What is the treatment for a stye (hordeolum)?

Treatment of Stye (Hordeolum)

Start with warm compresses applied to the affected eyelid for 5-10 minutes, 3-4 times daily, combined with eyelid hygiene using diluted baby shampoo or commercial eyelid cleaners. 1, 2, 3

First-Line Conservative Management

The cornerstone of stye treatment is conservative therapy, which resolves most cases without antibiotics:

Warm Compresses

• Apply warm compresses for 5-10 minutes, 3-4 times daily to soften debris, warm meibomian secretions, and promote spontaneous drainage 1, 2, 3
• Use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in a microwave for sustained warmth 2, 3
• Ensure water is warm but not hot enough to burn the skin 2, 3

Eyelid Hygiene

• After warm compresses, gently 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, 3
• Perform gentle vertical massage of the eyelid to help express secretions from the affected gland 1, 3
• Eye cleaners containing hypochlorous acid (0.01%) have strong antimicrobial effects and can be used 2, 3

Important Safety Considerations

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

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

If conservative measures fail after 2-4 weeks, add topical antibiotic ointment such as bacitracin or erythromycin applied to the eyelid margins once or more times daily for a few weeks. 1, 2, 3

• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 2, 3
• The frequency and duration should be guided by severity and response to treatment 1, 3
• Consider using different antibiotics intermittently to prevent development of resistant organisms 1
• Alternative topical option: mupirocin 2% ointment for minor skin infections 1

Third-Line Treatment for Persistent or Severe Cases

Oral Antibiotics

• For meibomian gland dysfunction not adequately controlled by topical treatments, consider oral doxycycline, minocycline, or tetracycline 1, 2
• Tetracyclines are contraindicated in pregnancy and children under 8 years old 1, 2
• For women of childbearing age and children, use oral erythromycin or azithromycin instead 1, 2

Surgical Intervention

• For worsening upper eyelid hordeolum despite conservative treatment, incision and drainage is the next step 1
• If signs of spreading infection are present, initiate oral antibiotics with consideration of trimethoprim-sulfamethoxazole or tetracycline (doxycycline/minocycline) for suspected MRSA 1
• Patients started on oral antibiotics should be reevaluated in 24-48 hours to verify clinical response 1

When to Refer to Ophthalmology

Immediate referral is necessary if there are signs of orbital cellulitis or systemic illness. 1

• If no improvement after incision and drainage plus appropriate antibiotic therapy 1
• If the stye is in a difficult-to-treat location such as the inner eyelid 1
• If signs of systemic illness or extensive infection develop 1

Special Considerations

Red Flags Requiring Biopsy

• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude carcinoma 2, 3

Long-Term Management

• 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, 3
• Regular eyelid hygiene is recommended for those prone to recurrent styes or with chronic blepharitis 2

Adjunctive Considerations

• Topical corticosteroids may provide symptomatic relief but should be used with caution and under ophthalmological supervision 1
• In patients with advanced glaucoma, use steroid-containing drops with caution and monitor intraocular pressure closely 1

Evidence Limitations

The Cochrane reviews found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum, indicating that current recommendations are based on expert consensus and observational data rather than high-quality trial evidence 4, 5