What is the treatment for Hordeolum?

Treatment of Hordeolum

Warm compresses are the first-line treatment for hordeolum (stye), followed by eyelid hygiene and massage to express the meibomian glands. 1

First-Line Management

Warm Compresses

• Apply warm compresses to the affected eyelid for 5-10 minutes, several times daily 1
• Warm compresses help to:
  • Increase blood circulation to the area
  • Promote drainage of the infected gland
  • Relieve pain and discomfort 1

Eyelid Hygiene

• Clean the eyelid margins with mild soap or commercial eyelid cleansers 1
• Perform gentle massage of the affected area after applying warm compresses to help express the obstructed gland 1

Second-Line Management

Topical Antibiotics

• Consider topical antibiotics for moderate to severe cases or when there are signs of spreading infection 1
• Antibiotic options may include:
  • Azithromycin ophthalmic solution has shown efficacy for internal hordeolum 2
  • However, evidence from randomized controlled trials is limited 3, 4

Oral Antibiotics

• Reserved for severe cases with spreading infection or systemic symptoms 1
• May be considered when multiple hordeola are present or when there's evidence of cellulitis 1

Special Considerations

Recurrent Hordeola

• More aggressive eyelid hygiene regimen may be needed 1
• Evaluation for underlying conditions such as blepharitis or meibomian gland dysfunction 1
• Consider evaluation for possible sebaceous carcinoma in cases of marked asymmetry, resistance to therapy, or unifocal recurrent chalazia 1

Surgical Management

• Incision and drainage may be considered for persistent hordeola that don't respond to conservative management 5
• However, evidence suggests that antibiotics after incision and curettage don't provide additional benefit over placebo 5

Alternative Therapies

• Acupuncture has shown some potential benefit in limited studies from China, but evidence quality is low to very low 6

Important Clinical Pearls

• Most hordeola are self-limiting and resolve spontaneously within 7-10 days 3, 4
• Avoid squeezing or attempting to "pop" the hordeolum, as this may spread infection 1
• Discontinue eye makeup use during active infection 1
• Consider addressing moderate to severe blepharitis prior to intraocular surgical procedures to reduce risk of complications 1

Treatment Algorithm

1. Start with warm compresses and eyelid hygiene for 7-10 days 1
2. If no improvement, consider topical antibiotics 1, 2
3. For severe or spreading infection, consider oral antibiotics 1
4. For persistent cases, consider referral for possible incision and drainage 5

Common Pitfalls

• Failure to distinguish between hordeolum (acute infection) and chalazion (chronic, non-infectious inflammation) 1
• Missing underlying chronic blepharitis that predisposes to recurrent hordeola 1
• Not considering sebaceous carcinoma in cases of recurrent unilateral disease resistant to therapy 1
• Overuse of antibiotics for a condition that is often self-limiting 3, 4