What is the treatment for a stye (hordeolum) in the eye?

Treatment of Stye (Hordeolum) in the Eye

The first-line treatment for a stye (hordeolum) is warm compresses applied for 10-15 minutes, 3-4 times daily, combined with gentle eyelid hygiene and massage. 1

Treatment Algorithm

First-line Treatment:

• Warm compresses: Apply for 10-15 minutes, 3-4 times daily
• Eyelid hygiene: Clean the eyelid margins with mild soap or commercial eyelid cleanser
• Gentle massage: After warm compress, gently massage the affected area to promote drainage

Second-line Treatment:

• Add topical antibiotic ointment (erythromycin or bacitracin) when:
  • Signs of infection are present
  • Risk of secondary infection exists
  • Apply approximately 1 cm in length directly to the affected eye 1, 2

Third-line Treatment:

• Consider combination antibiotic/steroid topical treatment for moderate to severe cases 1

Fourth-line Treatment:

• For persistent (>2 months) or large styes:
  • Consider intralesional steroid injection
  • Consider incision and curettage 1

Evidence-Based Considerations

The American Academy of Ophthalmology recommends this step-wise approach for treating styes, with warm compresses and eyelid hygiene forming the cornerstone of treatment 1. Topical erythromycin ointment can be applied up to six times daily depending on severity, with treatment typically lasting a few weeks 1, 2.

For severe or unresponsive cases, oral antibiotics may be considered. The American Academy of Ophthalmology suggests oral erythromycin for severe cases, particularly in pediatric patients 1.

Important Caveats

• A 2016 Cochrane review found no randomized controlled trials specifically evaluating non-surgical interventions for internal hordeolum, highlighting a gap in high-quality evidence 3, 4
• Most styes resolve spontaneously within 1-2 weeks, even without treatment 3
• Avoid squeezing or attempting to "pop" a stye, as this may spread infection
• Contact lens wearers should discontinue lens use until the stye resolves 1
• Recurrent styes may indicate underlying conditions such as blepharitis, rosacea, or diabetes that should be addressed 1

Prevention Strategies

To prevent recurrence:

• Maintain good eyelid hygiene
• Remove eye makeup completely before sleeping
• Treat any underlying conditions (blepharitis, rosacea)
• Replace eye makeup regularly, especially after an infection 1

When to Refer

Consider referral to an ophthalmologist if:

• Visual changes occur
• Corneal involvement is suspected
• Severe eyelid swelling persists despite treatment
• Malignancy is suspected (marked asymmetry, focal lash loss)
• Recurrent styes occur in the same location 1

The evidence strongly supports starting with conservative measures (warm compresses and eyelid hygiene), adding topical antibiotics when indicated, and progressing to more invasive options only for persistent cases.