Stye on the Upper and Lower Eyelid: What It Is and What It Looks Like

You notice a small painful swelling on your eyelid, and it doesn't go away within a day. Most often this is what a stye looks like — a common lesion that usually resolves within a week and is rarely a sign of anything serious. Below: how to distinguish it from similar eyelid changes and when it's time to see a doctor.

What a stye is and what hordeolum means

A stye, also known as a hordeolum, is an acute purulent inflammation of the hair follicle of an eyelash or of the sebaceous gland of Zeis, which is located near the root of the eyelashes. An internal stye is an inflammation of a lobule of the meibomian gland. The cause in both cases is bacterial: in 90–95% of cases Staphylococcus aureus is responsible. A stye more often appears when immunity is weakened, for example after colds, and occurs in both adults and children.

Risk factors include:

• general chilling of the body;
• endocrine disorders;
• chronic diseases of the gastrointestinal tract;
• conditions of the eyelids — blepharitis and demodicosis.

Where a stye appears: upper and lower eyelid, corner of the eye

An external stye sits on the edge of the eyelid, at the lash line. An internal one develops inside the eyelid and opens into the conjunctival sac.

A swelling on the lower eyelid is often called a "stye under the eye" or "stye under the eyelid." On the upper eyelid it is described as a "stye above the eye." The location on the upper or lower eyelid does not change the essence: eyelashes and glands are present in both, and a hordeolum of the upper eyelid looks the same as on the lower one.

What a stye looks like: signs of a pus-filled bump on the eyelid

First, a painful, well-defined swelling, edema, and redness appear on the edge of the eyelid. The skin around it may swell and redden; on dark skin, redness is harder to notice. After 2–4 days, a yellowish head forms at the apex — a typical pus-filled bump; when it opens, pus with particles of necrotic tissue comes out.

The eye may be red and watery, but vision should not be affected. Usually one eye is involved, although there may be several styes at once, including on both eyes. Sometimes headache, fever, and enlargement of the nearby lymph nodes are added.

My quick self-test — what you can notice yourself: whether there is specifically a bump rather than diffuse swelling, how painful it is, whether the redness stays within the eyelid, and whether vision has changed.

You must not squeeze out the pus or open the lesion yourself — this spreads the infection.

How a stye differs from other eyelid lesions

Not every swelling is a stye. If there is no bump and the eyelid or eye is simply swollen, red, and watery, it is more often conjunctivitis or blepharitis. If the bump is dense and almost painless, it is most likely a chalazion: a blockage of the meibomian gland duct. It often develops after an internal stye, the skin is not adherent to it, and it is mainly a cosmetic defect.

The diagnosis is confirmed by examination of the eyelid. Rarely, eyelid skin cancer looks like a chalazion — if suspected, a biopsy may be needed.

Possible complications and recurrent styes

Complications occur rarely. The most common is progression to a chalazion with cosmetic deformity and corneal irritation; such a chalazion often requires surgical removal. A large stye can interfere with vision. Eyelid cellulitis — a generalized infection of the eyelid — is also mentioned separately.

The most dangerous thing is trying to squeeze out the pus: the infection can spread toward the orbit, with orbital phlegmon, cavernous sinus thrombosis, meningitis. Improper surgical opening can cause impaired eyelash growth, eyelid deformity, or a fistula.

If styes recur, the doctor looks for predisposing factors — blepharitis, demodicosis, endocrine and chronic diseases. Personal hygiene is enough for prevention: do not rub your eyes with dirty hands, use your own towel and your own cosmetics.

When to see an ophthalmologist

The reason to make an appointment with a doctor is a stye that does not improve over several weeks. Urgently show the eyelid to a doctor if the lesion is very painful or severely swollen, vision is affected, pus is discharged from the eye, or the infection has spread to the eye and eyelid.

On its own it is not a reason to call an ambulance; 103/112 — if the condition has sharply worsened: high fever, severe headache, general malaise — this may be the beginning of the infection spreading beyond the eyelid, up to orbital phlegmon or meningitis.

This material is for reference and does not replace a doctor's consultation: if in doubt, show the eyelid to an ophthalmologist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer