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. 1, 2

First-Line Conservative Management

The cornerstone of stye treatment is conservative therapy with warm compresses and eyelid hygiene:

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

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 1, 2
• Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and can be used 1, 2
• Regular eyelid cleansing performed daily or several times weekly often reduces symptoms 2

Second-Line Antibiotic Therapy

For moderate to severe cases that don't respond to warm compresses and eyelid hygiene alone, add topical antibiotic ointment 1, 2:

• Apply bacitracin or erythromycin ointment 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

It's worth noting that a 2017 Cochrane review found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 3, meaning current recommendations are based on expert consensus rather than high-quality evidence. However, the American Academy of Ophthalmology guidelines strongly support this approach 4.

Important Safety Considerations

Patients must be counseled on proper technique to avoid complications:

• 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 necessary skill to perform the task safely 1, 2

When to Escalate Care

Consider further evaluation if:

• The stye is markedly asymmetric, resistant to therapy, or recurrent in the same location - consider biopsy to exclude carcinoma 1, 2
• Long-term antibiotic treatment may result in development of resistant organisms, so avoid prolonged use 4, 1, 2

Expected Course

Patients should understand that:

• Many styes drain spontaneously and resolve without treatment 5, 3
• Warm compress and eyelid cleansing treatment may be required long-term, as symptoms often recur when treatment is discontinued 1, 2
• A cure is usually not possible for chronic blepharitis, which predisposes to recurrent styes 4