What prescription drops are recommended for a stye?

Prescription Treatment for Styes

For styes (hordeola), topical erythromycin ophthalmic ointment applied directly to the infected eye up to 4-6 times daily is the recommended prescription treatment. 1

Understanding Styes

A stye (hordeolum) is a common, painful inflammation of the eyelid margin usually caused by bacterial infection affecting the oil glands of the eyelid. Styes can be:

• Internal (affecting meibomian glands deeper in the eyelid)
• External (affecting glands at the eyelid margin)

Treatment Algorithm

First-Line Treatment

1. Topical antibiotic ointment

   • Erythromycin ophthalmic ointment 0.5%
   • Apply approximately 1 cm in length directly to the affected eye
   • Frequency: 4-6 times daily depending on severity
   • Duration: Typically 7-14 days until complete resolution 1, 2

2. Supportive measures (to be used alongside antibiotics)

   • Warm compresses applied to the affected eyelid for 10-15 minutes, 1-2 times daily 2
   • Gentle eyelid cleansing to remove crusts and debris
   • Avoid eye makeup and contact lenses until resolved

Alternative Prescription Options

If erythromycin is not tolerated or available:

• Bacitracin ophthalmic ointment 2
• Tobramycin-containing ophthalmic preparations 2

For Severe or Persistent Cases

• Consider oral antibiotics if multiple styes are present or if there's significant surrounding cellulitis:
  • Doxycycline (100 mg twice daily) 2
  • Minocycline (100 mg twice daily) 2
  • For children or pregnant women: oral erythromycin or azithromycin 2

Important Clinical Considerations

• Proper application technique: Pull down the lower eyelid to create a pocket, apply the ointment, and close the eye for 1-2 minutes to distribute the medication
• Temporary blurred vision: Warn patients that ointments may temporarily blur vision; consider nighttime application if this is problematic
• Treatment duration: Continue treatment until complete resolution, typically 7-14 days 2
• Follow-up: If no improvement after 48-72 hours of treatment, reevaluation is necessary

When to Refer to Ophthalmology

• Lack of improvement after 7 days of appropriate treatment
• Recurrent styes in the same location
• Visual changes
• Severe pain or spreading erythema suggesting orbital cellulitis
• Immunocompromised patients

Evidence Quality

The evidence for topical antibiotic treatment of styes is primarily based on clinical practice guidelines rather than high-quality randomized controlled trials. A Cochrane review found no randomized controlled trials specifically addressing treatment of internal hordeola 3, 4. However, clinical practice guidelines consistently recommend topical antibiotics as first-line treatment 2.

Common Pitfalls to Avoid

• Premature discontinuation: Stopping treatment before complete resolution may lead to recurrence
• Insufficient application frequency: Less than 4 times daily may result in treatment failure
• Squeezing or popping: Advise patients against manually expressing the stye, which can spread infection
• Ignoring underlying conditions: Recurrent styes may indicate underlying blepharitis or meibomian gland dysfunction that requires additional treatment

Erythromycin ophthalmic ointment has the advantage of FDA approval for ocular infections with established safety and efficacy, making it the preferred prescription treatment for styes 1.