6. That Bump on Your Eyelid: Everything You Need to Know About Styes

You wake up one morning and there it is — a tender, red, angry little bump on your eyelid. Or maybe it's not painful at all, just stubbornly sitting there for weeks, refusing to go away no matter what you do. Sound familiar?

Styes (hordeola) and chalazia are two of the most common eyelid conditions I see in my clinic — and also two of the most misunderstood. Patients come in having tried every home remedy in the book, not sure whether to be worried, and almost always asking the same question: why does this keep coming back?

I'm Dr. Parul Khator, a board-certified ophthalmologist and glaucoma specialist in Marietta, Georgia — and in this episode I'm answering every single question you've ever had about that little bump on your eyelid.

In this episode, I'll cover:

• What a stye actually is — and how it's different from a chalazion
• Why they happen and who tends to get them
• The home treatments that actually work — and the ones to skip
• When it's time to stop waiting and see your eye doctor
• The medical and surgical treatment options available when things don't resolve on their own
• And most importantly — how to stop them from coming back!

Whether you're dealing with one right now or just want to be prepared for the future, this episode has everything you need. 👁️

📬 Have a question or topic you'd love me to cover? I'd love to hear from you! Email me at demystifytheeye1@gmail.com

📱 Follow along on social media: Find me everywhere @demystifytheeye

🌐 Learn more about Dr. Parul Khator, MD: https://www.gaeyepartners.com/metro-atlanta-eye-doctors/parul-khator-md/

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Demystify the Eye is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your eye doctor or qualified healthcare provider with any questions you may have regarding your eye health.

Transcript

SPEAKER_01 0:01

Hello, my name is Parl Kator MD. I'm an ophthalmologist in Atlanta, Georgia, specializing in cataract and glaucoma surgeries. After practicing medicine for over a decade, I have learned that the more a patient knows about their disease, the better they do. Patient education is a passion of mine. But like most doctors, I have a lot of patients and not a lot of time to see them. So I created this podcast where I could spend the time I don't have during the day to give you insights into the eyeball and ocular disease. Let's empower you as a patient or a patient support system. Together, let's demystify the eye. Do you remember being a teenager, swimming through life? Then all of a sudden, a few days before homecoming or before class pictures, you feel it. That subterranean bump and that pain. You've got to be kidding me. A pimple? Now as an adult, thank goodness, we are past all of that. No more pimples to contend with. Sure, now we have to worry about wrinkles, but at least not pimples. That is until we develop a hordeolum. Or in layman's terms, a sty. Or in teenager terms, a pimple of the eyelid. Yes, folks, as an adult, you can still get a pimple. This one, I'm going to say, is worse than the ones we got as kids. This one is right there, front and center. Anytime someone looks you in the eye, they see it. You can't cover it with concealer or by wearing your hair so it covers that side of your face. And this one, if it gets out of hand, can actually create vision loss. In this episode, we will discuss not only what a shalasian or a hordeolum is and how to treat it, but very importantly, how to prevent them from happening in the first place. And it turns out almost every portion of our body has layers to it as well. The eyelid is no exception. Interestingly, the layers of our eyelid change depending on where we are on the lid itself. We are going to focus on the bottom of the eyelid, the portion closest to the lashes. Here, the lid has four layers to it. The first layer we'll talk about is the one closest to the world, farthest away from the eyeball itself. This is the skin of the eyelid. It is just like the skin on the rest of our body, except a bit thinner and more fragile. The layer behind the skin is the orbicularis layer. This is the muscle of the eyelid and helps to close the eyelid. If you look at someone face on, this muscle does not go up and down. It goes in a semicircular band around the eye, one band on the top and one band on the bottom. This muscle orientation allows the orbicularis to act as a sphincter, and this pinches or closes the lids together. After that meaty muscle layer is the tarsus of the eyelid. This layer gives the eyelid its structure. Think back to when you were in elementary school. I'm sure you remember that kid in class, or maybe you were that kid in class, who could flip his eyelids inside out on command, grossing out everyone around him. Well, the portion of the lid that gets flipped is a plate of tissue, and that plate is the tarsus. This plate contains two important structures. The first are the roots of our beautiful eyelashes, and these are called our eyelash follicles. The second important structure inside our tarsal plates are the mibomian glands. These two structures are the focus of this podcast today, so we'll get back to these in just a moment. The final layer of the eyelid and the one that makes contact with the eyeball itself is the conjunctiva. This is mucosal tissue, meaning the same type of tissue that is inside our mouth. This tissue allows the lid to glide smoothly over the eyeball. Let's go back to that tarsal plate and the eyelash follicles. You can thank these guys for giving you the ability to look at someone coquettishly. These eyelash follicles have an entourage. They are surrounded by two important glands called the glands of zeiss and the glands of mall. Besides sounding like places in a fantasy story, these glands secrete material that is antiseptic in nature and part of our eyes' defense system. These glands keep our lids from getting overgrown with bacteria. The mibomian glands are the second super important structure inside our tarsal plate. Mybomian glands are teeny tiny oil glands. How small are they? Well, we have 30 of them stacked side by side in our upper eyelid and 20 stacked side by side in our lower lid. These glands look like skinny, long fingers. How long? About five millimeters in our upper lids and two millimeters in our lower lids. On a ruler, that's two to five teeny tiny hashtags between the zero centimeter mark and the one centimeter mark. These glands are small but mighty. What do they do? Have you ever taken a shower in the middle of winter? You step out and you feel so moist and refreshed. An hour later, after the heater hits your skin and the 30-degree winds hit your skin, you feel like a prune. So what do you do? You reach for a bottle of lotion and slather it on. The lipids or oil in the lotion coats the skin and keeps it from drying out for the rest of the day. Well, our mibomian glands do the same thing for our eyes. They secrete oil onto the surface of our eye, which gets added to our liquid tears and keeps the water from our tears from evaporating. So it makes our tears stronger and it makes them last longer. Without that oil component, our tears would dry up so quickly we would need to reach for a bottle of artificial tears nearly every few minutes. Pathophysiology. Now that you know about lead anatomy, we can really understand how a hordeolum gets formed. There are two major types of hordeola. One is an external hordeolum, and the second is an internal hordeolum. An external hordeolum is when our eyelash follicle gets infected with bacteria. The infection can create a pocket of pus around our lash follicle, essentially an eyelid pimple. The second type of hordeolum is an internal hordeolum, and it happens when the mybomian gland gets infected with bacteria. Well, where in the world is all this bacteria coming from? A lot of it comes from our own hands, like when we accidentally rub our eyes or touch them without washing our hands. Some of the bacteria come from things we put on our eyelids, like mascara or eyeliner or fake eyelashes. But a lot of the bacteria comes from the bacteria that normally live on our eyelids. Excuse me, what? Yes, folks, there are many places in our bodies that bacteria like to just hang out in. The eyelids are no exception. We all have four types of bacteria on our lids, with staphylococcus being the most common type. The problem happens when these bacteria either grow out of control or grow into places they shouldn't, such as our eyelash follicles. Remember the entourage that surrounds our eyelash follicles, the glands of zeiss and maul? They would normally keep bacteria out, but sometimes these glands can get clogged. The natural defense system of the lid goes down and the bacteria decide to get into the eyelash follicles of the mibomian glands and have a party. Now, I do want to take a moment to talk about what a sty is usually accidentally diagnosed as. That is called a salasian. Though a hordeolum and a chalasian are both bumps on the eyelid, they are two totally different animals. A salasian is a blockage of one of the mimomian glands without an infection. When something is clogged and infected versus just clogged, you can imagine the symptoms will be quite different. Symptoms. Of course, that's not actually what goes on in the lid, but let's talk about how a patient with a sty presents. First, a portion of the eyelid becomes red, tender, and swollen. Then, within a day or two, the redness and pain localize and a small bump forms at the area of the infection. This bump can have a whitish center to it, just like a pimple on the skin, and this indicates that there is pus inside. Schalasian or hordeolum can occur on either the upper or lower eyelids. The eyelid is right next to the eyeball, so you can imagine there can be some problems with the eyeball itself. The eye can tear or become light sensitive. If the bump is big enough, it can push into the eyeball and this creates blurry vision. If you have an internal hordeolum, you look better because the bump is tucked away on the undersurface of the lid, so it's not visible to the external world. However, unfortunately, you feel a lot worse. There's more pain, tearing, and blurry vision, and it can feel like you have something in your eye. A salazian, remember, this is the clogged oil gland without the infection part, usually starts as a small red, painful bump on the eyelid. After a few days, however, the pain goes away, but the bump keeps growing. How big? Well, it depends. I've seen salazia the size of a pea, and I've seen salazia the size of my knuckle. While these don't hurt, they tend to be more cosmetically noticeable. They are on the external surface of the lid, but if you take a close look, you'll see they are not at the lash line, but higher up into the eyelid itself. Risk factors. So, what makes it more likely for us to get a hordeolum or a schalesian? And how can we prevent it? Unlike a teenager with a pimple, raging hormones or chocolate binges are not usually the problem here. However, anything that can introduce bacteria to our lids can be a problem. Touching your eyelid with unclean hands. Not fully removing makeup, such as mascara or eyeliner or eyeshadow. Wearing contact lenses that haven't been cleaned or putting them in your eyes without first washing your hands. By the way, I'm cringing with you right now. Immunodeficiencies like being on chemotherapy or high dosteroids can lower your lid's ability to fight off bacteria. Any condition that creates chronic inflammation is going to provide just the right environment for a bacteria party. Things like blepharitis or rosacea will do the trick. So it makes sense then that to prevent these, we would want to wash our hands before touching our eyes. That, by the way, folks, is just a good general rule of thumb. Clean our contact lenses properly, take off all eye makeup before going to bed, even if you get home from a Christmas party at midnight. Cleaning our lids. You can do this with specially designed lid wipes over the counter called OcuSoft Lid Scrubs, or with an at-home concoction of water, baby shampoo, and a soft cloth. With either of these, the point is to clean the lid margin, not the actual lid itself. So what you would do if you wanted to get eyeliner or mascara off, not the motion to get eyeshadow off. For those unfamiliar with makeup, you would want to take the wipe and clean the edge of the lid, right where the lashes come out. If rubbing a soapy cloth this close to your eyelid sounds terrifying, you can also purchase a lid spray from your eye doctor's office called Avanova. Wash your hands, close your eyes, spray a pump or two right at your lashes, then take your clean hands and rub at the edge of the eyelid. Diagnosis. Though I can diagnose this pretty well from a blurry iPhone photograph, I'd much prefer to examine you at the slit lamp. That is our very powerful upright microscope. This way I can clearly tell what the source of the bump is: eyelash follicle or my bomian gland. Importantly, I can make sure your hordeolum is not turning into something more serious. Wait, what can my sty turn into? Well, anytime you have a localized infection, that infection can spread. So the hordeolum can become an infection of your eyelid, which is called preceptal cellulitis. Rarely, but seriously, the infection can spread from the eyelid to the orbit or surrounding tissues of the eye, which is called orbital cellulitis. Also, sometimes these lumps and bumps of the eyelid can actually be hidden tumors, like basal cell carcinoma. You would definitely not want to delay the diagnosis of a lid tumor. So even if you know an eye doctor that you can send a blurry iPhone photo to, I would recommend you still go in to the eye doctor's office to get your official diagnosis. Treatment. For external hordeolum, like a pimple, they can burst two to four days after they form. Internal hordeolum and chalasian can drain a little less dramatically over the course of a few weeks to a few months. There are many things you can do to help the process along. The most important being to add heat. Think about a pan with congealed butter in it. If you want to clean the pan, it's a lot easier to heat it up, let the butter melt, than simply wipe it off. Heat gets oils moving. It will get the oily debris in your lash follicle or backed up my bomium gland moving again. How do I apply heat? How hot should it be? How many times a day and for how long? These are all great questions. You can purchase a specially designed eye mask called a brooder mask or brooder moist heat eye compress to do this. It's a wild-looking mask that is pretty effective. You heat it in the microwave for about 30 seconds, close your eyes and put it on until it's no longer hot. This will be about 10 minutes. In order for the heat to work, it does need to be on your eyelid for about that long. A minute or two is not usually long enough to really get that oil melted and moving. If you do not want to purchase a mask, there's a great at-home trick you can use. I tell my patients to get a soft cloth, not a paper towel or napkin, run some water over it and squeeze the excess water out. Then take the cloth and fold it on itself. Then fold it again and again and again until you end up with just a teeny tiny square. Put this in the microwave for about 30 seconds. Test it on the back of your hand before putting it on your very delicate eyelid skin. We do not want to add a second degree burn to the equation. You then put the fully folded square on your eyelid. Once that becomes cool, open the folded square up once. The inside will still be warm. Put that on your lid until that becomes cool, and repeat this process until you've opened up the entire square you began with. By the time you're done, about 10 minutes should have passed. Now, how often should you do this? As often as you can. The more heat, the more likely you can drain this yourself. At a minimum, make sure you do this two times a day. As you are adding the heat, you want to massage the area to help the oil in there loosen up. You do not want to attempt to pop these things like a pimple because that can lead to infection. The other important thing to do is clean your lids, like we discussed previously, so the bacteria that are partying in your eyelids cannot invite their friends to come join. If you have a hordeolum, that's the infectious bump, you may be prescribed an antibiotic ointment, and we may even use a combined antibiotic steroid ointment to calm down the inflammation at the same time. Word of warning though, topical antibiotics like this don't completely clear up the infection, the way a ZPAC can instantly turn things around if you have a case of bronchitis. They only help you feel better while you are naturally healing, and they may help the hordeolum go away faster, but they are not super effective at treating hordeola and definitely not as effective as heat and massage. Well, what if your hordeolum or chalesian will not go away on its own? What then? You can get a sense whether a Salesian or Hordolum is planning on being around for the long haul. What once began as a squishy bump becomes more of a hardened concrete-like bump. If this happens, or if your bump has been around for weeks and it just doesn't seem to be getting better, you will need to see your local friendly eye doctor because they will need to intervene. We doctors can sometimes inject steroids into the non-resolving lesion in order to calm down all the inflammation that keeps these bumps from draining on their own. Alternatively, we may have to cut it out. Wait, what? What do you mean cut it out? Don't worry, it's not as dramatic as it sounds. We consider this a minor procedure, meaning the removal is done in the office and not the operating room. We inject lidocaine in the affected area. The lidocaine does hurt like the dickens, I'm not going to lie. However, you don't feel anything after that. Most of the time, we are excising in an internal hordeolum or shalesian, so we put a clamp on the eyelid and avert the lid. That means we flip it over. The incision we make to drain these is done on the undersurface of the lid so you don't have to worry about having a big scar. We open up the affected mybomian gland and scoop out the backed up oily debris. By the time they get to this point, they have developed a capsule, and we remove most of this capsule so the chalasian cannot simply grow right back. We clean up the area, unclamp the lid, and voila, you are done. The whole process takes approximately 15 to 20 minutes. You do get an antibiotic ointment after this procedure to make sure you don't get an infection. Since your vision can be blurry and you can tear after the procedure, it's probably best to have a driver with you. Conclusion. Bono from U2 said, it's stasis that kills you off in the end, not ambition. Our bodies reveal just how true this insight is. To stay healthy, we need to keep things moving. When there is a backup from our gut to our eyelash follicles, there are going to be problems. Salazia and Hordiola remind us what it was like to be a teenager when a new bump on your face is the last thing you need the week before your anniversary party or work retreat. But the good news is these bumps will go away on their own most of the time. Or we can make them go away. I hope you've enjoyed this episode of Demystify the Eye. Until next time, see well and be well.

SPEAKER_00 22:00

Right, they did pass out. Do you think you would pass out watching me do surgery?

SPEAKER_02 22:06

No, because I'm pretty good at watching gross stuff.

SPEAKER_00 22:09

All right. I'll see you in the OR on Monday.

SPEAKER_02 22:12

Okay.

SPEAKER_00 22:15

Thank you. You're welcome.