What is the treatment for a stye (hordeolum) on the eye?

Treatment of Stye (Hordeolum) on the Eye

The primary treatment for a stye (hordeolum) is warm compresses applied to the affected eyelid for 10-15 minutes, 3-4 times daily, combined with gentle eyelid cleansing and massage to help drain the infection. 1

Understanding Styes

A stye (hordeolum) is a localized, painful inflammation of the eyelid margin caused by bacterial infection of an oil gland. Styes can be:

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

First-Line Treatment

Warm Compresses

• Apply warm (not hot) compresses to the affected eyelid for 10-15 minutes
• Repeat 3-4 times daily
• Sustained warmth helps to:
  • Soften hardened secretions
  • Improve circulation to the area
  • Promote natural drainage of the infection
  • Relieve pain and swelling

Effective Warm Compress Methods

• Clean washcloth soaked in warm water (rewarming as needed)
• Commercially available heat packs designed for eye use
• Hard-boiled egg wrapped in cloth (retains heat well) 2

Eyelid Cleansing

• After warm compress application, gently clean the eyelid margin
• Use diluted baby shampoo or commercial eyelid cleanser on a cotton ball, pad, or clean fingertip
• Rub gently along the base of the eyelashes to remove crusting 1

Eyelid Massage

• Following warm compress, gently massage the eyelid toward the lash line
• This helps express the contents of the infected gland
• Use caution in patients with glaucoma to avoid excessive pressure on the eye 1

Second-Line Treatment

Topical Antibiotics

• For moderate to severe cases or when symptoms don't improve with warm compresses
• Erythromycin ophthalmic ointment applied to the eyelid margin 1 cm in length up to six times daily 3
• Bacitracin ointment is an alternative option 1

Oral Antibiotics

• Reserved for severe cases, spreading infection, or recurrent styes
• Options include:
  • Doxycycline
  • Minocycline
  • Tetracycline
  • Erythromycin (for children and pregnant women) 1

Important Considerations

When to Seek Medical Care

• If the stye doesn't improve within 48-72 hours with home treatment
• If vision is affected
• If the entire eyelid becomes red and swollen
• If there is pain in or around the eye
• If the stye recurs frequently

Common Pitfalls to Avoid

1. Don't squeeze or pop the stye - this can spread infection
2. Don't use eye makeup or contact lenses until the stye has healed completely
3. Don't apply extremely hot compresses that could burn the skin 1
4. Don't discontinue treatment prematurely - continue warm compresses even after improvement begins

Prevention of Recurrence

• Practice good eyelid hygiene regularly
• Remove eye makeup completely before sleeping
• Replace eye makeup every 3-6 months
• Treat underlying conditions like blepharitis or meibomian gland dysfunction
• Avoid touching or rubbing eyes with unwashed hands

Special Populations

Children

• Same treatment principles apply
• May need assistance with warm compresses
• Erythromycin ointment is safe for children

Contact Lens Wearers

• Discontinue contact lens wear until stye resolves
• Consider replacing contact lenses and case after resolution
• Daily disposable lenses may be recommended to prevent recurrence

Evidence Limitations

It's worth noting that despite the common occurrence of hordeola, high-quality randomized controlled trials evaluating treatments are lacking 4, 5. Current recommendations are based on clinical experience, expert consensus, and observational studies rather than robust clinical trials.