What is the treatment for a stye (hordeolum) on the eye?

Treatment for Eye Stye (Hordeolum)

Warm compresses applied for 5-10 minutes once or twice daily combined with gentle eyelid cleansing is the first-line treatment for eye styes, with topical antibiotics reserved only for moderate to severe cases that fail conservative management. 1

Initial Conservative Management

All patients should start with warm compresses and eyelid hygiene as first-line therapy:

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

After warm compresses, perform gentle eyelid cleansing:

• Gently rub the base of the eyelashes using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 2, 1
• Eye cleaners containing hypochlorous acid (0.01%) have strong antimicrobial effects and can be used 2, 1
• Gentle massage of the eyelids helps express the contents of the affected gland 1
• Continue this regimen daily or several times weekly, as regularly performed eyelid cleansing reduces symptoms 2, 1

When to Add Topical Antibiotics

Escalate to topical antibiotics only for moderate to severe cases that don't respond to 3-7 days of conservative management:

• Apply topical antibiotic ointments such as bacitracin or erythromycin to the eyelid margins once daily or at bedtime 1
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 1
• Continue for a few weeks based on severity and response to treatment 1
• Important caveat: Long-term antibiotic treatment may result in development of resistant organisms 2

For Severe or Recurrent Cases

Consider oral antibiotics for chronic symptoms not controlled by topical therapy:

• Oral tetracyclines (doxycycline, minocycline, or tetracycline) may be helpful for patients with meibomian gland dysfunction whose symptoms are not adequately controlled 1
• For women of childbearing age and children, use oral erythromycin or azithromycin instead of tetracyclines 1

Critical Safety Warnings

Patients with certain conditions require special precautions during eyelid cleansing:

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

Red Flags Requiring Biopsy

If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma. 1

Evidence Quality Note

The evidence base for stye treatment is notably weak. Two Cochrane reviews found no randomized controlled trials meeting inclusion criteria for acute internal hordeolum treatment 3, 4. The recommendations are primarily based on expert consensus from ophthalmology practice guidelines 2, 1. Despite limited high-quality evidence, the conservative approach of warm compresses and eyelid hygiene is safe, low-cost, and widely accepted as standard practice.

Expected Course

• Most styes drain spontaneously and resolve within about one week without treatment 5
• Patients should understand that symptoms often recur when treatment is discontinued, requiring long-term maintenance 1
• If the stye persists despite appropriate treatment or worsens, patients should seek further medical attention 1