What is the treatment for a stye (hordeolum) that has lasted 2 weeks?

Treatment of Stye (Hordeolum) Lasting 2 Weeks

For a stye (hordeolum) that has persisted for 2 weeks, warm compresses applied 1-2 times daily combined with gentle eyelid massage and a topical antibiotic ointment such as bacitracin or erythromycin is the recommended treatment approach. 1

First-Line Treatment

1. Warm Compresses and Massage:

   • Apply warm compresses to the affected eyelid for 5-10 minutes
   • Follow with gentle massage of the eyelid to express the meibomian glands
   • Perform this 1-2 times daily 1
   • This helps to liquefy the thickened secretions and promote drainage

2. Eyelid Hygiene:

   • Clean the eyelid margins daily using:
     • Diluted baby shampoo or
     • Commercial eyelid cleaner on a cotton ball, pad, or clean fingertip
   • Gently rub the base of the eyelashes to remove crusting 1

3. Topical Antibiotics:

   • Apply a topical antibiotic ointment such as bacitracin or erythromycin to the eyelid margin
   • Apply 1-3 times daily for a few weeks 1, 2
   • This helps reduce bacteria on the eyelid margin and provides symptomatic relief

For Persistent Cases (Not Responding After 2 Weeks)

If the stye has not improved with the above measures after 2 weeks of consistent treatment:

1. Consider Oral Antibiotics:

   • For meibomian gland dysfunction (MGD) with persistent symptoms
   • Options include:
     • Doxycycline (adults)
     • Erythromycin (for children and women of childbearing age) 1

2. Referral to Ophthalmologist:

   • If the stye continues to enlarge
   • If vision becomes affected
   • If there is significant spread of inflammation
   • For consideration of incision and drainage if the stye does not drain spontaneously 1

Important Considerations

• Avoid Squeezing: Do not attempt to squeeze or pop the stye as this may spread infection
• Avoid Contact Lens Wear: Discontinue contact lens use until the stye resolves
• Avoid Eye Makeup: Discontinue use of eye makeup until resolution
• Caution with Pressure: Patients with advanced glaucoma should be advised not to apply excessive pressure during massage 1

Expected Outcomes

Most styes will resolve with conservative treatment within 1-2 weeks 3. Persistent cases beyond 2 weeks may indicate:

• Inadequate treatment
• Development into a chalazion (chronic granulomatous inflammation)
• Need for more aggressive intervention

The evidence for non-surgical interventions for hordeolum is limited, with no high-quality randomized controlled trials specifically addressing their effectiveness 4, 5. However, clinical practice guidelines consistently recommend warm compresses, eyelid hygiene, and topical antibiotics as the mainstay of treatment 1.

Prevention of Recurrence

For patients with recurrent styes, consider:

• Regular eyelid hygiene (daily or several times weekly)
• Addressing underlying conditions like blepharitis or meibomian gland dysfunction
• Replacing eye makeup every 3-6 months to prevent bacterial contamination 1