye ointment may also be helpful.

General Prevention Strategies

• Wash hands frequently and avoid touching your eyes with unwashed hands
• Remove all eye makeup before going to bed using a gentle makeup remover
• Replace eye makeup regularly: Mascara and eyeliner should be replaced every 3-6 months
• Don't share eye makeup or makeup applicators with others
• Clean contact lenses properly and replace them according to your eye care provider's recommendations
• Manage underlying conditions like blepharitis, rosacea, or dry eye as directed by your healthcare provider