What are the treatment and prevention options for eye styes (hordeolum)?

Treatment and Prevention for Eye Styes (Hordeolum)

Warm compresses and eyelid hygiene are the first-line treatment for eye styes, with topical antibiotics reserved for moderate to severe cases that don't respond to conservative management. 1

First-Line Treatment

Warm Compresses

• Apply warm compresses to the affected eyelid for 5-10 minutes to soften debris and warm the meibomian secretions 1
• Perform warm compresses once or twice daily at convenient times 2, 1
• For sustained warmth, use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in a microwave 1
• Ensure water is warm but not hot enough to burn the skin 1

Eyelid Cleansing and Massage

• Follow warm compresses with 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 diluted baby shampoo, commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1
• Eye cleaners containing hypochlorous acid (0.01%) have strong antimicrobial effects and can be used for treatment 1
• A schedule of regularly performed eyelid cleansing, daily or several times weekly, often reduces symptoms of chronic blepharitis 2

Second-Line Treatment

Topical Antibiotics

• For moderate to severe cases that don't respond to warm compresses and eyelid hygiene, topical antibiotic ointments such as bacitracin or erythromycin can be applied to the eyelid margins once or more daily or at bedtime for a few weeks 2, 1
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 1
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1

Other Topical Treatments

• Topical perfluorohexyloctane (FDA approved in 2023) prevents tear evaporation and improves symptoms in patients with dry eye disease after 8 weeks of treatment 2
• Selenium sulfide has been explored for use in meibomian gland dysfunction (MGD) to unblock meibomian gland orifices and decrease meibum viscosity 2

For Severe or Recurrent Cases

Oral Antibiotics

• Oral tetracyclines (doxycycline, minocycline, or tetracycline) may be helpful for patients with meibomian gland dysfunction whose chronic symptoms and signs are not adequately controlled by eyelid cleansing or meibomian gland expression 2
• For women of childbearing age and children, oral erythromycin or azithromycin may be used instead of tetracyclines 2

Alternative Treatments

• Acupuncture may provide short-term benefits for treating acute hordeolum when compared with conventional treatments alone, though evidence quality is low to very low 3
• Ear-apex blood-letting therapy has shown effectiveness in relieving pain, reducing the size, and shortening the duration of external styes in one study, but is not widely practiced 4

Important Considerations and Cautions

• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 2, 1
• Patients with advanced glaucoma should avoid aggressive pressure on the eyelids as it may increase eye pressure 2, 1
• Eyelid cleaning can be dangerous if the patient lacks manual dexterity or skill to perform the task safely 1
• Long-term antibiotic treatment may result in the development of resistant organisms 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

Prevention Strategies

• Regular eyelid hygiene, especially for those prone to styes or with chronic blepharitis 2, 1
• Proper contact lens hygiene and avoiding wearing contact lenses longer than recommended 2
• Avoid sharing eye makeup and replace eye makeup regularly 1
• Wash hands thoroughly before touching eyes 5
• For recurrent styes, daily eyelid cleansing may help prevent recurrence 2, 1

Expected Course and Follow-up

• Most styes resolve spontaneously within 1-2 weeks 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 2, 1
• Follow-up should be based on the severity of the condition and response to treatment 1
• If the stye persists despite appropriate treatment or worsens, patients should seek further medical attention 1