A common problem in the office of primary care doctors and ophthalmologists is a stye.  These red, painful lumps form at the lid margin(the edge of the eyelid) and come in 2 basic forms:

  • Chalazion–from the Greek “hailstone” a non-infected lump
  • Hordeolum–from the Latin for “barley,” also a lump, but with more generalized redness and pain due to secondary infection. These can be further divided into internal or external  lid problems.

With both problems the cause is blocked glands within the lid itself; if on the inside surface a “Meibomian” gland, on the outside surface a “Zeiss” gland. In both instances, the purpose of these glands is to secrete lubricating mucous onto the lid as it slides over the eye; the gland’s duct becomes blocked and the mucous is unable to be pushed out.  So in some ways, it’s similar to acne–a pimple on your eyelid.

Risk factors for styes (either type) include blepharitis or conjunctivitis (either infectious or allergic), eyelid skin conditions like eczema, excessive sweating after play or workout, eye makeup, or unclean objects held against the face.

Given the above, the best approach is prevention–mainly, keep the eyelid clean.  Wash the child’s face well, launder blankets/stuffed animals and bedding regularly,  modest use of eye make up (editorial comment–isn’t that mostly better anyway?), use antibiotic (for BACTERIAL infection) or allergy drops where appropriate.

Generally, treatment for stye is conservative and supportive–OTC analgesics; moist, warm heat–teabag or washcloth against the eye for 5 minutes several times daily; do not use eye makeup or contact lenses until the problem has resolved.  Oral antibiotics are occasionally needed for more extensive infection, and surgical intervention with incision and drainage is even less frequently indicated.

In some instances, styes may be recurring.  Redouble efforts at keeping eyes clean from makeup, sunscreen, detergents, lotions, and other topical agents.  There is anecdotal, but good, data suggesting that regular supplementation with oral omega-3 oils can help prevent styes from recurring as well.

If you have questions about stye/chalazion/hordeolum  in your child please give me a call, and thanks for following.

Thanks to Eye Physicians of Northampton for featured image.

Tongue Tie

“Tongue Tie” (ankyloglossia) is a common condition in infants; it involves prominence– in length, thickness, or both–of the band of tissue that tacks the tongue to the floor of the mouth, as well as the similar tissue connecting the inner upper lip to the area above the upper teeth.  The exact frequency is unclear, but generally considered around 4-5%,  predominantly male.

I have avoided calling it a “disorder” or “abnormality” as ankyloglossia mostly appears to be an observation in search of a problem.  Some claim an association with poor dental hygiene, orthodontia, or bad breath, but tongue tie infants  don’t appear to grow up and require braces much more than the general population.  Another concern is speech problems; “dysarthria”(problems with enunciation) as opposed to problems of speech acquisition or comprehension–with tongue to teeth sounds of most concern (t, d, th, s, z, r, l).  However the little academic literature available on the subject suggests that the human tongue is a very agile muscle and mostly learns to adapt to the situation; children with prominent frenulums tend to speak at the normal time and ultimately clearly and normally without professional intervention.  Some worry over such activities as licking food, playing wind instruments, even “sexual expression” growing up or as adults, but, to my mind, none of these things should warrant aggressive intervention by parents for an infant(especially the latter one!).

The most immediate concern for ankyloglossia is breast feeding problems.  Here there is ample evidence that tongue tie babies may at least initially have some difficulties in latching causing frustration for both mother and baby, as well as variable nipple discomfort for Mom.  Even here, though, “problem” may be a stretch.  Most infants seem to gradually adjust and by 6 weeks are nursing well without disruptive discomfort for Mother.

So what to do?  Surgical repair is simple and straightforward–a mere “snip” of the frenulum with a scissors, scalpel, or laser, performed in a doctor’s office.  Complications are rare–post operative infections are very uncommon and the babies seem to tolerate the procedure well without significant increase in crying or fussiness afterwards.  The frequency that this procedure is utilized has dramatically increased recently and I’m not so sure that’s such a good thing.  However, as a man, far be it from me to tell a breast feeding woman to just “grin and bear it.”  6 weeks may seem a short time to me, but to a post partum woman, exhausted, nursing at 2am, may consider the experience very differently.

So context is important here.  My best advise to a nursing mother is that if you are mostly comfortable applying lanolin to nipples and using OTC pain meds, and your baby is feeding, voiding, and stooling well, then that conservative approach is always best.  Less is more–even for “minor” surgery. (I think most people legitimately feel that NO surgery is “minor” for one’s own baby–right?).

If that strategy is not working out, then come on in and let’s talk about it.

Thanks for following.

Image courtesy