What antibiotic eye ointment (e.g. erythromycin or bacitracin) can be used to treat a stye (hordeolum)?

Treatment of Styes (Hordeolum) with Antibiotic Ointment

For a stye, apply either erythromycin 0.5% or bacitracin ophthalmic ointment directly to the eyelid margin where the lashes emerge, 1-4 times daily, but only if the stye persists beyond 1-2 weeks or worsens despite warm compresses and eyelid hygiene. 1

Initial Conservative Management (First-Line Treatment)

Most styes resolve spontaneously within 1-2 weeks with conservative measures alone, making antibiotics unnecessary initially. 1

Start with these measures:

• Apply warm compresses for several minutes, 4-6 times daily, to soften material and promote spontaneous drainage 1
• Perform gentle eyelid cleansing and massage to maintain hygiene 1
• Continue this regimen for 1-2 weeks before considering antibiotic ointment 1

When to Add Antibiotic Ointment

Add topical antibiotics only if:

• The stye persists beyond 1-2 weeks despite conservative treatment 1
• The stye worsens or spreads despite warm compresses 1

Antibiotic Ointment Selection and Application

Both erythromycin and bacitracin are appropriate first-line choices:

• Erythromycin 0.5% ophthalmic ointment is effective against the typical pathogens (Staphylococcus aureus and S. epidermidis) that cause styes 2
• Bacitracin ophthalmic ointment is equally effective against these organisms 2
• Both antibiotics have similar susceptibility patterns for eyelid margin infections 2

Proper application technique:

• Apply approximately 1 cm ribbon of ointment directly to the eyelid margin where the lashes emerge 1, 3
• Never apply into the conjunctival sac when treating eyelid margin conditions like styes, as the infection is localized to the meibomian glands or lash follicles on the lid margin itself 1
• Apply 1-4 times daily depending on severity 1
• Continue for a few weeks, adjusting frequency based on clinical response 1

When Systemic Antibiotics Are Needed

Consider oral antibiotics for:

• Recurrent styes not responding to topical treatment 1
• Severe styes with spreading infection 1

Oral antibiotic options:

• Cephalexin or dicloxacillin for deeper infection in adults 1
• Oral erythromycin in children under 8 years or pregnant women to avoid tooth staining from tetracyclines 1, 4

Critical Pitfalls to Avoid

Application errors:

• Do not apply ointment into the conjunctival sac—the target is the lid margin where bacterial colonization occurs 1
• Avoid aggressive manipulation or squeezing of the stye, as this can spread infection or cause mechanical irritation 1

Medication errors:

• Do not use corticosteroid drops for an active stye, as steroids can worsen bacterial infections and are only indicated for inflammatory complications after the infection is controlled 1
• Bacitracin is not effective for neonatal ophthalmia prophylaxis, but this is irrelevant for stye treatment 5

Special populations:

• In patients with advanced glaucoma, avoid aggressive lid pressure during warm compress application, as this may increase intraocular pressure 1
• If long-term or repeated treatment is needed, rotate different antibiotics to prevent development of resistant organisms 1