Topical Treatment for Stye (Hordeolum)
For stye treatment, topical antibiotic ointment such as bacitracin or erythromycin applied to the eyelid margins one or more times daily or at bedtime for a few weeks is recommended. 1
First-Line Treatment Approach
Warm Compresses and Eyelid Hygiene
- Apply warm compresses to the affected eyelid for 5-10 minutes, once or twice daily to promote drainage of the stye 1
- Follow with gentle eyelid massage to express meibomian secretions and help drain the stye 1
- Clean eyelid margins by gently rubbing the base of the eyelashes using either diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1
Topical Antibiotic Treatment
- Apply topical antibiotic ointment such as bacitracin or erythromycin to the eyelid margins once or more times daily or at bedtime 1
- Continue treatment for a few weeks, guided by the severity of the stye and response to treatment 1
- Antibiotic drops placed in the conjunctival cul-de-sac appear to be as effective as ointment applied to the lid margins in reducing bacterial colonization 2
Treatment Considerations
Medication Selection
- Bacitracin and erythromycin ointments are effective first-line choices for styes 1
- For patients with antibiotic resistance concerns, consider alternating between different antibiotic mechanisms of action 1
- Tobramycin/dexamethasone ophthalmic suspension may be considered for cases with significant inflammation (off-label use) 1
Duration of Treatment
- Continue topical antibiotic treatment for a few weeks 1
- The frequency and duration should be guided by the severity of the stye and response to treatment 1
- Most styes will show significant improvement within 3-5 days with appropriate treatment 3
Special Considerations
When to Consider Additional Treatments
- For persistent or recurrent styes, consider evaluation for underlying conditions like meibomian gland dysfunction (MGD) 1
- Brief courses of topical corticosteroids may be helpful for cases with significant eyelid inflammation, but should be used with caution due to potential side effects 1
- For severe or recurrent cases, oral antibiotics may be considered, particularly if associated with MGD or rosacea 1
Cautions and Contraindications
- Patients should be instructed on proper application technique to avoid eye injury 1
- Patients with manual dexterity issues may require assistance with eyelid hygiene and medication application 1
- Long-term corticosteroid use should be avoided due to risks of increased intraocular pressure and cataract formation 1
- Patients with neurotrophic corneas require careful counseling to avoid corneal epithelial injury during eyelid cleaning 1
Evidence Limitations
- There is a lack of high-quality randomized controlled trials specifically evaluating treatments for internal hordeolum (stye) 4
- Most treatment recommendations are based on clinical experience and lower-quality evidence 4
- Despite limited evidence, topical antibiotics combined with warm compresses remain the standard of care for stye treatment 1, 2