Stye treatment
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Here is a complete, textbook-sourced guide to stye treatment:
Stye (Hordeolum) - Treatment
What Is a Stye?
A hordeolum (stye) is an acute bacterial infection - most commonly Staphylococcus aureus - of the oil glands (Zeis or meibomian) or hair follicle at the eyelid margin.
- External hordeolum: abscess of the Zeis gland or follicle at the lash line - appears as a small pustule on the eyelid margin
- Internal hordeolum: abscess of the meibomian gland - pustule on the inner tarsal surface
Treatment
1. First-Line: Warm Compresses (All Cases)
- Apply a warm, moist compress for 10-15 minutes, 3-5 times daily
- Follow with gentle massage over the lesion
- This is the primary treatment - it promotes drainage by normalizing flow through the obstructed oil gland
- Most styes resolve on their own with this alone within 1-2 weeks
2. Topical Antibiotics (For Hordeolum)
Use a short course when infection is apparent:
- Erythromycin ophthalmic ointment twice daily for 7-10 days (preferred)
- Bacitracin ointment b.i.d. for 1-2 weeks
- Tobramycin eye drops/ointment b.i.d. for 1-2 weeks
- Removing the offending eyelash can also be considered
3. Topical Antibiotic/Steroid (For Chalazion - chronic form)
If the lesion has evolved into a chalazion (non-tender, chronic):
- Neomycin/polymyxin B/dexamethasone ointment b.i.d. for 1-2 weeks
4. Systemic Antibiotics
Indicated when there is significant surrounding cellulitis (preseptal spread). Options include:
- Oral amoxicillin-clavulanate 875 mg twice daily for 10-14 days
- If MRSA is suspected: add clindamycin or TMP-SMX
5. Chronic Low-Dose Doxycycline
For multiple or recurrent styes/chalazia, or in patients with ocular rosacea:
- Doxycycline 20-50 mg orally daily to twice daily (for its antibacterial and anti-inflammatory properties)
Procedural Management (When Medical Therapy Fails)
| Scenario | Intervention |
|---|---|
| Hordeolum worsens or forms abscess | Incision and drainage (I&D) - refer to ophthalmologist |
| Chalazion persists >3-4 weeks | Incision and curettage OR intralesional steroid injection |
| Intralesional steroid | Triamcinolone 40 mg/mL mixed 1:1 with 2% lidocaine/epinephrine, 0.2-1.0 mL |
Note: Steroid injections carry a risk of permanent skin depigmentation or atrophy, especially in dark-skinned individuals. Rarely, retrograde intra-arterial infiltration can cause central retinal artery occlusion. Always discuss risks with the patient.
When to Refer/Admit
- Vision affected
- Lesion does not improve after a few days of home treatment
- Signs of preseptal cellulitis (spreading erythema, warmth, fever) - oral antibiotics and close follow-up
- Signs of orbital (post-septal) cellulitis (proptosis, ophthalmoplegia, pain with eye movement, chemosis) - hospitalize for IV antibiotics and CT imaging
What NOT To Do
- Do not squeeze or pop the stye - this can spread infection
- Do not wear contact lenses until the stye resolves
- Do not apply makeup to the affected eye area
Stye vs Chalazion - Key Distinction
| Feature | Hordeolum (Stye) | Chalazion |
|---|---|---|
| Onset | Acute | Subacute/chronic |
| Tenderness | Painful | Usually painless |
| Cause | Bacterial infection | Sterile granulomatous inflammation |
| Location | Lash line margin | Within lid/tarsal plate |
| Treatment | Warm compresses + antibiotics | Warm compresses; I&C or steroid injection if persistent |
Sources: Wills Eye Manual 6e, Tintinalli's Emergency Medicine, Rosen's Emergency Medicine
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