What eye drops are used to treat a sty (hordeolum)?

Treatment of Styes (Hordeola)

Warm compresses are the first-line treatment for styes (hordeola), which can be supplemented with topical antibiotic ointments in cases of infection or inflammation that doesn't resolve with conservative measures. 1, 2

First-Line Treatment

• Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily to help soften the oils, unblock the glands, and promote drainage of the hordeolum 1, 3
• For warm compresses, use specially designed microwaveable eyelid warming devices rather than hot wet flannels to avoid scalding and provide better heat retention 1, 4
• Perform gentle lid massage following warm compresses to help express the contents of the blocked gland 1
• Maintain good lid hygiene using commercially available lid wipes or homemade bicarbonate solution to clean eyelid margins and remove excess bacteria 1

Medication Options

When to Add Topical Antibiotics

• If the stye shows signs of significant infection (increasing redness, swelling, pain) or doesn't improve with warm compresses after 48 hours 2, 3
• For recurrent styes or when multiple styes are present 3

Topical Antibiotic Options

• Bacitracin ophthalmic ointment applied directly to the conjunctival sac 1-3 times daily; for blepharitis, carefully remove all scales and crusts and spread uniformly over lid margins 5
• Erythromycin ophthalmic ointment applied directly to the affected eye up to six times daily, depending on the severity of the infection 6

Treatment Algorithm

1. Initial Management (Days 1-3)

   • Warm compresses 3-4 times daily for 10-15 minutes 1, 3
   • Lid hygiene with gentle cleansing 1
   • Avoid eye makeup and contact lens wear during active infection 3

2. If No Improvement After 48-72 Hours

   • Continue warm compresses
   • Add topical antibiotic ointment (bacitracin or erythromycin) 5, 6
   • Apply antibiotic ointment directly to the affected area 2-3 times daily 5

3. For Persistent Cases (Beyond 7-10 Days)

   • Refer to ophthalmology for evaluation 3
   • May require incision and drainage if the stye has formed a focal point 2

Important Considerations and Cautions

• Avoid using tea bags as warm compresses due to risk of fungal contamination and potential for serious fungal keratitis 7
• Prolonged use of antibiotic-containing preparations may result in overgrowth of non-susceptible organisms, particularly fungi 5
• Do not use topical corticosteroids for routine stye treatment as they may worsen infection and have potential adverse effects including increased intraocular pressure and cataract formation 1
• Patients should be instructed to take appropriate measures to avoid contamination of the ointment when applying directly to the infected eye 5
• Bacitracin ophthalmic ointment should not be used in deep-seated ocular infections or those likely to become systemic 5

When to Refer to an Ophthalmologist

• If the stye doesn't respond to treatment after 7-10 days 2, 3
• If there is spreading infection, fever, or severe pain 3
• If vision is affected 3
• If recurrent styes occur in the same location (may indicate an underlying condition) 2