What is the treatment for a stye (hordeolum)?

Treatment for Stye (Hordeolum)

The first-line treatment for a stye (hordeolum) is warm compresses applied to the affected eyelid for 5-10 minutes, 3-4 times daily, combined with 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 crusts, 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
• Perform gentle eyelid cleansing after warm compresses using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip once or twice daily 1, 2
• For posterior blepharitis/meibomian gland involvement, perform gentle vertical massage of the eyelid to help express secretions 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)

• Apply topical antibiotic ointment such as bacitracin or erythromycin to the eyelid margins one or more times daily or at bedtime for a few weeks 1, 2
• Mupirocin 2% topical ointment is an alternative option for minor skin infections and secondarily infected skin lesions 2
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1, 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 (avoid tetracyclines in pregnant women and children under 8) 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, 2
• 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
• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 1

Evidence Limitations

• There is a lack of high-quality randomized controlled trials specifically evaluating treatments for hordeolum 3, 4
• A Cochrane review found no randomized controlled trials that met inclusion criteria for evaluating non-surgical interventions for acute internal hordeolum 4
• Most evidence for current treatment recommendations comes from expert consensus rather than controlled clinical trials 3, 4

While alternative treatments such as ear-apex blood-letting have shown some promise in limited studies 5, the standard approach of warm compresses, eyelid hygiene, and topical antibiotics (when needed) remains the mainstay of treatment based on current clinical guidelines.