What is the treatment for a stye (hordeolum)?

Treatment of Stye (Hordeolum)

Warm compresses for 5-10 minutes, 3-4 times daily combined with eyelid hygiene is the first-line treatment for styes, with topical antibiotics (bacitracin or erythromycin) reserved only for cases that fail to improve after 2-4 weeks of conservative management. 1, 2

First-Line Conservative Management

The cornerstone of stye treatment is thermal therapy and mechanical cleansing:

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften debris, warm meibomian secretions, and promote spontaneous drainage 2, 3
• Use water that is warm but not hot enough to burn the skin; options include hot tap water on a clean washcloth, over-the-counter heat packs, or microwaveable bean/rice bags 1, 3
• Follow each warm compress session with gentle eyelid cleansing and vertical massage to help express the contents of the affected gland 2, 3
• Clean the eyelid margin 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 1, 2
• Eye cleaners containing hypochlorous acid (0.01%) have strong antimicrobial effects and can be used as an alternative 1, 3

Most styes drain spontaneously and resolve without antibiotics when treated with warm compresses and hygiene alone. 4, 5

Second-Line Treatment: Topical Antibiotics

Reserve topical antibiotics for specific indications:

• Use topical antibiotic ointment (bacitracin or erythromycin) only if there is no improvement after 2-4 weeks of conservative management 2
• Apply 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 bacterial load from the eyelid margin 1, 3
• The frequency and duration should be guided by severity and response to treatment 1, 2

Severe or Recurrent Cases

For cases with systemic signs or extensive infection:

• Consider oral antibiotics (doxycycline, minocycline, or tetracycline) for patients with meibomian gland dysfunction whose symptoms are not controlled by topical treatments 1, 2
• For women of childbearing age and children under 8 years, use oral erythromycin or azithromycin instead of tetracyclines 1, 2
• If the stye is worsening despite conservative treatment, incision and drainage is the next step, along with consideration of oral antibiotics if there are signs of spreading infection 2

Critical Safety Considerations

• Patients with neurotrophic corneas must be counseled to avoid injury to the corneal epithelium during eyelid cleansing 1, 3
• Patients with advanced glaucoma should avoid aggressive pressure on the eyelids as it may increase intraocular pressure 1, 3
• Eyelid cleaning can be dangerous if the patient lacks manual dexterity or skill to perform the task safely 1, 3
• Long-term antibiotic treatment may result in development of resistant organisms 1, 3

When to Escalate Care

• If the stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude carcinoma 1, 3
• If there are signs of orbital cellulitis or systemic illness, immediate referral to ophthalmology is necessary 2
• If there is no improvement after incision and drainage plus appropriate antibiotic therapy, refer to ophthalmology 2

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, especially for those prone to styes or with chronic blepharitis, helps prevent recurrence 1

The evidence base for stye treatment is notably weak—no randomized controlled trials exist for acute internal hordeolum treatment, making current recommendations based primarily on expert consensus and observational data. 4, 5