What is the recommended treatment and eyedrop regimen for a patient with a stye?

Treatment of Stye (External Hordeolum)

For a stye, initiate warm compresses applied to the closed eyelid for 5-10 minutes, 3-4 times daily, combined with gentle eyelid cleansing using diluted baby shampoo or commercial eyelid cleaners once or twice daily. 1, 2

First-Line Conservative Management

Warm Compresses:

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften adherent material and promote spontaneous drainage 1, 2
• Use hot tap water on a clean washcloth, over-the-counter heat pack, or microwaveable bean/rice bag 1
• Critical warning: Instruct patients to avoid compresses so hot they burn the skin 1
• Patients with advanced glaucoma should avoid aggressive eyelid pressure during compress application as it may increase intraocular pressure 2

Eyelid Cleansing:

• Clean the eyelid margins using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip once or twice daily 1, 2, 3
• Eye cleaners containing hypochlorous acid at 0.01% have strong antimicrobial effects and are particularly useful 1, 2, 3
• Rub the eyelid margins gently from side to side to remove crusting from the eyelashes 1
• This regimen often needs to be continued long-term as symptoms frequently recur when treatment is discontinued 2

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

Topical Antibiotics:

• Apply topical antibiotic ointments (bacitracin or erythromycin) to the eyelid margins one or more times daily for a few weeks 3
• Note that most styes drain spontaneously and resolve without antibiotic treatment 4, 5, 6

Important Clinical Context

Natural History:

• In many cases, styes drain spontaneously and resolve untreated 4, 5
• The inflammation can spread to other ocular glands or tissues, and recurrences are common 4, 5
• Conservative therapies (warm compresses, eyelid scrubs, eyelid massage) are first-line treatments 6

Evidence Limitations:

• A Cochrane systematic review found no randomized controlled trials evaluating non-surgical interventions for internal hordeolum, indicating the evidence base relies primarily on clinical experience and observational data 4, 5
• Most treatment recommendations are based on expert consensus rather than high-quality trial evidence 4, 5

When to Consider Referral:

• If the lesion does not resolve with conservative management, surgical incision and drainage may be necessary (requires ophthalmology referral) 6
• Consider referral if there are signs of spreading infection or systemic illness 3