What are the treatment options for a stye, including medications?

Stye (Hordeolum) Treatment and Medication

First-Line Treatment: Conservative Management

Warm compresses and eyelid hygiene are the cornerstone of stye treatment, with topical antibiotics reserved for cases that fail to respond to conservative measures within 2-4 weeks. 1, 2, 3

Warm Compress Technique

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften debris, warm meibomian secretions, and promote drainage 2, 3
• Use water that is warm but not hot enough to burn the skin 3
• Options for sustained warmth include hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in a microwave 1, 3

Eyelid Hygiene Protocol

• After warm compresses, perform gentle eyelid cleansing and massage to help express the contents of the affected gland 1, 3
• Clean the eyelid by gently rubbing 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, 3
• Eye cleaners containing hypochlorous acid (0.01%) have strong antimicrobial effects and can be used for treatment 1, 3
• Perform eyelid cleansing once or twice daily to remove debris and inflammatory material 2, 3

Second-Line Treatment: Topical Antibiotics

If no improvement occurs after 2-4 weeks of conservative management, add topical antibiotic ointment. 1, 2

Antibiotic Selection and Application

• Bacitracin or erythromycin ointment applied to the eyelid margins one or more times daily or at bedtime for a few weeks 1, 2, 3
• Mupirocin 2% topical ointment is an alternative option for minor skin infections 2
• The frequency and duration should be guided by severity and response to treatment 1, 2, 3
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 1

Third-Line Treatment: Oral Antibiotics

For severe cases with meibomian gland dysfunction not controlled by topical measures, or for signs of spreading infection, consider oral antibiotics. 1, 2

Oral Antibiotic Options

• Doxycycline, minocycline, or tetracycline for patients whose symptoms are not adequately controlled by eyelid cleansing or topical treatments 1, 2
• Contraindicated in pregnancy and children under 8 years 2
• For women of childbearing age and children: use erythromycin or azithromycin instead 1, 2
• For suspected MRSA with spreading infection: consider trimethoprim-sulfamethoxazole or tetracycline (though treatment failure rates up to 21% have been reported with tetracyclines) 2

Surgical Management

For worsening hordeolum despite medical management, incision and drainage is the next step. 2

• Perform incision and drainage along with warm compresses 2
• Initiate oral antibiotics if there are signs of spreading infection 2
• Re-evaluate patients on oral antibiotics in 24-48 hours to verify clinical response 2

Critical Safety Considerations

Patient-Specific Precautions

• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1, 3
• Patients with advanced glaucoma should avoid aggressive pressure on the eyelids as it may increase intraocular pressure 1, 3
• Eyelid cleaning can be dangerous if the patient lacks manual dexterity or skill to perform the task safely 1, 3

Treatment Duration and Monitoring

• 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, 3
• Long-term antibiotic treatment may result in resistant organisms 1, 3
• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude carcinoma 1, 3

When to Refer to Ophthalmology

Immediate referral is necessary for signs of orbital cellulitis or systemic illness. 2

• No improvement after incision and drainage plus appropriate antibiotic therapy 2
• Signs of orbital cellulitis or systemic illness 2
• Extensive infection or stye in an area difficult to treat (such as inner eyelid) 2

Prevention Strategies

• Regular eyelid hygiene, especially for those prone to styes or with chronic blepharitis 1
• Proper contact lens hygiene and avoiding wearing contact lenses longer than recommended 1
• Avoid sharing eye makeup and replace eye makeup regularly 1
• For recurrent styes, daily eyelid cleansing may help prevent recurrence 1