Treatment of a Stye (Hordeolum)
The first-line treatment for a stye includes warm compresses 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
- This helps soften adherent debris and warm meibomian secretions
- Promotes drainage and resolution of the stye
- Eyelid hygiene: Clean the affected eyelid with a gentle cleanser
- Hypochlorous acid (0.01%) cleansers have strong antimicrobial effects
- Gentle eyelid massage: Helps express blocked gland contents
Second-Line Treatment
- Add topical antibiotic ointment if signs of infection are present or there's risk of secondary infection
- Options include bacitracin or erythromycin ointment applied to the affected eyelid margin 1
- Apply after warm compresses and eyelid cleansing
Third-Line Treatment
- For moderate to severe cases, consider combination antibiotic/steroid topical treatment 1
- This approach helps address both infection and inflammation
Fourth-Line Treatment
- For persistent (>2 months) or large styes, consider:
- Intralesional steroid injection
- Incision and curettage 1
Important Clinical Considerations
Self-Resolution
Most styes are self-limiting and will resolve spontaneously within a few days to weeks with proper eyelid hygiene and warm compresses 2. However, treatment can speed recovery and prevent complications.
Follow-Up
- Reassess treatment after 2-4 weeks 1
- If no improvement is seen after 3-4 days of treatment, the patient should return for reevaluation 3
Prevention of Recurrence
To prevent stye recurrence, advise patients to:
- Practice good eyelid hygiene consistently
- Remove eye makeup completely before sleeping
- Treat any underlying conditions (e.g., seborrheic dermatitis, rosacea)
- Discontinue contact lens wear until symptoms resolve 1
When to Refer to an Ophthalmologist
Refer patients to an ophthalmologist if they have:
- Visual changes
- Severe eyelid swelling unresponsive to initial treatment
- Persistent symptoms despite appropriate treatment
- Suspected malignancy (especially with marked asymmetry between eyes, resistance to standard therapy, unifocal recurrent styes, loss of normal eyelid margin anatomy, or focal lash loss) 1
Cautions and Pitfalls
- Chronic or recurrent styes, especially when only one eye is involved, may indicate sebaceous carcinoma and require further evaluation 1
- Avoid aggressive manipulation of the stye, which can spread infection
- Be cautious with prolonged steroid use due to risks of increased intraocular pressure and cataract formation 1
- Consider underlying conditions like seborrheic dermatitis, rosacea, eczema, and thyroid dysfunction in patients with recurrent styes 1
While alternative treatments like ear-apex bloodletting have shown some efficacy in studies 4, 5, these are not included in standard clinical guidelines and should not replace conventional first-line treatments.