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 5-10 minutes once or twice daily, followed by gentle eyelid cleansing and massage. 1

First-Line Treatment Approach

• Apply warm compresses to the affected eyelid for several minutes (5-10 minutes) to soften debris and warm the meibomian secretions 2, 1
• Use water that is warm but not hot enough to burn the skin; options include hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in the microwave 1
• Perform gentle eyelid cleansing and massage after warm compresses to help express the contents of the affected gland 1
• Clean the eyelid 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 2
• Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and can be used for treatment 2, 1

Second-Line Treatment

• If first-line treatment is ineffective, 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
• For moderate to severe cases, especially prior to intraocular surgery, topical antibiotics combined with eyelid hygiene are recommended to control symptoms and signs 2, 1

Important Considerations and Precautions

• Patients should understand that a cure is usually not possible, and symptoms often recur when treatment is discontinued 2, 1
• Eyelid cleansing can be dangerous if the patient lacks manual dexterity or the necessary skill to perform the task safely 2, 1
• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1
• Long-term antibiotic treatment may result in the development of resistant organisms 2, 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

Evidence Quality and Limitations

• There is a lack of high-quality randomized controlled trials specifically evaluating treatments for hordeolum 3, 4
• The Cochrane systematic reviews found no evidence for or against the effectiveness of non-surgical interventions for the treatment of internal hordeolum 3, 4
• Current treatment recommendations are based primarily on clinical experience and expert consensus rather than robust clinical trials 2, 1

Treatment Duration and Follow-up

• Warm compresses and eyelid cleansing should be performed once or twice daily at times convenient for the patient 2, 1
• In many cases, a stye will drain spontaneously and resolve without treatment; however, the inflammation can spread to other ocular glands or tissues, and recurrences are common 3
• If unresolved, an acute internal hordeolum can become chronic or develop into a chalazion 3