What are the treatment and discharge instructions for a 30-year-old patient presenting with a stye (hordeolum) on the eye?

Treatment and Discharge Instructions for Stye (Hordeolum)

Immediate Treatment

Start with warm compresses applied to the affected eyelid for 5-10 minutes, once or twice daily, followed by gentle eyelid cleansing and massage. 1

Warm Compress Technique

• Use water that is warm but not hot enough to burn the skin 1
• Options for sustained warmth include:
  • Hot tap water on a clean washcloth 2
  • Over-the-counter heat packs 2
  • Homemade bean/rice bags heated in the microwave 2
• Apply for 5-10 minutes to soften debris and warm meibomian secretions 1
• Perform once or twice daily at convenient times 1

Eyelid Cleansing After Warm Compresses

• Gently rub the base of the eyelashes using 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 1
• Gentle massage helps express the contents of the affected gland 1

When to Add Topical Antibiotics

If the stye does not improve with warm compresses and eyelid hygiene after several days, prescribe topical antibiotic ointment. 1

• Bacitracin or erythromycin ointment applied to the eyelid margins 1
• Apply one or more times daily or at bedtime 1
• Continue for a few weeks, with frequency and duration guided by severity and response 1
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin 1

Critical Safety Instructions for Discharge

Technique Warnings

• Patients lacking manual dexterity or necessary skill should not perform eyelid cleansing themselves 1
• Patients with advanced glaucoma must avoid applying excessive pressure on the eyelids as it may increase intraocular pressure 1
• Patients with neurotrophic corneas need proper counseling to avoid corneal epithelial injury 1

Expected Course

• Symptoms often recur when treatment is discontinued, so long-term maintenance may be required 1
• Most styes drain spontaneously and resolve without treatment 3
• If unresolved, an acute internal hordeolum can become chronic or develop into a chalazion 3

Red Flags Requiring Return Visit

• If the stye is markedly asymmetric, resistant to therapy, or recurrent in the same location, biopsy should be considered to exclude carcinoma 1
• Spreading inflammation to adjacent tissues 3
• Worsening pain or vision changes 3
• No improvement after 2-3 weeks of conservative treatment 4

Important Caveats

Long-term antibiotic treatment may result in development of resistant organisms, so avoid prolonged or repeated courses without clear indication 2, 1. The evidence base for stye treatment is limited—Cochrane reviews found no randomized controlled trials specifically for acute internal hordeolum 3, 5, so recommendations are based on expert consensus and blepharitis management guidelines 2, 1.