What is the recommended treatment for a stye?

Stye Treatment

First-Line Treatment: Conservative Management

Start with warm compresses applied to the affected eyelid for 5-10 minutes, 3-4 times daily, combined with gentle eyelid cleansing—this is the recommended first-line treatment for most styes. 1, 2, 3

Warm Compress Protocol

• Apply warm compresses for 5-10 minutes, 3-4 times daily using hot tap water on a clean washcloth, over-the-counter heat packs, or microwaveable bean/rice bags 1, 2, 3
• The warmth softens debris, warms meibomian secretions, and promotes spontaneous drainage 1, 2
• Critical safety warning: Ensure the compress is warm but not hot enough to burn the skin 2

Eyelid Cleansing Technique

• Perform gentle eyelid cleansing once or twice daily, immediately after warm compresses 1, 2, 3
• Use 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 at 0.01% have strong antimicrobial effects and are particularly useful 1, 2
• Apply gentle vertical massage of the eyelid to help express secretions from the meibomian glands 1, 2, 3

Critical Safety Considerations

• Patients with advanced glaucoma should avoid aggressive eyelid pressure, as it may increase intraocular pressure 1, 2, 3
• Patients with neurotrophic corneas require proper counseling to avoid corneal epithelial injury during eyelid cleansing 1, 2, 3
• Eyelid cleaning can be dangerous if the patient lacks manual dexterity or necessary skill to perform the task safely 2

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

Prescribe topical antibiotic ointment such as bacitracin or erythromycin applied to the eyelid margins 1-3 times daily for a few weeks if conservative measures fail. 1, 2, 3

• Mupirocin 2% topical ointment is an alternative for minor skin infections 1, 3
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 2
• Important caveat: Long-term antibiotic use risks development of resistant organisms, which is particularly concerning since staphylococcal species can cause serious complications like postoperative endophthalmitis 1, 4

Third-Line Treatment: Oral Antibiotics for Severe or Recurrent Cases

Consider oral tetracyclines (doxycycline, minocycline, or tetracycline) for patients whose symptoms are not controlled by topical treatments. 1, 2, 3

• Tetracyclines are contraindicated in pregnancy and children under 8 years 1, 2, 3
• For women of childbearing age and children, use oral erythromycin or azithromycin instead 1, 2, 3

Surgical Management: Incision and Drainage

For worsening hordeolum despite conservative management, incision and drainage is recommended as the next step. 2, 3

• Incision and drainage is not indicated for an already-draining stye 1
• Surgical drainage should be reserved for cases that fail conservative management 1

Red Flags Requiring Immediate Escalation

If there are signs of spreading infection, initiate oral antibiotics with consideration of trimethoprim-sulfamethoxazole or tetracycline for suspected MRSA infection. 2, 3

• Cellulitis extending >5 cm beyond the stye margins requires systemic antibiotics covering Gram-positive organisms, including MRSA if risk factors present 1
• Fever >38.5°C, tachycardia >110 bpm, or other systemic signs indicate need for systemic antibiotics 1
• Signs of orbital cellulitis (proptosis, ophthalmoplegia, or vision changes) require immediate ophthalmology referral 1, 2, 3
• Patients started on oral antibiotics should be reevaluated in 24-48 hours to verify clinical response 2, 3

When to Consider Biopsy or Specialist Referral

If the stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma. 2

• If there is no improvement after incision and drainage plus appropriate antibiotic therapy, refer to an ophthalmologist 2, 3
• If there are signs of orbital cellulitis or systemic illness, immediate referral to an ophthalmologist is necessary 2, 3

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, 2, 3

• Regular eyelid hygiene, especially for those prone to styes or with chronic blepharitis, helps prevent recurrence 1, 2

Common Pitfalls to Avoid

Simple, uncomplicated styes should be managed with local measures alone—oral antibiotics should not be prescribed for simple, uncomplicated styes. 1

• Avoid prescribing antibiotics unnecessarily, as this contributes to antibiotic resistance 1
• Do not perform incision and drainage on an already-draining stye 1