What is the treatment for a stye (hordeolum) in a child?

Treatment of Styes (Hordeola) in Children

The first-line treatment for a stye (hordeolum) in a child is warm compresses applied to the affected eyelid 3-4 times daily for 10-15 minutes, combined with gentle eyelid cleansing and massage to help express the blocked gland contents.

Understanding Styes in Children

A stye (hordeolum) is an acute, localized infection or inflammation of the eyelid margin, typically affecting the oil glands of the eyelid. Styes can be classified as:

• External hordeolum: Infection of the glands of Zeis or Moll (at the base of eyelashes)
• Internal hordeolum: Infection of the meibomian glands (deeper in the eyelid)

Staphylococcus aureus is the most common causative organism.

Treatment Algorithm

First-Line Treatment

1. Warm Compresses

   • Apply warm (not hot) compresses to the affected eyelid for 10-15 minutes
   • Repeat 3-4 times daily
   • This helps increase blood circulation to the area and promotes drainage 1

2. Eyelid Hygiene

   • Gentle cleansing of the eyelid margins with baby shampoo diluted with water or commercial eyelid cleansers
   • Massage the eyelid gently toward the margin to express blocked gland contents 1

3. Avoid Eye Rubbing

   • Instruct the child to avoid touching or rubbing the eye to prevent spreading infection

Second-Line Treatment

If no improvement after 48-72 hours of conservative treatment:

1. Topical Antibiotics

   • Antibiotic ointments such as erythromycin or bacitracin applied to the eyelid margin
   • Apply 2-3 times daily for 7-10 days 1

2. Oral Antibiotics (for severe cases or when multiple styes are present)

   • Consider oral antibiotics effective against S. aureus:
     • For children with no penicillin allergy: Dicloxacillin or cephalexin
     • For children with penicillin allergy: Clindamycin or trimethoprim-sulfamethoxazole 2

When to Refer to an Ophthalmologist

Refer to an ophthalmologist if:

• No improvement after 7 days of treatment
• Recurrent styes
• Spreading infection (preseptal cellulitis)
• Visual changes
• Severe pain or swelling
• Involvement of the entire eyelid 1

Special Considerations

Distinguishing from Chalazion

A chalazion is a non-infectious, granulomatous inflammation of a meibomian gland that may develop if a hordeolum doesn't resolve. It presents as a painless nodule on the eyelid and may require different management 1.

Recurrent Styes

For children with recurrent styes:

• Evaluate for underlying conditions like blepharitis or rosacea
• Consider more aggressive eyelid hygiene regimen
• Screen for possible immunodeficiency if recurrences are frequent 1

Caution with Children

• Ensure warm compresses are not too hot to avoid burns
• Supervise eyelid cleansing in younger children
• Avoid use of steroid-containing preparations unless specifically prescribed by an ophthalmologist 1

Prevention

• Regular eyelid hygiene, especially in children prone to blepharitis
• Hand hygiene to prevent spread of infection
• Avoid sharing towels, washcloths, or eye makeup
• Replace eye makeup regularly if used by adolescents 1

Evidence Quality

The evidence for stye treatment in children is limited, with no high-quality randomized controlled trials specifically addressing treatment options 3, 4. Current recommendations are based primarily on expert consensus and clinical experience from ophthalmology guidelines 1.