What is the recommended treatment for hordeolum (stye)?

Treatment of Hordeolum (Stye)

Warm compresses are the first-line treatment for hordeolum, applied to the affected eyelid for 5-10 minutes, several times daily, to increase blood circulation, promote drainage, and relieve pain. 1

First-Line Management

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to increase blood circulation, promote drainage, and relieve pain 1
• Clean eyelid margins with mild soap or commercial eyelid cleansers to maintain hygiene and prevent infection spread 1
• Perform gentle massage of the affected area after applying warm compresses to help express the obstructed gland 1
• Avoid squeezing or attempting to "pop" the hordeolum as this may spread infection 1
• Discontinue eye makeup use during active infection to prevent contamination and irritation 1

Second-Line Management

• Consider topical antibiotics for moderate to severe cases or when there are signs of spreading infection 1
• Reserve oral antibiotics for severe cases with spreading infection or systemic symptoms 1
• If no improvement is seen after 48 hours of appropriate therapy, consider modifying the treatment approach 1

Management of Recurrent Hordeola

• Implement a more aggressive eyelid hygiene regimen for recurrent hordeola 1
• Evaluate for underlying conditions such as blepharitis or meibomian gland dysfunction that may predispose to recurrence 1, 2
• Consider treatment of underlying skin conditions (rosacea, seborrheic dermatitis) that may contribute to recurrence 2

Warning Signs Requiring Further Evaluation

• Marked asymmetry, resistance to therapy, or unifocal recurrent lesions may suggest more serious conditions 3
• Eyelid margin distortion, lash loss (madarosis), or ulceration require prompt evaluation 3
• Recurrence in the same location, especially in elderly patients, raises suspicion for sebaceous carcinoma and may warrant biopsy 3, 2
• Unilateral chronic blepharitis unresponsive to therapy may indicate carcinoma 2

Differential Diagnosis Considerations

• Distinguish between hordeolum (acute infection with rapid onset) and chalazion (chronic, non-infectious inflammation with gradual onset) 3, 2
• A hordeolum presents as a painful, erythematous nodule at the eyelid margin with rapid onset and signs of acute inflammation 3
• A chalazion presents as a painless nodule within the tarsal plate with visible meibomian gland obstruction on eyelid eversion 3

Evidence Limitations

• Despite widespread clinical use of warm compresses and antibiotics, high-quality evidence from randomized controlled trials supporting these interventions is limited 4, 5
• A Cochrane review found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 5
• Some evidence suggests acupuncture may provide short-term benefits for treating acute hordeolum, but the certainty of evidence is low to very low 6

Complications and Prognosis

• Most hordeola resolve spontaneously within 1-2 weeks with appropriate treatment 7
• If unresolved, an internal hordeolum can develop into a chalazion or generalized eyelid cellulitis 6
• Rare but serious complications include eyelid necrosis, which requires prompt surgical intervention and intravenous antibiotics 8