Stye (Hordeolum) Treatment
For acute hordeolum, begin immediately with warm compresses applied for 10-15 minutes, 3-4 times daily, combined with eyelid hygiene measures; most cases resolve spontaneously within 5-14 days with this conservative approach alone. 1, 2, 3
First-Line Conservative Management
Warm Compresses:
- Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily 1, 2, 3
- This increases blood circulation, relieves pain, and promotes spontaneous drainage of purulent material 2
- Continue until complete resolution occurs 2
Eyelid Hygiene:
- Clean eyelid margins with mild soap or commercial eyelid cleansers 2
- After warm compresses, gently massage the affected area to help express obstructed glands 2
- Discontinue all eye makeup during active infection 2, 3
When to Add Topical Antibiotics
Consider topical antibiotic drops or ointment for:
- Moderate to severe cases 3
- Signs of spreading infection 2
- Cases not improving after 3-4 days of conservative therapy alone 2
The antibiotic choice should account for normal eyelid and conjunctival flora, as hordeolum is typically caused by staphylococcal infection 3. Azithromycin ophthalmic solution has demonstrated efficacy with complete resolution in treated cases 1.
Oral Antibiotics
Reserve systemic antibiotics only for severe cases with spreading infection or systemic symptoms 2.
Critical Management Points
Do NOT:
- Squeeze or attempt to "pop" the hordeolum, as this spreads infection 2
- Ignore underlying chronic blepharitis, which predisposes to recurrence 2, 3
DO evaluate for:
- Underlying blepharitis or meibomian gland dysfunction requiring aggressive treatment 1, 2, 3
- Rosacea or seborrheic dermatitis as predisposing conditions 2, 3
When to Refer or Escalate
Immediate ophthalmologic evaluation if:
- Moderate to severe pain (may indicate secondary infection or atypical presentation) 3
- Visual loss 3
- Severe or chronic redness 3
- No improvement after 3-4 days of conservative therapy 2
Biopsy consideration for:
- Recurrence in the same location, especially in elderly patients (raises suspicion for sebaceous carcinoma) 1, 2, 3
- Marked asymmetry or resistance to therapy 1
- Eyelid margin distortion, lash loss (madarosis), or ulceration 1, 3
- Unilateral chronic blepharitis unresponsive to therapy 1, 3
Prevention of Recurrence
For patients with recurrent hordeola:
- Implement aggressive eyelid hygiene as a regular routine 2, 3
- Treat underlying blepharitis and meibomian gland dysfunction 1, 2, 3
- Address systemic conditions like rosacea and seborrheic dermatitis 2, 3
- Avoid eye makeup during active inflammation 3
Evidence Quality Note
The evidence base for hordeolum treatment is notably weak, with current recommendations based primarily on expert consensus from the American Academy of Ophthalmology 3. Cochrane reviews found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 4, 5. Despite this limitation, the conservative approach with warm compresses and eyelid hygiene remains the standard of care, as most cases resolve spontaneously 3, 4, 5.