Is Terra-Cortril (oxytetracycline and hydrocortisone) ointment effective for treating a stye (hordeolum)?

Terra-Cortril Ointment for Stye Treatment

Terra-Cortril (oxytetracycline-hydrocortisone-polymyxin B) ointment is NOT recommended as first-line treatment for styes, and the corticosteroid component may actually worsen the bacterial infection during the acute phase. 1

Why Terra-Cortril Is Problematic for Styes

The Corticosteroid Component Is Contraindicated

• Corticosteroid drops or ointments should never be used for an active stye, as steroids can worsen bacterial infections. 1
• Corticosteroids are only indicated for inflammatory complications after the infection is controlled, not during active infection. 1
• The hydrocortisone in Terra-Cortril poses a risk of worsening the bacterial infection that defines a hordeolum. 1

The Antibiotic Component Is Not Optimal

• While Terra-Cortril contains oxytetracycline (a tetracycline antibiotic), the American Academy of Ophthalmology specifically recommends bacitracin or erythromycin as the preferred topical antibiotics for styes. 1, 2
• Tetracyclines should not be used in children under 8 years of age due to tooth staining risk. 3

Correct Treatment Algorithm for Styes

First-Line Conservative Management (Days 1-14)

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften material and promote spontaneous drainage. 1, 2
• Clean the eyelid margin once or twice daily using diluted baby shampoo or commercially available eyelid cleaner to remove debris. 2
• Perform gentle vertical massage of the eyelid to help express secretions. 2
• Most styes resolve spontaneously within 1-2 weeks with these measures alone. 1

Second-Line Topical Antibiotic Treatment (If No Improvement After 1-2 Weeks)

• Apply bacitracin or erythromycin ointment directly to the eyelid margin (where lashes emerge), NOT into the conjunctival sac. 1, 2
• Apply approximately 1 cm ribbon, 1-4 times daily for a few weeks. 1
• Adjust frequency based on severity and clinical response. 1, 2

Third-Line Systemic Treatment (For Persistent or Severe Cases)

• For recurrent or severe styes not responding to topical treatment, consider oral antibiotics like cephalexin or dicloxacillin for deeper infection. 1
• In children under 8 years or pregnant women, use oral erythromycin instead of tetracyclines. 1, 2
• For suspected MRSA with spreading infection, consider trimethoprim-sulfamethoxazole or oral tetracyclines (doxycycline/minocycline) in appropriate patients. 2

Surgical Intervention

• Incision and drainage is recommended for worsening hordeolum that fails conservative management. 2
• Reevaluate patients 24-48 hours after starting oral antibiotics to verify clinical response. 2

Critical Pitfalls to Avoid

• Never apply ointment into the conjunctival sac when treating eyelid margin conditions—the target is the lid margin where bacterial colonization occurs. 1
• Avoid aggressive manipulation or squeezing of the stye, as this can spread infection. 1
• In patients with advanced glaucoma, avoid aggressive lid pressure during warm compress application. 1, 2
• Rotate different antibiotics if long-term or repeated treatment is needed to prevent resistant organisms. 1, 2

Limited Evidence for Terra-Cortril

The only available evidence for Terra-Cortril is a 1977 case series showing efficacy for pyodermias (skin infections), not specifically for styes. 4 This outdated, low-quality evidence cannot support its use over guideline-recommended treatments, especially given the contraindication of corticosteroids in active eyelid infections. 1