Hordeolum Internum Palpebra Inferior

Okuli Sinistra

Muhammad Bagus Syaiful CH

Advisor :
dr. Isna Kusuma Nintyastuti, SpM

1
 INTRODUCTION

◆ Hordeolum is an acute bacterial ◆ adults may be more vulnerable because of

infection that occurs in the increased viscosity of sebum.
palpebra gland. ◆ In addition to conditions such as
◆ hordeolum internum blepharitis, seborrheic dermatitis, rosacea,
infection of the meibom diabetes.
gland with protrusion ◆ Complications that can result from
mainly located within the hordeolum are palpebral cellulitis and
palpebral abscesses
tarsus
◆ Hordeolum externum
infection of the glands of
Zeis or Moll in tarsus
◆ Staphylococcus bacterial
infection

2
 ANATOMY

3
 CASE REPORT
◆ Name : Mr. Asdiyan
◆ Age : 20 years old
◆ Gender : Male
◆ Job : Labor
◆ Religion : Moeslim
◆ Address : Lembar
◆ No. RM : 054458
◆ Inspection Date : December 11, 2019

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 1.
History

5
 Main complaint (Lump on the left eyelid)

◆ Current Disease History:

a. Patients came to the Eye Clinic of NTB Province Regional Hospital with
complaints of swelling on the left eyelid since ± 3 days.
b. begins after waking up the left lower eyelid is swollen.
c. small lumps like pimples and the day it gets bigger.
d. The patient had rubbed his eyes and then on a bump burst out of white fluid.
e. The lump feels itchy and slightly painful. Watery Eyes (+) and red eyes-

6
 History

Past medical history Family Disease

◆ A history of previous History
similar complaints (-). ◆ The same complaint in
◆ History using glasses the family is denied.
(-). ◆ Family history of
glaucoma (-)
◆ History of trauma (-).
◆ History of DM (-)
◆ Hypertension (-)
Allergy History
◆ The patient has no Medication History
history of allergies. ◆ Before the patient came to the
eye clinic, RSUDP NTB
treatedwith eye drops.

7
 Physical examination

◆ Generalist status
1. General Conditions: Good
2. Awareness / GCS: Compos mentis / E4V5M6
◆ Vital Signs Check
1. Blood pressure: 120/80 mmHg
2. Pulse: 88 times / minute
3. Breath frequency: 20 times / minute
4. Temperature: 36.6C

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 Status Ophtamology
No Pemeriksaan Mata Kanan Mata Kiri
1. Visus Naturalis (SC) 6/6 6/6
Pinhole - -
Correction - -
2. Eyeball position Ortoforia Ortoforia
3. Eyeball movement Good in all directions Good in all directions

4. Field of view Same with examiner Same with examiner

5. Palpebra Superior Edema (-) (-)

Hiperemi (-) (-)
Pseudoptosis (-) (-)
Entropion (-) (-)
Ektropion (-) (-)
Spasme (-) (-)
6. Palpebra Inferior Edema (-) (+)
Hiperemi (-) (+)
Entropion (-) (-)
Ektropion (-) (-)
7. Konjungtiva Palpebra Superior Hiperemi (-) (-)
Sikatrik (-) (-)
Masa (-) (-)
Eksudat (-) (-)
Tenderness (-) (-)
8. Konjungtiva Palpebra Inferior Hiperemi (-) (+)
Sikatrik (-) (-)
Masa (-) (+)
Eksudat (-) (-)
9. Konjungtiva Bulbi Injeksi Konjungtiva (-) (-)

Injeksi Siliar (-) (-)

Massa (-) (-)
Edema (-) (-)
10. Sclera Massa (-) (-)
11. Kornea Form Convex Convex
Clarity Clear Clear
Surface Slippery Slippery
Sikatrik (-) (-)
Foreign object (-) (-)
12. COA Depth Deep Deep
Hifema (-) (-)
Koagulum (-) (-)
13. Iris Color brown brown

14. Pupil Form Round Round

Size ± 3 mm ± 3 mm
Direct light reflex (+) (+)

Indirect light reflexes (+) (+)

15. Lensa Clarity Clear Clear

16. TIO palpation N/P (normal per palpation) N/P (normal per palpation)

17. Funduskopi Refleks Fundus (+) (+)

Blood vessel Blood vessels appear from Blood vessels appear from
papilla N II papilla N II

Papil N II The reddish yellow color is The reddish yellow color is

round and has a clear border round and has a clear border

Makula Looks like a reflection of light Looks like a reflection of light

without blood vessels around without blood vessels around
 A picture patient

◆ Supporting investigation:
Slit Lamp
◆ Conclusion: Hordeolum
internum palpebra inferior
oculi sinistra

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 CASE ANALYSIS

Subjective:
1. Swelling on the lower left eyelid since ± 3 days ago.
2. The patient complains of a lump coming suddenly, feels pain and itching
around the lump.
Objective:
1. Inferior palpebrae have lumps and hyperemia.
2. Palpebra Inferior conjunctiva found hyperemia and mass in the form of
white fluid.

13
 CASE ANALYSIS
◆ Based on history and
physical examination, the
patient came with
complaints of swelling in the
lower left eyelid since ± 3
days ago.
◆ Arises suddenly, pain and
itching around the lump.
14
◆ Anamnesis directs us that this
case is Hordeolum which is
inflammation of the eyelids that is
acute and accompanied by pain
because it is in accordance with
complaints ± 3 days ago and
arises suddenly
◆ usually caused by a bacterial
infection that affects the oil glands
in the eyelid and can be internal or
external.
 CASE ANALYSIS
◆ On physical examination
Palpebra Inferior found
lumps and hyperemia,
Palpebra Inferior conjunctiva
found hyperemia and mass
in the form of white fluid.
15
◆ In this case hordeolum is
classified into two namely
hordeolum internum: infection of
the meibomian gland with
protrusion mainly located in the
tarsus, obstruction from these
glands reacts to the tarsus and
surrounding tissue
◆ Hordeolum externum: infection
of the Zeis or Moll glands.
 CASE ANALYSIS
◆ The physical examination of
the patient is closely related
to the clinical symptoms of
hordeolum in general
16
◆ Swollen petals with pain and
lumps, red and painful when
pressed, the presence of
pseudoptosis or ptosis which
results in difficult lifting of the
petals, enlargement of the
preauricular glands, sometimes
the eyes are runny and
sensitive to light, an abscess
that can rupture by itself.
 To distinguish internal and external hordeolum in
these patients is as the following table

Hordeolum internum Hordeolum eksternum

 Swelling accompanied  Swelling accompanied
by pain by pain

 The tarsal swelling site  Swollen spots on the

can enlarge and exit eyelids that point
anteriorly (through the forward through the skin
skin) or posteriorly (via
the conjunctiva)

17
 CASE ANALYSIS
◆ In this case, the type of ◆ hordeolum internum according
hordeolum that occurs is
hordeolum internum
18
to the situation in the patient
where the patient's swelling is
accompanied by pain, when a
physical examination is
performed on the palpebra area
the patient gets swelling in the
tarsal can be enlarged and
come out anteriorly (through the
skin).
 “
Assessment
Hordeolum internum palpebra inferior okuli sinistra

Planning therapy
1. Warm water compress for 15 minutes
2. Erythromycin ointment 2x1

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 Therapy

◆ In this condition it will ◆ Erythromycin ophthalmic

usually heal itself in one
week. Both internal and
external hordeolum are
treated the same.
◆ To speed recovery and
prevent the spread of
infection, warm compresses
are carried out for 15
minutes four times a day
ointment is applied twice a
day because there is little
evidence that shows the
benefits of using topical
antibiotics but for 7 to 10
days it has been
recommended.

20
 Therapy
◆ Oral antibiotics are rarely
indicated unless there is
significant erythema around
and complicates periorbital
cellulitis.
21
◆ Referral to ophthalmologist
for very large hordeolum
where incision and drainage
is performed. Re-evaluation
in 2 to 3 days is appropriate
to assess the response to
treatment.
 Education

◆ Notifying the results of the examination to the patient and patient's

family.
◆ Maintain hygiene to prevent re-infection
Prognosis
◆ Vision prognosis (ad functionam)
◆ Prognosis of vision in patients with OS dubia ad bonam
◆ Prognosis for complete recovery (ad sanationam)
◆ Prognosis for complete recovery of dubia ad bonam

22
 Conclusion

◆ The patient is a male of 20 years with complaints of a lump on the

left eyelid ± 3 days ago. appear suddenly and the lump gets bigger
day by day. The complaint is accompanied by pain
◆ On physical examination of the eye obtained inferior palpebra
found lumps and hyperemia. Inferior palpebral conjunctiva is
hyperemic and the mass is white fluid.
◆ Based on the history and physical examination of the eye, the
patient was diagnosed with inferior internal palpebral ocular
hordeolum ocular.

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 Refrence

1. Ilyas Sidarta H. Hordeolum. Dalam : Ilmu Penyakiy Mata. Edisi keempat. Balai Penerbit FKUI. Jakarta, 2004
2. Lindsley, K., Nichols, J. J. and Dickersin, K. (2013) ‘Interventions for acute internal hordeolum’, in Lindsley, K.
(ed.) Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd. doi:
10.1002/14651858.CD007742.pub3.
3. Bragg, K. J. and Le, J. K. (2019) Hordeolum, StatPearls. Available at:
https://linkinghub.elsevier.com/retrieve/pii/S1743181617300884.
4. Lindsley, K., Nichols, J. J. and Dickersin, K. (2017) ‘Non-surgical interventions for acute internal hordeolum’,
Cochrane Database of Systematic Reviews, 2017(1). doi: 10.1002/14651858.CD007742.pub4.
5. MCALINDEN, C., GONZÁLEZ-ANDRADES, M. and SKIADARESI, E. (2016) ‘Hordeolum: Acute abscess within
an eyelid sebaceous gland’, Cleveland Clinic Journal of Medicine, 83(5), pp. 332–334. doi:
10.3949/ccjm.83a.15012.
6. Kadu, A. (2018) ‘Jalukavacharan ( Leech ) in Anjananamika ( External Hordeolum )’, (October), pp. 2–6. doi:
10.13140/RG.2.2.11852.26245.
7. Buttaravoli, P. (2007) ‘Hordeolum’, in Minor Emergencies. Elsevier, pp. 85–86. doi: 10.1016/B978-032304026-
6.50024-7.

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Is the color of gold, butter and
ripe lemons. In the spectrum of
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Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
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Is the colour of the clear sky
and the deep sea. It is located
between violet and green on the
optical spectrum.
Blue
Is the colour of the clear sky
and the deep sea. It is located
between violet and green on the
optical spectrum.
Red
Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
courage.
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Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
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