What is the recommended initial management for a patient presenting with a chalazion or stye in general practice?

Initial management of a chalazion or stye in general practice involves conservative measures focused on symptom relief and promoting drainage. The first-line approach includes applying warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily, to soften the lesion and encourage spontaneous drainage and resolution ¹. Patients should be advised to maintain good eyelid hygiene, including gentle cleaning of the eyelid margins with diluted baby shampoo or commercially available eyelid scrubs to reduce bacterial load and prevent further blockage ¹.

Topical antibiotics are generally not routinely recommended unless there is evidence of secondary bacterial infection or if the lesion is a stye (acute hordeolum) with purulent discharge, in which case topical antibiotic ointments such as fusidic acid may be considered ¹. Oral antibiotics are reserved for cases with spreading cellulitis or systemic symptoms ¹.

Patients should be counselled that chalazia often resolve spontaneously over weeks to months, and referral for specialist intervention (e.g., incision and curettage or steroid injection) is considered if the lesion persists beyond 6-8 weeks or causes significant cosmetic or functional problems ¹. Recent literature supports these conservative measures and highlights that early warm compresses remain the cornerstone of management, with antibiotics reserved for complicated cases (Gordon et al., 2020).