Treatment for Stye (Hordeolum)

Warm compresses and eyelid hygiene are the first-line treatment for styes, with topical antibiotics reserved for moderate to severe cases. 1

First-Line Treatment

Apply warm compresses to the affected eyelid for 5-10 minutes, once or twice daily, to soften debris and warm the meibomian secretions 2, 1
Sustained warmth can be achieved using hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in the microwave 2, 1
Follow warm compresses with gentle eyelid cleansing and massage to help express the contents of the affected gland 2, 1
Eyelid cleansing should be performed 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, 1
Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and can be used for treatment 1

For moderate to severe styes, topical antibiotic ointments 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
Topical antibiotics should be considered especially prior to any intraocular surgical procedures to reduce risk of complications 2
The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1

When applying warm compresses, use water that is warm but not hot enough to burn the skin 2, 1
Cleaning the eyelid can be potentially dangerous if the patient lacks manual dexterity or the necessary skill to perform the task safely 2
Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 2
Frequent manipulation of the eyelid may lead to mechanically induced irritation 2

Regular eyelid cleansing performed daily or several times weekly often blunts the symptoms of chronic blepharitis 2
Patients should be advised that warm compress and eyelid cleansing treatment may need to be continued long-term, as symptoms often recur when treatment is discontinued 1
Follow-up should be based on the severity of the condition and response to treatment 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
Patients must understand that a complete cure is usually not possible, and the condition may recur 2
Despite the widespread use of these treatments, there is limited high-quality evidence from randomized controlled trials supporting specific interventions for acute internal hordeolum 3, 4