From the Guidelines
For a 67-year-old patient with a hordeolum, I strongly recommend warm compresses as the primary treatment, applied to the affected eyelid for 10-15 minutes, 4-6 times daily, as this approach has been shown to promote drainage of the blocked gland and alleviate symptoms. This method is supported by general medical principles, although specific studies on hordeolum treatment in the provided evidence focus more on blepharitis management 1. Warm compresses increase blood circulation to the area, helping the body's immune system fight the infection while softening the material in the blocked gland to promote drainage. Gentle massage of the area after applying the warm compress can further facilitate drainage.
Over-the-counter pain relievers such as acetaminophen (325-650 mg every 4-6 hours as needed) or ibuprofen (200-400 mg every 4-6 hours with food) can help manage discomfort. It's crucial to avoid touching or squeezing the stye and to discontinue eye makeup and contact lenses until it resolves. If the hordeolum doesn't improve within 7-10 days, shows signs of spreading infection (increased redness, swelling, pain), or affects vision, medical attention is necessary. A healthcare provider may prescribe antibiotic ointments such as erythromycin or bacitracin applied to the eyelid margin 2-3 times daily for 7-10 days, as these have been shown to provide some symptomatic relief in cases of anterior blepharitis 1.
Key considerations for treatment include:
- Warm compresses for 10-15 minutes, 4-6 times daily
- Gentle massage after warm compresses
- Over-the-counter pain relievers as needed
- Avoidance of touching, squeezing, or applying makeup to the affected area
- Potential prescription of antibiotic ointments for severe or non-resolving cases
- Monitoring for signs of infection or vision impairment that may require further medical intervention.
From the FDA Drug Label
Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage The treatment for a 67-year-old patient with a hordeolum is to:
- Clean the affected area
- Apply a small amount of bacitracin (equal to the surface area of the tip of a finger) on the area
- Apply 1 to 3 times daily
- May be covered with a sterile bandage 2
From the Research
Treatment Options for Hordeolum
- There is no evidence for or against the effectiveness of nonsurgical interventions for the treatment of hordeolum 3, 4.
- The infection can resolve untreated, but the inflammation can spread to other ocular glands or tissues, and recurrences are common 3, 4.
- If unresolved, acute internal hordeolum can become chronic or develop into a chalazion 3, 4.
Nonsurgical Interventions
- Hot or warm compresses, lid scrubs, antibiotics, or steroids may be considered as nonsurgical interventions, but there is no evidence to support their effectiveness 3, 4.
- Controlled clinical trials would be useful in determining which interventions are effective for the treatment of acute internal hordeolum 3, 4.