Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

stye

1st line – warm compresses + massage ± lid hygiene

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ACUTE
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stye
1st line – 

warm compresses + massage ± lid hygiene

Warm compresses may be created by soaking a cloth towel in hot water and then applied with gentle pressure onto the closed eyelid. They may be applied 4-5 times per day for 10-15 minutes and may be accompanied by gentle massage of the area.​[1][2]​​​​​​​​[13]​ However, one Cochrane review found there was no evidence of effectiveness of nonsurgical interventions, including hot or cold compresses and lid scrubs, for internal hordeola.[15]​

If there is associated blepharitis eyelid hygiene measures are required.[2] See Blepharitis (Management).

Consider – topical ophthalmic antibiotic

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ACUTE
|
stye
Consider – 

topical ophthalmic antibiotic

Treatment recommended for SOME patients in selected patient group

Topical antibiotics that are effective against Staphylococcus aureus (e.g., erythromycin) are recommended in the presence of copious mucopurulent discharge.[2]

One Cochrane review found there was no evidence of the effectiveness of nonsurgical interventions, including topical antibiotics, 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]

Primary options

erythromycin ophthalmic: (0.5%) apply to affected eye(s) up to six times daily

Plus – oral antibiotic therapy

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ACUTE
|
stye
|
significant surrounding cellulitis
Plus – 

oral antibiotic therapy

Treatment recommended for ALL patients in selected patient group

An oral first-generation cephalosporin or amoxicillin/clavulanate may be indicated.​[1][2][13]

Primary options

cephalexin: 250-500 mg orally every 6 hours

OR

amoxicillin/clavulanate: 500 mg orally every 8 hours

Plus – referral to ophthalmologist/optometrist for incision and drainage

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ACUTE
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stye
|
distorted vision or refractory to medical therapy
Plus – 

referral to ophthalmologist/optometrist for incision and drainage

Treatment recommended for ALL patients in selected patient group

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]​​​​​​​[17]

chalazion

1st line – warm compresses + massage + lid hygiene

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ACUTE
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chalazion
1st line – 

warm compresses + massage + lid hygiene

Most chalazia respond (within 6 months) to conservative treatment of warm compresses and proper lid hygiene, 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]​​​

Warm compresses with gentle massage may be placed over the involved area 4-5 times per day for approximately 10-15 minutes. This aids in resolving any ductal obstruction in the longer meibomian glands and helps drain sebum.

Plus – referral to ophthalmologist/optometrist for corticosteroid injection or incision and curettage

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ACUTE
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chalazion
|
large, recurrent or refractory
Plus – 

referral to ophthalmologist/optometrist for corticosteroid injection or incision and curettage

Treatment recommended for ALL patients in selected patient group

For recurrent, large, or refractory chalazia, referral to an ophthalmologist or appropriately trained optometrist may be required for corticosteroid injection or incision and curettage and undertaken in a suitable clinical setting.[3][6][18]​​ Consider early referral for young children with large chalazion due to risk of amblyopia.[7]​ One study found invasive therapies are more likely to be needed for chalazia of over 2 months duration.[18]​ Corticosteroid injection and incision and curettage have similar recurrence rates and both are generally better than warm compresses and massage.[3][19]​​​[20][21][22]​​[23]

For recurrent or refractory chalazia a biopsy may be needed to rule out malignancy.​[7][8][14]

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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