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Eyes on the Styes

Styes, also known as hordeolums, are common occurrences in the school setting. Despite being generally benign, these minor infections of the eyelid's oil glands or hair follicles can be painful and irritating. They also raise concerns amongst students and school staff due to their visibility. Given the discomfort they cause, the potential impact on learning and activities, and the significant distress that can result, early recognition, appropriate treatment, and supportive education in the school setting are essential. 


A stye is an acute infection that most often occurs at the base of an eyelash on the outer edge of the eyelid (external hordeolum). More rarely, a stye can develop inside the eyelid when a meibomian gland becomes infected (internal hordeolum). Tender to the touch and resembling a pimple or boil, styes can also cause mild eyelid swelling and lead to a watery eye and light sensitivity, itchiness, and crusting along the eyelid.

Typically, most styes are isolated and affect only one eye; however, it's possible to have multiple styes simultaneously. If there's no bump present and the eye or eyelid is swollen, red, and watery, it's unlikely to be a stye. Instead, it's more likely to be conjunctivitis or blepharitis. If the lump is hard and not very painful, it's more likely to be a chalazion. 

Prevalence and Cause

Styes are more common in children than adults, which is no surprise considering a primary risk factor for developing a stye is rubbing the eyes, particularly after nose picking. This is because the most common cause of styes is Staphylococcus bacteria, which frequently live in the nose. When this bacterium manages to invade the eyelid's oil glands or a hair follicle, it results in a sty. Adolescents can also be more prone to styes due to makeup use and unhygienic contact lens practices. Additional risk factors for developing a stye include a history of previous styes, diabetes, and skin conditions, including seborrheic dermatitis or rosacea. 

Evidenced-Based Interventions

Managing styes effectively requires a comprehensive approach that addresses the presenting sty and considers the risk of recurrent or multiple styes in school-aged children. According to the AAP, most single styes can be treated at home and exclusion from school is unnecessary. Interventions that school nurses can incorporate within the school include:

  1. Education: Teach students about personal hygiene, particularly hand and face hygiene. They need to understand the importance of avoiding eye-rubbing or face-touching, as it is a common way to spread bacteria.
  1. Warm compresses: Applying warm, wet compresses up to four times a day is the preferred treatment for internal and external styes. Once the sty drains, continue the warm compresses to remove drainage.
  1. Referral: When a sty persists, in recurrent cases, or when two or more styes are present, students should be referred for an evaluation by their HCP. In some instances, antibiotics may be indicated.
  1. Early recognition: In rare cases, what appears to be a sty could be a sign of a more serious eye infection, such as palpebral cellulitis. School nurses should always have a high index of suspicion when inflammation is severe, erythema spreads to the entire eyelid, or fever is present.

Styes can be a painful and frustrating experience for anyone, especially school-aged children. While generally benign, early recognition and appropriate treatment are essential to prevent complications and potential disruption to learning and activities. With the right interventions, including education, warm compresses, and referral prn, school nurses can help manage styes and minimize their impact on students' health and wellbeing.

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