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

Treatment for Stye (Hordeolum)

Warm compresses and eyelid cleansing are the first-line treatment for styes (hordeola), 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 1, 2
• Follow warm compresses with gentle eyelid cleansing and massage to help express the contents of the affected gland 1, 2
• Use one of these methods for warm compresses:
  • Clean washcloth with hot (not scalding) tap water 1
  • Over-the-counter heat packs 1
  • Homemade bean/rice bags heated in microwave 1
  • Note: When using hard-boiled eggs as heat source, place close to but not touching the eyelid to avoid corneal distortion 3

Eyelid Cleansing Technique

• Gently rub the base of eyelashes using either:
  • Diluted baby shampoo on a cotton ball/swab or clean fingertip 2, 1
  • Commercially available eyelid cleaner 1
  • Hypochlorous acid 0.01% cleaners (strong antimicrobial effect) 2, 1

Second-Line Treatment

• For moderate to severe cases, topical antibiotic ointments such as bacitracin or erythromycin can be applied to the eyelid margins one or more times daily or at bedtime 1
• Topical antibiotics help provide symptomatic relief and decrease bacteria on the eyelid margin 1
• Consider addressing moderate to severe blepharitis with topical antibiotics prior to any planned intraocular surgical procedures 2

Important Considerations

• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1
• Frequent manipulation of the eyelid may lead to mechanically induced irritation 2
• Long-term antibiotic treatment may result in 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

Treatment Duration and Expectations

• Patients should understand that in many cases, styes drain spontaneously and resolve without treatment 4, 5
• However, warm compresses and eyelid hygiene accelerate resolution and prevent complications 1
• Patients should be advised that treatment may be required long-term, as symptoms often recur when treatment is discontinued 1
• Despite the common nature of this condition, there is a lack of high-quality randomized controlled trials evaluating treatments for hordeola 4, 5