What is a stye and how is it treated?

What is a Stye and How is it Treated?

A stye (hordeolum) is a painful, acute bacterial infection of the eyelid oil glands that should be treated first-line with warm compresses for 5-10 minutes once or twice daily, followed by gentle eyelid cleansing and massage, with topical antibiotic ointment (bacitracin or erythromycin) reserved for second-line therapy. 1

Definition and Pathophysiology

A stye, medically termed hordeolum, is an acute purulent localized inflammation of the eyelid margin caused by bacterial infection, most commonly Staphylococcus aureus. 2, 3 The infection affects the oil-producing glands of the eyelid and can be classified as:

• External hordeolum (stye): Infection of the eyelash follicle, Zeis gland, or Moll gland 4
• Internal hordeolum: Infection of the meibomian glands within the tarsal plate 4

The condition presents as a painful, localized swelling with redness at the eyelid margin. 5 In many cases, the lesion drains spontaneously and resolves without treatment, though inflammation can spread to other ocular tissues and recurrences are common. 6, 7

First-Line Treatment: Conservative Management

Warm Compresses

• Apply warm compresses to the affected eyelid for 5-10 minutes to soften adherent debris and warm meibomian secretions 1
• Perform once or twice daily at times convenient for the patient 1
• Use water that is warm but not hot enough to burn the skin 1
• For sustained warmth, use hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in the microwave 1

Eyelid Cleansing and Massage

• After warm compresses, perform gentle eyelid cleansing and massage to help express the contents of the affected gland 1
• Gently rub the base of the eyelashes using either diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip 1
• Eye cleaners with hypochlorous acid at 0.01% have strong antimicrobial effects and can be used for treatment 1

Second-Line Treatment: Topical Antibiotics

When conservative measures are insufficient:

• Prescribe topical antibiotic ointment such as bacitracin or erythromycin 1
• Apply to the eyelid margins one or more times daily or at bedtime for a few weeks 1
• The frequency and duration should be guided by the severity of the condition and response to treatment 1
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 1

Important Safety Considerations and Caveats

Patient-Specific Precautions

• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 1
• Patients with advanced glaucoma should not apply excessive pressure on the eyelids as it may increase intraocular pressure 1
• Patients lacking manual dexterity may find eyelid cleaning dangerous and require assistance or alternative approaches 1

Treatment Warnings

• Long-term antibiotic treatment may result in the development of resistant organisms 1
• If a stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, consider biopsy to exclude the possibility of carcinoma 1
• 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

For Severe or Recurrent Cases

• For moderate to severe cases, especially prior to intraocular surgery, topical antibiotics combined with eyelid hygiene are recommended 1
• A history of recurrent styes or chalazia is common in patients with underlying blepharitis and may require ongoing management 2
• Children with a history of styes have an increased risk of developing adult rosacea and may benefit from dermatologic evaluation 2

Evidence Quality Note

Despite the widespread use of these treatments, no randomized controlled trials have been conducted to evaluate the effectiveness of non-surgical interventions for acute internal hordeolum, with most evidence based on clinical experience and expert consensus. 6, 7 The recommendations are derived from high-quality ophthalmology guidelines rather than trial data, reflecting standard clinical practice supported by decades of clinical experience. 1