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Eyelid bumps, sometimes called styes, are very common. They are usually red, sometimes painful, and sometimes will stay there for months. Sometimes these bumps keep coming back. There are two major types of eyelid bumps, one called hordeolum and the other chalazion. Both are caused by blocked oil glands in the eyelid, called meibomian glands. This gland secretes oil through an opening on the eyelid margin (that’s the thin edge at the base of the eye lashes). This oil is really important to keep our tears in good quality (refer to some of my previous posts on meibomian gland and dry eye). When the opening is blocked, the oil backs up inside the gland, and forms a bump. In terms of the hordeolum, this oil content is infected by our normal skin bacterial flora, so this is technically an infection, but it’s often self-limited. In terms of the chalazion, this content undergoes an inflammatory process but not infection. This is one of the reasons that the hordeolum is often painful and chalazion is not.

Regardless, given similar etiology, the treatment is to open up the blocked gland and let the oil flow again. And one effective way to do this is to apply a warm compress on the bump, this allows the content to soften and drain more easily.

However, doctors sometimes prescribe antibiotics, be it an oral pill, or an eye drop or ointment. So the question is: is it necessary to take antibiotics for hordeolum or chalazion?

There is a recent research [1] that retrospectively looked at more than 2,712 cases of these two conditions, some of these were treated with warm compress alone, some with antibiotics alone, and some with warm compress as well as antibiotics. The final outcome shows that all 3 treatments led to a similar rate of resolution, over 70% for chalazion and over 90% for hordeolum. This shows that additional topic antibiotic drops/ointment or oral antibiotics do not really give additional benefit. Warm compress alone works just as well. It’s interesting that antibiotics alone also have a good success rate, though only 1% of patients were treated by this method. 

The limitation is that this is a retrospective study. There is a randomized controlled trial looking at chalazion and found similar outcome: antibiotics do not give additional benefit in addition to warm compress [2].

Given the rampant antibiotic resistance these days, I think it’s reasonable to apply just warm compress and not start antibiotics automatically for every eyelid bump.

References: 

[1] Alsoudi, Amer F. B.S.; Ton, Lauren B.S.; Ashraf, Davin C. M.D.; Idowu, Oluwatobi O. M.D.; Kong, Alan W. B.S.; Wang, Linyan M.D.; Kersten, Robert C. M.D.; Winn, Bryan J. M.D.; Grob, Seanna R. M.D.; Vagefi, M. Reza M.D. Efficacy of Care and Antibiotic Use for Chalazia and Hordeola, Eye & Contact Lens: Science & Clinical Practice: November 8, 2021 – Volume – Issue – doi: 10.1097/ICL.0000000000000859

[2] Wu AY, Gervasio KA, Gergoudis KN, Wei C, Oestreicher JH, Harvey JT. Conservative therapy for chalazia: is it really effective? Acta Ophthalmol. 2018 Jun;96(4):e503-e509. doi: 10.1111/aos.13675. Epub 2018 Jan 16. PMID: 29338124; PMCID: PMC6047938.