Recommended Treatment for a Stye
The recommended first-line treatment for a stye (hordeolum) is warm compresses applied to the eyelid for several minutes multiple times daily, combined with gentle eyelid cleansing to remove debris and express the affected gland. 1
Primary Treatment Approach
Warm Compresses
- Apply warm compresses to the eyelid for several minutes (typically 5-10 minutes)
- Use hot tap water on a clean washcloth, over-the-counter heat pack, or homemade bean/rice bag heated in microwave
- Apply once or twice daily at a time convenient for the patient
- Important safety note: Ensure compresses are not hot enough to burn the skin 1
- For optimal effectiveness without corneal distortion, place the warm compress close to but not directly touching the eyelid 2
Eyelid Cleansing
- After warm compress application, perform gentle eyelid massage to express the affected gland
- Clean the eyelid margin by gently rubbing the base of eyelashes using:
- Diluted baby shampoo or
- Commercially available eyelid cleaner on a pad, cotton ball, cotton swab, or clean fingertip 1
- Eye cleaners with hypochlorous acid at 0.01% have strong antimicrobial effects and can be beneficial 1
Secondary Treatments (for cases not responding to primary approach)
Topical Antibiotics
- For persistent or severe cases, a topical antibiotic ointment such as bacitracin or erythromycin can be applied to the eyelid margins
- Apply one or more times daily or at bedtime for a few weeks
- Duration and frequency should be guided by severity and response to treatment 1
Oral Antibiotics
- Reserved for cases with significant inflammation spreading beyond the eyelid or recurrent styes
- Options include:
- Doxycycline, minocycline, or tetracycline (for adults)
- Erythromycin or azithromycin (for children and women of childbearing age) 1
Special Considerations
Cautions
- Patients with manual dexterity issues may need assistance with eyelid cleansing to avoid injury
- Patients with neurotrophic corneas require careful counseling to avoid corneal epithelial injury
- Patients with advanced glaucoma should avoid aggressive lid pressure 1
Patient Education
- Inform patients that treatment may need to be continued long-term as symptoms often recur when treatment is discontinued
- Emphasize that while a complete cure may not be possible, daily treatment can significantly improve symptoms 1
- Regular eyelid hygiene may help prevent recurrence
When to Seek Further Care
- If the stye fails to improve after 1-2 weeks of home treatment
- If vision changes occur
- If the inflammation spreads beyond the eyelid
- If recurrent styes develop, which may indicate underlying conditions requiring additional treatment
The evidence for non-surgical interventions for styes is limited, with no high-quality randomized controlled trials specifically addressing their treatment 3, 4, 5. However, clinical practice guidelines consistently recommend warm compresses and eyelid hygiene as first-line therapy based on clinical experience and pathophysiological principles.