Bacitracin for Eye Stye (Hordeolum)
Bacitracin ophthalmic ointment should be applied to the affected eyelid margin 1-3 times daily for an eye stye, though it is not the preferred first-line antibiotic due to high rates of allergic sensitization. 1
Dosing and Application
- Apply bacitracin ophthalmic ointment directly to the eyelid margin 1-3 times daily, ensuring all scales and crusts are carefully removed before application 1
- The ointment should be spread uniformly over the lid margins, with patients instructed to avoid gross contamination of the tube tip 1
- For blepharitis-related conditions (which include hordeolum/stye), application at bedtime or one or more times daily is appropriate, with frequency guided by severity and response 2
Important Caveats and Limitations
Bacitracin has significant limitations as a topical antibiotic:
- Bacitracin is NOT effective for neonatal ophthalmia prophylaxis and should not be used for that indication 3
- Bacitracin has emerged as a leading allergen with increasing rates of clinically relevant allergic contact dermatitis 4
- Treatment failure and sensitization are common with topical bacitracin use, particularly in chronic or recurring conditions 5
- The North American Contact Dermatitis Group has documented rising allergic reaction rates, with some cases of near-fatal anaphylaxis 4
Alternative Considerations
For eyelid margin infections like styes, consider these alternatives:
- Erythromycin ophthalmic ointment can be applied 2-3 times daily for 10 days and is recommended for pediculosis palpebrarum (lice) treatment, suggesting efficacy for eyelid conditions 3
- Tobramycin applied to eyelid margins provides symptomatic relief and decreases bacteria, with recommendations to use intermittently with different antibiotics to prevent resistance 2
- Bland ophthalmic ointments (petrolatum, erythromycin) applied 2-3 times daily for 10 days are effective for certain eyelid conditions 3