Treatment of Hordeolum (Stye)
Warm compresses and eyelid hygiene are the recommended first-line treatments for hordeolum (stye), as they help soften the hardened oil, promote drainage, and resolve the infection. 1
First-Line Management
Warm Compresses
- Apply warm compresses to the affected eyelid for several minutes (typically 5-10 minutes)
- Can be achieved using:
- Over-the-counter heat packs
- Microwaveable eyelid warming devices
- Homemade bean/rice bags heated in microwave
- Apply 3-4 times daily
- Important safety note: Avoid using water-soaked cloths that are too hot to prevent scalding the delicate eyelid skin 1
Eyelid Cleansing and Massage
- Follow warm compresses with gentle eyelid massage to:
- Express the meibomian glands
- Unblock oil glands
- Remove excess bacteria
- Cleaning can be performed using:
- Commercial eyelid cleansers with hypochlorous acid (0.01%)
- Commercial eyelid wipes
- Gentle rubbing at the base of eyelashes 1
Second-Line Treatment
Topical Antibiotics
- Consider when hordeolum shows signs of spreading infection or fails to improve with warm compresses
- Typically applied as ointment or solution to the eyelid margin
- No strong evidence supports routine use in uncomplicated cases 2, 3
Systemic Antibiotics
- Reserved for cases with:
- Significant surrounding cellulitis
- Spreading infection
- Systemic symptoms
- Failed response to topical treatment 1
Special Considerations
When to Refer to Ophthalmology
- Hordeolum that fails to respond to conservative treatment after 1-2 weeks
- Signs of spread beyond the eyelid (preseptal or orbital cellulitis)
- Recurrent hordeola
- Visual changes
- Severe pain or rapid progression 4
Surgical Intervention
- Incision and drainage may be necessary for persistent cases
- Note: Research shows no significant benefit of antibiotics over placebo after incision and curettage 5
Prevention of Recurrence
- Regular eyelid hygiene
- Proper makeup removal
- Treatment of underlying blepharitis if present 1
Important Caveats
- Most hordeola will resolve spontaneously within 1-2 weeks 2, 3
- Avoid squeezing or attempting to "pop" the hordeolum, as this can spread infection
- Complications are rare but can include eyelid necrosis, preseptal cellulitis, and in severe cases, systemic infection 4
- Recurrent hordeola may indicate underlying chronic blepharitis that requires ongoing management 1
- Patients should be advised that hordeolum is usually self-limiting but proper treatment can speed recovery and prevent complications
Remember that warm compresses and eyelid hygiene remain the cornerstone of treatment despite limited high-quality evidence supporting any specific intervention for hordeolum 2, 3.