Treatment Options for Styes (Hordeolum)
The first-line treatment for styes consists of warm compresses for 10-15 minutes, 3-4 times daily, combined with gentle eyelid cleansing and massage, followed by topical antibiotic ointment such as bacitracin or erythromycin applied to the eyelid margins once or more daily for 5-7 days. 1
First-Line Treatment Approach
Warm Compresses and Eyelid Hygiene
- Apply warm compresses for 10-15 minutes, 3-4 times daily to:
- Liquefy thickened sebum
- Promote drainage
- Reduce inflammation 1
- Gently cleanse the eyelid margins with a clean pad, cotton ball, cotton swab, or clean fingertip
- For anterior styes: Focus on removing crusting from eyelashes
- For posterior styes: Include vertical eyelid massage to express meibomian gland secretions 1
Topical Antibiotics
- Apply bacitracin or erythromycin ointment to eyelid margins once or more daily for 5-7 days 1
- For adults and children over 2 years: Apply a small amount (equal to the surface area of a fingertip) to the affected area 1-3 times daily 2
- For children under 2 years: Consult a doctor before use 2
Second-Line Treatment Options
Oral Antibiotics
Consider oral antibiotics for severe cases, extensive disease, rapid progression with cellulitis, or immunocompromised patients:
- Dicloxacillin: 500 mg four times daily for adults
- Cephalexin: 500 mg four times daily for adults or 25-50 mg/kg/day in 4 divided doses for children
- Clindamycin: 300-450 mg three times daily for adults or 10-20 mg/kg/day in 3 divided doses for children 1
Topical Corticosteroids
- Short-term use of topical corticosteroids may be beneficial for marked inflammation 1
- Consider combination antibiotic/steroid topical treatment for moderate to severe cases 1
Prevention of Recurrence
- Continue regular eyelid hygiene even after resolution 1
- Remove eye makeup completely 1
- Replace contact lenses and cases after resolution 1
- Treat underlying conditions like blepharitis or meibomian gland dysfunction 1
When to Refer to an Ophthalmologist
- Persistent styes (>2 weeks)
- Styes that develop into chalazia
- Suspected MRSA infections
- Visual changes
- Severe eyelid swelling
- Immunocompromised patients 1
Treatment Limitations and Considerations
- Despite being commonly recommended, there is a lack of high-quality evidence for non-surgical interventions for acute internal hordeolum 3, 4
- Cochrane reviews found no randomized controlled trials evaluating the effectiveness of non-surgical treatments for internal hordeola 3, 4
- However, clinical practice guidelines from ophthalmology organizations continue to recommend warm compresses, eyelid hygiene, and topical antibiotics based on clinical experience and expert consensus 1
Special Considerations
- Ensure patients have adequate manual dexterity to perform eyelid hygiene safely
- Patients with advanced glaucoma should avoid aggressive lid pressure
- Patients with neurotrophic corneas need special care to avoid corneal epithelial injury 1
- For persistent cases (>2 months) or large chalazia, intralesional steroid injection or incision and curettage may be necessary 1