Treatment of Stye (Hordeolum)
The first-line treatment for a stye (hordeolum) is warm compresses applied to the affected eyelid for 5-10 minutes, 3-4 times daily, combined with good eyelid hygiene. This approach helps promote drainage of the infected gland and speeds resolution of the infection.
Treatment Algorithm
Step 1: Conservative Management
- Warm compresses: Apply to the affected eyelid for 5-10 minutes, 3-4 times daily
- Warm compresses have been shown to increase tear film lipid layer thickness by more than 80% after just 5 minutes of application 1
- Temperature should be approximately 40°C (warm but not hot enough to burn)
- Eyelid hygiene: Clean the eyelid margins with mild soap and water or commercial eyelid cleansers
- Avoid eye makeup and contact lenses until the stye resolves
Step 2: Topical Treatment (if needed)
- Bacitracin ointment: Apply a small amount (equivalent to the tip of a finger) to the affected area 1-3 times daily 2
- May be covered with a sterile bandage
- For children under 2 years of age, consult a doctor before using topical antibiotics
Step 3: For Persistent or Severe Styes
- Oral antibiotics may be considered if:
- Multiple styes are present
- Infection spreads beyond the eyelid
- Patient has systemic symptoms
- Patient is immunocompromised
- Options include:
- Dicloxacillin: 500 mg four times daily
- Cephalexin: 500 mg four times daily
- For penicillin-allergic patients: Clindamycin 300-450 mg three times daily 3
Step 4: Surgical Intervention
- Incision and drainage by an ophthalmologist if the stye:
- Does not respond to conservative treatment after 1 week
- Is very large and painful
- Affects vision
Special Considerations
Prevention of Recurrence
- Maintain good eyelid hygiene
- Keep draining wounds covered with clean, dry bandages
- Avoid sharing personal items like towels, washcloths, or makeup 3
- For recurrent styes, consider:
- Evaluation for underlying conditions (diabetes, immune disorders)
- Decolonization with mupirocin nasal ointment twice daily for 5-10 days if recurrent infections occur 3
Important Caveats
- Avoid squeezing or popping a stye, as this can spread infection
- If symptoms worsen or vision is affected, seek immediate medical attention
- Patients with diabetes or immunocompromised conditions should seek medical attention earlier
- A stye that doesn't resolve may develop into a chalazion (a non-infectious, chronic granulomatous inflammation) 4, 5
Evidence Quality
- Despite the common occurrence of styes, there is a notable lack of high-quality randomized controlled trials evaluating treatments 4, 5
- Most treatment recommendations are based on clinical experience and expert opinion
- A 2013 Cochrane review found no randomized controlled trials specifically for internal hordeolum treatment 5
While antibiotics are commonly prescribed, they should be reserved for cases where there is evidence of spreading infection or lack of response to conservative measures, as most styes will resolve with warm compresses and proper hygiene alone.