What is the recommended treatment for a stye?

Treatment for Stye (Hordeolum)

Start with warm compresses applied to the affected eyelid for 5-10 minutes once or twice daily, followed by gentle eyelid cleansing and massage—this is the first-line treatment recommended by the American Academy of Ophthalmology. 1, 2

First-Line Conservative Management

Warm Compress Application

• Apply warm compresses for 5-10 minutes to soften debris and warm meibomian secretions 1, 2
• Perform once or twice daily at times convenient for the patient 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 safety point: Ensure water is warm but not hot enough to burn the skin 3, 1

Eyelid Cleansing and Massage

• After warm compresses, perform gentle eyelid cleansing and massage to express the contents of the affected gland 1, 2
• Clean by gently rubbing the base of the eyelashes using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 3, 1
• Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and can be used 3, 1
• A schedule of regularly performed eyelid cleansing, daily or several times weekly, often reduces symptoms 2

Second-Line Treatment: Topical Antibiotics

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

• Prescribe bacitracin or erythromycin ointment applied to the eyelid margins once 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, 2
• The frequency and duration should be guided by severity and response to treatment 1, 2
• For moderate to severe cases, especially prior to intraocular surgery, combine topical antibiotics with eyelid hygiene 3, 1

Important Safety Considerations

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: Advise against applying excessive 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, 1, 2

Treatment Cautions

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

Expected Course and Follow-Up

• 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
• Follow-up should be based on the severity of the condition and response to treatment 1, 2
• A cure is usually not possible for chronic conditions, and treatment often requires persistence and a trial-and-error approach 3

Evidence Quality Note

The evidence base for stye treatment is limited. A 2017 Cochrane review found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeola, indicating that current treatment recommendations are based on clinical experience and expert consensus rather than high-quality trial data 4. The American Academy of Ophthalmology guidelines represent the best available evidence-based approach 3, 1, 2.