What is the recommended treatment for a stye (hordeolum)?

Treatment for Stye (Hordeolum)

Warm compresses applied for 5-10 minutes once or twice daily, followed by gentle eyelid cleansing and massage, is the first-line treatment for styes, with topical antibiotics reserved for cases that don't respond to conservative management. 1, 2

First-Line Conservative Treatment

Warm Compresses

• Apply warm compresses to the affected eyelid for 5-10 minutes to soften debris and warm the 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 a 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 help express the contents of the affected gland 1, 2
• 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 3, 1
• Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and can be used 3, 1
• Regular eyelid cleansing performed daily or several times weekly often reduces symptoms 2

Second-Line Antibiotic Treatment

For moderate to severe cases or those not responding to warm compresses and eyelid hygiene:

• Apply topical antibiotic ointment such as bacitracin or erythromycin to the eyelid margins once or more 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

Important Safety Considerations and Caveats

Patient-Specific Precautions

• Patients with neurotrophic corneas require proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1, 2
• Patients with advanced glaucoma should avoid aggressive pressure on the eyelids as it may increase intraocular pressure 2
• Eyelid cleaning can be dangerous if the patient lacks manual dexterity or necessary skill—tailor the therapeutic plan to the patient's abilities 3, 1

Treatment Duration and Resistance

• 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
• Long-term antibiotic treatment may result in the development of resistant organisms 3, 1

Red Flags Requiring Further Evaluation

• 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
• For moderate to severe cases, especially prior to intraocular surgery, topical antibiotics combined with eyelid hygiene are recommended 3, 1

Evidence Quality Note

The American Academy of Ophthalmology guidelines provide the strongest evidence for this treatment approach 3, 1, 2. A 2017 Cochrane review found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum, highlighting that current recommendations are based on expert consensus and clinical experience rather than high-quality trial data 4. Despite this limitation, the warm compress and eyelid hygiene approach remains the standard of care given its safety profile and clinical effectiveness in practice 1, 2.