What is the recommended treatment for a stye in a pregnant woman at 28 weeks gestation?

Treatment of Stye at 28 Weeks Pregnancy

For a stye (hordeolum) at 28 weeks gestation, apply warm compresses 4-5 times daily for 10-15 minutes and maintain eyelid hygiene; if topical antibiotic therapy is needed, erythromycin or bacitracin ophthalmic ointment are safe first-line options throughout pregnancy.

Conservative Management (First-Line)

• Warm compresses remain the cornerstone of stye treatment during pregnancy, applied 4-5 times daily for 10-15 minutes to promote spontaneous drainage 1, 2.

• Gentle eyelid hygiene with diluted baby shampoo or commercially available eyelid cleansers should be performed daily to prevent recurrence 2.

• Most styes resolve spontaneously within 1-2 weeks with conservative management alone, avoiding the need for medication 1.

Topical Antibiotic Therapy (When Needed)

• If topical antibiotic therapy is indicated for persistent or worsening styes, erythromycin ophthalmic ointment or bacitracin ophthalmic ointment are considered safe throughout all trimesters of pregnancy 2.

• Topical antibiotics have minimal systemic absorption when applied to the eyelid, making them safer than oral agents during pregnancy 1, 2.

• Apply the ointment to the affected eyelid margin 2-4 times daily until resolution 2.

Systemic Antibiotics (Rarely Needed)

• Oral antibiotics are rarely necessary for uncomplicated styes but may be considered for severe cases with surrounding cellulitis or failure of topical therapy 3.

• If systemic therapy is required at 28 weeks gestation, cephalexin (500 mg orally 3-4 times daily) or amoxicillin (500 mg orally 3 times daily) are safe options 3.

• Erythromycin (250-500 mg orally 4 times daily) is also safe throughout pregnancy if beta-lactam allergy exists 3.

Treatments to Avoid

• Avoid incision and drainage during pregnancy unless absolutely necessary, as this increases infection risk and is rarely needed for simple styes 1.

• Do not use topical corticosteroids without ophthalmology consultation, as their safety profile in pregnancy requires careful risk-benefit assessment 2.

• Avoid squeezing or manually expressing the stye, which can spread infection and worsen inflammation 1.

Common Pitfalls

• Prescribing topical ketoconazole or other azole antifungals for presumed fungal eyelid infections is inappropriate for styes (which are bacterial) and ketoconazole should be avoided during the first trimester 2.

• Failing to distinguish between a stye (hordeolum) and a chalazion (sterile lipogranuloma) can lead to inappropriate antibiotic use; chalazia typically require warm compresses only 1.

• Discontinuing warm compresses once symptoms begin improving often leads to incomplete resolution and recurrence 2.

When to Refer

• Refer to ophthalmology if the stye does not respond to 2 weeks of conservative management with warm compresses and topical antibiotics 1.

• Immediate ophthalmology referral is warranted if there is vision change, severe periorbital cellulitis, or signs of preseptal/orbital cellulitis 1, 2.