What is the next step for a persistent hordeolum (stye) that has not responded to erythromycin (erythromycin) ointment after 1.5 months?

From the Guidelines

If you've had a stye for 1.5 months that hasn't responded to erythromycin ointment, you should see an eye doctor (ophthalmologist) as soon as possible. This persistent stye may require more aggressive treatment such as incision and drainage, steroid injections, or oral antibiotics 1. In the meantime, continue applying warm compresses to the affected area for 10-15 minutes, 3-4 times daily to help bring the stye to a head and promote drainage. Some key points to consider in the management of a persistent stye include:

• Avoid wearing eye makeup and contact lenses until the stye resolves
• Don't try to pop or squeeze the stye yourself as this can spread infection
• A stye that persists beyond 1-2 weeks or doesn't respond to initial treatment may indicate a more serious condition like a chalazion (blocked oil gland) or even a sebaceous cell carcinoma, which is why professional evaluation is necessary 1
• The lack of response to erythromycin suggests either antibiotic resistance, improper application technique, or that the condition may not be a simple bacterial stye It's also important to note that topical antibiotics like erythromycin may be helpful in some cases, but oral antibiotics like doxycycline or azithromycin may be necessary for more severe or persistent cases 1. However, these medications can have side effects and should only be used under the guidance of an eye doctor. Some of the treatment options for blepharitis, which may be related to the stye, include:
• Topical perfluorohexyloctane, which can help prevent tear evaporation and improve symptoms 1
• Selenium sulfide, which can help break down proteins and unblock the meibomian gland orifices 1
• Oral tetracyclines, which can help reduce inflammation and improve symptoms, but can have side effects like photosensitization and gastrointestinal upset 1

From the Research

Stye Treatment and Duration

• A stye, also known as an external hordeolum, is a common and painful inflammation of the eyelid margin, usually caused by a bacterial infection 2.
• The provided studies do not specifically address the treatment of styes, but rather focus on internal hordeolum 3, 4, 5.
• However, it is mentioned that external hordeola (styes) can resolve spontaneously and may not require treatment 3, 4, 5.
• In some cases, styes may persist or recur, and it is essential to exclude other conditions, such as malignant tumors, through excisional biopsy and histopathological assessment 2.

Effectiveness of Erythromycin Ointment

• There is no direct evidence in the provided studies to support or refute the effectiveness of erythromycin ointment in treating styes 3, 4, 5.
• The studies primarily focus on internal hordeolum and do not include external hordeola (styes) in their scope 3, 4, 5.
• Therefore, it is unclear whether erythromycin ointment is an effective treatment for styes, and further research is needed to determine its efficacy.

Duration of Stye and Treatment Outcome

• The duration of a stye can vary, and in many cases, the lesion may drain spontaneously and resolve without treatment 3, 4, 5.
• However, if the stye persists or recurs, it may be necessary to consider other treatment options or seek medical attention to rule out other conditions 2.
• The provided studies do not offer specific guidance on the treatment of styes or the expected duration of the condition, highlighting the need for further research in this area 3, 4, 5.