What is the treatment for a stye (hordeolum)?

Treatment of Stye (Hordeolum)

The most effective first-line treatment for a stye is applying warm compresses to the affected eyelid for 5-10 minutes, 4-6 times daily, followed by gentle eyelid cleansing and massage. 1

First-Line Treatment

• Apply warm compresses to the affected eyelid for 5-10 minutes to soften debris and warm meibomian secretions 1
• Perform warm compresses 4-6 times daily for optimal results 2
• Follow warm compresses with gentle eyelid cleansing using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1
• Perform gentle massage of the eyelid after warm compresses to help express the contents of the affected gland 1
• Eye cleaners with hypochlorous acid at 0.01% can be used for their antimicrobial effect 1

Proper Technique for Warm Compresses

• Use water that is warm but not hot enough to burn the skin 1
• Options for sustained warmth include:
  • Hot tap water on a clean washcloth
  • Over-the-counter heat packs
  • Homemade bean/rice bags heated in the microwave 1
• Apply compresses for the full recommended time (5-10 minutes) to ensure adequate warming of the affected area 1

Second-Line Treatment

• If no improvement after 48 hours of warm compress therapy, add a topical antibiotic ointment such as bacitracin or erythromycin 1
• Apply the antibiotic ointment to the eyelid margins one or more times daily or at bedtime for a few weeks 1
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 1

For Severe or Recurrent Cases

• For moderate to severe cases, especially prior to intraocular surgery, use topical antibiotics combined with eyelid hygiene 1
• For recurrent styes, evaluate for underlying conditions such as blepharitis, rosacea, or seborrheic dermatitis 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

Special Considerations

• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1
• Patients with advanced glaucoma should be advised not to apply excessive pressure on the eyelids as it may increase eye pressure 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

Common Pitfalls to Avoid

• Inadequate duration or frequency of warm compress application can lead to poor outcomes 2
• Premature discontinuation of treatment can lead to recurrence 2
• Cleaning the eyelid can be dangerous if the patient lacks manual dexterity or the necessary skill to perform the task safely 1
• Long-term antibiotic treatment may result in the development of resistant organisms 1

Evidence Quality

• Despite the widespread recommendation of warm compresses and lid hygiene, there is limited high-quality evidence from randomized controlled trials specifically for internal hordeolum treatment 3, 4
• Current recommendations are based primarily on clinical experience and expert consensus 1, 2