What is the treatment for a stye (hordeolum)?

Treatment for Stye (Hordeolum)

The primary treatment for a stye (hordeolum) consists of warm compresses applied to the affected eyelid for 10-15 minutes, 3-4 times daily, combined with gentle eyelid cleansing and massage to promote drainage. 1, 2

First-Line Treatment

1. Warm compresses

   • Apply for 10-15 minutes, 3-4 times daily
   • Use hot tap water on a clean washcloth, commercial heat pack, or homemade bean/rice bag heated in microwave
   • Ensure temperature is comfortable and won't burn skin
   • Helps soften hardened secretions and promote drainage

2. Eyelid cleansing

   • Clean eyelid margins after warm compress application
   • Use diluted baby shampoo or commercial eyelid cleanser on a cotton ball, pad, swab, or clean fingertip
   • Gently rub the base of eyelashes to remove crusting
   • Eye cleaners with hypochlorous acid (0.01%) have antimicrobial effects for anterior blepharitis

3. Eyelid massage

   • Perform gentle massage after warm compress to express contents of the infected gland
   • For meibomian gland dysfunction (MGD), vertical massage can help express secretions
   • Caution: Patients with advanced glaucoma or history of glaucoma filtering procedure should avoid aggressive lid pressure 1

Second-Line Treatment

If no improvement after several days of conservative management:

1. Topical antibiotics

   • Antibiotic ointments such as bacitracin or erythromycin applied to eyelid margins 1-2 times daily for a few weeks 1, 2
   • Helps decrease bacteria from the eyelid margin and provides symptomatic relief
   • Can be used intermittently with different medications to prevent resistance

2. Combination treatments (for moderate to severe cases)

   • Topical tobramycin/dexamethasone or loteprednol etabonate 0.5%/tobramycin 0.3% may reduce signs and symptoms 1, 2
   • Loteprednol has lower risk of increasing intraocular pressure compared to dexamethasone 1

Special Considerations

• Persistent styes: If no improvement after 7 days, follow-up evaluation is recommended 2
• Recurrent styes: May indicate underlying conditions that require evaluation, especially in children 2
• Immunocompromised patients: Need more aggressive treatment and closer monitoring 2
• Patients with rosacea: More prone to developing styes and may require more aggressive management 2

Important Caveats

1. Avoid squeezing or puncturing the stye, which can spread infection
2. Discontinue contact lens wear until the stye resolves; consider replacing lenses and case after resolution 2
3. Remove eye makeup completely and practice good eyelid hygiene to prevent recurrence 2
4. Surgical consultation is recommended for aggressive infections with signs of systemic toxicity 1

When to Consider Referral

• Stye doesn't improve with treatment after 1 week
• Vision changes occur
• Severe pain or spreading redness beyond the eyelid
• Recurrent styes in the same location (may indicate sebaceous carcinoma requiring biopsy) 1
• Signs of cicatricial changes in conjunctiva (may indicate ocular mucous membrane pemphigoid) 1

While most styes resolve with conservative management, proper treatment can reduce discomfort, prevent complications, and speed healing. The evidence for non-surgical interventions specifically for acute internal hordeolum is limited, with no randomized controlled trials identified in systematic reviews 3, 4, highlighting the importance of following established guidelines from ophthalmology societies.