What medication should be used to treat a stye?

Treatment of Styes (Hordeolum)

Topical antibiotic ointment (bacitracin or erythromycin) should be used as the first-line medication treatment for a stye, in combination with warm compresses and eyelid hygiene. 1

Treatment Algorithm

1. First-line treatment:

   • Warm compresses (10-15 minutes, 3-4 times daily)
   • Eyelid hygiene with gentle massage
   • Topical antibiotic ointment (bacitracin or erythromycin)

2. Second-line treatment (for moderate to severe cases):

   • Consider combination antibiotic/steroid topical treatment
   • Continue warm compresses and eyelid hygiene

3. Third-line treatment (for persistent cases):

   • Consider oral antibiotics (doxycycline or azithromycin) for refractory cases
   • Note: Use oral antibiotics with caution due to potential side effects

4. Fourth-line treatment (for persistent chalazia):

   • Consider intralesional steroid injection or incision and curettage for persistent (>2 months) or large chalazia

Evidence for Treatment

Topical antibiotics are recommended based on their ability to treat the bacterial infection that causes styes. According to the American Academy of Ophthalmology guidelines, bacitracin or erythromycin ointment should be applied to the eyelid margin 1. These antibiotics are effective against the common causative organisms, particularly Staphylococcus species.

The evidence supporting specific treatments for acute internal hordeolum is limited. A Cochrane review found no randomized controlled trials specifically evaluating nonsurgical treatments for acute internal hordeolum 2. However, clinical practice guidelines consistently recommend topical antibiotics as part of the management approach.

Application Technique

• Apply a small amount of antibiotic ointment to the affected eyelid margin using a clean fingertip or cotton swab
• Apply 2-4 times daily for 7-10 days
• Continue treatment until the stye has resolved

Important Considerations

1. Warm compresses are crucial: Warm compresses (10-15 minutes, 3-4 times daily) help to soften debris and promote drainage of the infected gland. This should always accompany antibiotic treatment.

2. Eyelid hygiene: Gentle cleansing of the eyelid margins helps remove bacteria and debris that contribute to stye formation.

3. Avoid eye makeup: Patients should discontinue eye makeup use until the stye resolves to prevent further contamination.

4. Contact lens wear: Discontinue contact lens wear until the stye resolves to prevent complications.

5. When to seek further care: Patients should be advised to seek further evaluation if:

   • The stye doesn't improve within 48 hours of treatment
   • Vision changes occur
   • Severe eyelid swelling develops
   • The stye recurs frequently in the same location (may indicate more serious conditions)

Prevention of Recurrence

To prevent recurrence of styes, patients should be advised to:

• Maintain good eyelid hygiene
• Completely remove eye makeup before sleeping
• Replace eye makeup regularly (every 3-6 months)
• Avoid sharing eye makeup or towels
• Treat underlying conditions like blepharitis or rosacea

Cautions

While brief courses of topical corticosteroids may be helpful for severe inflammation, they should be used cautiously due to potential adverse effects including increased intraocular pressure and cataract formation 3. The minimal effective dose should be used, and long-term corticosteroid therapy should be avoided if possible.

For persistent or recurrent styes, consider evaluation for underlying conditions such as seborrheic dermatitis, rosacea, or thyroid dysfunction 1.