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

Treatment of Stye (Hordeolum)

Warm compresses applied to the affected eyelid for 10-15 minutes several times daily is the recommended first-line treatment for a stye (hordeolum). 1, 2, 3

First-Line Management

• Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily to promote drainage of the infected gland 1, 2
• Maintain good eyelid hygiene with gentle lid scrubs to keep the area clean 4
• Avoid touching or squeezing the stye to prevent spreading infection 4
• Avoid wearing contact lenses and eye makeup until the stye resolves 3

When to Consider Antibiotics

• Topical antibiotic ointments (such as erythromycin or bacitracin) may be considered if:

  • The stye is large or particularly painful 3
  • There is significant surrounding erythema or cellulitis 4
  • The infection appears to be spreading beyond the immediate area 4

• Oral antibiotics should be reserved for cases with:

  • Significant surrounding cellulitis 4
  • Systemic symptoms (fever, malaise) 4
  • Failed response to topical therapy 4

Antibiotic Options (When Indicated)

• For topical use: mupirocin 2% ointment applied to the affected eyelid margin 4
• For oral therapy (if needed for more severe cases):
  • Clindamycin (300-450 mg orally three times daily) 4
  • Trimethoprim-sulfamethoxazole (1-2 DS tablets twice daily) 4
  • Doxycycline (100 mg twice daily) - not for children under 8 years 4

Special Considerations

For Children

• Warm compresses remain the first-line treatment 1, 2
• Mupirocin 2% topical ointment can be used for minor infections 4
• Avoid tetracyclines in children under 8 years of age 4
• For more severe cases requiring systemic therapy, clindamycin at 10-13 mg/kg/dose IV every 6-8 hours (to administer 40 mg/kg/day) is an option 4

For Recurrent Styes

• Continue regular warm compresses and lid hygiene 4
• Consider decolonization strategies:
  • Nasal mupirocin twice daily for 5-10 days 4
  • Topical body decolonization with chlorhexidine for 5-14 days 4
  • Dilute bleach baths (1 teaspoon per gallon of water for 15 minutes twice weekly) 4

When to Refer to an Ophthalmologist

• No improvement after 48-72 hours of appropriate treatment 3
• Visual changes or severe pain 3
• Recurrent styes despite appropriate treatment 4
• Progression to a chalazion (painless, firm nodule) 2
• Spread of infection beyond the eyelid 4

Evidence Limitations

It's important to note that despite the widespread recommendation of warm compresses as first-line therapy, Cochrane systematic reviews found no randomized controlled trials specifically evaluating non-surgical interventions for internal hordeolum 1, 2. Treatment recommendations are largely based on clinical experience and expert opinion rather than high-quality evidence.