What medication is used to treat a stye?

Medication Treatment for Stye

For stye (hordeolum) treatment, topical antibiotic ointments such as bacitracin or erythromycin are the recommended second-line medications after warm compresses and eyelid hygiene. 1

First-Line Treatment Approach

1. Warm compresses (10-15 minutes, 3-4 times daily)
2. Eyelid hygiene with gentle cleansing
3. Gentle massage of the affected area

Medication Options

Topical Antibiotics (Second-Line)

When signs of infection are present or there's risk of secondary infection, add:

• Erythromycin ophthalmic ointment - Apply approximately 1 cm directly to the affected eye(s) up to six times daily 1
• Bacitracin ophthalmic ointment - Alternative option for anterior blepharitis 1

Combination Treatments (Third-Line)

• For moderate to severe cases, consider antibiotic/steroid combination topical treatments 1
• Brief course of topical corticosteroids may help with eyelid inflammation 2
  • Use minimal effective dose
  • Avoid long-term corticosteroid therapy
  • Consider site-specific corticosteroids like loteprednol etabonate or fluorometholone phosphate to minimize adverse effects

Oral Antibiotics (Fourth-Line)

For severe or unresponsive cases:

• Adults: Doxycycline or azithromycin 1
  • Azithromycin: 500 mg per day for 3 days in three cycles with 7-day intervals, or 1 g per week for 3 weeks 2
  • Doxycycline: Sustained-release preparation can reduce side effects 2
• Children under 8: Oral erythromycin (30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks) or azithromycin (5 mg/kg daily for 2 months) 1

Important Considerations

Medication Cautions

• Tetracyclines (including doxycycline):
  • Contraindicated in pregnancy, nursing women, and children under 8 years 2
  • May cause photosensitivity and sunburn 2
  • Minocycline can stain skin, nails, sclera, teeth, conjunctiva, tongue, and bone 2
• Azithromycin:
  • FDA warning about potential cardiac risks and heart rhythm abnormalities 1
  • Small but absolute increase in cardiovascular deaths in high-risk patients 2
• Corticosteroids:
  • Risk of increased intraocular pressure and cataract formation 2, 1
  • Should be tapered and discontinued once inflammation is controlled 2

When to Refer to a Specialist

Refer to an ophthalmologist if:

• Visual changes occur
• Corneal involvement is present
• Severe eyelid swelling is unresponsive to initial treatment
• Malignancy is suspected
• Cicatricial changes appear in the conjunctiva 1

Evidence Limitations

It's worth noting that a Cochrane review found no randomized controlled trials specifically evaluating nonsurgical treatments for acute internal hordeolum, indicating a gap in high-quality evidence for these interventions 3. However, clinical guidelines from the American Academy of Ophthalmology provide a structured approach based on expert consensus and clinical experience 1.

Prevention Strategies

• Practice good eyelid hygiene
• Remove eye makeup completely before sleeping
• Treat underlying conditions (seborrheic dermatitis, rosacea, eczema)
• Discontinue contact lens wear until symptoms resolve 1