What is the treatment for an eye stye (hordeolum)?

Treatment for Eye Stye (Hordeolum)

Start with warm compresses applied to the affected eyelid for 5-10 minutes, 3-4 times daily, followed by gentle eyelid cleansing and massage. 1

First-Line Conservative Management

The cornerstone of stye treatment is consistent warm compress therapy combined with eyelid hygiene:

• Apply warm compresses for 5-10 minutes, 3-4 times daily to soften debris, warm meibomian secretions, and promote spontaneous drainage 1
• Use water that is warm but not hot enough to burn the skin 1
• For sustained warmth, use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in the microwave 1
• Perform gentle eyelid cleansing once or twice daily immediately after warm compresses to help express the contents of the affected gland 1
• 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
• Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and can be used 1
• Apply gentle vertical massage of the eyelid to help express secretions from the meibomian glands 1

Critical Safety Warnings

• Patients with neurotrophic corneas need proper counseling to avoid injury to the corneal epithelium during eyelid cleansing 1
• Patients with advanced glaucoma should avoid aggressive pressure on the eyelids as it may increase intraocular pressure 1
• Eyelid cleaning can be dangerous if the patient lacks manual dexterity or the necessary skill to perform the task safely 1

Second-Line Treatment (If No Improvement After 2-4 Weeks)

Prescribe topical antibiotic ointment such as bacitracin or erythromycin applied to the eyelid margins one or more times daily or at bedtime for a few weeks 1:

• 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
• Mupirocin 2% topical ointment is an alternative option for minor skin infections 1

Third-Line Treatment for Severe or Recurrent Cases

For cases not responding adequately to conservative measures:

• For moderate to severe cases with meibomian gland dysfunction not adequately controlled by topical treatments, consider oral tetracyclines (doxycycline, minocycline, or tetracycline) 1
• Tetracyclines are contraindicated in pregnancy and children under 8 years 1
• For women of childbearing age and children, use oral erythromycin or azithromycin instead 1
• For worsening hordeolum despite conservative management, incision and drainage is recommended as the next step 1
• If there are signs of spreading infection, initiate oral antibiotics with consideration of trimethoprim-sulfamethoxazole or tetracycline for suspected MRSA infection 1
• Patients started on oral antibiotics should be reevaluated in 24-48 hours to verify clinical response 1

When to Consider Biopsy or Urgent Referral

If the stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 1:

• If there is no improvement after incision and drainage plus appropriate antibiotic therapy, refer to an ophthalmologist 1
• If there are signs of orbital cellulitis or systemic illness, immediate referral to an ophthalmologist is necessary 1

Long-Term Management Expectations

• 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
• Regular eyelid hygiene, especially for those prone to styes or with chronic blepharitis, helps prevent recurrence 1
• Follow-up should be based on the severity of the condition and response to treatment 1

Evidence Quality Note

A Cochrane review found no high-quality randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum, indicating that current treatment recommendations are based on clinical experience and lower-quality evidence 2, 3. Despite this limitation, the conservative approach outlined above remains the standard of care and is widely effective for most cases.