Stye Treatment
Begin with warm compresses applied 1-2 times daily and gentle eyelid hygiene using diluted baby shampoo or hypochlorous acid 0.01% cleaners, then add topical antibiotic ointment (bacitracin or erythromycin) to the eyelid margins if no improvement occurs after 2-4 weeks. 1, 2
Understanding the Condition
A stye (hordeolum) is an acute bacterial infection of the eyelid margin oil glands that often occurs in the context of underlying chronic blepharitis. 3 The treatment approach must address both the acute infection and any underlying eyelid margin disease to prevent recurrence. 1, 4
First-Line Treatment: Conservative Management
Apply warm compresses to the affected eyelid for several minutes once or twice daily using hot tap water on a clean washcloth, over-the-counter heat packs, or microwaveable bean/rice bags. 1 The heat softens crusts and warms meibomian secretions to facilitate drainage. 5, 2
Avoid compresses hot enough to burn the skin. 1
Perform gentle eyelid cleansing at the base of eyelashes using diluted baby shampoo or commercially available eyelid cleaners on a cotton swab, pad, or clean fingertip. 1, 2
Hypochlorous acid 0.01% eye cleaners provide strong antimicrobial effects and are particularly effective for both anterior and posterior blepharitis. 1, 2
Remove all scales and crusts carefully before applying any topical treatments. 6
Continue this regimen daily, as symptoms often recur when treatment is discontinued. 5, 1
Second-Line Treatment: Topical Antibiotics
If conservative measures provide inadequate relief after 2-4 weeks, escalate to topical antibiotics: 1, 2
Bacitracin or erythromycin ointment should be applied directly to the eyelid margins 1-3 times daily or at bedtime for several weeks. 1, 6
The FDA-approved dosing for bacitracin ophthalmic ointment is 1-3 times daily applied directly into the conjunctival sac or spread uniformly over the lid margins after removing all scales and crusts. 6
Azithromycin in sustained-release formulation has demonstrated efficacy in reducing signs and symptoms. 1, 2
Rotate different antibiotic classes intermittently to prevent development of resistant organisms. 1, 2
Adjust frequency and duration based on severity and treatment response. 1, 2
Third-Line Treatment: Oral Antibiotics
For severe or recurrent cases with inadequate response to topical therapy, particularly when associated with meibomian gland dysfunction: 1, 2
Doxycycline, minocycline, or tetracycline given daily, then tapered after clinical improvement. 5, 1
Alternative regimens for women of childbearing age and children: oral erythromycin (30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks in children) or azithromycin (1 g per week for 3 weeks or 500 mg daily for 3 days in three cycles with 7-day intervals). 5, 1, 2
Tetracyclines and macrolides provide both antimicrobial and anti-inflammatory effects. 5, 1
Special Considerations and Cautions
Patients with advanced glaucoma should avoid aggressive lid pressure during massage or warm compress application, as this may increase intraocular pressure. 5, 1
Long-term antibiotic use carries risk of creating resistant organisms. 1, 2
Styes are typically associated with chronic blepharitis, which is incurable and requires long-term daily eyelid hygiene for symptom control. 1, 2 Patients must understand this chronic nature to maintain compliance. 4
Before intraocular surgery, patients with moderate to severe blepharitis should receive topical antibiotics and intensive eyelid hygiene to reduce endophthalmitis risk. 1, 4
Treatment Algorithm Summary
Weeks 1-4: Warm compresses 1-2 times daily + eyelid hygiene with hypochlorous acid 0.01% or diluted baby shampoo 1, 2
If inadequate response after 2-4 weeks: Add bacitracin or erythromycin ointment to eyelid margins 1-3 times daily 1, 6
If persistent or severe: Consider oral doxycycline (adults) or erythromycin/azithromycin (children/pregnant women) 5, 1
Maintain long-term: Daily eyelid hygiene to prevent recurrence 1, 2