What Is An Internal Stye?

Overview

A stye (or hordeolum)  is a typical but uncomfortable eyelid infection. They usually present as a small, pus-filled red or yellow spot on the borders of the eyelid. The majority of styes heal on their own in one or two weeks and do not require medical attention. They are taken care of by home remedies like hot sponging, which can reduce aches and promote self-drainage and healing. Although they rarely indicate anything sinister, they are painful while they're healing.

A stye commonly presents on one eye at a time, but there are chances of having more than one at a time. It might not be a stye if the following are not present: a lump or pain. It could be conjunctivitis (inflammation of the conjunctiva) or blepharitis (inflammation of the eyelid) if there is no lump, but the eye is watery, swollen, and red. Or it could be a chalazion if there is a hard lump, but it is not painful. 

Styes are classified as being of two variants; external (which are more common) and internal (which are less common). Internal styes are lumps that arise when a gland (known as a meibomian gland) becomes infected. This leads to swelling that can be felt by an individual against their eyeball, along with some dull pain. From the outside, this is only visible as a swelling. 

In this article we will discuss more about internal styes, what causes them, what they are associated with, and how to deal with them.^1,3

Causes of internal styes

An internal stye is an acute bacterial infection of the meibomian glands of the eyelid, whereas an external stye is due to an infected eyelash follicle. The majority of styes normally develop for no apparent reason, though an external stye may be more likely if your eyelids are scratchy or frequently touched. About 90% to 95% of instances of a stye are caused by Staphylococcus aureus, with Staphylococcus epidermidis (both types of bacteria) being the second most frequent culprit. These bacteria are germs that are typically discovered on healthy skin. Usually, they cause no harm, but can occasionally penetrate the skin and lead to diseases like spots, abscesses, and styes.

For some people with blepharitis,  the eyelids may swell and become dry and itchy, which may make them more prone to acquiring styes.

A bacterial infection in the eyelid can lead to inflammation, which in turn leads to blockage of the meibomian gland and subsequently to the development of a chalazion. Therefore, the styes and chalazions can easily be confused.¹

Signs and symptoms of internal styes

Each person's stye will manifest differently, however, the frequent symptoms that can help to distinguish styes from other illnesses are listed below:^1,2

Symptoms

Without a history of trauma or foreign bodies, the patient would typically describe a slow onset of a painful, burning, red, and swollen eyelid. The problem may initially appear as a generalized swelling and redness of the lids before becoming localized. If the stye is pressing on the cornea due to its size, the clearness of vision may be compromised. Eye pain shouldn't be reported by the patient.

Signs

The affected eyelid is red, but the area of redness is more spread out than it is in other eye illnesses. To find an internal stye, you may observe a pimple and need to twist your eyelids outwards. Patients commonly have a history of eyelid issues that are identical to this one. Also, their eye movements ought to be painless and intact. 

Diagnosis of internal styes

If you or someone you know are experiencing any of the symptoms mentioned above, and these symptoms have been persistent for a few days, you should see your GP.

Diagnosing a stye does not require testing. Instead, it is a clinical diagnosis requiring one to only answer a few questions and undergo a quick physical exam. Your doctor will ask questions to rule out other conditions of the eyelid like cellulitis, chalazion, or more sinister conditions like carcinomas. A chalazion may look very similar to an internal stye, making telling the difference between the two very difficult. Chalazion usually last longer, with a nodule that is not red or painful. But thankfully, the initial treatment for both is the same, i.e warm compression and maintaining face hygiene

Rarely, other tests are required. Sometimes, if complications occur (like orbital cellulitis), a dye-stained strip (fluorescein strip)  is used to check if there are any scrapes on the surface of the eye.^1,2

Management and treatment for internal styes

Typically, a stye resolves on its own within a week. The treatment for internal and external styes is the same. Warm compresses and erythromycin ointment administered twice daily are typically sufficient treatments to speed healing and stop the spread of infection– along with painkillers like paracetamol for the pain.

The use of erythromycin ointment for seven to ten days has been advised despite the lack of data supporting its effectiveness. At least four times per day, warm compresses should be used for 15 minutes each time. It has also been recommended to gently massage the nodule to aid in the release of any blocked substance. Unless there is extensive surrounding redness and risk of an eyelid or eye infection, oral antibiotics are rarely necessary. If the patient needs antibiotics, these are usually given for a week, before the patient is called back for a reassessment.

Generally, you will get the above management advice from your GP. However, in some cases, referral to an ophthalmologist is appropriate for particularly big styes, in which incision and drainage are taken into consideration, or if the diagnosis is unclear, like between a stye or a chalazion.^1,2

Risk factors of internal styes

Factors that can increase your chance of getting a stye include:

1. Previous history of styes
2. Foreign body contact with the eye surface (ex; contact lenses)
3. Lack of hygiene
4. Previous history of other conditions like blepharitis
5. Makeup

FAQs

How can I prevent internal stye?

You can avoid styes by doing the following:

1. Removing makeup and washing your face before going to sleep
2. Making sure your make-up is not old
3. Maintaining good daily face hygiene.

You should not do the following:

1. Share towels
2. Rub eyes with unwashed hands
3. Wear contact lenses without washing hands

How common is an internal stye?

Styes are very common, although their exact numbers are not known. They are slightly more common in people aged 30 to 50.¹

What can I expect if I have an internal stye?

If you have an internal stye, it might just appear as a swelling from the outside, with a dull ache. You might also feel a lump against your eyeball.

Does an internal stye go away on its own?

Usually, internal styes do not need any treatment, and go away on their own within 3 to 4 days, or sometimes up to two weeks. They pop spontaneously and the pus drains away, leaving no further ailments. However, one should not pop a stye on their own.

How long does an internal style last?

Usually, a stye lasts for around a week or two. The duration can vary based on your level of care and hygiene.

When should I see a doctor?

See a doctor if your eyelid is:

1. Very swollen or painful.
2. Not getting better within a few weeks.
3. Affecting your eyesight

Summary

A stye (hordeolum) is a common condition of the eyelid that is increasingly seen in people aged 30 - 50. An internal stye is comparatively less common. This will be noticeable as a swollen, red, dull aching eyelid that does not get better within a few days.

This is nothing to be worried about since it can usually be easily treated at home, by doing warm compressions and maintaining good face hygiene. However, if the stye does not subside in a few days, then one should go see their doctor. Your doctor will take a history and examine the eye. If they think that it is an internal stye they may prescribe some antibiotic ointment to help speed up the recovery. Along with this, they will try to rule out any other conditions and complications.

There are a few steps that you can take at home to prevent having a stye in the future, these include making sure you clean your face and hands often, not using old makeup, not sharing towels, and finally, not touching your eyes with unwashed hands. Since a stye is a result of an infection, all these methods involve spreading germs that can cause a stye. Last but not least, if you wear contact lenses, make sure that you keep them in their liquid medium, and whenever you wear them, wash your hands before wearing them.