stye-pain in the eye

What is a stye?

A stye is a tender, painful red bump located at the base of an eyelash or under or inside the eyelid. The medical term for a stye is hordeolum.

A stye results from an acute infection of the oil glands of the eyelid (meibomian glands) that occurs after these glands have become clogged. A stye also may arise from an infected hair follicle at the base of an eyelash. The term external hordeolum has been used to refer to a stye that develops at the base of an eyelash involving a hair follicle of the eyelid, whereas the term internal hordeolum refers to a stye arising due to an inflamed meibomian gland under the eyelid.

How we get the infection in the glands?
The commonest organism is staphylococcus, which is normally present on the skin and eyelid surface. The meibomian gland produces the oily secretions which help in tear film stability. When the mouths of these glands get clogged and some of the bacteria gain the access into the blocked gland, they proliferate there. A clogged gland is very fertile ground for these organisms. This converts into abscess and called as stye. All the local conditions which favor clogging of the glands openings are a reason for recurrent stye.

What are the signs and symptoms of a stye?

Eye Stye has various symptoms such as:
• Swelling in a small area or the entire eyelid.
• Redness of the eyelid itself.
• Discomfort when blinking.
• Frequent watering in the affected eye.
• Raised, swollen bump on the upper or lower eye lid.
• Pain and itch, over the affected area.
A common sign of a stye is a small, yellowish spot at the center of the bump that develops as pus expands in the area.



Who is most susceptible to the development of a stye?

Styes are quite common. People of all ages can develop a stye, with males and females are equally affected. People with chronic eye conditions blepheritis, seborrhea, allergic conjunctivitis, lice infestation etc, and people with chronic systemic diseases like diabetes mellitus, and chronic debilitating illnesses are more prone to develop stye. In many susceptible people, stress seems to trigger the development of a stye. Studies have shown that those who have high levels of blood lipids are more susceptible to blockages in the oil glands and suffer from recurrent styes.

What is the treatment for the stye?
There are hundreds of home remedies in circulation for the stye. Most of the patients must have used one or the other remedy before they reach to me. Some of them are simple (hot fomentation) and some are really dangerous (applying Limocol). As we don’t know what all is safe and what all is unsafe I will request all to use their common sense before applying anything to the eye.
Application of a warm compress or warm washcloth to the affected area for 10 minutes, four to six times a day, can speed drainage of the stye and aid in the relief of symptoms. Antibiotic eye drops along with warm compresses is a routine treatment for small and early stye.
A stye should not be pressed or squeezed to facilitate drainage until it has an opening on the surface. If a stye persists for several days, it requires a surgical drainage. This can be performed under local anesthesia as day care procedure.

Systemic (oral) antibiotics are recommended for persistent or multiple styes. It is also advised for large and non responding styes from previous treatment. Pain killer and anti inflammatory drugs are used to alleviate the pain.
Contact lenses and eye makeup should never be worn during treatment for a sty.

Are there any potential complications resulting from a stye?

Complications from a stye are rare. Stye is a small localized infection which may heal without any problem with treatment. Sometimes the infection may spread to other eyelash follicles, leading to multiple styes. Occasionally when infective organism is very notorious it may lead to widespread infection resulting in preseptal cellulitis.

When the abscess from the meibomein gland spread in the surrounding tissue, the oily secretion from the gland is directed to the nearby tissue rather than the mouth of the gland. This causes a slow grade inflammatory response and converts into a painless cyst. This is called as chalazion.
This is the most common complication that develops from a stye. Chalazion is painless and always a cosmetic problem only.
A chalazion can be treated by a small surgery where it is been opened by an incision and the walls of the gland is removed completely. The surgery is done under local anesthesia in cooperative patients.


Can a stye be prevented?

While it is impossible to completely prevent the development of a stye still good hygienic practices, including proper hand washing and resisting the frequent eye touch will reduce the frequency. Other measures that can help prevent stye include -

Do not share your eye makeup with anyone else.
Do not use your old makeup it may be contaminated.
Always keep your makeup in clean and closed place.
Do not rub your eyes.
Do not use old and contaminated eye drops in the eye.

Floaters and posterior Vitreous detachment.

What are the floaters?
As the name suggest, floaters are little "cobwebs" or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.
Most people have floaters .they are usually not noticed until they become numerous or more prominent. Floaters can become apparent when looking at something bright, such as white paper or a blue sky.
What causes floaters?

The vitreous is a transparent gel-like substance that fills about 80 percent of the eye volume (please refer the picture). It helps the eye to maintain its round shape. Due to degenerative processes (old age or inflammation) its contents are lost and it slowly shrinks. This process may lead to development of liquid pockets in between interwoven gel substance .Which ultimately causes the collapse of vitreous gel and leads to detachment from its adhesion sites with the retina. As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina. These are floaters.
In most cases, floaters are part of the natural aging process however there are other, more serious causes of floaters, including infection, inflammation (uveitis), hemorrhage, retinal tears, and injury to the eye. Over the time the floaters tend to "settle" at the bottom of the eye, becoming less bothersome. They usually settle below the line of sight and do not go away completely.
Who is at risk for floaters?
Floaters are more likely to develop as we get older and are more common in people who are very nearsighted, have diabetes, had trauma to the eye or who have had a cataract operation. There are some congenital disorders which allows vitreous to degenerate fast.

What is a vitreous detachment?

Generally the vitreous gel is a semisolid jelly like substance inside the eye. It is adherent to the retina at multiple places and remains in position due to these tight junctions. The degenerative processes in the vitreous forms lots of liquid pockets inside the gel substance. The sheer forces of movement no longer can hold the whole vitreous together and its starts moving at a different rate than the eye movements. This leads to separation of vitreous from its retinal attachment sites. Once the vitreous is totally detached from retina it becomes free moving body inside the eye and finally sinks inferiorly.
Although a vitreous detachment does not threaten sight, once in a while some of the vitreous fibers pull so hard on the retina that they create a hole or lead to a retinal detachment. Both of these conditions (retinal hole and retinal detachment) are sight-threatening and should be treated immediately.
What are the symptoms of a vitreous detachment?
Usually the symptoms affect one eye and over the years it may involve the other. Bilateral symptoms are not rare as well-
• Floaters - seen as spots, dots, circles, clouds, spidery webs, or various effects. All "float" in front of the eyes and move with the eye.
• Flashes - Visual light without any source, due to the vitreous pulling on the retina
• No symptoms - in some cases PVD is only found on routine eye examination
• Sudden loss of vision –due to hemorrhage or retinal detachment.
How it is diagnosed?
It can be diagnosed by examination, which includes-
• Dilated eye exam to evaluate the vitreous, retina with the help of indirect ophthalmoscopy and diagnostic lenses.
• Eye ultrasonography- when the cornea, lens or vitreous is not clear.
Floaters and Retinal Detachment
The floaters originate due to degenerative process in the vitreous. The posterior vitreous detachment is the sequel of the degenerative process and retinal detachment is the unusual complication of the posterior vitreous detachment. It is important that floaters are common feature for retinal detachment and posterior vitreous detachment.
The only way to diagnose the cause of the problem is by a comprehensive dilated eye examination. If the vitreous detachment has led to a retinal hole or detached retina, early treatment can help prevent loss of vision.
What is the treatment?
For people who have floaters that are simply annoying, no treatment is recommended. Over the time with the collapse of vitreous body all floaters tends to disappear. No doubt it’s a slow process and takes years.
On rare occasions, floaters can be so dense and numerous that they significantly affect vision. In these cases, a Vitrectomy (a surgical procedure that removes floaters from the vitreous) may be needed. This operation carries significant risks to sight because of possible complications. Most eye surgeons are reluctant to recommend this surgery unless the floaters seriously interfere with vision.
What is the prognosis?
Often being a normal part of aging, posterior vitreous detachment does not require specific treatment. So in general this holds a very good prognosis.
However, a sudden increase in floaters, possibly accompanied by light flashes or peripheral (side) vision loss, could indicate a retinal detachment.
Those who experience a sudden increase in floaters, flashes of light in peripheral vision, or a loss of peripheral vision should have an eye care professional examine their eyes as soon as possible.

after catarct and yag laser treatment

Whenever a patient comes to know that he has got after cataract, he feels like the surgery wasn’t done properly or the surgeon has left some catarct in the eye which is causing trouble to him. To clarify the confusion originated due to similar looking words “cataract” and “after cataract”, today I m discussing the situation which is called as “after cataract or posterior capsular opacification”.

What is cataract?

A cataract is clouding of the lens in the eye that affects the vision. The lens is made up of a bag filled with protein and protein like material and is suspended in the eye with the help of tiny spokes (zonules). When a person gets a cataract the material in the bag gets cloudy and causes blurring of the vision. This can be treated by surgery (phacoemulsification) and once the opaque material(cataract) is removed from the bag, the same bag is used to hold the artificial lens.

What is Intra ocular lens?

An IOL(intraocular lens) is the substitute to the natural lens to maintain the vision without thick glasses. After a cataract surgery IOL implant is a routine step. Most common implants are placed “in the bag” which is considered the safest implant site. There are other sites for the lens implant but they are chosen only if “in the bag” implant is not possible.

What is after cataract?

A posterior capsular opacity is a opacity that can form behind an intra ocular lens implant after cataract surgery. The opacity develops in the posterior capsule ( posterior part of the clear membranous bag) that supports the lens implant after cataract surgery.

After a successful cataract surgery, It may take several weeks to several years to develop a after cataract. It is not essential that all will have after cataract. Other names for this condition include secondary cataract, after-cataract, posterior capsular membrane, or posterior capsular fibrosis.

Why after cataract develops?

The natural lens is made up of the bag and the material filled inside it. The bag is coated with the cells which keep secreting the material inside. When a person develops the cataract this material gets opaque and by surgery it is removed. Even though a meticulous removal of proteinious material is done some calls are always left behind which starts growing and forms the opacity. But this time this opacity develops behind the IOL and above or in the posterior part of the bag.

What are the symptoms of after cataract?

• Slowly progressive blur in the vision.
• Colors seem faded.
• Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
• Poor night vision.
• Double vision or multiple images in one eye.

How after cataract is treated?

Most common and most effective method is YAG laser capsulotomy. The final objective is to make the small opening in the post wall of the bag so that a small window can be created from the partially opaque capsule. When capsule is too thick some surgical methods can be employed to cut the central opaque part of the bag.

What is YAG laser?

YAG Laser is a disruptive type of laser which is used to cut or make a hole in the bag. Because of precise nature of lasers this process involves making a controlled small window in the bag. So after the laser we get a window as well as bag is still tough to hold the lens in it without displacing it.

What is the procedure?

This "after cataract" condition is treated by the YAG laser capsulotomy, performed as a minor in-office or outpatient procedure. The pupil is generally dilated prior to the procedure. A laser is then used to cut through the hazy capsule behind the IOL implant. Entirely painless, it takes just a few minutes and results in no postoperative discomfort.

An anti-inflammatory eye drop medication is usually recommended after the procedure. Patients may resume normal activities immediately. Some "floaters" can be expected, which will generally disappear within a few weeks. YAG laser capsulotomy almost always enables vision to be restored or improved.

Is there any risk involved?

After the laser very few may feel the pain, some may develop the inflammation and high Intra ocular pressure. There may be development of floaters which generally disappears with time. In rare instances there may be retinal detachment.however there are very small risks,

Will I get any other opacity after “after cataract”?

No. once after cataract is done there should be no opacity for lifetime. As capsular bag is utilized to hold the Intra ocular lens, some may get the opacity of it (that is after cataract). But when YAG laser is done and a window is made in the bag there is no possibility of getting any kind of opacity in future, related to bag or cataract.