Treatment of Stye (Hordeolum)
The primary treatment for a stye 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
First-Line Treatment
Warm Compresses
- Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily
- Helps soften hardened secretions and promote drainage
- Can be achieved using:
- Hot tap water on a clean washcloth
- Over-the-counter heat pack
- Homemade bean/rice bag heated in microwave
- Important: Avoid temperatures hot enough to burn the skin 2
Eyelid Hygiene
- Perform eyelid cleansing after warm compress application
- Options include:
- Gentle massage helps express contents of the infected gland
- Caution: Patients with advanced glaucoma or history of glaucoma filtering procedure should avoid aggressive lid pressure 1
Second-Line Treatment
Topical Antibiotics
- Consider adding when there are signs of blepharitis or risk of secondary infection
- Options include:
- Bacitracin ointment applied to eyelid margins 1-2 times daily
- Erythromycin ointment applied to eyelid margins 1-2 times daily 1
- These can be applied for several weeks to reduce bacterial load and prevent secondary infections
Combination Treatments
- For moderate to severe cases, consider combination antibiotic/steroid topical treatments:
- Tobramycin/dexamethasone
- Loteprednol etabonate 0.5%/tobramycin 0.3% (lower risk of increasing intraocular pressure) 1
When to Seek Further Care
- If no improvement after 7 days of treatment
- Signs of systemic toxicity requiring surgical consultation
- Recurrent styes requiring evaluation for underlying conditions:
- Rosacea
- Ocular mucous membrane pemphigoid
- Sebaceous carcinoma 1
Special Considerations
Immunocompromised Patients
- May need more aggressive treatment and closer monitoring 1
Contact Lens Wearers
- Discontinue contact lens wear until stye resolves
- Consider replacement of contact lenses and case after resolution 1
Children with Recurrent Styes
- Should be evaluated for possible underlying conditions 1
Prevention of Recurrence
- Practice good eyelid hygiene regularly
- Remove eye makeup completely
- Treat underlying conditions like rosacea or blepharitis 1
Evidence Quality
The evidence for warm compresses, eyelid hygiene, and topical antibiotics is based on clinical guidelines and expert consensus rather than high-quality randomized controlled trials. Cochrane reviews have found no randomized controlled trials specifically evaluating non-surgical interventions for acute internal hordeolum 3, 4. This highlights a gap in the literature despite the common nature of this condition.
While acupuncture has shown some potential benefit in small studies conducted in China 5, 6, the evidence is of low certainty due to methodological limitations, and these findings may not be generalizable to non-Chinese populations.
The treatment approach outlined above represents the current standard of care based on clinical guidelines from the American Academy of Ophthalmology, despite the limited high-quality evidence available.