What is the treatment for a stye (hordeolum)?

Treatment for Stye (Hordeolum)

Start with warm compresses applied to the affected eyelid for 5-10 minutes, 3-4 times daily, combined with gentle eyelid cleansing—this conservative approach is first-line therapy and often sufficient for resolution. 1, 2, 3

First-Line Conservative Management

Warm Compress Technique

• Apply warm compresses for 5-10 minutes to soften debris and warm meibomian secretions 1, 2, 3
• Perform once or twice daily at convenient times for the patient 4, 2
• Use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in the microwave 4, 2, 3
• Critical caveat: Ensure water is warm but not hot enough to burn the skin 4, 2, 3

Eyelid Cleansing After Warm Compresses

• 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 4, 1, 2
• Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and can be used 4, 3
• Perform gentle vertical massage of the eyelid after warm compresses to help express secretions 1, 2
• Regular eyelid cleansing daily or several times weekly often reduces chronic symptoms 4, 3

When to Escalate to Topical Antibiotics

Add topical antibiotic ointment if there is no improvement after 2-4 weeks of conservative therapy. 1

Antibiotic Selection and Application

• Apply erythromycin or bacitracin ophthalmic ointment to the eyelid margins once or more times daily (or at bedtime) for a few weeks 4, 1, 2
• Topical antibiotics provide symptomatic relief and decrease bacterial load from the eyelid margin 1, 2, 3
• The frequency and duration should be guided by severity and response to treatment 4, 1, 2

Important Antibiotic Considerations

• Prolonged antibiotic treatment may promote development of resistant organisms 1, 2, 3
• Some Staphylococcus aureus and Streptococcus pyogenes strains may already be resistant to erythromycin 1
• Topical antibiotic treatment can be repeated intermittently using different medications with different mechanisms of action to prevent resistance 4

Special Population Precautions

Patients Requiring Extra Caution

• Patients with neurotrophic corneas need proper counseling to avoid corneal epithelial injury during eyelid cleansing 4, 1, 3
• Patients with advanced glaucoma should avoid aggressive eyelid pressure as it may increase intraocular pressure 4, 1, 3
• Patients lacking manual dexterity or necessary skill to perform eyelid cleansing safely require tailored therapeutic plans 4, 2

For Severe or Recurrent Cases

Oral Antibiotic Therapy

• Oral doxycycline, minocycline, or tetracycline can be given daily and tapered after clinical improvement for meibomian gland dysfunction not controlled by topical treatment 4, 3
• For women of childbearing age and children, use oral erythromycin or azithromycin instead of tetracyclines 4, 1, 3
• Pediatric erythromycin dosing: 30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks 4

Red Flags Requiring Immediate Action

If the stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude carcinoma. 1, 2, 3

• Signs of orbital cellulitis or systemic illness require immediate ophthalmology referral 1
• For moderate to severe cases, especially prior to intraocular surgery, address with topical antibiotics and eyelid hygiene 4, 3

Long-Term Management Expectations

• Patients should be advised that treatment may be required long-term, as symptoms often recur when discontinued 4, 1, 2, 3
• A schedule of regularly performed eyelid cleansing, daily or several times weekly, often blunts chronic symptoms 4, 3
• Follow-up should be based on severity and response to treatment 2, 3