What medication dose and frequency would you order for an uncomplicated stye in a healthy adult patient with no significant past medical history?

Treatment of Uncomplicated Stye (Hordeolum)

For an uncomplicated stye in a healthy adult, warm compresses applied 4 times daily for 10-15 minutes are the primary treatment, with topical antibiotic ointment (erythromycin or bacitracin) applied to the eyelid margin 1-4 times daily for a few weeks as an optional adjunct. 1

Primary Treatment Approach

• Warm compresses are the cornerstone of stye management, applied directly to the affected eyelid for 10-15 minutes, 4 times daily 1
• This promotes spontaneous drainage and resolution, as most hordeola drain without intervention 2, 3
• The heat helps liquefy inspissated meibomian gland secretions and improves local blood flow 1

Topical Antibiotic Options (Optional Adjunct)

If you choose to prescribe a topical antibiotic, the following regimens are appropriate:

• Erythromycin ophthalmic ointment: Apply to eyelid margins 1-4 times daily (or at bedtime) for a few weeks 1
• Bacitracin ophthalmic ointment: Apply to eyelid margins 1-4 times daily (or at bedtime) for a few weeks 1
• The frequency and duration should be guided by severity and response to treatment 1

Why Topical Antibiotics Are Optional

• Topical antibiotics provide symptomatic relief and decrease bacterial load from the eyelid margin in anterior blepharitis 1
• However, no randomized controlled trials demonstrate their effectiveness specifically for acute internal hordeolum 2, 3
• Most styes resolve spontaneously with warm compresses alone 2, 3

When Oral Antibiotics Are NOT Indicated

Oral antibiotics have no role in uncomplicated stye treatment and should be reserved exclusively for:

• Complicated cases with preseptal or orbital cellulitis 1
• Recurrent styes associated with chronic meibomian gland dysfunction (MGD) 1
• Suspected methicillin-resistant Staphylococcus aureus (MRSA) with systemic signs 1

Critical Pitfalls to Avoid

• Do not prescribe oral antibiotics for simple, uncomplicated styes - this promotes unnecessary antibiotic resistance and exposes patients to adverse effects without proven benefit 4, 2, 3
• Avoid topical corticosteroids unless there is severe inflammation requiring ophthalmology supervision, as they can worsen infection and cause elevated intraocular pressure 1, 4
• Do not use tetracyclines in children <8 years of age due to risk of dental enamel abnormalities 1

When to Refer to Ophthalmology

Immediate referral is indicated for:

• Visual loss or moderate to severe pain 4
• Corneal involvement or conjunctival scarring 4
• Lack of response to conservative therapy after 2-3 weeks 1
• Recurrent episodes suggesting underlying MGD 1
• Signs of preseptal or orbital cellulitis (eyelid edema, erythema extending beyond lid margin, fever) 1

Management of Recurrent Styes

For patients with recurrent styes despite warm compresses and hygiene:

• Eyelid hygiene measures: Daily lid scrubs with diluted baby shampoo or commercial lid cleansing products 1
• Consider oral doxycycline 100 mg twice daily (in adults and children ≥8 years) if associated with chronic MGD, tapered after clinical improvement 1, 5
• Oral erythromycin 30-40 mg/kg/day divided into 3 doses for children <8 years with recurrent disease, given for 3 weeks then twice daily for 4-6 weeks 1, 6
• Decolonization strategies (nasal mupirocin twice daily for 5-10 days) may be considered if S. aureus carriage is suspected 1