What ointment or eyedrop is prescribed for a stye (hordeolum)?

Treatment of Stye (Hordeolum)

For stye (hordeolum), topical antibiotic ointments such as bacitracin or erythromycin applied directly to the eyelid margins 1-3 times daily are the recommended first-line treatment. 1, 2

Understanding Styes (Hordeola)

A stye, or hordeolum, is a common, painful inflammation of the eyelid margin usually caused by bacterial infection affecting the oil glands of the eyelid. It can be classified as:

• External hordeolum (stye): Affects glands at the base of eyelashes
• Internal hordeolum: Affects meibomian glands deeper in the eyelid

Treatment Algorithm

First-Line Treatment:

1. Warm compresses

   • Apply to affected eyelid for 10-15 minutes, 4 times daily
   • Helps to promote drainage and resolution

2. Eyelid hygiene

   • Gentle cleansing of eyelid margins to remove crusts and debris
   • All scales and crusts should be carefully removed before applying medication 1

3. Topical antibiotic ointment

   • Bacitracin ophthalmic ointment: Apply directly to eyelid margins 1-3 times daily 1
   • Erythromycin ophthalmic ointment: Apply approximately 1 cm in length directly to affected eye up to 6 times daily 2
   • Apply uniformly over lid margins after cleaning

For Persistent or Severe Cases:

• If no improvement after 48-72 hours of conservative treatment, consider:
  • More frequent application of antibiotic ointment
  • Evaluation for possible incision and drainage if pointing occurs

Important Considerations

• Avoid squeezing or manually expressing the stye as this may spread infection
• Discontinue contact lens wear until the stye resolves
• Avoid eye makeup during the infection period
• Practice good hand hygiene to prevent spread of infection

Evidence Quality and Limitations

The evidence for treatment of hordeolum is surprisingly limited despite its common occurrence. Multiple Cochrane reviews (2010,2013,2017) found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 3, 4, 5. Treatment recommendations are largely based on clinical experience and FDA-approved indications for ophthalmic antibiotic ointments.

Prevention of Recurrence

• Regular eyelid hygiene with warm compresses and gentle cleansing
• Replace eye makeup every 3-6 months
• Avoid sharing eye makeup or towels
• Proper hand hygiene before touching eyes

While most styes resolve spontaneously within 1-2 weeks, topical antibiotic ointments can help prevent spread of infection and accelerate healing 6. Patients should be advised to seek further evaluation if symptoms worsen or if vision becomes affected.