What is the treatment for a stye (hordeolum)?

Treatment of Styes (Hordeolum)

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

Treatment Algorithm

1. First-line Treatment:

   • Warm compresses (10-15 minutes, 3-4 times daily)
   • Eyelid hygiene (cleansing eyelid margins with clean pad/cotton)
   • Gentle vertical eyelid massage to express secretions 1

2. Second-line Treatment:

   • Add topical antibiotic (bacitracin or erythromycin ointment) if signs of blepharitis or risk of secondary infection exist 1

3. Third-line Treatment:

   • Consider combination antibiotic/steroid topical treatment for moderate to severe cases 1

4. Fourth-line Treatment:

   • For persistent (>2 months) or large chalazia, consider intralesional steroid injection or incision and curettage 1

Proper Application of Warm Compresses

• Apply warm (not hot) compress to closed eyelid
• Maintain warmth for 10-15 minutes
• Repeat 3-4 times daily
• This helps liquefy thickened sebum, promotes drainage, and reduces inflammation 1

Eyelid Hygiene Technique

• Gently cleanse eyelid margins with clean pad, cotton ball, cotton swab, or clean fingertip
• Focus on removing crusting from eyelashes
• Include vertical eyelid massage to express meibomian gland secretions 1

When to Consider Antibiotics

Topical antibiotics should be added when:

• Signs of blepharitis are present
• There is risk of secondary infection
• The stye doesn't respond to warm compresses within a few days 1

Prevention of Recurrence

• Practice good eyelid hygiene regularly
• Remove eye makeup completely
• Treat underlying conditions
• Discontinue contact lens wear until symptoms resolve
• Maintain good personal hygiene with regular bathing
• Keep draining wounds covered with clean, dry bandages 1

When to Refer to an Ophthalmologist

Refer to an ophthalmologist if:

• Stye persists >2 weeks
• Stye develops into a chalazion
• Suspected MRSA infection
• Visual changes occur
• Severe eyelid swelling develops
• Patient is immunocompromised 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

Evidence Limitations

It's worth noting that despite these recommendations from the American Academy of Ophthalmology, systematic reviews have found limited high-quality evidence for non-surgical interventions in the treatment of hordeola. Cochrane reviews from both 2013 and 2017 found no randomized controlled trials specifically addressing acute internal hordeolum treatment 2, 3. However, clinical practice continues to support the use of warm compresses as first-line therapy based on expert consensus and clinical experience.