What is the treatment for a stye (hordeolum)?

Treatment for Stye (Hordeolum)

Warm compresses and eyelid hygiene are the first-line treatment for eye styes (hordeolum), with topical antibiotics reserved for moderate to severe cases that don't respond to conservative management. 1, 2, 3

First-Line Treatment

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften debris, warm meibomian secretions, and promote drainage 1, 3
• 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 (ensure water is warm but not hot enough to burn the skin) 1, 2
• Follow warm compresses with gentle eyelid cleansing and massage to help express the contents of the affected gland 1, 2
• Clean the eyelid by gently rubbing the base of the eyelashes using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1, 3
• Eye cleaners containing hypochlorous acid (0.01%) have strong antimicrobial effects and can be used for treatment 1, 2

Second-Line Treatment

• For moderate to severe cases that don't respond to warm compresses and eyelid hygiene after 2-4 weeks, 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 1, 3
• Erythromycin topical solution should be applied over the affected areas twice a day (morning and evening) after the skin is thoroughly washed with warm water and soap and patted dry 4
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1, 2

For Severe or Recurrent Cases

• 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 1, 3
• For women of childbearing age and children, oral erythromycin or azithromycin may be used instead of tetracyclines 1, 3
• If there are signs of spreading infection, oral antibiotics should be initiated, with consideration of trimethoprim-sulfamethoxazole or tetracycline (doxycycline/minocycline) for suspected MRSA infection 3

Important Considerations and Cautions

• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1, 3
• Patients with advanced glaucoma should avoid aggressive pressure on the eyelids as it may increase eye pressure 1, 2
• Eyelid cleaning can be dangerous if the patient lacks manual dexterity or skill to perform the task safely 1, 2
• Long-term antibiotic treatment may result in the development of resistant organisms 1, 3
• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 1, 2

When to Refer to Ophthalmology

• If there is no improvement after appropriate treatment or if the condition worsens 1, 3
• For worsening upper eyelid hordeolum, incision and drainage may be necessary 3
• If there are signs of orbital cellulitis or systemic illness, immediate referral to an ophthalmologist is necessary 3

Prevention Strategies

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

Expected Course

• 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, 2
• Most styes resolve within 1-2 weeks with appropriate treatment 1, 3