Eye problems

If you have a stye, your eye may also be watery and you may have a red eye or eyelid.

A stye; also called a hordeolum – usually only affects one eye, although it’s possible to have styes in both eyes or to have more than one stye in the same eye. Your vision shouldn’t be affected.

Types of stye

There are two types of stye. They are:

• external stye (external hordeolum) – a swelling that develops along the edge of your eyelid; it may turn into a yellow pus-filled spot that is painful to touch
• internal stye (internal hordeolum) – a swelling that develops on the inside of your eyelid; it’s usually more painful than an external stye

What causes a stye?

Styes are usually caused by an infection with staphylococcus bacteria (staphylococcal infection).

Long-term blepharitis (inflammation of the eyelids) may also increase the risk of developing a stye.

Styes are fairly common and you may have at least one or two during your lifetime. A stye is usually caused by an infection with staphylococcus bacteria. These bacteria often live on the skin without causing any harm.

Treating a stye

Most styes get better without treatment within a few days or weeks.

External styes may turn into yellow spots and release pus after three to four days. Internal styes are more painful and may last slightly longer.

• A warm compress (a cloth warmed with warm water) held against the eye will encourage the stye to release pus and heal more quickly.

Further treatment isn’t usually needed unless your stye is very painful and isn’t getting better. In this case, your GP may decide to drain it.

You should never attempt to burst a stye yourself.

Conjunctivitis is a common condition that causes redness and inflammation of the thin layer of tissue that covers the front of the eye (the conjunctiva).

Symptoms of Conjunctivitis

The symptoms of conjunctivitis will depend on the cause, but generally they include:

• Eye redness
  This happens as a result of the inflammation and widening of the tiny blood vessels in the conjunctiva (thin layer of cells that covers the front of the eyes)
• Watering eyes
  The conjunctiva contains thousands of cells that produce mucus and tiny glands that produce tears – inflammation causes the glands to become overactive, so that they water more than usual
• Stickiness of the eyelashes
  Can happen if the conjunctivitis is caused by allergies
• Itchiness
• Watering of the eyes

Although only one eye tends to be affected at first, symptoms usually affect both eyes within a few hours.

What causes conjunctivitis?

The conjunctiva can become inflamed as result of:

• Infective conjunctivitis – Caused by a bacterial or viral infection
• Allergic conjunctivitis – Caused by an allergic reaction to a substance such as pollen or dust mites
• Irritant conjunctivitis – The eye coming into contact with substances that can irritate the conjunctiva
  Irritant examples: Chlorinated water or shampoo, or a loose eyelash rubbing against the eye

Treating conjunctivitis

Conjunctivitis often doesn’t require treatment as the symptoms usually clear up within a couple of weeks. If treatment is necessary, the type of treatment will depend on the cause.

• Infective conjunctivitis – In severe cases, antibiotic eye drops can be used to clear the infection.
• Allergic conjunctivitis – Can usually be treated with anti-allergy medications such as antihistamines. If possible, avoid the substance that triggered the allergy.
• Irritant conjunctivitis – Will clear up as soon as whatever is causing it is removed.

It’s best not to wear contact lenses until the symptoms have cleared up. Any sticky or crusty coating on the eyelids or lashes can be cleansed with cotton wool and water.

Washing your hands regularly and avoiding sharing pillows or towels will help prevent it spreading.

When to see your doctor

If you experience any of these symptoms, contact your GP immediately. If this isn’t possible, visit your nearest accident and emergency (A&E) department

• pain in your eyes
• sensitivity to light (photophobia)
• disturbed vision
• intense redness in one or both of your eyes

It usually happens if your tears don’t drain away properly or too many tears are produced.

These problems can occur as a result of conditions such as conjunctivitis (eye inflammation), problems with your eyelids, an eye injury, a blocked tear duct or something irritating your eye, such as car fumes.

How tears work

Tears are constantly produced to keep the eyes moist. They are produced in small glands (lacrimal glands) located underneath your upper eyelids.

When you blink, tears are spread over the front of your eyes. The tears then pass into tiny channels known as canaliculi, before draining into a tear “sac” and flowing down the tear duct into your nose.

Watering eyes are the result of problems with this process.

Tear ducts are the passageways through which excess tears drain away. If they become blocked, it can cause your eyes to water.

In adults, this is usually the result of age, or sometimes inflammation, compression or injury.

A blocked tear duct can mean your tears will be unable to drain away and will remain in the tear sac. If this happens, the tears in the tear sac may become stagnant and a sticky liquid (mucus) may discharge through the tear duct opening into the eye.

You may also develop a swelling on the side of your nose, next to your eye, which is called a mucocele. If it becomes infected, it can cause a painful abscess to develop just below your eye which may need to be treated with antibiotics and possibly surgery.

Occasionally, the canaliculi (the narrow drainage channels on the inside of your eyes that lead into the tear ducts) can become blocked. This can be caused by inflammation or scarring due to a viral infection, or injury.

In addition, the lower eyelid can sometimes turn out (ectropion), causing the openings to the tear ducts to move away from the eye and making it difficult for the tears to reach them.

Blocked tear ducts in babies

Babies are sometimes born with under-developed tear ducts. The tear ducts can be completely or partially closed (congenital nasolacrimal duct obstruction) and can cause the baby’s eyes to water. Most blocked tear ducts in babies get better on their own before the baby is one year old.

In some cases, a blocked tear duct can lead to eye infections (conjunctivitis) in babies. Their eye may be red and have a sticky discharge coming from it. Take your baby to see your GP if you think they might have an eye infection.

Poor tear pump

A good blink ensures tears drain properly into the tear duct. People with a weak blink, for example due to a condition called Bell’s palsy (a type of facial paralysis) have problems with this which contributes to their watery eyes

Excess tears

Excessive tear production (reflex tearing) is usually the result of eye irritation. Extra tears are needed to wash away the substance irritating your eye. 

Problems that can cause extra tears to be produced include:

• chemical irritants, such as onions or fumes
• an eye infection, such as conjunctivitis
• an allergy
• an eye injury, such as grit that becomes lodged in the eye
• an inward-turning eyelid (entropion)
• an outward-turning eyelid (ectropion)

Who is affected?

You can get watering eyes at any age but it is most common in young babies (0-12 months) and people over the age of 60. It can affect one or both eyes and can cause blurred vision, sore eyelids and sticky eyes.

How are watering eyes treated?

Watering eyes do not always need to be treated. Treatment will depend on how severe the problem is and what is causing it.

If watering eyes aren’t interfering with your life, you may choose not to have treatment.

You should make an appointment to see a GP if you are concerned by persistently watering eyes.

In cases where irritation is causing the eye to water, treatment involves removing the source irritation. For example, if an eyelash is growing into your eye, it can be removed.

If a watering eye is caused by a blocked tear duct, surgery may be needed to clear the blockage or create an alternative way for tears to drain away.

Read more about diagnosing watering eyes and treating watering eyes.

When to see your GP:

You should see your GP if you have persistent watering eyes, or any lumps or swelling around your eyes.

It is a common condition, accounting for an estimated 1 in 20 eye problems reported to GPs. Blepharitis can develop at any age, but is more common in people over 40.

Symptoms of blepharitis

• itchy and sore eyelids
• eyelids that stick together and are difficult to open, particularly when you wake up
• eyelashes that become crusty or greasy

What causes blepharitis?

Blepharitis can be caused by an infection with Staphylococcus bacteria, or as a complication of a skin condition, such as;

• seborrhoeic dermatitis – a condition that causes the skin to become oily or flaky
• rosacea – a condition that causes the face to appear red and blotchy

Blepharitis is not contagious.

Treating blepharitis

Blepharitis is usually a long-term condition. Most people experience repeated episodes, separated by periods without symptoms.

Blepharitis cannot usually be cured, but a daily eyelid-cleaning routine that involves applying a warm compress – gently massaging your eyelids and wiping away any crusts – can help control the symptoms.

More severe cases may require antibiotics that are either applied to the eye or eyelid directly, or taken as tablets.

When to visit your GP:

See your GP if you are unable to control the symptoms of blepharitis with simple cleaning measures alone.
Your GP can usually diagnose blepharitis based on your symptoms and an examination of your eyes. They may refer you to an ophthalmologist (eye specialist) for further tests and treatment if you have severe symptoms, or initial treatment is unsuccessful.