Treatment of a Stye (Hordeolum)
The first-line treatment for a stye consists of warm compresses applied for 10-15 minutes, 3-4 times daily, combined with eyelid hygiene and gentle massage. 1
Treatment Algorithm
First-line Treatment
- Warm compresses: Apply for 10-15 minutes, 3-4 times daily
- Eyelid hygiene: Clean the affected eyelid margins with mild soap or commercial eyelid cleanser
- Gentle massage: After warm compress, gently massage the affected area to promote drainage
Second-line Treatment
- Add topical antibiotic ointment (erythromycin or bacitracin) to the affected eyelid margins
- Apply 1-4 times daily depending on severity
- Standard course: 7-10 days for acute symptoms 1
Third-line Treatment
- Consider combination antibiotic/steroid topical treatment for moderate to severe cases that don't respond to initial therapy 1
Fourth-line Treatment
- For persistent styes (>2 months) or those that develop into chalazia:
- Consider intralesional steroid injection
- Consider incision and curettage 1
Application Technique
- Wash hands thoroughly before treatment
- Apply warm compress first to soften debris
- Clean eyelid margins before applying medication
- Apply antibiotic ointment directly to the affected area using a clean fingertip or cotton swab
When to Refer to an Ophthalmologist
Refer patients with:
- Persistent styes (>2 weeks)
- Styes that develop into chalazia
- Suspected MRSA infections
- Visual changes
- Severe eyelid swelling
- Immunocompromised status 1
Prevention of Recurrence
- Maintain regular eyelid hygiene
- Remove eye makeup completely
- Treat underlying conditions (blepharitis, rosacea)
- Discontinue contact lens wear until symptoms resolve 1
Important Considerations
- Inadequate application, premature discontinuation, or overuse of antibiotic ointment can reduce effectiveness and lead to antibiotic resistance 1
- Regular follow-up is recommended in 2-4 weeks for moderate cases to monitor response and adjust treatment 1
- Tetracyclines (if prescribed orally for severe cases) are contraindicated in pregnancy, nursing women, and children under 8 years 1
Evidence Quality
The American Academy of Ophthalmology guidelines provide the strongest evidence for stye treatment, emphasizing the importance of warm compresses and eyelid hygiene as first-line therapy 1. While the Cochrane reviews from 2013 and 2017 found no high-quality randomized controlled trials specifically for internal hordeolum treatment 2, 3, clinical practice continues to follow the stepped approach outlined by professional ophthalmology organizations.
A 2013 study suggested ear-apex blood-letting as an alternative therapy with potentially superior results compared to conventional medication 4, but this approach is not endorsed by major ophthalmology guidelines and requires further validation before recommendation.