Treatment of Stye (Hordeolum)
Warm compresses and eyelid hygiene are the first-line treatments for stye (hordeolum). 1
Understanding Styes
A stye (hordeolum) is a painful, localized inflammation of the eyelid margin usually caused by bacterial infection affecting the oil glands of the eyelid. Styes can be:
- External hordeolum: Infection of the glands of Zeis or Moll (at the eyelash base)
- Internal hordeolum: Infection of the meibomian glands
Common causative organisms include:
- Staphylococcus species (particularly coagulase-negative Staphylococcus and S. aureus)
- Streptococcus species
First-Line Treatment
1. Warm Compresses
- Apply warm compresses to the affected eyelid for several minutes (3-5 minutes) multiple times daily
- This helps to:
- Soften adherent crusts and scales
- Warm the meibomian secretions
- Promote drainage of the infected gland
- Increase blood circulation to the area
- Methods for applying warm compresses:
- Clean washcloth with hot tap water
- Over-the-counter heat pack
- Homemade bean/rice bag heated in microwave
- Important safety note: Ensure compresses are not too hot to avoid burning the skin 1
2. Eyelid Hygiene
- Gentle massage of the eyelids to express the contents of the infected gland
- Cleanse the eyelid margin by gently rubbing the base of the eyelashes using:
- Diluted baby shampoo
- Commercially available eyelid cleaner
- Hypochlorous acid 0.01% cleaners (have strong antimicrobial effects)
- Use a clean pad, cotton ball, cotton swab, or clean fingertip 1
Second-Line Treatment
Topical Antibiotics
- Consider for moderate to severe cases or when initial treatment fails
- Options include:
- Antibiotic ointments (bacitracin, erythromycin)
- Applied to the eyelid margin one or more times daily 1
Systemic Antibiotics
- Reserved for severe cases or when there is spreading infection
- Particularly useful for recurrent hordeola or associated with rosacea 1
Treatment Frequency and Duration
- Apply warm compresses and perform eyelid hygiene once or twice daily
- Continue treatment until resolution (typically 7-10 days)
- Many styes will drain spontaneously with this treatment 1
When to Seek Further Care
Patients should seek additional medical attention if:
- No improvement after 48-72 hours of treatment
- Increasing pain, redness, or swelling
- Spreading of infection to surrounding tissues
- Vision changes
- Recurrent styes (may indicate underlying conditions)
Special Considerations
- Patients with neurotrophic corneas need careful counseling to avoid injury during eyelid cleansing 1
- Patients with advanced glaucoma should avoid aggressive pressure on the eyelids 1
- Recurrent styes may indicate underlying blepharitis requiring long-term management 1
- Persistent or recurrent styes may require evaluation for underlying conditions like diabetes or immune disorders
Important Pitfalls to Avoid
- Squeezing or attempting to "pop" the stye - this can spread infection
- Using makeup on the affected eye until complete resolution
- Sharing towels or washcloths with others during an active infection
- Wearing contact lenses until the stye has resolved
- Neglecting hand hygiene before and after touching the affected area
While some studies have investigated alternative treatments like ear-apex bloodletting 2, 3, there is insufficient high-quality evidence to recommend these approaches over conventional treatment. Cochrane reviews have found no randomized controlled trials evaluating non-surgical interventions for internal hordeolum 4, 5, 6.
Remember that styes are typically self-limiting conditions that resolve with conservative management, but proper treatment can speed healing and prevent complications.