Stye (Hordeolum) Treatment
The recommended first-line treatment for a stye (hordeolum) is warm compresses for 10-15 minutes 3-4 times daily combined with eyelid hygiene and gentle massage, followed by topical antibiotics such as erythromycin or bacitracin ointment if there are signs of infection. 1
Treatment Algorithm
First-Line Treatment
- Warm compresses: Apply for 10-15 minutes, 3-4 times daily
- Eyelid hygiene: Clean the eyelid margins with a mild, diluted baby shampoo or commercial eyelid cleanser
- Gentle massage: After warm compress application to help drain the blocked gland
Second-Line Treatment
- Topical antibiotics: Apply erythromycin or bacitracin ointment to the affected eyelid margin 1-4 times daily for 7-10 days if there are signs of infection 1
- Application technique: Apply a small amount of ointment to the base of the eyelashes using a clean fingertip or cotton swab
Third-Line Treatment
- Combination antibiotic/steroid topical treatment: For moderate to severe cases with significant inflammation 1
Fourth-Line Treatment
- Intralesional steroid injection or incision and curettage: For persistent styes (>2 months) or large chalazia 1
Monitoring and Follow-up
- Evaluate for redness, swelling, crusting at lid margins, discharge, and eyelash abnormalities
- Follow-up recommended in 2-4 weeks for moderate cases 1
- Reassess initial treatment after 2-4 weeks
Prevention of Recurrence
- Regular eyelid hygiene
- Complete removal of eye makeup
- Treatment of underlying conditions (blepharitis, rosacea)
- Discontinuation of contact lens wear until symptoms resolve 1
Important Considerations and Pitfalls
Common Pitfalls
- Inadequate application of treatment: Ensure proper application of warm compresses and antibiotics
- Premature discontinuation: Complete the full course of treatment even if symptoms improve
- Overuse of antibiotics: Can lead to antibiotic resistance 1
- Failure to address underlying conditions: Chronic blepharitis or rosacea may predispose to recurrent styes
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
Evidence Quality Assessment
The treatment recommendations are primarily based on guidelines from the American Academy of Ophthalmology, as summarized in Praxis Medical Insights 1. These guidelines represent the most current and comprehensive approach to stye management.
Notably, a Cochrane review found no randomized controlled trials specifically evaluating non-surgical interventions for internal hordeolum, highlighting a gap in high-quality evidence for stye treatments 2, 3. Despite this limitation, the clinical consensus supports the approach outlined above.
While one study suggested ear-apex blood-letting as an alternative treatment 4, this approach is not mentioned in current ophthalmology guidelines and would not be considered standard practice in most clinical settings.