|Year : 1970 | Volume
| Issue : 2 | Page : 56-58
Styes and refractive erros their aetiological relationship
Department of Ophthalmology, Government Hospital, Masulipatam, (A. P.), India
C M Sarma
Department of Ophthalmology, Government Hospital, Masulipatam, (A. P.)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sarma C M. Styes and refractive erros their aetiological relationship. Indian J Ophthalmol 1970;18:56-8
Eye strain, refractive errors, and styes, though not in their present perspective, were known to exist, since the days of Demosthenese. Presbyopia has been recognised 2,000 years ago by the Greeks. In ancient days, a group of symptoms like photophobia, lacrimation, heaviness of the lids, irritation, itchiness, and blood shot eyes, have been recognised and attributed to some factor within the eye. About the middle of the last century, Mackenzie coined the term asthenopia, for this group of symptoms known as eye strain. A little later, Donders, Von Graefe, and others recognised the part played by the ciliary muscles, refractive errors, and accommodation, in the causation of these symptoms and correction of the accommodative strain in relieving the symptoms. Gradually, this subject has been studied by different ophthalmologists on the continent and by the early part of the 20th century, the concept of styes and refractive errors being related aetiologically has been established.
It is now appreciated by many, that refractive errors have a place in the aetiology of styes. The need to verify the refraction of the eyes suffering from styes is recognised. The importance of this is more in those cases where no other aetiological factor of styes can be found.
Pathogenesis of styes is varied. There are many factors that play a part in the causation of styes. According to Duke Elder, these factors can be divided into the following heads:
1) Predisposing factors
a) Smoky and dusty atmosphere.
b) Uncorrected and malcorrected refractive errors.
c) Uncorrected and malcorrected muscular imbalances.
d) Improper ventilation and lighting.
e) Exposure to arc light etc.
f) Excessive near work with uncorrected refractive errors and muscle imbalances.
In all such cases superadded infaction is necessary.
2) Chronic conjunctivitis and angular conjunctivitis.
4) Tarsal infections.
5) Skin diseases:
d) Acne vulgaris.
6) Constitutional diseases like,
c) vitamin deficiency
d) focal infection and sepsis
e) intestinal autoinfaction
g) septicaemia and pyaemia.
In these cases styes form part of a crop of boils occurring all over the body.
7) As a pure infection of the tarsal glands and other glands of the eyelid, where the infection is primary.
| Object and Method of Study|| |
The present work was undertaken, to determine the aetiological association of styes with refractive errors, and their relation to , nature of work, age, and sex. For this 250 cases have been collected and studied.
When the patient came with the complaint of styes, attention was first paid to the styes. A bacteriological examination of the conjunctiva was made. Patients were given sulphacetamide ointment, sulphadiazine tablets, 2 tablets six hourly, and hot fomentations. This treatment was continued for about 4 days by which time the styes used to subside.
A special history of any eye strain was taken, attention being paid to the nature of work, excessive near work, any discomfort after near work, blurring of vision after reading, any relief after rest and closing the eyes, any itching, headache and relief after rubbing the eyes. A general examination was made for signs of malnutrition, anaemia, boils anywhere else in the body, and enlarged lymph glands.
Vision was tested on the same day and refraction was then done after instilling homatropine drops. Patients were asked to report three days later, for the postmydriatic test. Astigmatic error was particularly tested for and, if necessary, glasses were prescribed. Muscle balance was tested with Maddox wing and Maddox rods and treated accordingly.
All the patients were asked to report at fortnightly intervals after they started using the glasses, for about two months. At these visits enquiries were made about any improvement in symptoms or of any fresh attacks of styes.
| Clinical Observations|| |
a) Sex: It was observed that out of the 250 cases studied, 88% were males and 12% were females.
b) Age incidence: It was observed that 80% of cases were between the ages of 20 to 30 years, 16% between the ages of 10 to 20 years, 2% below 10 years, and 2% above 30 years.
c) Refractive errors: It was observed that out of the 250 cases studied 88% had astigmatic error, and in majority of cases the astigmatism was of a low order of 0.25 to 0.5 D.
d) Occupations: It was seen that the majority of cases were students and clerks. Others like teachers and housewives contributed only 9% and 6% respectively to the aetiological list. 20% of cases were labourers, painters, car drivers etc.
e) Visual Symptoms: It was observed that 82% had visual symptoms. Only 18% had no visual symptoms.
f) Muscle Balance: It was observed that 45% had exophoria of varying degrees for near and distance; 18% had orthophoria for both near and distance, and 37% had a combination of orthophoria and exophoria Esophoria was not observed in this series.
g) Relief after correction o f refractive errors: It was observed that 78% had relief following correction of refractive errors and muscle imbalances. The remaining 22% had recurrence of styes even after correction.
| Discussion|| |
It is said often, that refractive errors, if left uncorrected produce recurrent attacks of styes. When patients complain of styes, attention is first paid to the styes and treatment given. When the patient is relieved of his trouble he is no more bothered and does not present himself for further examinations unless he gets another attack of styes.
When an emmetropic eye looks at a near object three phenomenon set in simultaneously, the eyes converge so that they can fix on the object, the pupil contracts to increase the depth of the focus and the ciliary muscle contracts to produce accommodation. A certain amount of energy is spent by all the three muscles to achieve this accommodation. When, however there is ametropia, the patient has to put in excessive effort to obtain and sustain clear vision. In these conditions the limits of capability are over stepped, bringing into action more muscle fibres to act in relays for a long time reducing the resting intervals. This excessive effort by the muscles results in getting clear vision, only in minor refractive errors and this acts as a further stimulus. In the case of high degrees of errors, any amount of extra energy on the part of the muscles does not obtain clear vision for the patient and he has to take resort to correcting glasses.
Astigmatism is the commonest refractive error associated with styes.
This is because the accommodative effort to clarify indistinct vision is more successful in astigmatism. These attempts to get clear vision are made in hypermetropic and mixed astigmatism, but not in myopic astigmatism.
Whenever there is over work on the part of muscles, there is an increased supply of blood to the parts concerned. There is reflex hyperaemia of the j conjunctiva, the eyelids and the lid margins. Eyes appear blood shot and conjunctiva gets suffused and burns. All these result in irritation, lacrimation, itchiness and sandy feeling in the eyes.
When there is over work on the part of the muscles, there is liberation of histamine like substances which produce vasodilation irritation and lacrimation. The patient is inclined to rub his eyes. If organisms are already present in the conjunctival sac or the lid margin or infection is introduced by rubbing of the eyes, it becomes active, invades the Meibomian glands and produces styes.
It is necessary to appreciate that refractive errors by themselves do not produce styes. They act as predisposing factors only. As long as the refractive errors are left uncorrected there is a possibility of styes recurring. Every case of minor astigmatic error need not have styes. But there is a possibility of many cases of styes having minor degrees of astigmatism.
| Summary|| |
A series of 250 cases of styes studied with the object of finding out their errors has been presented and their relationship discussed.