Approach

Styes (hordeola) are typically self-limited and resolve spontaneously in 5-7 days. Warm compresses and topical antibiotic therapy help speed recovery and prevent the spread of infection.[2][4]​ Chalazia, due to their more chronic inflammatory nature, may take longer to resolve (up to 6 months).[6]

Stye

Both internal and external hordeola are treated similarly. Hot spoon bathing and/or warm compresses applied to the eyelid may help speed spontaneous resolution and drainage.[2][4]​ For external hordeola, lash removal from the associated follicle may help. If there is associated blepharitis eyelid hygiene measures are required.[2]​ See Blepharitis (Management).

Topical antibiotics that are effective against Staphylococcus aureus are recommended in the presence of copious mucopurulent discharge.[2]​ Systemic antibiotics are rarely indicated unless there is a significant surrounding cellulitis. An oral first-generation cephalosporin or amoxicillin/clavulanate may be indicated.​[1]​​[2][13]

One Cochrane review found there was no evidence of the effectiveness of nonsurgical interventions (topical or systemic antibiotics, hot or cold compresses, lid scrubs, corticosteroids) for internal hordeola.[15]​ One retrospective study of 2712 patients with hordeola or chalazia found that the addition of antibiotics to conservative measures did not improve treatment success.​[16]

For very large hordeola that distort vision, or for those that are refractory to medical therapy, referral to an ophthalmologist or optometrist for incision and drainage is appropriate.​[1][2]​​​​​​​[13]​ The American Academy of Ophthalmology supports the prompt and appropriate referral of individuals to an ophthalmologist when they present with visual impairment, including that due to inflammation of the lids, with or without discharge.[17]

Chalazia

Most chalazia respond (within 6 months) to conservative treatment of warm compresses and proper lid hygiene (for blepharitis), which includes washing the affected eyelid with drops of baby shampoo.[4][6][8]​​[18]​​​​​ Early treatment may lead to faster resolution.[7]​ Keeping the eyelids free of discharge, pus, or crusting also helps to improve the condition. Chalazia are noninfective; antibiotics are not necessary.​[1]​​[7][13][16]​​​[18]​​​​

Referral to an ophthalmologist may be recommended for recurrent, large, or refractory chalazia (interfering with vision function, causing corneal distortion, or affecting eyelid function). Consider early referral for young children with large chalazion due to risk of amblyopia.[7]​ Persistent chalazia may require more invasive therapies, for example, corticosteroid injection (e.g., triamcinolone) or incision and curettage.[3][6][18]​​​ Invasive therapies are more likely to be needed for chalazia of over 2 months duration.[4][18]​​​ Corticosteroid injection or incision and curettage should be carried out by an ophthalmologist or an appropriately trained optometrist in a suitable clinical setting.[6] Both options are about the same in terms of recurrence rates and generally better than warm compresses and massage.[3][19]​​​[20][21]​​​​​[22][23]​​​ A biopsy may be needed to rule out malignancy (e.g., sebaceous cell carcinoma).​[7][8][14]

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