What is stye? | Symptoms, causes & treatment

A stye (medical term: hordeolum) is an acute, localized bacterial infection of an eyelid gland, presenting as a tender, red, focal swelling that may point with a pustule. Most styes are caused by Staphylococcus aureus. Diagnosis is clinical. First-line treatment is warm compresses and eyelid hygiene; topical antibiotic ointment may be added for drainage at the lid margin, and incision and drainage is reserved for persistent or complicated cases.

Key Points

• A stye is an acute bacterial infection of an eyelid gland; external styes involve lash-line glands, internal styes involve meibomian glands.
• Most cases resolve with warm compresses and eyelid hygiene; do not squeeze or lance at home.
• Topical antibiotic ointment can be used when there is lash-line drainage; systemic antibiotics are indicated for spreading cellulitis or systemic risk factors.
• Distinguish from chalazion (painless, firm, chronic nodule) and from preseptal/orbital cellulitis (diffuse swelling, systemic signs).
• Recurrent styes suggest underlying blepharitis, meibomian gland dysfunction, or rosacea; treat the lid disease to prevent recurrence.
• Urgent evaluation is needed for fever, worsening diffuse swelling, reduced vision, painful eye movements, or lack of improvement after 48–72 hours of appropriate care.

Anatomy and Physiology

• Eyelid margin contains:
  • Glands of Zeis (sebaceous) and Moll (apocrine) associated with eyelashes.
  • Meibomian glands embedded in the tarsal plate, secreting meibum that stabilizes the tear film.
• External hordeolum arises from Zeis or Moll gland infection at the lash line.
• Internal hordeolum arises from infected meibomian gland within the tarsus, pointing toward the palpebral conjunctiva.

Etiology

• Usual pathogen: Staphylococcus aureus; methicillin-resistant S. aureus (MRSA) is an occasional cause.
• Predisposing conditions:
  • Chronic anterior/posterior blepharitis, meibomian gland dysfunction, ocular rosacea, seborrheic dermatitis.
  • Contact lens wear, contaminated cosmetics, poor eyelid hygiene.
  • Diabetes mellitus, immunosuppression.
  • Demodex infestation (Demodex folliculorum) associated blepharitis.

Pathophysiology

• Obstruction of a lash-line (Zeis/Moll) or meibomian gland orifice allows bacterial overgrowth.
• Focal suppurative inflammation produces a painful papule/pustule (external) or tender tarsal swelling (internal).
• Internal hordeola can rupture through conjunctiva or skin or organize into a chronic lipogranulomatous nodule (chalazion).

Epidemiology

• Styes are common across all ages in primary eye care; exact US incidence and prevalence are not well defined.
• Recurrent disease correlates with chronic blepharitis and meibomian gland dysfunction.

Classification

• By site:
  • External hordeolum (stye): Zeis/Moll gland at lash line.
  • Internal hordeolum: meibomian gland in tarsal plate.
• By course:
  • Acute uncomplicated.
  • Recurrent (≥3/year) often with chronic lid disease.
  • Complicated: associated preseptal cellulitis, abscess, or progression to chalazion.

Symptoms and Signs

• General:

  • Acute focal eyelid pain, tenderness, erythema, and swelling.
  • Tearing, foreign-body sensation, mild photophobia.
  • Localized yellow pustule (external) or focal tarsal induration (internal).

• External hordeolum:

  • Tender, erythematous papule at lash follicle with a visible pustular head.
  • Crusting, lash matting, adjacent blepharitis.

• Internal hordeolum:

  • Diffuse, tender tarsal swelling; may “point” on the palpebral conjunctiva.
  • Conjunctival hyperemia; meibomian gland plugging.

• Complicated or spreading infection:

  • Preseptal cellulitis: diffuse lid edema, warmth, tenderness without proptosis or ophthalmoplegia.
  • Orbital cellulitis (rare from a stye): fever, proptosis, painful or limited extraocular movements, decreased vision.

Complications

• Chalazion (chronic lipogranuloma) after resolution of acute infection.
• Preseptal cellulitis; rarely orbital cellulitis.
• Abscess formation, lash follicle destruction, lid margin scarring.
• Secondary blepharoconjunctivitis.
• Keratitis in contact lens wearers if hygiene is poor or if infection extends to ocular surface.

Diagnosis

Clinical evaluation

• Diagnosis is clinical based on history and exam of eyelid margin and tarsal plate.

• Evert the eyelid to assess for internal pointing, meibomian gland involvement, and to exclude foreign body.

• Assess for blepharitis, meibomian gland dysfunction, and rosacea stigmata (telangiectasia, phymatous changes).

• Red flags prompting urgent evaluation:

  • Fever, malaise, or rapidly progressive swelling.
  • Painful or restricted eye movements, diplopia, proptosis.
  • Decreased vision, afferent pupillary defect.
  • No improvement after 48–72 hours of appropriate conservative care.

Imaging and laboratory testing

• Not routinely required.
• Obtain eyelid swab or expressed material culture in recurrent cases, immunocompromised hosts, or suspected MRSA outbreaks.
• CT orbit with contrast if orbital cellulitis is suspected (proptosis, ophthalmoplegia, systemic toxicity).

Differential diagnosis

Treatment

Medical management

• Warm compresses:

  • Apply warm (not scalding) compresses 10–15 minutes, 3–6 times daily to promote drainage.
  • Gentle lid massage toward the orifice after warming can help express secretions.

• Eyelid hygiene:

  • Cleanse lid margins daily with diluted baby shampoo or commercially prepared lid scrubs.
  • Discontinue eye makeup and contact lens wear until resolution; replace or disinfect implicated products.

• Topical antibiotics (for external drainage or associated blepharitis):

  • Erythromycin ophthalmic ointment 0.5%: apply a 0.5-inch ribbon to the lid margin qid (4 times daily) for 7–10 days [1,2].
  • Bacitracin ophthalmic ointment: similar dosing and duration [1,2].
  • Evidence for faster resolution is limited; use is common to reduce bacterial load at the margin [2,3].

• Systemic antibiotics (indications: preseptal cellulitis, multiple/recurrent lesions with significant inflammation, immunocompromise, or failure of conservative care):

  • Cephalexin 500 mg PO q6h (four times daily) for 5–7 days; pediatric: 25–50 mg/kg/day divided q6–12h [2,4].
  • Amoxicillin-clavulanate 875/125 mg PO bid (twice daily) for 5–7 days; pediatric: 45 mg/kg/day (amoxicillin component) divided bid [4].
  • Suspected MRSA: trimethoprim-sulfamethoxazole (TMP 160 mg/SMX 800 mg) 1–2 DS tablets PO bid for 5–7 days; pediatric weight-based dosing [4].
  • Meibomianitis/rosacea-associated recurrence: doxycycline 50–100 mg PO bid for 2–4 weeks, then consider taper/maintenance; avoid in children <8 years and during pregnancy/lactation [2,5]. Off-label for prevention.

• Analgesia:

  • Acetaminophen or NSAIDs PO as needed unless contraindicated.

• Avoid:

  • Squeezing or incising at home (risk of cellulitis/orbital spread).
  • Routine topical corticosteroids for active infection.

Procedural and surgical management

• Incision and drainage (I&D):

  • Indications: persistent or enlarging stye >1–2 weeks despite conservative therapy, focal abscess formation, or significant pain.
  • External hordeolum: small stab incision at the lash follicle with expression and curettage under local anesthesia.
  • Internal hordeolum: incision from the conjunctival side with a chalazion clamp and curettage; topical antibiotic ointment post-procedure [2].
  • Culture material when drainage is purulent, recurrent, or atypical.

• Conversion to chalazion:

  • If a painless nodule persists after inflammation resolves, manage as chalazion (conservative care, intralesional corticosteroid, or chalazion excision per standard protocols).

Special populations

• Pediatric:

  • Emphasize safe compress temperature to avoid burns; parental assistance required.
  • Avoid tetracyclines in children <8 years.
  • Consider systemic antibiotics earlier if diffuse swelling or fever develops.

• Pregnancy/lactation:

  • Warm compresses and lid hygiene are safe.
  • Erythromycin ophthalmic ointment is generally considered compatible.
  • Avoid doxycycline and tetracyclines.

• Immunocompromised and diabetes:

  • Lower threshold for systemic antibiotics and for culture.
  • Close follow-up to detect cellulitis or orbital extension.

• Older adults:

  • Recurrent, non-resolving lesions warrant evaluation for sebaceous carcinoma or basal cell carcinoma; consider biopsy.

Prognosis

• Most styes resolve within 1–2 weeks with conservative care.
• Recurrence is common in the setting of chronic blepharitis, meibomian gland dysfunction, and rosacea; addressing underlying lid disease reduces frequency.
• Complications are uncommon with timely care; preseptal cellulitis may require systemic therapy, and orbital cellulitis is rare.

Prevention and Patient Counseling

• Maintain daily eyelid hygiene if prone to styes; treat chronic blepharitis/meibomian gland dysfunction.
• Manage ocular rosacea; consider long-term measures if recurrences are frequent.
• Replace eye makeup every 3 months and avoid sharing cosmetics.
• Adhere to strict contact lens hygiene; avoid lens wear during active infection.
• Do not squeeze or puncture a stye; this increases the risk of cellulitis.

When to Seek Immediate Care

• Fever, chills, or feeling very unwell.
• Swelling that rapidly worsens or spreads beyond the eyelid.
• Eye pain with eye movement, double vision, bulging of the eye, or trouble moving the eye.
• Decreased or blurry vision.
• No improvement after 2–3 days of warm compresses and hygiene.
• A stye in a newborn or in someone with diabetes or a weakened immune system.

References

1. Erythromycin Ophthalmic Ointment, USP 0.5% [package insert]. DailyMed. Accessed 2026. https://dailymed.nlm.nih.gov
2. Wladis EJ, Bradley EA, Bilyk JR, Yen MT. Hordeolum (Stye). StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. PMID: 28722915.
3. American Academy of Ophthalmology EyeWiki. Hordeolum and External Hordeolum. Updated 2023. https://eyewiki.aao.org/Hordeolum
4. Stevens DL, Bisno AL, Chambers HF, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the IDSA. Clin Infect Dis. 2014;59(2):e10–e52. doi:10.1093/cid/ciu444. [for systemic antibiotic principles]
5. Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea. J Am Acad Dermatol. 2020;82(6):1501-1510. doi:10.1016/j.jaad.2020.01.077.
6. National Eye Institute (NEI). Stye (Hordeolum). Reviewed 2022. https://www.nei.nih.gov
7. Cochrane Eyes and Vision. Interventions for acute internal hordeolum. Cochrane Database Syst Rev. 2017; Issue: Article. doi:.
8. American Academy of Pediatrics/AAO. Preseptal and Orbital Cellulitis. In: Pediatric Ophthalmology/Strabismus PPP. 2018. https://www.aao.org
9. AAPOS. Chalazion and Stye. Updated 2022. https://aapos.org
10. Cleveland Clinic. Stye (Hordeolum): Symptoms & Treatment. Reviewed 2024. https://my.clevelandclinic.org

Disclaimer: This article is for informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified eye care professional about your specific condition. If you have sudden vision loss, severe eye pain, or an eye injury, seek emergency care immediately.