Stye Town

"Code red, Dr. Keshet to the surgical suite, STAT!"  With great alacrity and concern, a surgery attending once called me to the intensive care unit for a stye consult -- if the patient did not receive clearance for a new pimple that cropped up on his left upper lid, he would be denied life-saving cardiac bypass surgery.  I was bewildered that a little spot of inflammation on the upper lid would prevent a cardiothoracic surgeon from performing a vital procedure, but this true story illustrates the widespread misconceptions about styes.  They are largely misunderstood, and deserve just representation.

Sometimes referred to as a chalazion, a stye is merely a ball of inflammation (a granuloma) surrounding a blocked oil gland.  (Technically, a chalazion occurs anywhere on the eyelid, while a stye occurs on the lid margin.) Unlike infectious processes, styes are not caused by bacteria or other micro-organisms.  The body simply mounts a white cell response to a constipated oil gland.  Styes and chalazia often happen to folks with baseline blepharitis, a.k.a. eyelid inflammation.  If your eyelid margins are a tad reddish, and you notice crusties on the lashes, you probably have blepharitis yourself.

I usually recommend putting a potato in the microwave for a minute or two (or boiling an egg), then wrapping it with a damp washcloth and laying it on the affected eyelid for ten minutes, at least thrice daily.  This technique allows the constipated oil gland to experience relief and release its contents.  The granuloma surrounding it then calls off its siege and disperses.  To help this process along, I usually prescribe a steroid drop.  Steroids assuage inflammatory niduses as diplomatically as Bill Clinton in the Mideast peace talks.  If the stye or chalazion does not resolve within two weeks of treatment, I recommend performing a chalazion excision.  For some reason, this painless procedure (after proper local anesthesia, that is) makes grown men --  especially body builders -- cry like school-girls.  But it is a dirty job, and someone has to clean up their stye.  In order to prevent chalazia from returning, I recommend a daily regimen of warm compresses with a hot washcloth, followed by gentle eyelash scrubbing.  Other possibilities are ointments or drops (like Azasite).

Of course, in my humble opinion, the cardiac patient should have been cleared for surgery, but despite my detailed clinical and histopathological explanation of chalazia to the cardiothoracic attending, he stared at me with disbelief and insisted he could not perform surgery on a patient with an infection.  In conclusion, cardiac surgeons think they are smarter than ophthalmologists. . . but. . . *wink*. . . between you and me the eyeball is a bit more complex than a pump.