Treatment of Stye (Hordeolum)
The most effective treatment for a stye is warm compresses applied to the affected eyelid for several minutes multiple times daily, combined with gentle eyelid cleansing to help drain the infection. 1
What is a Stye?
A stye (hordeolum) is a painful, localized infection of an eyelid gland. It can be:
- External (affecting the glands of Zeis or Moll at the eyelash base)
- Internal (affecting the meibomian glands within the eyelid)
First-Line Treatment Approach
Warm Compresses
- Apply warm (not hot) compresses to the affected eyelid for 5-10 minutes, 3-4 times daily 1
- This helps soften adherent crusts and warm the meibomian secretions
- Can be achieved using:
- Clean washcloth soaked in warm water
- Over-the-counter heat pack
- Homemade bean/rice bag heated in microwave
Eyelid Cleansing
- After warm compresses, gently clean the eyelid margin 1
- Options include:
- Diluted baby shampoo on a clean pad, cotton ball, or cotton swab
- Commercial eyelid cleansers (including those with 0.01% hypochlorous acid)
- Gentle massage to express the infected gland
Second-Line Treatment
Topical Antibiotics
- If symptoms persist or infection appears severe, apply antibiotic ointment to the eyelid margin 1
- Options include:
- Bacitracin ointment
- Erythromycin ointment
- Applied 1-3 times daily for 7-10 days
Oral Antibiotics
- Reserved for more severe cases with spreading infection or multiple recurrent styes 1
- Tetracyclines may be considered for recurrent cases
Important Considerations
When to Seek Medical Attention
- If symptoms worsen despite treatment
- If vision becomes affected
- If redness spreads beyond the eyelid
- If fever develops
- If styes recur frequently (may indicate underlying conditions)
Common Pitfalls to Avoid
- Do not squeeze or attempt to "pop" a stye - this can spread infection
- Avoid eye makeup until the stye resolves
- Do not share towels or washcloths to prevent spreading infection
- Do not use very hot compresses that could burn the skin 1
- Do not continue wearing contact lenses during active infection
Special Populations
- Children: May need assistance with warm compresses; ensure temperature is appropriate
- Patients with glaucoma: Should avoid aggressive pressure on eyelids during massage as this may increase intraocular pressure 1
- Patients with neurotrophic corneas: Need careful counseling to avoid corneal epithelial injury during cleansing 1
Evidence Limitations
Current evidence for stye treatment is limited, with no high-quality randomized controlled trials specifically addressing internal hordeolum treatment 2, 3. Treatment recommendations are based primarily on expert consensus and clinical experience as reflected in ophthalmology guidelines 1.
Expected Outcome
Most styes resolve within 1-2 weeks with conservative treatment. If a stye persists beyond this time or fails to drain spontaneously, it may develop into a chalazion requiring additional treatment.