Stye (Hordeolum) - Treatment

What is it?

• External hordeolum - infection of the follicle of an eyelash and adjacent glands of Zeis (sebaceous) or Moll (sweat). Appears as a pustule at the eyelid margin.
• Internal hordeolum - infection of the meibomian glands; the pustule forms on the inner surface of the tarsal plate.

Treatment

1. First-Line: Warm Compresses

• Apply for 5-15 minutes, 3-5 times per day
• Helps soften the stye and encourage spontaneous drainage
• This alone resolves most styes within 1-2 weeks

2. Topical Antibiotics

• Erythromycin ophthalmic ointment twice daily for 7-10 days is the most commonly recommended option
• Alternatives: bacitracin ointment, or antibiotic drops such as moxifloxacin or gatifloxacin
• Topical antibiotics help treat the infection and prevent spread

3. Eyelid Hygiene

• Gentle cleansing of the eyelid margin daily
• Removal of the offending eyelash can be considered in some cases

4. Systemic (Oral) Antibiotics

• Reserved for cases with significant surrounding cellulitis or spread beyond the eyelid
• Low-dose doxycycline (20-40 mg/day) may be considered for recurrent or refractory cases, particularly if meibomian gland dysfunction is a contributing factor

5. Incision and Drainage (I&D)

• Performed by an ophthalmologist if the stye does not improve within 48-72 hours (some guidelines say 1-2 weeks for milder cases)
• Should not be attempted outside an ophthalmology setting - refer if needed

Key Points

Do NOT squeeze or puncture a stye - this can spread the infection.

Contact lenses should be avoided until the stye resolves.