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

Treatment for Stye (Hordeolum) in the Eye

The first-line treatment for a stye (hordeolum) is warm compresses applied to the affected eyelid for 10-15 minutes, 3-4 times daily, combined with gentle eyelid hygiene and massage. 1

First-Line Management

1. Warm Compresses

   • Apply for 10-15 minutes
   • Frequency: 3-4 times daily
   • Purpose: Softens crusts and warms meibomian secretions
   • Technique: Ensure compress is warm but not hot enough to burn the skin

2. Eyelid Hygiene

   • Clean eyelids with diluted baby shampoo or commercial eyelid cleaner
   • Consider products with 0.01% hypochlorous acid for stronger antimicrobial effect
   • Perform after warm compress application

3. Eyelid Massage

   • For posterior blepharitis/meibomian gland dysfunction: Use vertical massage to express meibomian glands
   • For anterior blepharitis: Gently rub eyelid margins side to side to remove crusting
   • Apply gentle pressure to avoid mechanical irritation

Second-Line Treatment

If first-line treatment is insufficient or there are signs of infection:

• Add topical antibiotic ointment (bacitracin or erythromycin) 1
• Apply to the eyelid margin according to prescription instructions

Third-Line Treatment

For moderate to severe cases:

• Consider combination antibiotic/steroid topical treatment 1
• Short-term use of topical corticosteroids for significant inflammation

Special Considerations

• Contact lens wearers: Discontinue contact lens wear until symptoms resolve 1
• After resolution: Consider replacement of contact lenses and case 1
• Prevention of recurrence:
  • Practice good eyelid hygiene
  • Remove eye makeup completely
  • Treat underlying conditions (e.g., rosacea)

When to Refer to an Ophthalmologist

• Persistent styes lasting >2 months
• Styes that develop into chalazia
• Aggressive infections with signs of systemic toxicity
• Failure to respond to conservative management 1

Important Caveats

• Despite common recommendations, there is a lack of high-quality clinical trials evaluating non-surgical interventions for hordeola 2, 3
• When using hard-boiled eggs as warm compresses (a home remedy), place them close to but not touching the eyelid to avoid corneal distortion 4
• Patients should be advised that blepharitis is often chronic and may require long-term management 1
• Immunocompromised patients and those with rosacea may need more aggressive treatment and closer monitoring 1
• Patients with advanced glaucoma should avoid aggressive lid pressure during massage as it may increase intraocular pressure 1

The treatment approach outlined above follows the most recent guidelines from the American Academy of Ophthalmology, which recommends a stepwise approach starting with conservative measures before progressing to medications or surgical interventions when necessary.