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

Treatment for Stye (Hordeolum)

The most effective first-line treatment for a stye (hordeolum) is applying warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily, followed by gentle eyelid cleansing and massage. 1, 2

First-Line Management

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften debris, warm meibomian secretions, and promote drainage 1, 2
• Use water that is warm but not hot enough to burn the skin; options include hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags that can be heated in the microwave 1
• After warm compresses, perform gentle eyelid cleansing using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1, 2
• Gently massage the eyelid after cleansing to help express the contents of the affected gland 1, 2
• Eye cleaners with hypochlorous acid at 0.01% have strong antimicrobial effects and can be used for treatment 1

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

• Topical antibiotic ointment such as bacitracin or erythromycin can be prescribed and applied to the eyelid margins one or more times daily or at bedtime 1, 2
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1, 2
• Consider using different antibiotics intermittently to prevent development of resistant organisms 2

For Persistent or Severe Cases

• Oral antibiotics such as doxycycline, minocycline, or tetracycline may be considered for patients with meibomian gland dysfunction whose symptoms and signs are not adequately controlled by eyelid cleansing or topical treatments 2
• Alternative oral antibiotics such as erythromycin or azithromycin may be used for women of childbearing age and children 2
• Topical corticosteroids may provide symptomatic relief but should be used with caution and under ophthalmological supervision 2

Important Considerations and Cautions

• 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, 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
• Avoid aggressive manipulation of the eyelid, particularly in patients with advanced glaucoma, as it may increase eye pressure 1, 2
• Patients with neurotrophic corneas require proper counseling to avoid injury to corneal epithelium during eyelid cleaning 1, 2

When to Consider Further Evaluation

• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 1
• Follow-up should be based on the severity of the condition and response to treatment 1

Evidence Limitations

• There is a notable lack of high-quality randomized controlled trials specifically evaluating treatments for acute internal hordeolum 3, 4
• Most available evidence comes from clinical practice guidelines rather than comparative studies 1, 2