Styes and Blepharitis

By Sandra M. Brown, M.D.

The word “stye” is commonly used to describe a lump on the eyelid, under the skin, that seems to “come out of nowhere”. Styes usually start small and continue to grow for weeks or months. Sometimes they fluctuate in size and they may become inflamed, which makes them red and tender to the touch. Styes are often treated with antibiotic eye drops and/or antibiotics by mouth, but since a stye is not an infection, these treatments do not help.

What is a Stye?

Styes form when the secretions of the Meibomian glands become thick and pasty and do not drain properly. The Meibomian glands are an important row of oil glands that lines all four eyelids. If you look carefully you can sometimes see them as a row of tiny openings, evenly spaced, on the edge of the eyelid between the lashes and the eye ball. The oils produced by these glands are important for healthy tears, as they allow the eyelids to blink smoothly over the eye without dragging. However, just like any other oil gland on the body, the secretions can “back up” and become packed into a solid mass in the lid, which forms a stye.

What other problems can the Meibomian glands cause?

In addition to styes, unhealthy Meibomian glands can cause a condition called blepharitis (meaning “inflammation of the eyelid”). Normal bacteria that live on our skin decide to “take up residence” in the glands because they can live off of the unhealthy oils. These bacteria are not technically causing an infection, but they worsen the problem by secreting substances into the unhealthy, sticky oil that makes it toxic to the front surface of the eye.

Blepharitis symptoms include chronic redness of the eyes, irritation, sensitivity to light or wind, and intermittent tearing. Severe blepharitis can damage the front surface of the eye and cause scarring and permanent vision loss. Often children with blepharitis have been treated with several different antibiotic and anti-allergy eye drops without improvement.

What are the Treatments for Styes and Blepharitis?

The key to long-term success is to restore the health of the Meibomian glands so that they secrete clear, liquid oil into the tears. There are three aspects to treatment:

  1. Heat
    Hot compresses liquefy the stale, packed oils in the glands and inside styes and encourage improved drainage. Hot compresses using a warm washcloth do not work as the cloth stays warm for a few seconds only. The best way to apply heat is to use the “rice in a nylon sock” trick: place about ½ cup of uncooked rice in the foot of a nylon stocking, knot it off, cut off the leftover stocking, and place the rice bag in the microwave. Depending on your microwave you will have to nuke the rice 20 to 40 seconds. Experiment on yourself first so that you do not scald your child! The rice sock will stay warm for up to 5 minutes, and it packs down well over the eye lids. Often children can hold the rice sock on themselves, in return for a “treat” activity such as watching TV while using the sock. The more heat the better! Two times per day is good, three to four times per day is great. Do one eye at a time so that the child is not frightened by having both eyes covered.
  2. Tobradex Ointment
    Tobradex ointment is a particular type of eye ointment that contains both antibiotic and anti-inflammatory medicines. It is very helpful for causing rapid improvement in blepharitis symptoms. It is less useful in styes unless the stye is inflamed. Tobradex ointment can seem like a miracle medicine to parents who have been struggling with an uncomfortable, red-eyed child for months. However, it is a powerful medication which, if used long term, can cause early cataracts and sometimes increased eye pressure. If Dr. Brown prescribes Tobradex, it is essential that you use it exactly as instructed and do not use it for longer than told, even if you feel your child is not fully improved.Tobradex is usually prescribed one to two times a day for ten to 14 days. Often it is rubbed into the eyelashes at bedtime.
  3. Flaxseed Oil
    Flaxseed oil is a dietary supplement that can be purchased in both liquid and gel-cap form. Most grocery stores carry it; the liquid form is needed. Flaxseed oil has a funny texture but almost no taste, and can easily be swallowed when mixed with a yogurt or apple sauce cup. When we “feed” the Miebomian glands flaxseed oil, they can use it as an ingredient to produce healthier, thinner oils themselves. This nutritional treatment is long term; your child will need to be on flaxseed oil for a minimum of three to four months, typically. The dose is not very scientific; Dr. Brown will instruct you in the amount to give your child daily, which will be a few teaspoons to tablespoons, depending on the child’s weight and the severity of the problem.Very rarely flaxseed oil causes gas and diarrhea. This is not something that gets better; if your child is having loose stool and a tummy ache after two to three days of flaxseed treatment, stop giving the oil and let Dr. Brown’s staff know at the next visit.

Other Issues

Junk food: children with blepharitis often eat a lot of junky snack foods. There are many health reasons to limit intake of snack foods. Even children who have a good diet at “regular” meals and eat several servings of vegetables and fresh foods daily can become prone to blepharitis if they also eat many snack foods between meals. This may be related to “feeding” the Meibomian glands low-quality oils, which are not good ingredients for the Meibomian oil-production process.

Eyelashes: taking a little extra care to “scrub” the eye lashes with a wet washcloth wrapped around your finger can help to loosen sticky, dried oils. The rubbing motion also massages the Meibomian glands and helps them to drain.

Is there Surgical Treatment?

There is no surgical treatment for blepharitis. Very stubborn styes can be drained surgically; in most children this requires a trip to the Operating Room and a short general anesthesia. There is no guarantee that the styes will not return in the same places or other places, especially if the blepharitis has not been well-treated. Dr. Brown will discuss the surgery for draining styes in more detail if this becomes necessary.

Copyright Sandra M. Brown MD, August 30, 2005

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