Antibiotic Treatment for Stye (External Hordeolum)
Most styes do not require antibiotic therapy and resolve with conservative management alone—warm compresses and eyelid hygiene are first-line treatment. 1
Initial Conservative Management (First-Line)
Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften crusts, warm meibomian secretions, and promote spontaneous drainage 1
Clean the eyelid margin once or twice daily using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip to remove debris and inflammatory material 1
Gentle vertical massage of the eyelid can help express secretions if there is posterior blepharitis or meibomian gland involvement 1
Patients with advanced glaucoma should avoid aggressive eyelid manipulation as it may increase intraocular pressure 1
When to Add Topical Antibiotics
If no improvement occurs after 2-4 weeks of conservative management, add topical antibiotic ointment to the eyelid margins. 1
Topical Antibiotic Options:
Bacitracin ointment applied to eyelid margins one or more times daily or at bedtime for a few weeks 1
Erythromycin ointment applied to eyelid margins one or more times daily or at bedtime for a few weeks 1
Mupirocin 2% topical ointment is an alternative for minor skin infections 2, 1
Rotate different antibiotics intermittently to prevent development of resistant organisms 1
When to Use Oral Antibiotics
Oral antibiotics are reserved for patients whose symptoms are not adequately controlled by eyelid cleansing or topical treatments, or when there are signs of spreading infection. 1
Oral Antibiotic Options:
For adults and children ≥8 years:
For children <8 years, pregnant women, or nursing mothers (tetracyclines contraindicated due to tooth staining):
- Erythromycin 1
- Azithromycin 500 mg daily for 3 days in three cycles with 7-day intervals between cycles 1
Important Caveat:
The FDA warns that oral azithromycin may cause cardiac electrical abnormalities with potential for serious heart rhythm irregularities, particularly in patients with high baseline cardiovascular disease risk 1
Surgical Intervention
Incision and drainage is indicated for worsening styes that fail conservative and antibiotic management, along with continuation of warm compresses and consideration of oral antibiotics if there are signs of spreading infection. 1
Long-Term Management
Patients should understand that warm compress and eyelid cleansing may be required long-term, as symptoms often recur when treatment is discontinued 1
Ongoing maintenance therapy may be necessary due to the chronic nature of eyelid inflammation 1
Avoid long-term topical corticosteroids despite their symptomatic benefit, as they increase risk of elevated intraocular pressure and cataract formation 1
If topical corticosteroids are used, limit to 1-2 weeks at minimal effective doses with site-specific agents like loteprednol etabonate 1
Evidence Quality Note
High-quality evidence for antibiotic treatment of styes is lacking—Cochrane reviews found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum 3, 4. Current recommendations are based on expert consensus and clinical practice patterns rather than robust trial data.