Treatment of a Sty (Hordeolum)
The primary treatment for a sty includes warm compresses applied to the affected area 3-4 times daily for 10-15 minutes, along with good eyelid hygiene. For persistent or severe cases, topical antibiotics like bacitracin may be applied 1-3 times daily.
First-Line Treatment Approach
Warm Compresses and Eyelid Hygiene
- Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily
- This helps promote drainage and resolution of the sty
- Maintain good eyelid hygiene by gently cleaning the eyelid margins with mild soap or baby shampoo
Topical Antibiotics
- For persistent or worsening stys, apply bacitracin ointment to the affected area 1-3 times daily 1
- A small amount (equivalent to the surface area of a fingertip) is sufficient
- May be covered with a sterile bandage if needed
Management Based on Severity
Mild Cases
- Conservative management with warm compresses and eyelid hygiene is often sufficient
- Most stys will resolve spontaneously within 7-10 days with this approach
- Avoid squeezing or attempting to "pop" the sty
Moderate to Severe Cases
- If no improvement after 48-72 hours of conservative treatment, consider:
- Topical antibiotic ointment (bacitracin) 1
- For internal hordeola with significant inflammation, oral antibiotics may be considered
Recurrent Stys
- For patients with recurrent stys, consider:
Special Considerations
Pediatric Patients
- For children under 2 years of age, consult a doctor before applying topical antibiotics 1
- For children with minor skin infections, mupirocin 2% topical ointment can be used 2
When to Refer to an Ophthalmologist
- No improvement after 1-2 weeks of treatment
- Severe pain, redness, or swelling
- Visual changes
- Recurrent stys
- Spread of infection beyond the eyelid
Prevention of Recurrence
- Maintain good hand hygiene, washing hands with soap and water or using alcohol-based hand gel 2, 3
- Avoid touching or rubbing eyes with unwashed hands
- Replace eye makeup regularly (every 3-6 months)
- Remove eye makeup before sleeping
- Avoid sharing eye makeup or face towels
Evidence Limitations
It's worth noting that high-quality evidence specifically for the treatment of stys is limited. A Cochrane review found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 4, 5. However, clinical practice has established warm compresses and eyelid hygiene as standard first-line treatment based on clinical experience and pathophysiological principles.