What are the recommended management options for a stye (hordeolum)?

Management of Stye (Hordeolum)

The first-line treatment for styes (hordeola) is warm compresses applied to the affected eyelid for 5-10 minutes once or twice daily, followed by gentle eyelid cleansing and massage to help express the contents of the affected gland. 1

First-Line Management

• Apply warm compresses to the affected eyelid for 5-10 minutes to soften adherent debris and warm the meibomian secretions 1
• 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, or homemade bean/rice bags heated in the microwave 1
• After warm compresses, perform gentle eyelid cleansing and massage to help express the contents of the affected gland 1
• Clean the eyelid by gently rubbing the base of the eyelashes using either diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1
• Eye cleaners with hypochlorous acid at 0.01% have strong antimicrobial effects and can be used for treatment 1

Second-Line Treatment

• If first-line treatment doesn't resolve the stye within a few days, topical antibiotic ointment such as bacitracin or erythromycin can be prescribed 1
• Apply the antibiotic ointment to the eyelid margins 1-3 times daily or at bedtime for a few weeks 1, 2
• For adults and children 2 years and older: clean the affected area, apply a small amount of antibiotic ointment (equal to the surface area of a fingertip) 1-3 times daily 2
• For children under 2 years of age: consult a doctor before using topical antibiotics 2

For Severe or Recurrent Cases

• For moderate to severe cases, especially prior to intraocular surgery, combine topical antibiotics with eyelid hygiene 1
• 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
• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 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
• 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 and Gaps

• Cochrane reviews from 2013 and 2017 found no randomized controlled trials evaluating the effectiveness of non-surgical interventions for acute internal hordeolum 3, 4
• Despite the lack of high-quality evidence, warm compresses and eyelid hygiene remain the standard first-line treatment based on clinical experience and expert consensus 1
• Some evidence suggests acupuncture may provide short-term benefits for treating acute hordeolum, but the quality of evidence is low to very low 5