Why did I get a stye (Chalazion)?

Chalazia as tip of iceberg in children to adults:

A chalazion (or “Stye”) is essentially an acne pimple in your eyelid. Once one of these oil glands blocks, it can keep making oil and eventually exceed the capacity of the gland at which time it can burst into the skin around it and start an immune reaction. If there are germs trapped inside when it bursts, then that can start an eyelid infection and it may either spread into the lid or be contained in a “whitehead” that looks like a bigger acne pimple. What makes it different is the tough tarsal tissue (the skeleton on the eyelid) in which it is located. Often more important is the condition of the other 99-119 or so similar glands spread throughout the 4 lids as they may be heading in the same direction- or worse - withering instead of producing more oil and becoming a chalazion (or style) once blocked.

As a chalazion, your immune system will attack the oil and attempt to wall it off with scar tissue. Early on (typically in the first 2-3 weeks), hot compresses may “melt” the waxy blockages commonly involved in this problem (also know as obstructive MGD) and may allow the gland to open and drain through it’s natural opening. After 2-4 weeks, it will commonly begin “walling off,” so more heat may bring it to a “head” and allow it to drain through the skin or on the inside of the lid. The further out it gets, the harder the scar tissue becomes and the harder to get it to drain short of surgery.

If caught in the first month, in office procedures like IPL (Intense Pulsed Light or Broad Band Light) and/or radio frequency heating can often help resolve this without surgery. Injections of steroids can help “melt” some residual scar tissue as well. Once it socks in with scarring, that “band of steel” may leave surgery as the only option, but remember that the operation only solves that one “Zit” and doesn’t deal with all the other oil producing glands that may be following suite or are withering. This oil is critical to your tears and thus to your eye health, so I recommend you find a dry eye specialist with IPL and/or RF who can image and treat your glands. If there is infection involved, you may need topical and/or oral antibiotics in addition to other care. Once you get your glands on track, adding Omega 3-6-9 oral oils to your diet, working on stronger blinking, lid hygiene and occasional hot compresses are commonly needed to prevent recurrences. We all need to take better care of these glands since they need to last a lifetime and we are all living longer and using our eyes more than ever.

As one who deals almost daily with surgical degrees of chalazia, I have some strong opinions based on 30+ years of observations. Chalazia are de facto evidence of obstructive MGD and in my opinion, are begging for office-based levels of heated expression. Off label IPL and RF both appear highly useful for chronic chalazia (though better if caught in earlier stages). Lipiflow misses in acute settings as the activators don't fit well over solid cysts and when they do, the paddles get hung up on the "marbles" in the lids and don't compress over the remaining MGs. Hot compresses, Doxycycline and steroids are helpful in acute settings but don't relieve significant obstructions (waxy plugging) very well and leave remaining glands at risk for more chalazia or atrophy (or both). Lipid containing ATs are bandaids. I would strongly advocate for off label heating and expressing treatment in these cases.

I’ve seen what seems an epidemic of this problem in the younger age group. Duke University published on a study on nearly 100 kids between the ages of 4-16 (avg age 10.5yrs) and over 1/2 had some dry eye related issues with their oil-producing glands (MGD). We think it’s related to screen time and diet. Many kids are “picky eaters” - meaning they won’t consume significant amounts of the essential omega oils 3,6&9 (such as found in fish, tree nuts and seeds -) like “we” all ate 100 years ago, but researchers find we Americans eat 95% less of today (- largely thanks to plentiful processed foods). Make sure your kids get enough of these good foods (or sufficient supplements) to nourish these oil glands. Better, stronger blinks (as already suggested) along with hot (but not burning hot) moist compresses can often help, too.

The link to the Duke University study (suggesting upwards of half of kids between the ages of 4-16 years old have some degree of MGD) is here: https://www.ncbi.nlm.nih.gov/m/pubmed/29286952/ I published a couple of cases of kids presenting with chalazia (styes) who had advanced MGD and pretty bad dry eye (the 7 year old was already on artificial tears after multiple chalazia), here: http://www.jdryeyedisease.com/index.php/JDED/article/view/8.

Scary stuff. I'd advocate that if your child develops a stye, that you take your child to a dry eye doctor who has good tools to document the stage of dry eye so you can track progress and adjust treatments based on how it goes. (My experience is that most pediatric eye docs don't have the right equipment for this.) I routinely scan MGs on all my chalazia patients and rarely go a week without finding significant MGD in kids with them (& in adults). I see chalazia as the "tip of the iceberg" of MGD. Lots of glands going bad but only a few turn into "zits" in the lid with most withering quietly away. Most kids (and many adults) respond to the "homework" taking Omega Oils, daily hot moist compresses, good lid hygiene and good blink habits. Catch it early.

Previous
Previous

When eyelids are irritated (including “mucus fishing” - as well as allergies, such as to our best friend - pets!)

Next
Next

Contact lenses and dry eye - Part 2