What is the best treatment for a swollen eye with a stye (hordeolum)?

Treatment for Swollen Eye and Stye (Hordeolum)

The best treatment for a swollen eye with a stye (hordeolum) is warm compresses applied to the affected eyelid for 5-10 minutes several times daily, combined with gentle eyelid cleansing and hygiene. 1

First-Line Treatment

Warm Compresses

• Apply warm (not hot) compresses to the affected eyelid for 5-10 minutes
• Frequency: 2-4 times daily
• Method: Use clean washcloth with warm water, commercial heat pack, or homemade bean/rice bag heated in microwave
• Purpose: Softens crusts/scales, warms meibomian secretions, helps bring the stye to a head
• Caution: Ensure compress is not hot enough to burn skin 1

Eyelid Hygiene

• Clean eyelid margins after warm compress application
• Method: Gently rub the base of eyelashes using either:
  • Diluted baby shampoo on cotton ball/pad/swab
  • Commercial eyelid cleaner
  • Clean fingertip (if patient has adequate dexterity)
• Direction: For crusting, rub eyelid margins from side to side
• Frequency: Once or twice daily 1

Second-Line Treatment

If symptoms persist after 48-72 hours of warm compresses and eyelid hygiene:

Topical Antibiotics

• Apply antibiotic ointment to eyelid margin
• Options:
  • Bacitracin ointment
  • Erythromycin ointment
• Frequency: 1-3 times daily or at bedtime
• Duration: Few weeks, based on severity and response 1

Oral Antibiotics (for severe or recurrent cases)

• Consider for internal hordeola not responding to topical treatment
• Options:
  • Doxycycline
  • Minocycline
  • Tetracycline
  • Erythromycin or azithromycin (for children or women of childbearing age)
• These medications also have anti-inflammatory properties 1

Special Considerations

When to Seek Medical Attention

• If stye doesn't improve after 48 hours of home treatment
• If vision is affected
• If redness/swelling spreads beyond the eyelid
• If pain is severe
• If styes recur frequently (may indicate need for different treatment approach)

Surgical Intervention

• Incision and drainage (I&C) may be considered for:
  • Flocculated/pointing styes that don't drain spontaneously
  • Styes larger than 4-5mm 2
• Should be performed by an ophthalmologist

What to Avoid

• Squeezing or attempting to "pop" the stye
• Wearing contact lenses until stye resolves
• Eye makeup until infection clears
• Aggressive pressure on eyelids, especially in patients with glaucoma 1

Evidence Quality

The evidence for non-surgical interventions for hordeolum is surprisingly limited. Cochrane reviews in 2013 and 2017 found no randomized controlled trials evaluating the effectiveness of common treatments for internal hordeola 3, 4. Despite this lack of high-quality evidence, warm compresses and eyelid hygiene remain the cornerstone of treatment based on clinical experience and expert consensus as reflected in ophthalmology practice guidelines 1.

Most styes will resolve spontaneously within 1-2 weeks, but proper treatment can speed healing, reduce discomfort, and prevent complications or recurrence.