Styes
Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.
Clinical features
- Can be external or internal and are usually painful with localised swelling. External styes usually appear around an eyelash follicle which may appear like a pus-filled spot which is sore to touch/press
- See under the heading 'blepharitis' as to how blepharitis differs from a stye
Stye
Referral criteria
- Entropion or ectropion
- Very swollen eyelids or systemic symptoms (possible orbital or periorbital cellulitis)
- Suspected carcinoma (painless nodule or ulcer which may bleed)
- Herpes infection or infestation of scabies/lice involving eyes
- Persisting beyond a few days and has not resolved despite non-pharmacological measures
- Large and painful (particularly if internal) or if vision is affected
Time frame to resolution
- Should resolve after a few days (this is difficult to quantify as resources say 'several days', '5 days' or '7-10 days')
Management strategy
Non-pharmacological advice
- Apply a warm compress to the affected eye for 5-10 minutes and do this three to four times daily until the stye resolves
- Do not puncture (this may need to be done but it should be undertaken by an expert rather than the patient)
- Avoid using eye makeup and contact lenses until resolution
- If applicable, manage blepharitis too (see blepharitis) as this could limit the likelihood of further styes
Pharmacological advice
- No OTC antibacterial pharmacological measures are advocated
- If antibacterials are deemed necessary, they should be prescribed rather than purchased OTC, since OTC chloramphenicol is not licensed for styes. While ocular propamidine isetionate 0.1% w/v is available OTC for minor eye infections this should not be recommended for styes given that the BNF states that it is “of little value in bacterial infections but is used by specialists to treat the rare, but potentially sight-threatening, condition of acanthamoeba keratitis [unlicensed indication].”
- Pregnancy: provide non pharmacological advice. If analgesia required, check individual paracetamol products are licensed for use prior to sale