I have a stye on my lower eyelid for the third time in three years, although each time it has been in a different place. The first one went away by itself. The second needed antibiotics. What can I do to prevent them? -M.H.
Styes are essentially tiny abscesses of the hair follicles of the eyelashes or deeper down in the oil-secreting glands of the lids. A duct gets plugged and fills with oily debris that causes painful inflammation.
People make them worse if they needle or squeeze them, which pushes the infection deeper.
The mainstay of treatment is warm compresses (a flannel wet with very warm water then wrung out and placed over the closed eyelids) three or four times a day for five minutes.
Some think the warmth liquefies the oils in the glands, promoting easier drainage. It's more likely the warmth dilates blood vessels, stimulating more white blood cells to migrate to the region to fight infection, creating more pus, which accumulates under pressure and eventually ruptures, usually to the inner surface of the eyelid.
Like a mini volcano, a rupturing abscess suddenly releases pressure, bringing relief from pain and a speedy resolution of the infection.
When compresses fail, doctors may lance the stye, but this is rare.
Because antibiotics can't penetrate well into pus-filled abscesses they are not the mainstay of treatment. But they are used to treat skin infections that are spreading, which we would call cellulitis.
Regarding prevention, some people have chronic blepharitis, which is eyelid follicle inflammation that results in crusty eyelash buildup.
It responds very well to gentle cleansing with a cotton bud soaked in tear-free baby shampoo.
This removes protein and oil debris from the ducts, preventing blockage.
People with diabetes or other diseases that weaken the immune system often get more styes and infections than normal.
This isn't likely, but it is something that doctors and patients should keep in mind if repeated infections keep occurring.