Treatment for a Stye (Hordeolum)
The first-line treatment for a stye includes warm compresses applied to the affected eyelid for 10-15 minutes, 3-4 times daily, combined with gentle eyelid massage and good eyelid hygiene. 1
First-Line Treatment Approach
Warm compresses: Apply for 10-15 minutes, 3-4 times daily
- This helps to liquefy the blocked secretions and promote drainage
- Use a clean washcloth soaked in warm (not hot) water
Gentle eyelid massage: After applying warm compresses
- Massage the affected area gently to help express the contents of the blocked gland
Eyelid hygiene: Clean eyelids daily
- Use mild soap or commercial eyelid cleanser
- Avoid eye makeup until the stye resolves
- Remove eye makeup completely before sleeping
Second-Line Treatment
If the stye doesn't improve with first-line treatment within a few days, or if there are signs of infection:
- Topical antibiotics: Apply antibiotic ointment (such as bacitracin or erythromycin) to the affected eyelid margin 1
- Apply approximately 1 cm in length directly to the affected eye
- Can be used up to six times daily depending on severity
- Treatment duration typically lasts a few weeks, guided by symptom response
Third-Line Treatment
For moderate to severe cases that don't respond to the above treatments:
- Combination antibiotic/steroid topical treatment may be considered 1
- Should be used with caution and for short duration unless specifically indicated
- Monitor for increased intraocular pressure and cataract formation
Fourth-Line Treatment
For persistent (>2 months) or large styes:
- Referral to an ophthalmologist for possible:
- Intralesional steroid injection
- Incision and curettage (surgical drainage) 1
Important Considerations
- Avoid squeezing or popping the stye, as this can spread infection
- Discontinue contact lens wear until the stye resolves
- Styes typically resolve within 1-2 weeks with appropriate treatment
- Patients should be reassessed after 2-4 weeks to evaluate treatment response 1
Prevention of Recurrence
To prevent recurrent styes:
- Maintain good eyelid hygiene
- Completely remove eye makeup before sleeping
- Replace eye makeup every 3-6 months
- Treat underlying conditions like seborrheic dermatitis, rosacea, or blepharitis 1
When to Refer to a Specialist
Refer to an ophthalmologist if:
- Visual changes occur
- There is corneal involvement
- Severe eyelid swelling unresponsive to initial treatment
- Suspected malignancy
- Recurrent styes in the same location
- Loss of normal eyelid margin anatomy or focal lash loss 1
The evidence supporting these treatments is primarily based on clinical practice guidelines rather than high-quality randomized controlled trials. A Cochrane review found no randomized controlled trials specifically evaluating treatments for internal hordeolum (stye) 2, highlighting the need for more research in this area.