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Hordeolum (1)
Def: A hordeolum is a common disorder of the eyelid.[1]
It isan acute focal infection (usually staphylococcal) involvingeither the glands of Zeis (external hordeola, or styes) or,less frequently, the meibomian glands (internalhordeola).
[2]
Pathophysiology
There is usually underlying meibomitis with thickening andstasis of gland secretions with resultant inspissation of theZeis or meibomian gland orifices. Stasis of the secretionsleads to secondary infection, usually byStaphylococcusaureus.
[3]Histologically, hordeola represent focal
collections of polymorphonuclear leukocytes and necroticdebris (ie, an abscess).
Hordeola should not be confused with chalazia, whichrepresent focal, chronic, lipogranulomatous inflammationof the Zeis or meibomian glands.
[4]Chalazia form when
underlying meibomitis results in stasis of gland secretions,and the contents of the glands (sebum) are released intothe tarsus and adjacent tissues to incite a noninfectious
inflammatory reaction. Histologically, chalazia appear as agranulomatous reaction (ie, histiocytes, multinucleatedgiant cells) surrounding clear spaces that were onceoccupied by sebum/lipid before they were dissolved by thesolvents used for tissue processing, hence the termlipogranuloma.
Essentially, a hordeolum represents an acute focalinfectious process, while a chalazion represents a chronic,noninfectious granulomatous reaction. However, chalaziaoften evolve from internal hordeola.
[5]
History
Hordeola essentially represent focal abscesses; therefore,they will present with features of acute inflammation, suchas a painful, warm, swollen, red lump on the eyelid.
The eyelid lump may also induce corneal astigmatism andcause blurring of vision.
The patient often has a past history of similar eyelidlesions or risk factors for hordeola, such as meibomiangland dysfunction, blepharitis, or rosacea.
[6]
Clinically differentiating hordeola from acute chalazia maybe difficult, because they both present with acuteinflammation and tender eyelid lumps. However, chronicchalazia represent a granulomatous reaction and, thus,appear firm and nontender on clinical examination
Causes
Hordeola are associated with S aureus infection.[3]
Patients with chronic blepharitis, meibomian glanddysfunction, and ocular rosacea are at greater risk of developing hordeola than the general population.
[6]
There are published case reports where multiple recurrenthordeola have been associated with selectiveimmunoglobulin M (IgM) deficiency.
[7]The lipid component
of chalazia has been found to have large cholesterolcontent and is dissimilar to the lipid found in meibomianglands. Studies have reported an association betweenmultiple chalazia and elevated serum cholesterol levels.Some studies have even suggested that elevated serumlipid levels may increase the risk of blockage to oil glandsof the eyelids and, therefore, predispose to hordeola andchalazia.
On examination, a tender erythematous subcutaneousnodule is present near the eyelid margin, which mayundergo spontaneous rupture and drainage. If sufficient
edema is present, then it may be difficult to palpate adiscrete nodule. These nodules may be unilateral or bilateral, single or multiple.
The inflammation associated with hordeola may spread toadjacent tissue and cause a secondary preseptal cellulitis.
Patients may also have signs of meibomitis, blepharitis,
or ocular rosacea.[6
Differentials
Basal Cell Carcinoma, Eyelid
Cellulitis, Preseptal
Chalazion
Sebaceous Gland Carcinoma
Squamous Cell Carcinoma, Eyelid
Laboratory Studies
The diagnosis is based on history and clinicalexamination, and cultures are not indicated in
uncomplicated cases. There is no indication to check serum lipid levels, as the
association among hordeola, chalazia, andhypercholesterolemia remains unclear
Histologic Findings
Histopathology of a hordeolum reveals an abscess or afocal collection of polymorphonuclear leukocytes andnecrotic tissue.
Histologically, chalazia represent a lipogranulomatousinflammatory reaction. Histiocytes, multinucleated giantcells, lymphocytes, plasma cells, and neutrophils surroundan optically clear space. This optically clear spacerepresents lipids that were dissolved by solvents during
tissue processing.
Basal cell carcinoma or sebaceous cell carcinoma of theeyelid can be misdiagnosed clinically as a recurrenthordeolum or chalazion; therefore, histopathologicexamination is very important in determining thediagnosis, especially in patients with a persistent or recurrent lesion.
[8]
Medical Care
Hordeola are usually self-limited, spontaneously improvingin 1-2 weeks.
Medical therapy for hordeola includes eyelid hygiene,warm compresses and massages of the lesions for 10minutes 4 times per day, and topical antibiotic ointment in
the inferior fornix if the lesion is draining or if there is anaccompanying blepharoconjunctivitis.
Systemic antibiotics may be indicated if the hordeola iscomplicated by preseptal cellulitis. Oral doxycycline mayalso be added if there is a history of multiple or recurrentlesions or if there is significant and chronic meibomitis.
Internal hordeola may occasionally evolve into chalazia,which may require topical steroids, intralesional steroids,or surgical incision and curettage.
Surgical Care
Incision and drainage is indicated if the hordeolum is largeor if it is refractory to medical therapy.
Incision and drainage is done under local anesthesia, andthe incision is made through the skin and orbicularis (inthe case of external hordeola) or through the tarsal
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conjunctiva and tarsus (in the case of internal hordeola).The specimen should be sent for histopathologicalevaluation to confirm the diagnosis and to rule out a moresinister pathology (eg, basal cell carcinoma).
Medication Summary
The goals of pharmacotherapy are to treat the infection, to
reduce morbidity, and to prevent complications.
Antibiotics
Class Summary
A course of oral antibiotics is indicated if the hordeolum iscomplicated by preseptal cellulitis.
First-generation cephalosporin often used in skin or skinstructure infections (eg, acute hordeolum) caused bystaphylococci or streptococci. Administered orally and hasa half-life of 50-80 min. Only 10% is protein bound andgreater than 90% recovered unchanged in urine.
Erythromycin base (E-Mycin)
Inhibits bacterial growth, possibly by blocking dissociation
of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.Indicated for infections caused by susceptible strains of microorganisms and for prevention of corneal andconjunctival infections.
Further Outpatient Care
Patients should be followed within 2-4 weeks of institutionof medical therapy to assess response to therapy andneed for surgical incision and curettage
Deterrence/Prevention
Try to prevent recurrences by minimizing or eliminatingrisk factors, such as blepharitis and meibomian glanddysfunction, through daily lid hygiene and warm
compresses.
Complications
Large lesions of the upper eyelid have been reported tocause decreased vision secondary to induced astigmatismor hyperopia resulting from central corneal flattening.
Prognosis
Hordeola are usually self-limited and spontaneouslyresolve within 1-2 weeks. The resolution is hastened withthe use of warm compresses and lid hygiene.Internal hordeola may occasionally evolve into chalazia,which may require topical or intralesional steroids or evenincision and curettage.
[9]
Patient Education
For excellent patient education resources, visiteMedicine's Eye and Vision Center. Also, see eMedicine'spatient education articles Chalazion (Lump inEyelid) and Sty.
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Chalazion
Background
A chalazion (Greek for hailstone) is a lipogranuloma of either a meibomian gland or a Zeis gland. When theformer is involved, the lid nodule is a characteristicallyhard and painless lid nodule; if the latter is involved, it ismarginal or superficial. Examples of a chalazion areshown in the images below.
Pathophysiology
Lipid breakdown products, possibly from bacterialenzymes (as free fatty acids) or from retained sebaceoussecretions, leak into the surrounding tissue and incite agranulomatous inflammatory response. The resultingmass of granulation tissue and chronic inflammation (withlymphocytes and lipid-laden macrophages) distinguishes achalazion from an internal or external hordeolum, which isprimarily an acute pyogenic inflammation withpolymorphonuclear leucocytes and necrosis with pustuleformation. However, one condition can result in the other because of their close proximity.
Upon clinical examination, the single, nontender, firmnodule (or, in rare cases, multiple nodules) is located deepwithin the lid or the tarsal plate, whereas a hordeolum ismore superficial and is typically centered on an eyelash.Eversion of the lid may reveal the dilated meibomian glandand chronic inspissation of adjoining glands. With judicious pressure on the lid, the thick secretions can beseen extruding like toothpaste, resulting in tear debris.
Epidemiology
Frequency
United States
Chalazia are common, but the exact incidence or prevalence is unknown.
International
No data about the prevalence or incidence are available.
Mortality/Morbidity
Acute inflammatory exacerbation can result in a ruptureanteriorly (through the skin) or posteriorly (through theconjunctiva), forming a granuloma pyogenicum.
Race
No information about prevalence or incidence with respectto race is available.
Sex
Male and females seem equally affected, but preciseinformation about prevalence and incidence is notavailable. Contrary to popular opinion, research has notshown that the use of eyelid cosmetic products either causes or aggravates the condition.
Age
Chalazia occur in all age groups. Chalazia are morecommon in adults than in children, as androgenichormones increase sebum viscosity. Although they areuncommon at extremes of age, pediatric cases may beencountered.
Hormonal influences on sebaceous secretion and viscositymay explain clustering at the time of puberty and duringpregnancy. However, the large number of patients withoutevidence of hormonal alteration suggests that other mechanisms also apply.
History
Patients with chalazia usually present with a short historyof recent lid discomfort, followed by acute inflammation(eg, redness, tenderness, swelling). They frequently havea long history of previous similar occurrences, becausechalazia tend to recur in predisposed individuals.
PhysicalChalazia are more common on the upper lid than on thelower lid because of the increased number and length of meibomian glands present on the upper lid.
Chronic inspissation of the meibomian secretions may beapparent as meibomian gland dysfunction. This conditionis characterized by pressure on the eyelids that producescopious toothpaste-like secretions instead of the normalsmall amount of clear, oily secretion. Sebaceousdysfunction and obstruction elsewhere (eg, comedones,oily face) are the only associated features or specificgeneral findings.
Rosacea is a frequent associated finding. When present,rosacea demonstrates very specific findings, such as
facial erythema; telangiectatic and spider nevi on themalar, nasal, and lid skin; and rhinophyma.
Causes
Chalazia may arise spontaneously due to blockage of agland orifice or due to an internal hordeolum. Chalazia areassociated with seborrhea, chronic blepharitis, and acnerosacea.
Poor lid hygiene is occasionally associated with chalazia,although its causal role needs to be established. Althoughstress is often apparently associated with chalazia, it hasnot been proven as a cause, and the mechanism by whichstress acts is unknown.
Differential Dx
ActinomycosisBasal Cell Carcinoma, EyelidBlepharitis, AdultCellulitis, OrbitalCellulitis, PreseptalConjunctivitis, BacterialContact Lens ComplicationsDacryoadenitisDacryocystitisDemodicosisDermatitis, AtopicDermatitis, ContactDermatochalasisDermoid, OrbitalDistichiasis
Floppy Eyelid SyndromeHemangioma, CapillaryHemangioma, CavernousHerpes SimplexHerpes Zoster HordeolumJuvenile XanthogranulomaKaposi SarcomaLacrimal Gland TumorsMelanoma, ConjunctivalMolluscum ContagiosumNasolacrimal Duct, Congenital AnomaliesNasolacrimal Duct, ObstructionNeurofibromatosis-1Ocular Manifestations of HIVPapilloma, Eyelid
Pigmented Lesions of the EyelidPsoriasisPtosis, Adult
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Red Eye EvaluationSarcoidosisSebaceous Gland CarcinomaSpider BitesSquamous Cell Carcinoma, ConjunctivalSquamous Cell Carcinoma, EyelidSturge-Weber SyndromeTrichiasis
TuberculosisTumors, OrbitalXanthelasma
Laboratory Studies
Clinical findings and responses to therapy in patients withchalazia are usually specific.The material obtained from a chalazion shows a mixture of acute and chronic inflammatory cells, as well as large,lipid-filled, foreign body-type giant cells.Lipid analysis may reveal fatty acids with long carbonchains resulting in an increased melting point. This findingpossibly accounts for the blockage of secretions.Bacterial culture findings are usually negative.However, Staphylococcus aureus, Staphylococcusalbus, or other cutaneous commensal organisms can beisolated. Propionibacterium acnes may be present in theglandular contents.
Imaging Studies
Infrared photographic imaging of the meibomian glandscan demonstrate abnormally dilated and inspissatedsecretions, which are visible on the tarsal surface of theeverted lid.
Other Tests
Pressure directly over the tarsal plate of the lid results inthe extrusion of lipids, especially of thick viscous materialwith meibomian gland dysfunction
Histologic FindingsHistology reveals a chronic granulomatous reaction withnumerous lipid-filled, Touton-type giant cells. Typically, thenuclei of these cells are arranged around the periphery of a central foamy cytoplasmic area that contains theingested lipid material. Other typical mononuclear cells(eg, lymphocytes, macrophages) also may occur aroundthe periphery.In the event of secondary bacterial infection, an acutenecrotic reaction with polymorphonuclear cells may ensue.Destruction of the fibrocartilage of the tarsal plate may beevident. Foreign bodies (eg, embedded polymethylmethacrylate [PMMA] contact lenses) in the tarsal platehave been encountered in chronic chalazia.
Medical CareSmall, inconspicuous, asymptomatic chalazia may beignored. Conservative treatment with lid massage, moistheat, and topical mild steroid drops usuallysuffices.
[1] Acute therapy with oral tetracycline (eg,
doxycycline 100 mg or minocycline 50 mg every day for 10d) minimizes the infectious component and decreases theinflammation, reputedly by inhibiting polymorphdegranulation. Chronic therapy with low-dose tetracycline(eg, doxycycline 100 mg orally every week for 6 mo)frequently prevents recurrence. If tetracycline cannot beused, then metronidazole has been used in a similar fashion. In most cases, surgery should be performed onlyafter a few weeks of medical therapy.
For local nonsurgical care early in the condition, blocked
glandular orifices may be opened by means of vigorousmassage between 2 cotton wool buds at the slit lamp.
Local anesthesia may be beneficial to facilitate athorough massage.
A wet facecloth, as hot as can be tolerated, can beapplied twice daily to promote drainage by melting thelipid secretions.
o A self-administered technique called the "4 fingerstimes 10 massage" can be beneficial.
o
This technique is performed as follows: At theconclusion of a bath or shower, the patient warms hisor her hands under hot water. Using 1 drop of babyshampoo (which does not sting the eyes), the patientworks up a lather, places the index finger over theclosed lids at the lid margin, and vigorously massagesthe lid back and forth 10 times. The patient thenrepeats the procedure with the middle, ring, and littlefingers.
Most marginal chalazia are connected to another chalazion located deeper in the substance of the lid.
o The contents of a purely marginal chalazion may beexpressed by rolling 2 cotton-tipped applicatorstoward the lid margin from both sides of the lid.
o If the contents cannot be expressed, incise the distalchalazion, and curette the contents.
The management of infected chalazia (ie, internalhordeolum) includes heat and topical and/or systemicantibiotics.
o In select cases, incision and drainage may bebeneficial.
o Evacuate only the pus; overly aggressive curettagecan disseminate the infection by breaking down tissuebarriers.
o Topical steroids are necessary to prevent the chronicinflammatory response, as well as the acutenoninfectious reaction produced by irritants (eg, freefatty acids liberated by bacterial enzymes) fromcausing excessive scarring.
o Once the acute inflammation has subsided, revisionand definitive curettage or excision of thegranulomatous mass may be required.
Surgical Care
Drainage by means of a transconjunctival incision andcurettage is optimal. Establish anesthesia by means of alocal infiltration, possibly augmented with topicalanesthetic cream (eutectic mixture of local anesthetics[EMLAs]) to reduce the pain of the injection in youngpatients. With recurrent chalazia, it is imperative that abiopsy be performed, with histological evaluation using fatstains (specifically request this on the specimen) to ruleout sebaceous cell carcinoma.
Apply a chalazion clamp to evert the lid and to controlbleeding.
o Vertically incise the lesion with a sharp blade, goingno closer than 2-3 mm to the lid margin. Avoidperforating the skin.
o Curette the contents, including any cyst lining.
o A few minutes of pressure are usually sufficient toachieve hemostasis.
o A light pressure bandage should be applied for a fewhours to absorb any further oozing.
If previous external drainage (or granuloma extension)was performed, an external approach may berecommended.
o Make the incision horizontally, at least 3 mm from thelid margin in an existing crease.
o Do not sacrifice normal tissue.
o After hemostasis, the wound may be closed withappropriate sutures (eg, 7-0 silk).
o Involvement of both skin and conjunctiva may requireoffsetting the incisions to avoid fistula formation.
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o Cauterization with phenol or trichloroacetic acid after incision and drainage may prevent the recurrence of small chalazia.
Large or chronically neglected and excessively fibroticchalazia may require more extensive surgical excision,including removal of parts of the tarsal plate.
o Leaving a 3-mm bridge of normal tarsus near the lid
margin prevents notching.o Multiple chalazia may be excised carefully, without
fear of major lid deformity; the fibrous tarsal plateheals without leaving gaps.
o Even complete tarsal plate removal has been reportednot to cause a lid deformity.
A local intralesional corticosteroid injection (0.5-2 mLtriamcinolone acetonide 5 mg/mL) is administered andcan be repeated in 2-7 days.
[2]
o Soluble aqueous preparations are preferred tocrystalline suspensions to minimize complications of hypopigmentation, atrophy, or a visible depot of medication.
o A transconjunctival injection route may also provide afurther safeguard.
o Injection or cautious surgical drainage of a chalazion
located near the lacrimal drainage system can preventserious complications involving tear flow.
A study by Simon et al compared triamcinoloneacetonide injection with incision and curettage in 94patients with chalazion.
[3]The study determined that
intralesional triamcinolone acetonide injection was aseffective as incision and curettage and may beconsidered as an alternative first-line treatment in caseswhere diagnosis is straightforward and biopsy is notrequired. Biopsy may be performed by simply excising asection of the remaining edge of the lesion. Do notoverlook the specific request to the pathologist to ruleout sebaceous cell carcinoma and to especially consider using fat stains (ie, do not have the specimen processedas usual).
Consultations
Referral to a dermatologist may be beneficial to help treatproblems with rosacea or sebaceous dysfunction.
Diet
Dietary modification has not been evaluated.
Similar advice given to manage severe acne may beappropriate in certain individuals. This advice is asfollows: avoid or decrease the ingestion of coffee,chocolate, and highly refined foods, as well as friedfoods and those containing saturated fats.
On average, most of the public is not consumingsufficient amounts of vegetables and fruits, fresh or
cooked, to meet the minimum recommendations of the American Dietary Association.
Dietary supplements with omega-3 and omega-6 fattyacids, available in flax seeds or in flax seed oil, may bebeneficial. A practical and simple intervention is to use acoffee grinder to grind flax seeds into meal. Onetablespoon per day of fresh meal is an excellent dietarysupplement and quite palatable
Activity
Regular habits of sufficient sleep, moderate sun exposure,exercise, and fresh air may be of benefit to cutaneoushealth and hygiene of the skin and glands of the eyelids.Stress is often associated with episodes of recurrentchalazia, although a causal role has not been established.
Medication Summary
Medical therapy for a chalazion is only rarely indicated,except in cases of rosacea, for which a 6-month course of low-dose tetracycline may be of benefit. Doxycycline indosages of as little as 100 mg every week for 6 monthsmay result in permanent biochemical change, with thesebaceous glands producing shorter-chain fatty acids,which are less likely than longer-chain fatty acids tocongeal and block the gland orifices.
Although probably innocuous, topical antibiotics do nothelp this condition, which is not infectious. Systemictetracycline may be beneficial, but local drops are unlikelyto help and are more likely to cause a contact dermatitis-type reaction. Topical steroids can be helpful in minimizinginflammation and in reducing edema, thereby facilitatingany drainage that may take place.
Antibiotics
Class Summary
Antibiotics are not indicated as treatment of infection.Significant benefit may be derived from low-dose, long-term therapy with tetracycline.
Tetracycline (Sumycin)
Useful adverse effect is altering bacterial flora in skin andaltering lipids to produce shorter-chain fatty acids,lowering melting point of sebaceous secretions, whichmay prevent blockage of meibomian glands.
Doxycycline (Bio-Tab, Doryx, Vibramycin)
Inhibits protein synthesis and, thus, bacterial growth bybinding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Alters lipids to produce shorter-chainfatty acids, lowering melting point of sebaceoussecretions, which may prevent blockage of the meibomianglands.
Minocycline (Dynacin, Minocin)
Adverse effect alters lipids to produce shorter-chain fattyacids, lowering melting point of sebaceous secretions,which may prevent blockage of the meibomian glands.
Metronidazole (Flagyl)
Taken PO, may benefit patients unable to taketetracyclines.
Corticosteroids
Class Summary
Corticosteroids have anti-inflammatory properties andcause profound and varied metabolic effects. In addition,these agents modify the immune response of the body todiverse stimuli.
Triamcinolone acetonide (Kenalog, Aristocort)
Advantages of Kenalog over other depot corticosteroids(eg, Celestone) are less discomfort and reduced cost. For inflammatory dermatosis responsive to steroids;decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillarypermeability. Used to minimize scarring and inflammation.
Further Outpatient Care
Routine follow-up at approximately 1 month should revealresolution of the chalazion, with no swelling, redness, or persistent lump. Any persistence of a nodule suggests the
diagnosis included not simply a chalazion but alsosebaceous cell carcinoma or other lid lesion.
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For further evaluation and management, appropriatespecimens of tissue should be obtained for histologicevaluation.Because sebaceous cell carcinoma is best evaluated byusing lipid stains, alert the pathologist to perform tissueprocessing without dehydration (ie, frozen section).The specimen should still be prepared in formalin to avoidautolysis; formalin does not remove the lipid, but rather,
the alcohol baths used in paraffin sectioning remove thelipid.
Transfer
Urgent transfer to an experienced orbital and/or ophthalmic plastic surgeon is mandatory after biopsyresults are documented or if the clinical findings suggestsebaceous cell carcinoma.
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Hordeolum (2)
Bintitan disebabkan sering mengintip? Sama sekaliSALAH tuh. Bintitan bukan terjadi sebab sering mengintiporang, namun bintitan itu sendiri sebenarnya adalahtergolong infeksi mata. Gejala yang timbul pada bintitanadalah kelopak mata terasa bengkak dan nyeri (kemeng),kadang keluar kotoran mata, dan pada perabaan seringterasa nyeri.
Pada bintitan (hordeolum), terjadi infeksi bacterial padakelenjar Meibom maupun kelenjar Zeiss dan Moll.Penyebab tersering dari bintitan ini sendiri adalahStaphylococcus aureus and Staphylococcus epidermidis.
Bintitan ini sendiri harus diobati dengan benar, sebabapabila berlangsung lama, maka infeksi tersebut berubahmenjadi infeksi granulomatus yang disebut Chalazia.
Apabila infeksi bintitan ini tidak diobati dengan baik, jugadapat menyebabkan penyebaran infeksi ke kelenjar disekitar kelopak mata yang dapat menimbulkan suatupreseptal selulitis.
Bintitan ini sebenarnya terdiri dari dua fase, yaitu faseinfiltratif dimana gejalanya masih meradang dan nyeri,
serta fase supuratif yaitu fase dimana kondisi peradangansudah reda namun bintitan sudah memasuki tahap untukmemerlukan incisi dan kuretase.
Pada bintitan yang masih dalam tahap awal, makapengobatan dapat dilakukan secara medika mentosa(konservatif), yaitu berupa kompres dingin untukmengurangi inflamasi dan obat-obatan seperti tetes mata,salep mata, maupun obat oral yang mengandungantibiotika.
klik gambar untuk melihat lebih jelas
Apabila bintitan sudah memasuki tahap supuratif, makapengobatan oral maupun topical sudah tidak dapatdilakukan. Satu-satunya jalan adalah membuatkan 'jalan'atau melakukan insisi dan kuretase pada hordeolumtersebut.
Untuk pencegahan bintitan, hindari menggosok kelopak
mata dengan tangan, terutama apabila tangan kita kotor karena dapat menyebabkan infeksi pada kelenjar dikelopak mata tersebut.
STYE An external stye (pronounced /ˈstaɪ/), also could bespelled as styor hordeolum (/hɔrˈdiːələm/) is an infectionof the sebaceousglands of Zeis at the base of the eyelashes, or an infection of theapocrine sweat glandsof Moll.
[1] External styes form on the outside of the lids and
can be seen as small red bumps. Internal styes are
infections of the meibomian sebaceous glands lining theinside of the eyelids. They also cause a red bumpunderneath the lid with only generalized redness andswelling visible on the outside. Styes are similar to chalazia, but tend to be of smaller size and are morepainful and usually produce no lasting damage. Styes arecharacterized by an acute onset and usually short induration (7 –10 days without treatment) compared tochalazia that are chronic and usually do not resolvewithout intervention.
Cause
Styes are commonly caused by a Staphylococcusaureus bacterial infection, or by the blocking of an oil
gland at the base of the eyelash. Although they areparticularly common in infants, styes are experienced bypeople of all ages. Styes can be triggered by poor nutrition, sleep deprivation, lack of hygiene or rubbing of the eyes. Sharing of washcloths or face towels should becurtailed to avoid spreading the infection betweenindividuals.
[2][3] Styes can last from one to two weeks
without treatment, or as little as four days if treatedproperly.
[4]
Medical professionals will sometimes lance a particularlypersistent or irritating stye with a needle to accelerate itsdraining.
[5] A stye's expansion can also be fought
with erythromycin ophthalmic ointment.[6]
Medicalprofessionals may also treat styes with other antibiotics,such as chloramphenicol or amoxicillin.
[7] Chloramphenicol
is used successfully in many parts of the world, but
contains a black box warning in the United States due toconcerns about aplastic anemia, which on rare occasionscan be fatal. Erythromycin ointment enjoys widespreaduse, and may add to comfort and aid in preventingsecondary infections. However, it is poorly absorbed whenused topically, and usually requires oral dosing to reachthe infection with therapeutic levels inside of a stye. Azasite, a topical eye drop form of azithromycin, doesappear to penetrate eyelid tissues fairly well, and may bea topical treatment for styes used in the future.If a stye bursts, care must be taken to cleanse the woundto prevent reinfection.
Signs and symptoms
The first sign of a stye is a small, yellowish spot at the
center of the bump that develops as pus expands in thearea.[8]
Other stye symptoms may include:
A lump on the top or bottom eyelid
Localized swelling of the eyelid
Localized pain
Redness
Tenderness to touch
Crusting of the eyelid margins
Burning in the eye
Droopiness of the eyelid
Scratchy sensation on the eyeball
Blurred vision
Mucous discharge in the eye
Irritation of the eye[9]
Light sensitivity
Tearing
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Discomfort during blinking[10]
Sensation of a foreign body in the eye
Treatment
Stye on lower part of a person's eyeThe primary mode of treatment for a stye is application of warm compresses. Incision and drainage is performed if resolution does not begin in the next 48 hours after warmcompresses are started.
As a part of self-care at home, patients may cleanse theaffected eyelid with tap water or with a mild,
nonirritating soap or shampoo (such as baby shampoo) tohelp clean crusted discharge. Cleansing must be donegently and while the eyes are closed to prevent eyeinjuries.
[11]
Patients are highly advised to not lance the stye, asserious infection can occur as a result. The infection couldspread to the surrounding tissues and areas.Eye stye sufferers should avoid eye makeup (e.g.,eyeliner), lotions and wearing contact lenses, since thesecan aggravate and spread the infection (sometimes to thecornea).Medical treatment can also be provided by a doctor and itis aimed on relieving the symptoms. Pain relievers suchasacetaminophen may be prescribed and in somecases, antibiotics may be needed. Antibiotics are normallygiven to patients with multiple styes or with styes that do
not seem to heal, and to patients who also suffer from blepharitis orrosacea. Commonly, theophthalmologist prescribes oral or intravenous antibiotics,such as doxycycline, only when the infection has spread.Topical antibiotic ointments or antibiotic/steroidcombination ointments can also be administered in styetreatment.
Surgery is the last resort in stye treatment. Styes that donot respond to any type of therapies are usually surgicallyremoved. Stye surgery is performed by anophthalmologist, and generally under local anesthesia.The procedure consists of making a small incision on theinner or outer surface of the eyelid, depending if the stye ispointing externally or not. After the incision is made, thepus is drained out of the gland, and very small and
unnoticeablesutures are used to close the lesion. It iscommon for the removed stye to be sent for histopathological examination to rule out the possibility of skin cancer.
Complications
Stye complications occur in very rare cases. However, themost frequent complication of styes is progression toachalazion that causes cosmetic deformity, cornealirritation, and often requires surgicalremoval.
[12] Complications may also arise from the
improper surgical lancing, and mainly consist of disruptionof lash growth, lid deformity or lidfistula. Styes that are toolarge may interfere with one's vision.Eyelid cellulitis is another potential complication of eye
styes, which is a generalized infection of the eyelid.Progression of a stye to a systemic infection (spreading
throughout the body) is extremely rare, and only a fewinstances of such spread have been recorded.
[13]
Prognosis
Although styes are harmless in most cases andcomplications are very rare, styes often recur. They do notcause intraocular damage, meaning they do not affect theeye. Styes normally heal on their own by rupturing withinfew days to a week, causing the relief of symptoms. Fewpeople require surgery as part of stye treatment. Withadequate treatment, styes tend to heal quickly and withoutarising any type of complications.The prognosis is better if one does not attempt to squeezeor puncture the stye, as infection may spread to adjacenttissues. A stye usually will heal within a few days to aweek, but if it does not improve or it worsens within twoweeks, a doctor's opinion should be sought. Also, patientsare recommended to call a doctor if they encounter problems with vision, the eyelid bumps becomes verypainful, the stye bleeds or reoccurs or the eyelid or eyebecomes red.
[14]
Prevention
Stye prevention is closely related to proper hygiene.Proper hand washing can not only reduce the risks of developing styes, but also all other types of infections.Upon awakening, application of a warm washcloth to theeyelids for one to two minutes may be beneficial indecreasing the occurrence of styes by liquefying thecontents of the oil glands of the eyelid and therebypreventing blockage. Some studies suggest oral flaxseedsupplementation to prevent the occurrence of styes.
[15]
To prevent developing styes, it is recommended to never share cosmetics or cosmetic eye tools with other people.People should also keep their eye tools clean andgenerally practice proper eye hygiene. It is recommendedto remove makeup every night before going to sleep anddiscard old or contaminated eye makeup.
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Ulkus Kornea, Referat.
TINJAUAN PUSTAKAIII.1 DefinisiUlkus Kornea adalah keadaan patologik kornea yangditandai oleh adanya infiltrat supuratif disertaidefek kornea bergaung, diskontinuitas jaringan kornea
dapat terjadi dari epitel sampai stroma.Ulkus kornea merupakan hilangnya sebagian permukaankornea akibat kematian jaringan kornea.Ulkus kornea yang luas memerlukan penanganan yangtepat dan cepat uuntuk mencegah perluasanulkus dan timbulnya komplikasi seperti desmetokel,perforasi, endoftalmitis.III.2 EtiologiPenyakit kornea adalah penyakit mata yang seriuskarena menyebabkan gangguan tajam penglihatan,bahkan dapat menyebabkan kebutaan. Ulkus korneamerupakan hilangnya sebagian permukaankornea akibat kematian jaringan kornea.Ulkus biasanya terbentuk akibat; infeksi oleh bakteri(misalnya stafilokokus, pseudomonas, ataupneumokokus), jamur virus (misalnya herpes) atau
protozoa akantamuba, selain itu ulkus korneadisebabkan reaksi toksik, degenerasi, alergi danpenyakit kolagen vaskuler. Kekurangan vitamin Aatau protein, mata kering (karena kelopak mata tidakmenutup secara sempurna dan melembabkankornea).Faktor resiko terbentuknya antara lain adalah cederamata, ada benda asing di mata, dan iritasi akibatlensa kontak.III.3 PatofisiologiBila pertahanan normal pada mata seperti epitelkornea mengalami gangguan, resikoterjadinyainfeksi sangat tinggi. Penyebab yang mungkinseperti trauma langsung pada kornea, penyakit alismata yang kronis, abnormalitas tear film yangmengganggu keseimbangan permukaan bola matadan trauma hipoksia akibat pemakaian lensakontak.Koloni bakteri patologi pada lapisan kornea bersifatantigen dan akan melepaskan enzim dantoksin. Hal ini akan mengaktifkan reaksi antigenantibodi yang mengawali proses inflamasi. Sel-sel PMN pada kornea akan membentuk infiltrat.PMN berfungsi memfagosit bakteri. Lapisankolagen stroma dihancurkan oleh bakteri dan enzimleukosit dan proses degradasi berlanjutmeliputi nekrosis dan penipisan. Karena penipisanlapisan ini, dapat terjadi perforasimenyebabkan endoftalmitis. Bila kornea telahsembuh, dapat timbul jaringan sikatrik yangmenyebabkan penurunan tajam penglihatan.Bakteri gram positif lebih banyak menjadipenyebab
infeksi bakterialis di dunia bagianselatan.Psaeudomonas aeruginosa paling banyakditemukanpada ulkus kornea dan keratitis karena lensakontak.Terbentuknya ulkus pada kornea mungkin banyakditentukan oleh adanya kolagenase yangdibentuk oleh sel epitel baru dan selradang.Dikenal ada 2 bentuk tukak pada kornea,yaitusentral dan marginal/perifer.Tukak kornea sentral disebabkan oleh infeksibakteri, jamur, dan virus.Sedangkan perifer umumnya disebabkan oleh reaksi toksik, alergi,autoimun, dan infeksi.Infeksi pada korneaperifer biasanya disebabkan oleh kuman Stafilokok
aureus, H. influenza, dan M. lacunata.III.4 JenisIII.4.1 Ulkus Kornea Sentral
Ulkus kornea sentral dapat disebabkan olehpseudomonas, streptococcus, pneumonia, virus, jamur, dan alerg i. Pengobatan ulkus korne a secaraumum adalah dengan pemberian antibiotikayang sesuai dan sikloplegik.Pembentukan parutakibat ulserasi kornea adalah penyebab utamakebutaan dan gangguan penglihatan di seluruhdunia. Kebanyakan gangguan penglihatan ini
dapat dicegah, namun hanya bila diagnosispenyebabnya ditetapkan secara dini dan diobatisecara memadai. Ulserasi supuratif sentral dahuluhanya disebabkan oleh S pneumonia. Tetapiakhir-akhir ini sebagai akibat luasnya penggunaanobat-obat sistemik dan lokal (sekurang-kurangnya di negara-negara maju), bakteri, fungi,dan virus opurtunistik cenderung lebih banyakmenjadi penyebab ulkus kornea daripada Spneumonia.Ulkus kornea sentral dengan hipopionUlkus sentral biasanya merupakan ulkus infeksiakibat kerusakan pada epitel. Lesi terletek disentral, jauh dari limbus vaskuler. Hipopionbiasanya (tidak selalu) menyertai ulkus. Hipopionadalah pengumpulan sel-sel radang yang tampak
sebagai lapis pucat di bagian bawah kameraanterior dan khas untuk ulkus sentral korneabakteri dan fungi. Meskipun hipopion itu steril padaulkus kornea bakteri, kecuali terjadi robekan padamembran descemet, pada ulkus fungi lesi inimungkin mengandung unsur fungi.Ulkus Kornea BakterialisUlkus kornea yang khas biasanya terjadi padaorang dewasa yang bekerja di bidang konstruksi,industri, atau pertanian yang memungkinkanterjadinya cedera mata. Terjadinya ulkus biasanyakarena benda asing yang masuk ke mata, ataukarena erosi epitel kornea. Dengan adanya defekepitel, dapat terjadi ulkus kornea yang disebabkanoleh mikroorganisme patogen yang terdapatpada konjungtiva atau di dalam kantong lakrimal.
Banyak jenis ulkus kornea bakteri mirip satusama lain dan hanya bervariasi dalam beratnyapenyakit. Ini terutama berlaku untuk ulkus yangdisebabkan bakteri oportunitik (misalnyaStreptococcus alfa-hemolyticus, Staphylococcusaureus, Staphylococcus epidermidis, Nocardia, danM fortuitum-chelonei), yang menimbulkanulkus indolen yang cenderung menyebar perlahandan superficial.Ulkus sentral yang disebabkan Streptococcus beta-hemolyticus tidak memiliki ciri khas. Stromakornea disekitarnya sering menunjukkan infiltratdan sembab, dan biasanya terdapat hipopionyang berukuran sedang. Kerokan memperlihatkankokus gram (+) dalam bentuk rantai. Obat-obat yang disarankan untuk pengobatan adalah
Cefazolin, Penisillin G, Vancomysin danCeftazidime.Ulkus kornea sentral yang disebabkanStaphylococcus aureus, Staphylococcusepidermidis, danStreptococcus alfa-hemolyticus kini lebih seringdijumpai daripada sebelumnya, banyakdiantaranya pada kornea yang telah terbiasaterkena kortikosteroid topikal. Ulkusnya seringindolen namun dapat disertai hipopion dan sedikitinfiltrat pada korneasekitar. Ulkus ini seringsuperficial, dan dasar ulkus teraba padat saatdilakukan kerokan. Kerokan mengandung kokusgram (+) satu-satu, berpasangan, atau dalambentuk rantai. Keratopati kristalina infeksiosa telahditemukan pada pasien yang menggunakan
kortikosteroid topikal jangka panjang, penyebabumumnya adalah Streptococcus alfa-hemolyticus.Ulkus Kornea Fungi
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Ulkus kornea fungi, yang pernah banyak dijumpaipada pekerja pertanian, kini makin banyakdiantara penduduk perkotaan, dengan dipakainyaobat kortikosteroid dalam pengobatan mata.Sebelum era kortikosteroid, ulkus kornea fungihanya timbul bila stroma kornea kemasukansangat banyak mikroorganisme. Mata yang belumterpengaruhi kortikosteroid masih dapat
mengatasi masukkan mikroorganisme sedikit-sedikit.Ulkus kornea akibat jamur (fungi)Ulkus fungi itu indolen, dengan infiltrate kelabu,sering dengan hipopion, peradangan nyata padabola mata, ulserasi superficial, dan lesi-lesi satelit(umumnya infiltrat, di tempat-tempat yang jauh dari daerah utama laserasi ). Lesi utamamerupakan plak endotel dengan tepian tidak teratur dibawah lesi kornea utama, disertai dengan reaksikamera anterior yang hebat dan abses kornea.Kebanyakan ulkus fungi disebabkan organismeoportunistik seperti Candida, Fusarium, Aspergi llus , Penici ll ium , Cephalospor ium, dan lain -lain. Tidak ada ciri khas yang membedakanmacam-macam ulkus fungi ini.
Kerokan dari ulkus kornea fungi, kecuali yangdisebabkan Candida umumnya mengandungunsur-unsur hifa; kerokan dari ulkus Candidaumumnya mengandung pseudohifa atau bentukragi, yang menampakkan kuncup-kuncup khas.Ulkus Kornea Virus A. Ke rati ti s Herpes Simp leksKeratitis herpes simpleks ada dua bentuk yaituprimer dan rekurens. Keratitis ini adalahpenyebab ulkus kornea paling umum danpenyebab kebutaan kornea paling umum di Am er ika.Bentuk epitelialnya adalah padanan dari herpeslabialis yang memiliki ciri-ciri imunologik danpatologik sama juga perjalanan penyakitnya.Perbedaan satu-satunya adalah bahwa perjalanan
klinik keratitis dapat berlangsung lama karenastroma kurang vaskuler sehingga menghambatmigrasi limfosit dan makrofag ke tempat lesi.Penyakit stroma dan endotel tadinya didugahanyalah respons imunologik terhadap partikelvirus atau perubahan seluler akibat virus, namunsekarang makin banyak bukti yang menunjukkanbahwa infeksi virus aktif dapat timbul di dalam
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BAB I
PENDAHULUANI. 1 Latar BelakangBilik mata depan adalah ruang yang terdapat antarakornea dan iris. Sedangkan bilik matabelakang adalahruang yang lebih kecil yang terdapat diantara iris danlensa. Keduaruangan ini diisi oleh cairan aqueous.Berbagai perubahan yang terjadi pada matadapatmenyebabkan perubahan dari cairan aqueous danbilik mata depan. Karena itu gambaranklinis pada bilikmata depan dapat membantu dalam menegakan diagnosapenyakit, jugadalam memantau respons pasien terhadapterapi.Reaksi inflamasi iris dan badan siliar akan memberikangambaran Anterior chamber cell and flare di bilik mata depan. Diartikan sebagai kumpulansel dan peningkatan protein
(flare) di aqueous humor. Kumpulan sel biasanya terdiridari sel darah putih, disebut jugahipopion. Kadang bisa juga terdiri dari sel darah merah, disebut sebagaihifema.Kumpulan sel ini akan mengendap di bagianinferior, membentuk lapisan yang dapatterlihat di bilikmata depan.1Sel darah di bilik mata depan merupakan hasil pelepasansel darah akibat dilatasipembuluh darah di iris dan badansiliar. Adanya sel di bilik mata depanmemberikangambaran penyakit yang onsetnya akut.Sedangkan flare adalah akumulasi dari protein dibilik matadepan. Dapat menetap, bahkan setelah sel darah tidakditemukan lagi.Mungkin disebabkan karena adanyakebocoran persisten dari blood-aqueous barrier.1
Karena itu, presentasi flare sendiri tidak bisa dijadikanpegangan sebagai gejala inflamasiyang masih aktif.2I. 2 Tujuan PenulisanTujuan dari penulisan referat ini adalah untuk mengenallebih dalam tentang hipopiondari segi definisi, gambaranklinis, faktor-faktor yang dapat menyebabkanterjadinyahipopion maupun terapinya. Sehinggadapatdilakukan penanganan yang tepat danmencegahterjadinya komplikasi lebih lanjut.
Beberapa keadaan yang dapat memberikan gambaranhipopion, diantaranya5,6:
Ulkus Kornea. Apabila terjadi peradangan hebat tapibelum terjadi perforasi dari ulkus,
maka toksin dari peradangan kornea dapat sampai ke irisdan badan siliar, dengan melaluimembran Descemet,endotel kornea ke cairan bilik mata depan. Dengandemikian iris danbadan siliar mengalami peradangan dantimbulah kekeruhan di cairan bilik mata depandisusuldengan terbentuknya hipopion.Uveitis Anterior. Peradangan dari iris dan badan siliar.menyebabkan penurunan
permeabilitas dari blood-aqueous barrier sehingga terjadipeningkatan protein, fibrin dansel radang dalam cairan aqueous.Rifabutin. Merupakan terapi profilaksis untukMycobacterium avium complex pada penderita dengan HIV. Uveitis merupakan efek sampingyang dapat terjadi padapemakaian Rifabutin.Trauma. Corpus alienum, toxic lens syndrome, postoperasi. II. 4Presentasi KlinisGejala subyektif yang biasanya menyertai hipopion adalahrasa sakit, iritasi, gatal danfotofobia pada mata yangterinfeksi. Beberapa mengalami penurunan visus ataulapangpandang, tergantung dari beratnya penyakit utamayang diderita.
5
Gejala obyektif biasanya ditemukan aqueous cell andflare, eksudat fibrinous, sinekiaposterior dan keratitis presipitat.2,3II. 5 DiagnosaDiagnosa hipopion ditegakan berdasarkan anamnesa danpemeriksaan menggunakan slitlamp. Pada anamnesa,ditanyakan adanya riwayat infeksi, pemakaian lensakontak,trauma, pemakaian obat serta riwayat operasi.Pada pemeriksaan dengan slit lamp, ditemukan lapisanberwarna putih pada bagianinferior dari bilik mata depan.Jarang sekali hipopion ini ditemukan pada bagian laindaribilik mata depan.Hipopion biasanya dinilai berdasarkan tingginya, diukur dari dasar bilik mata depandengan satuan milimeter. Ataubisa juga dengan hitungan kasar, misalnya.ringan,moderat, setengah bilik mata depan dan seluruhmata depan.Cara terbaik untuk menilai hipopion adalah denganterlebih dahulu meminta pasienduduk beberapa saatsupaya hipopion dapat mengendap sempurna.Selanjutnya pasiendiminta melihat ke bawah dan sinar diarahkan dari bagian atas-depan iris.1,4II. 6 Diagnosa BandingHipopion harus dibedakan dari7:• Pseudohipopion yang ditemukan pada retinoblastoma,injeksi steroid okular dan ghost cell glaucoma. Pseudohipopion termasuk dalamkelompok sindrommasquerade. Untuk membedakan harusdilakukan pemeriksaan dengan pupil yangtelah dilebarkandengan midriatik. Sindrom Masquerade disebabkan oleh
iridoskisis, atrofi iris esensial, limfoma maligna, leukemi,sarkoma sel retikulum,retinoblastoma, pseudoeksfoliatif dan tumor metastasis.Pseudohipopion dan infiltrasi tumor di irisGambar diambil dari http://www.sarawakeyecare.com/Atlasofophthalmology Ghost Cell Glaucoma merupakan glaukoma sekunder sudut terbukadimanatrabecular meshwork mengalamiobstruksi oleh sel darah merah yangterdegenerasi,disebut “ghost cells”. Biasanya didahului oleh trauma. • Metastasis ke bilik mata depan, misalnya dari leukemiadan Ca mammae.
II. 7 Komplikasi KlinisStruktur dari hipopion yang mengandung fibrin,merupakan reaksi tubuh terhadainflamasi. Tetapi fibrin-
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fibrin ini dapat menyebabkan terjadinya perlengketanantara irisdan lensa (sinekia posterior) Bila seluruh pinggir iris melekat pada lensa disebut seklusiopupil, sehinggacairan dari cop tidak dapat melalui pupil untuk masuk kecoa, iristerdorong ke depan, disebut iris bombe danmenyebabkan sudut coa sempit sehinggatimbul glaukomasekunder.Kepaniteraan Klinik Ilmu Penyakit Mata
Fakultas Kedokteran Universitas TarumanagaraRumah Sakit Umum Daerah Kota Semarang Periode 07 Juni 2010 – 10 Juni 2010 7
Peradangan di badan silier dapat juga menyebabkankekeruhan dalam badan kaca olehsel-sel radang, yangtampak sebagai kekeruhan seperti debu. Peradanganinimenyebabkan metabolisme lensa terganggu dan dapatmenimbulkan kekeruhan lensa,hingga terjadi katarak.Pada kasus yang sudah lanjut, kekeruhan badan kaca punmengalami jaringan organisasidan tampak sebagaimembrana yang terdiri dari jaringan ikat denganneovaskularisasiyang berasal dari sistem retina, disebutretinitis proliferans.
Bila membrana ini mengkerut, dapat menarik retinasehingga robek dan cairan badankaca melalui robekan itumasuk ke dalam celah retina potensial danmengakibatkan ablasi retina.5,6II. 8 PenatalaksanaanPenatalaksanaan hipopion tergantung dari ringan atauberatnya penyakit. Sel darah putihbiasanya akan direabsorpsi. Tetapi bila hipopion memberikan gambaranyang berat,maka bisa dilakukan drainase.1,3Terapi yang lebih spesifik biasanya tergantung daripenyakit utama yang menyebabkanhipopion. Apabila terjadi inflamasi, dapat diberikankortikosteroid. Anti inflamasi yang biasanya digunakan adalahkortikosteroid, dengan dosis sebagaiberikut:Dewasa : Topikal dengan dexamethasone 0,1 % atauprednisolone 1 %.Bila radang sangat hebat dapat diberikan subkonjungtivaatau periokuler :dexamethasone phosphate 4 mg (1 ml)prednisolone succinate 25 mg (1 ml)
triamcinolone acetonide 4 mg (1 ml)methylprednisolone acetate 20 mgCycloplegic dapat diberikan dengan tujuan untukmengurangi nyeri dengan memobilisasiiris, mencegahterjadinya perlengketan iris dengan lensa anterior ( sinekiaposterior ),yang akan mengarahkan terjadinya iris bombedan peningkatan tekanan intraocular,menstabilkan blood-aqueous barrier dan mencegah terjadinya protein leakage
(flare) yanglebih jauh. Agent cycloplegics yang biasadipergunakan adalah atropine 0,5%, 1%, 2%,homatropine2%, 5%, Scopolamine 0,25%, dan cyclopentolate 0,5%,1%, dan 2%.8II. 9 PrognosaHipopion adalah gejala klinis yang muncul sebagai responinflamasi. Sel darah putihakan diabsorpsi sepenuhnya.Tetapi prognosis tergantung dari penyakit dankomplikasiyang dapat terjadi.1Kepaniteraan Klinik Ilmu Penyakit MataFakultas Kedokteran Universitas TarumanagaraRumah Sakit Umum Daerah Kota Semarang Periode 07 Juni 2010 – 10 Juni 2010 9
BAB IIIKESIMPULAN
Hipopion adalah pus steril yang terdapat pada bilik matadepan yang terlihat sebagailapisan putih yang mengendap di bagian bawah bilik matadepan.Bangunan yang berhubungan dengan hipopion adalah irisdan badan siliar. Radang irisdan badan siliar menyebabkan penurunan permeabilitas dari blood-aqueous barrier sehingga terjadi peningkatan protein, fibrin
dan sel radang dalam cairan aqueous,sehinggamemberikan gambaran hipopion.Hipopion merupakan reaksi inflamasi di bilik mata depan.Karena itu semua penyakityang berhubungan dengan uveitis anterior dapatmenyebabkan terjadinya hipopion.Diagnosa hipopion ditegakan berdasarkan anamnesa danpemeriksaan menggunakan slitlamp.Hipopion harus dibedakan dengan pseudohipopion yangmerupakan tanda keganasan. Apabila berkelanjutan, hipopion dapat menyebabkankomplikasi berupa glaukomasekunder, katarak, retinitisproliferans dan pada kasus yang berat dapatmenyebabkan ablasi retinaPenatalaksanaan hipopion biasanya tergantung dari
banyaknya lapisan pus di bilik matadepan. Bila prosesinflamsi akut sudah diatasi, biasanya hipopion akandireabsorpsi. Bilapresentasi pus sangat banyak, bisadilakukan drainase.Prognosa dari hipopion tergantung dari penyakit yangmenjadi keluhan utama.
