What is the treatment for hordeolum?

Treatment for Hordeolum

The primary treatment for hordeolum includes warm compresses, eyelid cleansing, and eyelid massage to promote drainage, with antibiotics reserved for cases that don't respond to conservative management or show signs of spreading infection. 1

Initial Management

Warm Compresses

• Apply warm (not hot) compresses to the affected eyelid for 10-15 minutes, 4 times daily
• This helps to:
  • Increase blood circulation to the area
  • Soften the material in the blocked gland
  • Promote natural drainage of the infection

Eyelid Hygiene

• Gentle cleansing of the eyelid margins with diluted baby shampoo or commercial eyelid cleansers
• Massage the affected eyelid gently after applying warm compresses to help express the contents of the obstructed gland
• For meibomian gland dysfunction (MGD) associated with internal hordeolum, eyelid massage is particularly important 1

When to Consider Additional Treatment

Topical Antibiotics

• Indicated when:
  • Hordeolum shows no improvement after 48-72 hours of conservative treatment
  • Signs of spreading infection are present
  • Multiple hordeola are present
• Common options include:
  • Erythromycin ointment
  • Bacitracin ointment
  • Applied to the lid margin 2-4 times daily

Oral Antibiotics

• Reserved for more severe cases with:
  • Significant surrounding cellulitis
  • Systemic symptoms
  • Immunocompromised patients
• Typically target Staphylococcus species, which are the most common causative organisms 1

Special Considerations

Internal vs. External Hordeolum

• External hordeolum (stye): Affects the glands of Zeis or Moll associated with eyelash follicles
• Internal hordeolum: Affects the meibomian gland in the tarsal plate
• Both are treated similarly, though internal hordeola may be more likely to develop into chalazia if unresolved 2, 3

Recurrent Hordeola

• May indicate underlying conditions such as:
  • Chronic blepharitis
  • Meibomian gland dysfunction
  • Seborrheic dermatitis
  • Rosacea
• Treatment of the underlying condition is essential for preventing recurrence 1

When to Refer to Ophthalmology

• No improvement after 7-10 days of appropriate treatment
• Recurrent hordeola despite adequate treatment
• Visual changes or severe pain
• Marked asymmetry or unifocal recurrent hordeola (to rule out sebaceous carcinoma) 1
• Progressive loss of normal eyelid margin anatomy
• Focal lash loss (ciliary madarosis)

Important Caveats

• Avoid squeezing or attempting to "pop" the hordeolum, as this can spread infection
• Contact lens wearers should discontinue lens wear until the hordeolum resolves
• Patients should be advised not to share towels or washcloths to prevent spread of infection
• Although multiple Cochrane reviews have examined interventions for hordeola, they have consistently found insufficient evidence from randomized controlled trials to definitively guide treatment 2, 3, 4, 5
• Despite the lack of high-quality evidence, the consensus approach of warm compresses and eyelid hygiene remains the mainstay of treatment based on clinical experience and expert opinion

Surgical Intervention

• Incision and drainage may be considered for persistent hordeola that don't respond to conservative management
• This is typically performed by an ophthalmologist after topical anesthesia
• More commonly needed for internal hordeola that have evolved into chalazia