Antibiotics Unlikely to Manage Chalazion, Hordeolum

Chalazion on the eyelid of a man close-up
Chalazion on the eyelid of a man close-up.
Acute care centers were more likely to prescribe antibiotics for a chalazion, and older patients were more likely to receive antibiotics for a hordeolum.

Antibiotics are unlikely to improve the resolution of a chalazion or hordeolum despite the fact that clinicians frequently prescribe them, according to research published in Eye & Contact Lens. 

Researchers conducted a retrospective, cross-sectional analysis of 2712 patients (mean age 37±24 years, 58% women) from 2012 to 2018 to determine the efficacy of treating chalazia and hordeola with either topical or oral antibiotics. Success was defined by patient reportage or provider’s documentation of clinical resolution.

Overall, 36.5% of study participants received antibiotics as part of their treatment management. Investigators noted that treatment in an acute care facility and older age increased the likelihood of antibiotic treatment (95% CI, 1.06-2.22, P =.025 and 95% CI, 1.05-1.11, P <.001, respectively). 

Clinicians primarily utilized conservative measures (warm compresses or eyelid hygiene) as a means of treatment, followed by a combination of conservative measures and antibiotics, and antibiotics alone (63%, 36%, and 1%, respectively). A total of 397 (14.6%) patients undergoing these methods failed medical management and needed subsequent procedures.

Overall, medical management yielded a 75.9% success rate for chalazion patients and 93.5% for hordeolum patients. Procedural management, which included intralesional steroid injection or incision and drainage resulted in 94.8% and 97.1% success rates for chalazion and hordeolum patients, respectively.   

Investigators note that their study shows antibiotic use is not associated with an increased likelihood of success in either chalazion or hordeolum patients (adjusted relative risk (RR), 0.97, 95% CI, 0.89–1.04, P =.393 and adjusted RR, 0.99, 95% CI, 0.96–1.02, P =.489, respectively).

“Over a third of patients diagnosed with a chalazion or hordeolum were prescribed an antibiotic despite a lack of evidence demonstrating efficacy,” according to the researchers. They also noted the role care facilities play in prescribing antibiotics stating that “Variation in prescribing patterns was significant with patients presenting to an emergency or acute care setting more likely to receive an antibiotic for the diagnosis of a chalazion and older patients more likely to receive an antibiotic for a hordeolum.”

Limitations include the study’s retrospective nature, single center design, the potential for recall bias due to the researcher’s strict reliance on clinical documentation, and potential for abstraction bias from a failure to mask researchers from diagnoses or outcomes.   


Alsoudi AF, Ton L, Ashraf DC, et al. Efficacy of care and antibiotic use for chalazia and hordeola. Eye Cont Lens. 2022;48(4):162-168. doi:10.1097/ICL.0000000000000859