What is the treatment for an eye stye (hordeolum)?

Treatment for Eye Stye (Hordeolum)

Warm compresses applied to the affected eyelid for 5-10 minutes once or twice daily, followed by gentle eyelid massage, is the first-line treatment for eye styes (hordeola). 1

First-Line Treatment

• Apply warm compresses to the affected eyelid for 5-10 minutes, 1-2 times daily to soften debris and warm the meibomian secretions 1
• Follow warm compresses with gentle eyelid 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, or hypochlorous acid 0.01% solution on a cotton ball, cotton swab, or clean fingertip 1
• For sustained warmth, use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in the microwave 1

Second-Line Treatment

• If the stye doesn't improve with warm compresses and eyelid hygiene, apply a topical antibiotic ointment such as bacitracin or erythromycin to the eyelid margins 1-3 times daily or at bedtime 1, 2, 3
• Bacitracin ophthalmic ointment should be applied directly into the conjunctival sac 1-3 times daily 2
• Erythromycin ophthalmic ointment (approximately 1 cm in length) can be applied directly to the affected eye up to six times daily, depending on severity 3

Important Technique Considerations

• Use water that is warm but not hot enough to burn the skin when applying compresses 1
• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1
• Patients with advanced glaucoma should avoid applying excessive pressure on the eyelids as it may increase eye pressure 1

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 be required 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

Cautions and Pitfalls

• Long-term antibiotic treatment may result in the development of resistant organisms 1
• Cleaning the eyelid can be dangerous if the patient lacks manual dexterity or the necessary skill to perform the task safely 1
• There is limited high-quality evidence supporting non-surgical interventions for hordeola, as systematic reviews have found no randomized controlled trials specifically evaluating these treatments 4, 5
• Do not confuse a hordeolum with a chalazion, which is a non-inflammatory condition that develops due to retained secretion of the meibomian or Zeis glands and may require different management if persistent 6

Follow-up Recommendations

• Follow-up should be based on the severity of the condition and response to treatment 1
• Most hordeola will resolve within 7-10 days with conservative management 7
• If the condition worsens or shows no improvement after 1-2 weeks of treatment, reevaluation is recommended 1