What is the treatment for a stye (hordeolum) under the eye?

Treatment for Stye (Hordeolum) Under the Eye

Start with warm compresses applied for 5-10 minutes once or twice daily, followed by gentle eyelid cleansing—this is the first-line treatment for all styes, with topical antibiotics reserved only for moderate to severe cases that fail conservative management. 1, 2

First-Line Conservative Management

Warm Compress Application

• Apply warm compresses to the affected eyelid for 5-10 minutes to soften debris and warm the meibomian gland secretions 1, 2
• Perform this once or twice daily at times convenient for you 3, 1
• Use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in the microwave for sustained warmth 1, 2
• Critical warning: Ensure the compress is warm but not hot enough to burn the skin 3, 2

Eyelid Cleansing and Massage

• After warm compresses, perform gentle eyelid cleansing and massage to help express the contents of the affected gland 1, 2
• Gently rub the base of the eyelashes using either diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 3, 2
• Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and can be used 3, 1
• Continue this regimen daily or several times weekly, as regular eyelid cleansing often reduces symptoms 3, 1

Second-Line Treatment for Non-Responsive Cases

If the stye does not improve after several days of warm compresses and eyelid hygiene, add topical antibiotic ointment. 1, 2

• Apply bacitracin or erythromycin ointment to the eyelid margins one or more times daily or at bedtime for a few weeks 1, 2
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 1
• The frequency and duration should be guided by severity and response to treatment 1, 2

Important Safety Considerations and Pitfalls

Patient-Specific Precautions

• Patients with neurotrophic corneas: Provide proper counseling to avoid injury to corneal epithelium during eyelid cleansing 3, 1, 2
• Patients with advanced glaucoma: Avoid aggressive pressure on the eyelids as it may increase intraocular pressure 1, 2
• Patients lacking manual dexterity: Eyelid cleaning can be dangerous if the patient lacks the necessary skill or judgment to perform the task safely 3, 2

When to Suspect Something More Serious

• If the stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 1, 2
• Long-term antibiotic treatment may result in the development of resistant organisms 3, 1, 2

Expected Course and Long-Term Management

• Patients should understand that warm compress and eyelid cleansing treatment may be required long-term, as symptoms often recur when treatment is discontinued 1, 2
• For those prone to recurrent styes, daily eyelid cleansing may help prevent recurrence 1
• Follow-up should be based on the severity of the condition and response to treatment 1, 2

Evidence Quality Note

While warm compresses and eyelid hygiene are universally recommended by the American Academy of Ophthalmology 3, 1, 2, a Cochrane systematic review found no randomized controlled trials specifically evaluating treatments for acute internal hordeolum 4, 5. Despite this lack of high-level evidence, the conservative approach remains standard of care based on clinical experience and guideline consensus.