What is the recommended management for an uncomplicated stye (hordeolum)?

Management of Uncomplicated Stye (Hordeolum)

Primary Treatment Approach

For uncomplicated styes, conservative management with warm compresses is the mainstay of treatment, as most cases resolve spontaneously without antibiotics. 1

The evidence base for treating acute internal hordeola is remarkably limited—a systematic Cochrane review found no randomized controlled trials evaluating any non-surgical interventions for this condition 1. This absence of high-quality evidence means treatment recommendations are based primarily on clinical experience and observational data rather than rigorous trials.

Conservative Management

• Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily 1

  • This promotes spontaneous drainage and resolution of the lesion
  • The heat increases blood flow and helps liquefy the contents of the blocked gland

• Gentle lid massage after warm compresses may facilitate drainage 1

  • Massage should be directed toward the eyelid margin
  • Avoid aggressive manipulation that could spread infection

• Maintain eyelid hygiene with gentle lid scrubs 1

  • Use diluted baby shampoo or commercial lid scrub solutions
  • This reduces bacterial colonization and prevents recurrence

When Antibiotics Are NOT Routinely Indicated

Topical or systemic antibiotics are not necessary for uncomplicated styes, as the infection is typically self-limited and confined to the gland. 1 The Cochrane review specifically noted that most hordeola drain spontaneously without antibiotic treatment 1.

When to Consider Antibiotics

Antibiotics may be considered only in specific circumstances:

• Presence of surrounding cellulitis extending beyond the immediate eyelid margin 2

  • If cellulitis develops, treat according to standard cellulitis protocols with beta-lactam antibiotics
  • Typical regimens would include cephalexin 500 mg four times daily or dicloxacillin 250-500 mg every 6 hours for 5 days 3

• Signs of systemic infection (fever, malaise) 2

  • This is extremely rare with simple hordeola

• Immunocompromised patients 2

  • Consider prophylactic topical antibiotics in this population

Topical Antibiotic Application (If Used)

If topical antibiotics are deemed necessary due to complications:

• Apply topical antibiotic ointment (erythromycin or bacitracin) to the eyelid margin 2-4 times daily 4
• Fluoroquinolone drops (levofloxacin, moxifloxacin) can be used if broader coverage is desired 2
  • Apply four times daily to the affected eye

Expected Timeline and Follow-Up

• Most uncomplicated styes resolve within 5-7 days with conservative management alone 4, 1
• Reassess at 48-72 hours if no improvement 1
• If the lesion persists beyond 7-10 days or worsens, consider referral to ophthalmology 1

When Surgical Intervention Is Needed

• Incision and drainage is indicated if the hordeolum does not resolve with conservative measures or becomes a chronic chalazion 1
• Urgent ophthalmology referral is required if there is vision change, severe pain, or signs of orbital cellulitis 2

Critical Pitfalls to Avoid

• Do not routinely prescribe antibiotics for simple styes—this represents unnecessary antibiotic use and promotes resistance 5, 1
• Do not attempt to squeeze or manually express the stye, as this can spread infection 1
• Do not confuse an internal hordeolum with preseptal or orbital cellulitis, which require systemic antibiotics 2
• Do not ignore warning signs of deeper infection: proptosis, restricted eye movement, or vision changes require immediate ophthalmology consultation 2