Treatment for Stye (Hordeolum)
Warm compresses and eyelid cleansing are the first-line treatments for styes, which should be applied several times daily until the stye resolves. 1
What is a Stye?
A stye (hordeolum) is an acute, localized inflammation of the eyelid margin, usually caused by bacterial infection affecting the oil glands of the eyelid. It can be either internal (affecting meibomian glands) or external (affecting glands of Zeis or Moll).
Treatment Algorithm
First-Line Treatment:
Warm Compresses
- Apply to the affected eyelid for several minutes (typically 5-10 minutes)
- Use 3-4 times daily
- Helps soften crusts and scales, warm meibomian secretions
- Can be applied using:
- Clean washcloth with hot tap water
- Over-the-counter heat pack
- Homemade bean/rice bag heated in microwave
- Important: Ensure temperature is comfortable and won't burn the skin 1
Eyelid Cleansing
- Perform after warm compresses
- Gently massage the eyelid to express the contents of the infected gland
- Clean eyelid margins by rubbing the base of eyelashes using:
- Diluted baby shampoo
- Commercial eyelid cleaner
- Hypochlorous acid 0.01% cleaners (antimicrobial effect) 1
- Use a cotton ball, pad, swab, or clean fingertip
Second-Line Treatment (for moderate to severe cases):
Topical Antibiotics
- Consider when stye doesn't respond to warm compresses and cleansing
- Typically erythromycin or bacitracin ointment 1
- Apply to the affected area 2-3 times daily
Systemic Antibiotics
- Reserved for severe cases or when multiple styes are present
- Anti-staphylococcal antibiotics are typically used
For Recurrent or Persistent Styes:
- Consider evaluation for underlying conditions like blepharitis
- More aggressive eyelid hygiene regimen
- Possible surgical intervention (incision and drainage) if the stye doesn't drain spontaneously
Special Considerations
Cautions:
- Patients with neurotrophic corneas should be counseled to avoid injury to corneal epithelium during eyelid cleaning 1
- Patients with advanced glaucoma should avoid aggressive eyelid pressure 1
- Manual cleaning may be dangerous for patients lacking dexterity or judgment 1
When to Seek Further Care:
- No improvement after 48-72 hours of treatment
- Increasing pain, redness, or swelling
- Fever or systemic symptoms
- Vision changes
- Recurrent styes (may indicate underlying chronic blepharitis)
Prevention:
- Regular eyelid hygiene, especially for those prone to styes
- Avoid eye rubbing
- Replace eye makeup regularly
- Remove eye makeup before sleeping
Evidence Quality
The recommendations for warm compresses and eyelid hygiene are well-established in ophthalmology practice guidelines 1, though high-quality randomized controlled trials specifically for stye treatment are limited 2, 3. Despite this, clinical experience and consensus strongly support these interventions as first-line therapy for their effectiveness in promoting drainage and resolution of the infection.