What is the recommended treatment for a stye (hordeolum)?

Treatment for Stye (Hordeolum)

The recommended first-line treatment for a stye (hordeolum) is warm compresses applied to the affected eyelid for several minutes multiple times daily, combined with gentle eyelid cleansing to promote drainage and resolution. 1

First-Line Treatment

• Apply warm compresses to the affected eyelid for several minutes (typically 5-10 minutes) to soften adherent debris and warm the meibomian secretions 1
• Perform warm compresses once or twice daily at times convenient for the patient 1
• Follow warm compresses with gentle eyelid cleansing and massage to help express the contents of the affected gland 1
• Eyelid cleansing can be accomplished by gently rubbing the base of the eyelashes using either diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1
• Eye cleaners with hypochlorous acid at 0.01% have a strong antimicrobial effect and can be used for treatment 1

Important Technique Considerations

• When applying warm compresses, use water that is warm but not hot enough to burn the skin 1
• For sustained warmth, options include hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags that can be heated in the microwave 1
• When using hard-boiled eggs as a heat source (a traditional remedy), place the egg close to but not touching the eyelid to avoid distorting the corneal shape 2
• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1
• Patients with advanced glaucoma should be advised not to apply excessive pressure on the eyelids as it may increase eye pressure 1

Second-Line Treatment

If the stye does not respond to warm compresses and eyelid hygiene:

• A topical antibiotic ointment such as bacitracin or erythromycin can be prescribed and applied to the eyelid margins one or more times daily or at bedtime for a few weeks 1
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1
• Topical antibiotics have been shown to provide symptomatic relief and decrease bacteria from the eyelid margin 1

For Severe or Recurrent Cases

• For moderate to severe cases, especially prior to intraocular surgery, topical antibiotics combined with eyelid hygiene are recommended 1
• For recurrent or persistent internal hordeola that develop into chalazia, additional treatments may be necessary 3, 4
• Patients should be advised that warm compress and eyelid cleansing treatment may be required long-term, as symptoms often recur when treatment is discontinued 1

Treatment Duration and Follow-up

• Most acute hordeola will resolve within about a week with proper treatment 5
• If unresolved, an acute internal hordeolum can become chronic or develop into a chalazion 3, 4
• Follow-up should be based on the severity of the condition and response to treatment 1

Cautions

• Cleaning the eyelid can be dangerous if the patient lacks manual dexterity or the necessary skill to perform the task safely 1
• Long-term antibiotic treatment may result in the development of resistant organisms 1
• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 1