Treatment for Stye (Hordeolum)
Warm compresses applied for 5-10 minutes once or twice daily combined with gentle eyelid cleansing is the first-line treatment for styes, with topical antibiotics reserved as second-line therapy for cases that don't respond to conservative management. 1, 2
First-Line Conservative Management
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:
- Follow warm compresses with 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 for treatment 3, 1
- A schedule of regularly performed eyelid cleansing, daily or several times weekly, often reduces symptoms 2
Second-Line Antibiotic Therapy
When to Add Topical Antibiotics:
- For moderate to severe cases that don't respond to warm compresses and eyelid hygiene alone 1, 2
- Topical antibiotic ointments such as bacitracin or erythromycin can be applied 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
- The frequency and duration should be guided by severity and response to treatment 1
Important caveat: Long-term antibiotic treatment may result in the development of resistant organisms 3, 1
Special Populations and Safety Considerations
Patients requiring extra caution:
- Patients with neurotrophic corneas need 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 eye pressure 2
- Eyelid cleaning can be dangerous if the patient lacks manual dexterity or skill to perform the task safely—tailor the therapeutic plan accordingly 3, 1
Red Flags Requiring Further Evaluation
Consider biopsy if:
- The stye is markedly asymmetric 1, 2
- Resistant to therapy 1, 2
- Recurrent in the same location (to exclude the possibility of carcinoma) 1, 2
Long-Term Management Expectations
- 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
Evidence quality note: While the American Academy of Ophthalmology guidelines strongly recommend warm compresses and eyelid hygiene 3, 1, a Cochrane review found no randomized controlled trials specifically evaluating non-surgical interventions for acute internal hordeolum, highlighting that current recommendations are based on clinical experience rather than high-quality trial evidence 4, 5. However, these conservative measures remain the standard of care given their safety profile and clinical utility.