A stye — clinically termed a hordeolum — is an acute, localised infection of a gland in the eyelid. It presents as a tender, red, swollen lump on or near the eyelid margin, sometimes with a visible yellow point of pus. Styes are extremely common, generally self-limiting, and one of the conditions pharmacists can manage effectively without GP referral.

Types of Stye

There are two forms, distinguished by their anatomical location:

External styes are far more common and are typically caused by Staphylococcus aureus infection of a lash follicle or associated gland. Internal styes tend to be more painful and may take longer to resolve.

A stye should be distinguished from a chalazion (meibomian cyst), which is a chronic, painless, firm lump in the eyelid caused by blockage of a meibomian gland without acute infection. Chalazions develop more slowly, lack acute tenderness, and may require referral if they persist.

Pharmacy Treatment

Warm compresses — the cornerstone

The most effective treatment for styes is consistent application of warm compresses. This softens the blocked gland, promotes drainage and relieves discomfort. NICE CKS recommends this as first-line management.

Technique to advise patients:

1. Soak a clean flannel or lint-free cloth in hot (not boiling) water — comfortably warm to the touch
2. Wring out excess water
3. Hold the cloth gently against the closed eyelid for 5–10 minutes
4. Repeat three to four times daily
5. Use a fresh cloth each time to prevent reinfection

Microwavable eye masks specifically designed for warm compress application are available in pharmacy and maintain heat for longer than a flannel. They are a worthwhile recommendation for patients with recurrent styes.

Lid hygiene

Advise patients to clean the eyelid gently after each warm compress session:

• Use a dilute solution of baby shampoo (one drop in a cup of warm water) on a cotton pad, wiping along the lash line
• Alternatively, pre-made lid-cleansing wipes (Blephaclean, Systane Lid Wipes) are convenient and sterile
• Do not attempt to squeeze, pop or lance the stye — this risks spreading infection to surrounding tissue

Chloramphenicol eye drops or ointment

Chloramphenicol 0.5% eye drops or 1% eye ointment are available over the counter for bacterial eye infections. However, NICE CKS does not recommend routine topical antibiotics for uncomplicated styes — warm compresses alone are sufficient in most cases.

Chloramphenicol may be appropriate if:

• There is spreading infection beyond the stye itself (preseptal cellulitis)
• The patient has a concurrent bacterial conjunctivitis
• The stye has been present for more than a week without improvement despite warm compresses

If supplying chloramphenicol, the standard regimen is one drop every two hours for the first 48 hours, then four times daily for five days (drops), or a small ribbon of ointment four times daily (ointment, or at night alongside drops).

Pain relief

Paracetamol or ibuprofen at standard OTC doses can manage the discomfort associated with styes, particularly internal hordeola which can be quite painful.

What NOT to Do

Pharmacists should advise patients to:

• Not squeeze the stye — this can cause the infection to spread
• Not wear contact lenses until the stye has fully resolved
• Not share towels, flannels or pillowcases during the infection
• Not apply eye makeup to the affected eye until healed
• Not use old or contaminated eye cosmetics — these are a common source of recurrent styes

When to Refer

Most styes resolve within 7–10 days with warm compresses. Referral to a GP is appropriate if:

• The stye has not improved after two weeks of consistent warm compress treatment
• Redness and swelling are spreading beyond the eyelid — this may indicate preseptal or orbital cellulitis, which requires systemic antibiotics
• The patient develops fever alongside the eye swelling
• Vision is affected
• The stye is recurrent (three or more episodes in 12 months) — this may indicate an underlying condition such as blepharitis, rosacea or diabetes
• The patient has a painless, firm lump that has been present for more than a month — this is likely a chalazion and may require referral for incision and curettage

Prevention of Recurrence

For patients with recurrent styes, pharmacists can recommend:

• Daily lid hygiene with dilute baby shampoo or lid wipes, even when symptom-free
• Regular replacement of eye makeup (mascara every 3–6 months, eyeliner pencils sharpened regularly)
• Hand hygiene before touching the eye area
• Management of any underlying blepharitis with warm compresses and lid cleaning as a daily routine
• Consider omega-3 supplementation — some evidence suggests it may improve meibomian gland function, though this is not yet a formal NICE recommendation

A Simple Condition, Good Pharmacy Practice

Styes represent an ideal pharmacy management opportunity: the condition is common, the treatment is simple and effective, and avoiding a GP appointment saves time for both the patient and the NHS. Clear, confident advice on warm compress technique and lid hygiene is the pharmacist's primary tool.

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