What medication is used to treat a stye (hordeolum)?

Treatment of Stye (Hordeolum)

The first-line treatment for a stye (hordeolum) is warm compresses and eyelid hygiene, with topical antibiotics like bacitracin or erythromycin ointment reserved for cases that don't respond to initial management. 1, 2

First-Line Treatment

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften crusts, warm meibomian secretions, and promote drainage 1, 2
• Clean the eyelid margin using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1, 2
• Perform eyelid cleansing once or twice daily to remove debris and inflammatory material 1, 2
• For posterior blepharitis/meibomian gland involvement, gentle vertical massage of the eyelid can help express secretions 2

Second-Line Treatment (If No Improvement After 2-4 Weeks)

• Topical antibiotic ointment such as bacitracin or erythromycin applied to the eyelid margins one or more times daily for a few weeks 1, 2
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1
• Use different antibiotics intermittently to prevent development of resistant organisms 1, 2

For Persistent or Severe Cases

• Oral antibiotics may be considered for patients with meibomian gland dysfunction whose symptoms and signs are not adequately controlled by eyelid cleansing or topical treatments 1, 3
• Options include:
  • Doxycycline, minocycline, or tetracycline (contraindicated in pregnancy and children under 8) 1
  • Erythromycin or azithromycin (for women of childbearing age and children) 1
• Topical corticosteroids (e.g., tobramycin/dexamethasone) may provide symptomatic relief but should be used with caution and under ophthalmological supervision 1, 3

Important Considerations

• Most styes drain spontaneously and resolve without treatment within 1-2 weeks 4, 5
• Patients should be advised that warm compress and eyelid cleansing treatment may be required long-term, as symptoms often recur when treatment is discontinued 1
• Avoid aggressive manipulation of the eyelid, particularly in patients with advanced glaucoma, as it may increase eye pressure 1
• Patients with neurotrophic corneas require proper counseling to avoid injury to corneal epithelium during eyelid cleaning 1

Evidence Limitations

• There is a lack of high-quality randomized controlled trials specifically evaluating treatments for acute internal hordeolum 4, 5
• Most available evidence comes from expert opinion, case series, and observational studies 4, 5
• A Cochrane review found no evidence for or against the effectiveness of non-surgical interventions for internal hordeolum treatment 4, 5

Special Populations

• For pregnant women or children under 8 years, avoid tetracyclines and consider alternatives like erythromycin if oral antibiotics are needed 1, 3
• In patients with advanced glaucoma, use steroid-containing drops with caution and monitor intraocular pressure closely 1, 3

Remember that complete cure is usually not possible for chronic blepharitis, and long-term management is often required as symptoms tend to recur when treatment is discontinued 2.