What is the recommended treatment for a stye?

Treatment of Styes (Hordeolum)

The first-line treatment for a stye is warm compresses applied to the eyelid for 10-15 minutes, 3-4 times daily, followed by gentle eyelid cleansing. 1

First-Line Management

1. Warm Compresses

   • Apply for 10-15 minutes, 3-4 times daily
   • Helps to soften crusts and warm meibomian secretions
   • Promotes drainage of the infected gland
   • Can be applied using washcloths, though specialized heat-retaining devices like hard-boiled eggs may provide more sustained heat 2

2. Eyelid Hygiene

   • Clean eyelid margins after warm compresses
   • Use diluted baby shampoo or commercially available eyelid cleaners
   • Products with 0.01% hypochlorous acid are particularly effective 1
   • Apply using a pad, cotton ball, cotton swab, or clean fingertip

3. Gentle Massage

   • For posterior involvement, perform vertical eyelid massage to express meibomian glands
   • For anterior blepharitis, rub eyelid margins side-to-side to remove crusting from eyelashes
   • Massage should be gentle to avoid mechanical irritation 1

Second-Line Treatment

If symptoms persist after 1 week of consistent eyelid hygiene:

• Apply antibiotic ointment such as bacitracin or erythromycin to eyelid margins
• Use once or more daily or at bedtime for 2-3 weeks 1

Third-Line Treatment

For moderate to severe cases with significant inflammation:

• Consider topical tobramycin/dexamethasone ophthalmic suspension 1
• For cases not responding to topical treatment, oral antibiotics may be considered:
  • Doxycycline, minocycline, or tetracycline (tapered after clinical improvement)
  • Erythromycin or azithromycin (especially for women of childbearing age and children) 1

Fourth-Line Treatment

For persistent (>2 months) or large chalazia:

• Consider intralesional steroid injection or incision and curettage 1

Important Considerations and Precautions

• Styes often resolve spontaneously with proper eyelid hygiene 3, 4, 5
• Discontinue contact lens wear until symptoms resolve
• Consider replacement of contact lenses and case after resolution 1
• Patients with advanced glaucoma should avoid aggressive lid pressure during massage
• Immunocompromised patients may need more aggressive treatment and closer monitoring
• Patients with rosacea are more prone to developing styes and may require more intensive management 1

When to Refer

Refer to an ophthalmologist for:

• Persistent styes (lasting >2 months)
• Styes that develop into chalazia
• Aggressive infections with signs of systemic toxicity 1

Evidence Quality Note

While the American Academy of Ophthalmology provides clear guidelines for stye management, it's worth noting that multiple Cochrane reviews 3, 4, 5 have found no high-quality randomized controlled trials specifically evaluating non-surgical interventions for internal hordeola. However, the consistent clinical practice and expert consensus support the use of warm compresses and eyelid hygiene as first-line treatment.