Many of us will occasionally suffer with a sore and swollen eyelid. Of the many possible causes, amongst the commonest are cysts called an external hordeolum (a stye) and an internal hordeolum.
An external hordeolum occurs when a gland on the outer surface of the eyelid becomes blocked and infected, and a yellow or cream coloured ‘head’ is visible on the eyelid.
An internal hordeolum is where a gland located more on the inner surface of the eyelid is involved and the head is only visible when the eyelid is everted (turned out).
Although these two cysts are different they can be considered together as the treatment for them is the same.
In most cases they present quite suddenly over a day or so with a painful and red swelling on the eyelid. It is important to seek advice from an optometrist or your doctor to confirm the diagnosis.
The most important part of the treatment of these cysts involves applying pressure with a warm compress, and to start treatment as soon as possible: any other treatment is in addition to this. Use a folded facecloth soaked in warm water to apply pressure to the closed eye for 15 minutes, four times a day. Intermittent massage with the fingertips is also useful, but wash your hands before and after.
Sometimes, antibiotic ointment is also useful, rubbed onto the surface of the eyelid in an external hordeolum, or applied behind the lower eyelid in an internal hordeolum. This should be done twice daily until the cyst improves.
In most cases the cyst will resolve within 1 – 2 weeks, especially if treatment is started early. Sometimes, particularly if treatment is delayed, the cyst will not resolve completely but remains as a smaller, hard lump. It is worth continuing the warm compress for several weeks in these cases as some will respond, but others fail to resolve completely; these will often need to be referred to an eye specialist (ophthalmologist) to be excised (cut out).
With young children, care must be taken to ensure that treatment is supervised, but also it is necessary to watch them for signs of the infection spreading. Raised temperature and generally feeling unwell can indicate pre-septal cellulitis which requires medical treatment (from your GP) with systemic antibiotics at an early stage, and continued observation in case of further spread of infection.
Some people are particularly prone to developing these cysts, and may require long term treatment for a mild inflammation of the eyelids called blepharitis. Your optometrist can advise on this.
Repeated (three or more) internal hordeolum in the same location should be reported to your GP or optometrist.