First-Line Treatment for Stye (Hordeolum) Infection
Warm compresses and eyelid hygiene are the primary first-line treatment for stye infections, with topical antibiotics (bacitracin or erythromycin ointment) reserved for cases with significant inflammation or those not responding to conservative measures. 1
Initial Conservative Management
Apply warm compresses to the affected eyelid for several minutes, multiple times daily to soften adherent material and promote spontaneous drainage 1
- Use hot tap water on a clean washcloth, over-the-counter heat pack, or microwaveable bean/rice bag
- Critical caveat: Instruct patients to avoid compresses hot enough to burn the skin 1
Perform gentle eyelid cleansing after warm compress application 1
- Use diluted baby shampoo or commercially available eyelid cleaner on a cotton swab or clean fingertip
- Gently rub the base of the eyelashes to remove crusting
- Eye cleaners with hypochlorous acid at 0.01% have strong antimicrobial effects 1
Continue this regimen once or twice daily until resolution 1
When to Add Topical Antibiotics
Add topical antibiotic ointment if:
- Significant inflammation is present
- No improvement after several days of conservative treatment
- Patient has recurrent styes 1
Recommended topical antibiotics:
- Bacitracin ointment applied to eyelid margins 1-3 times daily 1, 2
- Erythromycin ointment applied to eyelid margins 1-3 times daily or at bedtime 1
- Duration: Continue for a few weeks, then reassess 1
Important Clinical Considerations
Do NOT routinely use systemic antibiotics for simple styes, as they are superficial infections that typically resolve with local measures 1
Incision and drainage is NOT first-line treatment for acute hordeolum—reserve surgical intervention for cases that fail conservative management or develop into abscesses 1, 3, 4
Patient counseling points:
- Most styes drain spontaneously and resolve without treatment 3, 4
- Treatment may need to be long-term or intermittent, as symptoms often recur when discontinued 1
- Patients lacking manual dexterity should receive modified instructions to avoid injury 1
Evidence Quality Note
The evidence base for stye treatment is notably weak—no randomized controlled trials exist comparing interventions for acute internal hordeolum 3, 4. Current recommendations are based on expert consensus from ophthalmology guidelines and extrapolation from blepharitis management 1.