Treatment of Stye (Hordeolum)
The recommended first-line treatment for a stye (hordeolum) is maintaining good eyelid hygiene with warm compresses and gentle lid scrubs, while avoiding touching or squeezing the area to prevent spreading infection. 1
First-Line Management
- Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily to promote drainage and resolution of the stye 1
- Maintain good eyelid hygiene with gentle lid scrubs to keep the area clean 1
- Avoid touching or squeezing the stye to prevent spreading the infection 1
- Most styes will resolve spontaneously within 1 week with these conservative measures 2, 3
When to Consider Antibiotics
- Topical antibiotic ointments should be considered if there is significant surrounding erythema or cellulitis 1
- Recommended topical option: Mupirocin 2% ointment applied to the affected eyelid margin 1
- Oral antibiotics should be reserved for cases with:
- Significant surrounding cellulitis
- Systemic symptoms
- Failed response to topical therapy 1
- When oral antibiotics are indicated, options include:
- Clindamycin
- Trimethoprim-sulfamethoxazole
- Doxycycline 1
Special Considerations
For Children
- Mupirocin 2% topical ointment can be used for minor infections 1
- Clindamycin is an option for more severe cases requiring systemic therapy 1
For Recurrent Styes
- Consider decolonization strategies such as:
- Nasal mupirocin
- Topical body decolonization with chlorhexidine
- Dilute bleach baths 1
When to Refer to an Ophthalmologist
- Recurrent styes despite appropriate treatment 1
- Spread of infection beyond the eyelid 1
- No improvement after 48 hours of treatment 1
- Suspicion of internal hordeolum developing into a chalazion 2, 3
Treatment Efficacy Considerations
- There is limited high-quality evidence for non-surgical interventions for hordeola 2, 3
- Cochrane reviews found no randomized controlled trials evaluating the effectiveness of conventional treatments for internal hordeola 2, 3
- Some evidence suggests acupuncture may provide short-term benefits for treating acute hordeolum, but the certainty of evidence is low to very low 4
Common Pitfalls and Caveats
- Avoid squeezing or attempting to "pop" the stye, as this can spread the infection 1
- Do not confuse a stye with a chalazion, which is a chronic, non-infectious inflammation of the meibomian gland that may require different management 2, 3
- If a stye does not improve with conservative treatment, it may develop into a chalazion or spread to cause cellulitis 2, 3
- Recurrent styes may indicate underlying conditions like blepharitis or may require evaluation for Staphylococcus aureus colonization 1