What is the recommended treatment for a stye?

Treatment for Stye (Hordeolum)

The first-line treatment for a stye is applying warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily, combined with gentle eyelid cleansing and massage to promote drainage. 1, 2

First-Line Management

• 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, 2
• For sustained warmth, use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags that can be heated in the microwave 1
• Clean the eyelid margin using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip once or twice daily 1, 2
• Perform gentle vertical massage of the eyelid after warm compresses to help express the contents of the affected gland 1, 2
• Eye cleaners with hypochlorous acid at 0.01% have a strong antimicrobial effect and can be used for treatment 1

Second-Line Treatment (If No Improvement After 2-4 Weeks)

• 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 1, 2
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1, 2
• Mupirocin 2% topical ointment is an alternative option for minor skin infections and secondarily infected skin lesions 2

For Persistent or Severe Cases

• For moderate to severe cases, especially prior to intraocular surgery, topical antibiotics combined with eyelid hygiene are recommended 1
• Oral antibiotics such as doxycycline, minocycline, or tetracycline may be considered for patients with meibomian gland dysfunction whose symptoms are not adequately controlled by eyelid cleansing or topical treatments 2
• Alternative oral antibiotics such as erythromycin or azithromycin may be used for women of childbearing age and children (tetracyclines are contraindicated in pregnancy and children under 8) 2

Important Considerations and Cautions

• 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
• Cleaning the eyelid can be dangerous if the patient lacks manual dexterity or the necessary skill to perform the task safely 1
• Long-term antibiotic treatment may result in the development of resistant organisms 1, 2
• Avoid aggressive manipulation of the eyelid, particularly in patients with advanced glaucoma, as it may increase eye pressure 1, 2
• Patients with neurotrophic corneas require proper counseling to avoid injury to corneal epithelium during eyelid cleaning 1, 2

When to Refer to an Ophthalmologist

• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 1
• If there are signs of spreading infection, orbital cellulitis, or systemic illness, immediate referral to an ophthalmologist is necessary 2
• If there is no improvement after appropriate treatment, referral to an ophthalmologist is recommended 2

Evidence Limitations

• Despite the common occurrence of styes, there is a lack of high-quality randomized controlled trials evaluating the effectiveness of non-surgical interventions for hordeolum treatment 3, 4
• Most treatment recommendations are based on expert opinion and clinical experience rather than robust clinical trials 3, 4