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 moderate to severe cases that don't respond to conservative management. 1, 2

First-Line Conservative Treatment

Warm compresses are the cornerstone of stye management:

• 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 convenient times 1, 2
• Use water that is warm but not hot enough to burn the skin 1, 2
• For sustained warmth, use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in a microwave 1, 2

After warm compresses, perform gentle eyelid cleansing and massage:

• 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
• This helps express the contents of the affected gland 1, 2

Second-Line Treatment: Topical Antibiotics

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

• Prescribe topical antibiotic ointment such as bacitracin or erythromycin 1, 2
• Apply to the eyelid margins once or more times 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

The evidence base for topical antibiotics is limited—Cochrane reviews found no randomized controlled trials specifically evaluating non-surgical interventions for acute internal hordeolum 3, 4. However, guideline recommendations support their use based on clinical experience and pathophysiology.

Important Safety Considerations

Special populations requiring 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 intraocular pressure 1, 2
• Eyelid cleaning can be dangerous if the patient lacks manual dexterity or skill to perform the task safely 1, 2

Long-term considerations:

• Long-term antibiotic treatment may result in the development of resistant organisms 1, 2
• Patients should be advised that warm compress and eyelid cleansing treatment may be required long-term, as symptoms often recur when treatment is discontinued 1, 2

Red Flags Requiring Further Evaluation

Consider biopsy to exclude carcinoma if the stye is:

• Markedly asymmetric 1, 2
• Resistant to therapy 1, 2
• Recurrent in the same location 1, 2

This is a critical pitfall to avoid—chronic unilateral blepharitis unresponsive to therapy may represent sebaceous gland carcinoma masquerading as a benign condition 5.

Follow-up

Follow-up should be based on the severity of the condition and response to treatment 1, 2. Most styes drain spontaneously and resolve within about a week, but if the lesion persists despite appropriate treatment or worsens, patients should seek further medical attention 2.