From the Guidelines
For a resistant stye in a pediatric patient, the first line of treatment should be warm compresses applied to the affected eyelid for 10-15 minutes, 4-6 times daily to promote drainage, as this approach is non-invasive and can help resolve the condition without the need for antibiotics 1.
Treatment Approach
If this fails after 48 hours, consider topical antibiotic ointments such as mupirocin 2% applied to the lid margin 3-4 times daily for 7-10 days, as it is effective against Staphylococcus aureus, including MRSA 1.
- Key considerations for treatment include:
- Promoting drainage with warm compresses
- Using topical antibiotics for localized infection
- Avoiding the use of antibiotics that may not be effective against MRSA
Antibiotic Therapy
For more resistant cases, oral antibiotics may be necessary, with clindamycin (10–13 mg/kg/dose PO every 6–8 h, not to exceed 40 mg/kg/day) being a good option for children, as it provides coverage for both b-hemolytic streptococci and CA-MRSA 1.
- It is essential to note that the choice of antibiotic should be guided by the severity of the infection and the potential for MRSA.
Referral to Specialist
If the stye persists beyond 2 weeks despite treatment, shows signs of spreading infection, or is associated with fever or significant eyelid swelling, refer to an ophthalmologist, as they may perform incision and drainage under local anesthesia for older children or sedation for younger ones 1.
- Recurrent styes may indicate underlying conditions like blepharitis or diabetes that require additional management.
Important Considerations
Never attempt to squeeze or pop a stye at home as this can spread infection, and always prioritize the use of evidence-based treatments to minimize morbidity, mortality, and improve quality of life 1.