What is the typical prescription for a stye (hordeolum)?

Management 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 to the affected eyelid for 10-15 minutes, 3-4 times daily

  • Can use hot tap water, over-the-counter heat pack, or homemade bean/rice bag heated in microwave
  • Ensure temperature is warm but not hot enough to burn the skin

• Eyelid hygiene: Perform after warm compress application

  • Use diluted baby shampoo, commercial eyelid cleanser, or clean fingertip
  • Gently massage to express contents of the infected gland

Second-Line Treatment

If no improvement after several days of warm compresses and eyelid hygiene, or if there are signs of significant infection:

• Topical antibiotics: Apply to eyelid margins 1-2 times daily for a few weeks
  • Bacitracin or erythromycin ointment are commonly prescribed 2, 1
  • These decrease bacteria and provide symptomatic relief

Third-Line Treatment

For moderate to severe cases or those not responding to topical antibiotics:

• Combination antibiotic/steroid treatments:
  • Topical tobramycin/dexamethasone or loteprednol etabonate 0.5%/tobramycin 0.3% 2
  • Loteprednol has lower risk of increasing intraocular pressure compared to dexamethasone

Fourth-Line Treatment

For persistent styes (lasting >2 months) or those that develop into chalazia:

• Referral to ophthalmologist for possible:
  • Intralesional steroid injection
  • Incision and drainage procedure

Special Considerations

• Recurrent styes: May indicate underlying conditions such as:

  • Blepharitis
  • Rosacea
  • Sebaceous gland dysfunction
  • Consider evaluation for these conditions

• Immunocompromised patients: May require more aggressive treatment and closer monitoring 1

• Contact lens wearers: Should discontinue lens wear until stye resolves and consider replacing lenses and case after resolution 1

Follow-up Recommendations

• Follow-up evaluation if no improvement after 7 days of treatment 1
• For recurrent styes, evaluation for underlying conditions is recommended

Prevention

• Regular eyelid hygiene
• Complete removal of eye makeup
• Treatment of underlying conditions like blepharitis or rosacea
• Avoid sharing towels or washcloths

Evidence Quality

It's worth noting that despite the widespread use of these treatments, high-quality evidence from randomized controlled trials specifically for internal hordeola is limited 3, 4. However, the recommendations from the American Academy of Ophthalmology represent the current standard of care based on clinical experience and expert consensus 1.