Best Treatment for Styes
The best treatment for a stye is warm compresses applied for 10-15 minutes, 3-4 times daily, combined with eyelid hygiene as first-line therapy. 1
First-Line Treatment
- Warm compresses: Apply for 10-15 minutes, 3-4 times daily
- Helps to soften adherent scales, discharge, and warm meibomian secretions
- Facilitates natural drainage of the stye
- Eyelid hygiene: Clean eyelids with mild soap or commercial eyelid cleanser
- Gentle massage: After warm compresses to encourage drainage
Second-Line Treatment
If the stye doesn't improve with first-line treatment after 48-72 hours:
- Topical antibiotics: Apply bacitracin or erythromycin ointment to the eyelid margins
- Apply once or more daily
- Use intermittently to prevent development of resistant organisms 1
Third-Line Treatment
For moderate to severe cases with significant inflammation:
- Combination antibiotic/steroid topical treatments
- Short-term use only
- Monitor for steroid-related complications 1
Fourth-Line Treatment
For persistent styes (lasting >2 months) or those that develop into chalazia:
- Consider referral for surgical intervention
- Intralesional steroid injection
- Incision and curettage 1
Special Considerations
- Contact lens wearers: Discontinue contact lens use until symptoms resolve
- Replace contact lenses and case after resolution 1
- Demodex infestation: Consider tea tree oil-based products 1
- Severe cases: For posterior blepharitis or recurrent styes, oral antibiotics like doxycycline, minocycline, or tetracycline may be considered
- Contraindicated in pregnancy, nursing women, children under 8 years 1
Prevention
- Practice good eyelid hygiene daily
- Remove eye makeup completely
- Treat underlying conditions that may predispose to styes (e.g., blepharitis, rosacea) 1
When to Refer
- Styes lasting more than 2 months
- Signs of spreading infection (increasing redness, swelling, pain)
- Signs of systemic toxicity
- Visual changes 1
It's important to note that while there are many treatments available for styes, the evidence base for most interventions is limited. A Cochrane review found no randomized controlled trials specifically evaluating non-surgical interventions for internal hordeola (styes) 2, 3. Despite this lack of high-quality evidence, warm compresses and eyelid hygiene remain the cornerstone of treatment based on clinical experience and expert consensus, as recommended by the American Academy of Ophthalmology 1.