From the Research
The treatment for an internal hordeolum typically involves warm compresses as the primary therapy, applied to the affected eyelid for 10-15 minutes, 4-6 times daily. This helps to promote drainage of the blocked meibomian gland. Gentle massage of the eyelid after applying warm compresses can further facilitate drainage. Over-the-counter pain relievers such as acetaminophen or ibuprofen may be used for discomfort. If the hordeolum doesn't improve within a week or worsens, antibiotic treatment may be necessary. Topical antibiotic ointments like erythromycin or bacitracin can be applied to the eyelid margin, while more severe cases might require oral antibiotics such as doxycycline (100mg twice daily for 7-10 days) or amoxicillin-clavulanate (875/125mg twice daily for 7-10 days). Persistent internal hordeola may require incision and drainage by an ophthalmologist. During treatment, avoid eye makeup and contact lenses, and practice good eyelid hygiene to prevent recurrence. Warm compresses work by increasing blood circulation to the area, which helps the body's immune system fight the infection while also softening the hardened oil in the blocked gland.
Some studies have investigated the effectiveness of non-surgical interventions for acute internal hordeolum, but no relevant studies were found that compared the effectiveness of different treatments 1, 2. However, a study on acupuncture for acute hordeolum suggested that acupuncture with or without conventional treatments may provide short-term benefits for treating acute hordeolum when compared with conventional treatments alone, although the certainty of the evidence was low to very low 3. Another study found that combined antibiotic ophthalmic solution was not more effective than placebo in the treatment of hordeolum after incision and curettage 4.
In terms of specific treatments, some case reports have described the use of systemic ivermectin for demodicosis, which can be associated with hordeolum, but this is not a standard treatment for internal hordeolum 5.
Overall, the best approach to treating internal hordeolum is to start with warm compresses and gentle massage, and to consider antibiotic treatment if the condition does not improve or worsens. It is essential to prioritize good eyelid hygiene and avoid eye makeup and contact lenses during treatment to prevent recurrence.