Assess first: Confirm that the presentation is consistent with a typical left-eye stye, while checking visual acuity and asking about eye pain, redness, blurred vision, photophobia, rapid visual loss, and features suggesting cellulitis or an atypical eyelid lesion. NICE CKS,NICE CKS
Typical uncomplicated stye: Reassure the patient that styes are usually self-limiting and rarely cause serious complications. NICE CKS Apply a warm compress, such as a clean flannel rinsed with hot water, to the closed left eyelid for 5–10 minutes, 2–4 times daily until drainage or resolution. NICE CKS Avoid eye makeup and contact lenses until the area has healed. NICE CKS Do not puncture or squeeze the stye, as this may aggravate or spread infection or cause eye injury. NICE CKS Treat co-existing blepharitis or acne rosacea where present. NICE CKS
Topical treatment: Antibiotics are not routinely indicated for a stye. NICE CKS Consider a topical antibiotic, such as chloramphenicol eye drops or ointment, only if there is copious mucopurulent discharge. NICE CKS If chloramphenicol ointment is used alone, the SmPC dose is approximately 1 cm in the affected eye 3–4 times daily for 5 days; when drops are used in the day, ointment may be applied at night. SmPC Optrex Avoid prolonged or frequent intermittent topical chloramphenicol use, and seek review if symptoms worsen or fail to improve within 48 hours. SmPC Optrex Stop chloramphenicol immediately if hypersensitivity occurs. SmPC Clorogen
Procedural management: For a painful external stye, eyelash plucking from the infected follicle or sterile-needle incision and drainage may be considered only where suitable primary-care expertise and facilities are available; otherwise refer to ophthalmology. NICE CKS
Emergency admission: Arrange emergency hospital admission for signs or symptoms of periorbital or orbital cellulitis. NICE CKS Periorbital cellulitis may present with acute eyelid swelling, redness and tenderness, sometimes with fever or malaise; orbital disease is suggested by visual impairment, limited or painful eye movements, conjunctival oedema, or proptosis. NICE CKS
Same-day ophthalmology assessment: Refer the patient on the same day for corneal-disease symptoms such as pain with blurred vision, rapid-onset visual loss, or an eye that becomes painful and/or red. NICE CKS
Other escalation: Refer to ophthalmology, with urgency guided by clinical judgement, if the lesion is very large, severe, atypical, associated with gradual visual deterioration, diagnostically uncertain, or does not improve or resolve with primary-care management. NICE CKS Use a suspected-cancer pathway if eyelid malignancy is suspected, particularly with features such as eyelid distortion, a nodular mass, ulceration, bleeding, extensive scarring, lash loss, localised crusting or scaling, or yellow conjunctival nodules with intense inflammation. NICE CKS