What are the best antibiotic drops for a patient with a stye (hordeolum)?

Management of Styes (Hordeola)

For a patient with a stye (hordeolum), warm compresses and lid hygiene are the first-line treatments, and antibiotic drops are generally not necessary unless there are signs of spreading infection or lack of improvement with conservative measures.

First-Line Management

Non-Pharmacological Approaches

• Warm compresses: Apply to the affected eye for 10-15 minutes, 4 times daily
• Lid hygiene: Gentle cleansing of eyelid margins with mild soap and water or commercial lid scrubs
• Avoid eye makeup and contact lenses until the stye resolves

When to Consider Antibiotics

Antibiotic drops are not routinely recommended for uncomplicated styes, as:

• Most styes are self-limiting and resolve spontaneously within 7-10 days
• There is insufficient evidence supporting routine antibiotic use for uncomplicated styes
• No high-quality clinical trials demonstrate superiority of antibiotic drops over conservative management 1, 2

Antibiotic Treatment (If Needed)

If the stye shows signs of spreading infection, worsening symptoms despite conservative management, or involvement of the entire eyelid, consider antibiotics:

Preferred Options:

1. Moxifloxacin 0.5% ophthalmic solution:

   • Dosing: One drop in the affected eye 3 times daily for 7 days 3
   • Advantages: Broad-spectrum coverage against common eyelid pathogens including Staphylococcus species 3, 4

2. Alternative options (if moxifloxacin is unavailable):

   • Ciprofloxacin ophthalmic solution 5
   • Erythromycin ophthalmic ointment (particularly good for nighttime use)

Special Considerations

When to Refer to Ophthalmology

• No improvement after 48-72 hours of appropriate treatment
• Visual changes
• Severe pain or swelling extending beyond the eyelid
• Recurrent styes (may indicate underlying conditions)

Cautions

• Avoid squeezing or attempting to drain the stye manually
• Patients should be instructed not to touch the dropper tip to any surface to avoid contaminating the medication 3
• Contact lens wearers should discontinue lens use until the stye resolves 3

Monitoring and Follow-up

• Most styes should begin to improve within 48-72 hours of starting treatment
• If no improvement is seen after 72 hours, reassess the need for antibiotic therapy or consider referral

Patient Education

• Explain that styes are common and typically resolve without antibiotics
• Emphasize the importance of warm compresses and lid hygiene
• Advise against sharing towels, washcloths, or eye makeup to prevent spread of infection

While the Infectious Diseases Society of America guidelines address skin and soft tissue infections broadly 6, there are no specific high-quality guidelines for stye treatment. The lack of randomized controlled trials specifically addressing antibiotic treatment for styes 1, 2 suggests that conservative management should be the first approach, with antibiotics reserved for cases that fail to respond to conservative measures or show signs of spreading infection.