of the eyelids and, therefore, predispose to hordeola and

chalazia.

Hordeolum (1)
Def: A hordeolum is a common disorder of the eyelid. [1] It is
an acute focal infection (usually staphylococcal) involving
either the glands of Zeis (external hordeola, or styes) or,
less frequently, the meibomian glands (internal hordeola).

On examination, a tender erythematous subcutaneous

nodule is present near the eyelid margin, which may
undergo spontaneous rupture and drainage. If sufficient
edema is present, then it may be difficult to palpate a
discrete nodule. These nodules may be unilateral or
bilateral, single or multiple.

[2]

Pathophysiology
There is usually underlying meibomitis with thickening and
stasis of gland secretions with resultant inspissation of the
Zeis or meibomian gland orifices. Stasis of the secretions
leads to secondary infection, usually byStaphylococcus
aureus.[3] Histologically,
hordeola
represent
focal
collections of polymorphonuclear leukocytes and necrotic
debris (ie, an abscess).

The inflammation associated with hordeola may spread to

adjacent tissue and cause a secondary preseptal cellulitis.
Patients may also have signs of meibomitis, blepharitis,
or ocular rosacea.[6

Hordeola should not be confused with chalazia, which

represent focal, chronic, lipogranulomatous inflammation
of 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 into
the tarsus and adjacent tissues to incite a noninfectious
inflammatory reaction. Histologically, chalazia appear as a
granulomatous reaction (ie, histiocytes, multinucleated
giant cells) surrounding clear spaces that were once
occupied by sebum/lipid before they were dissolved by the
solvents used for tissue processing, hence the term
lipogranuloma.
Essentially, a hordeolum represents an acute focal
infectious process, while a chalazion represents a chronic,
noninfectious granulomatous reaction. However, chalazia
often evolve from internal hordeola.[5]
History

Hordeola essentially represent focal abscesses;

therefore, they will present with features of acute
inflammation, such as a painful, warm, swollen, red lump
on the eyelid.
The eyelid lump may also induce corneal
astigmatism and cause blurring of vision.
The patient often has a past history of similar
eyelid lesions or risk factors for hordeola, such as
meibomian gland dysfunction, blepharitis, or rosacea.[6]
Clinically differentiating hordeola from acute
chalazia may be difficult, because they both present with
acute inflammation and tender eyelid lumps. However,
chronic chalazia represent a granulomatous reaction and,
thus, appear firm and nontender on clinical examination

Differentials

Basal Cell Carcinoma, Eyelid

Cellulitis, Preseptal
Chalazion
Sebaceous Gland Carcinoma
Squamous Cell Carcinoma, Eyelid
Laboratory Studies

The diagnosis is based on history and clinical

examination, and cultures are not indicated in
uncomplicated cases.
There is no indication to check serum lipid
levels, as the association among hordeola, chalazia, and
hypercholesterolemia remains unclear

Histologic Findings
Histopathology of a hordeolum reveals an abscess or a
focal collection of polymorphonuclear leukocytes and
necrotic tissue.
Histologically, chalazia represent a lipogranulomatous
inflammatory reaction. Histiocytes, multinucleated giant
cells, lymphocytes, plasma cells, and neutrophils surround
an optically clear space. This optically clear space
represents lipids that were dissolved by solvents during
tissue processing.

Causes
Hordeola are associated with S aureus infection.[3]
Patients with chronic blepharitis, meibomian gland
dysfunction, and ocular rosacea are at greater risk of
developing hordeola than the general population.[6]
There are published case reports where multiple recurrent
hordeola have been associated with selective
immunoglobulin M (IgM) deficiency.[7]The lipid component
of chalazia has been found to have large cholesterol
content and is dissimilar to the lipid found in meibomian
glands. Studies have reported an association between
multiple chalazia and elevated serum cholesterol levels.
Some studies have even suggested that elevated serum
lipid levels may increase the risk of blockage to oil glands

Basal cell carcinoma or sebaceous cell carcinoma of the

eyelid can be misdiagnosed clinically as a recurrent
hordeolum or chalazion; therefore, histopathologic
examination is very important in determining the
diagnosis, especially in patients with a persistent or
recurrent lesion.[8]
Medical Care
Hordeola are usually self-limited, spontaneously improving
in 1-2 weeks.

Medical therapy for hordeola includes eyelid hygiene,

warm compresses and massages of the lesions for 10
minutes 4 times per day, and topical antibiotic ointment in
the inferior fornix if the lesion is draining or if there is an
accompanying blepharoconjunctivitis.
Systemic antibiotics may be indicated if the hordeola is
complicated by preseptal cellulitis. Oral doxycycline may
also be added if there is a history of multiple or recurrent
lesions 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.

Try to prevent recurrences by minimizing or eliminating

risk factors, such as blepharitis and meibomian gland
dysfunction, through daily lid hygiene and warm
compresses.
Complications
Large lesions of the upper eyelid have been reported to
cause decreased vision secondary to induced astigmatism
or hyperopia resulting from central corneal flattening.
Prognosis
Hordeola are usually self-limited and spontaneously
resolve within 1-2 weeks. The resolution is hastened with
the use of warm compresses and lid hygiene.
Internal hordeola may occasionally evolve into chalazia,
which may require topical or intralesional steroids or even
incision and curettage.[9]

Surgical Care
Patient Education
Incision and drainage is indicated if the hordeolum is large
or if it is refractory to medical therapy.
Incision and drainage is done under local anesthesia, and
the incision is made through the skin and orbicularis (in
the case of external hordeola) or through the tarsal
conjunctiva and tarsus (in the case of internal hordeola).
The specimen should be sent for histopathological
evaluation to confirm the diagnosis and to rule out a more
sinister 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 is
complicated by preseptal cellulitis.
First-generation cephalosporin often used in skin or skin
structure infections (eg, acute hordeolum) caused by
staphylococci or streptococci. Administered orally and has
a half-life of 50-80 min. Only 10% is protein bound and
greater than 90% recovered unchanged in urine.
Erythromycin base (E-Mycin)
Inhibits bacterial growth, possibly by blocking dissociation
of peptidyl t-RNA from ribosomes, causing RNAdependent protein synthesis to arrest.
Indicated for infections caused by susceptible strains of
microorganisms and for prevention of corneal and
conjunctival infections.
Further Outpatient Care
Patients should be followed within 2-4 weeks of institution
of medical therapy to assess response to therapy and
need for surgical incision and curettage
Deterrence/Prevention

For excellent patient education resources, visit

eMedicine's Eye and Vision Center. Also, see eMedicine's
patient
education
articles Chalazion
(Lump
in
Eyelid) and Sty.

more superficial and is typically centered on an eyelash.

Eversion of the lid may reveal the dilated meibomian gland
and chronic inspissation of adjoining glands. With
judicious pressure on the lid, the thick secretions can be
seen 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 rupture
anteriorly (through the skin) or posteriorly (through the
conjunctiva), forming a granuloma pyogenicum.
Race
No information about prevalence or incidence with respect
to race is available.
Sex

Chalazion
Background
A chalazion (Greek for hailstone) is a lipogranuloma of
either a meibomian gland or a Zeis gland. When the
former is involved, the lid nodule is a characteristically
hard and painless lid nodule; if the latter is involved, it is
marginal or superficial. Examples of a chalazion are
shown in the images below.
Pathophysiology
Lipid breakdown products, possibly from bacterial
enzymes (as free fatty acids) or from retained sebaceous
secretions, leak into the surrounding tissue and incite a
granulomatous inflammatory response. The resulting
mass of granulation tissue and chronic inflammation (with
lymphocytes and lipid-laden macrophages) distinguishes a
chalazion from an internal or external hordeolum, which is
primarily an acute pyogenic inflammation with
polymorphonuclear leucocytes and necrosis with pustule
formation. However, one condition can result in the other
because of their close proximity.
Upon clinical examination, the single, nontender, firm
nodule (or, in rare cases, multiple nodules) is located deep
within the lid or the tarsal plate, whereas a hordeolum is

Male and females seem equally affected, but precise

information about prevalence and incidence is not
available. Contrary to popular opinion, research has not
shown that the use of eyelid cosmetic products either
causes or aggravates the condition.
Age
Chalazia occur in all age groups. Chalazia are more
common in adults than in children, as androgenic
hormones increase sebum viscosity. Although they are
uncommon at extremes of age, pediatric cases may be
encountered.
Hormonal influences on sebaceous secretion and viscosity
may explain clustering at the time of puberty and during
pregnancy. However, the large number of patients without
evidence of hormonal alteration suggests that other
mechanisms also apply.
History
Patients with chalazia usually present with a short history
of recent lid discomfort, followed by acute inflammation
(eg, redness, tenderness, swelling). They frequently have
a long history of previous similar occurrences, because
chalazia tend to recur in predisposed individuals.

Physical

Psoriasis
Ptosis, Adult
Red Eye Evaluation
Sarcoidosis
Sebaceous Gland Carcinoma
Spider Bites
Squamous Cell Carcinoma, Conjunctival
Squamous Cell Carcinoma, Eyelid
Sturge-Weber Syndrome
Trichiasis
Tuberculosis
Tumors, Orbital
Xanthelasma

Chalazia are more common on the upper lid than on the

lower lid because of the increased number and length of
meibomian glands present on the upper lid.
Chronic inspissation of the meibomian secretions may be
apparent as meibomian gland dysfunction. This condition
is characterized by pressure on the eyelids that produces
copious toothpaste-like secretions instead of the normal
small amount of clear, oily secretion. Sebaceous
dysfunction and obstruction elsewhere (eg, comedones,
oily face) are the only associated features or specific
general findings.

Laboratory Studies
Clinical findings and responses to therapy in patients with
chalazia 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 carbon
chains resulting in an increased melting point. This finding
possibly accounts for the blockage of secretions.
Bacterial culture findings are usually negative.
However, Staphylococcus
aureus,
Staphylococcus
albus, or other cutaneous commensal organisms can be
isolated. Propionibacterium acnes may be present in the
glandular contents.

Rosacea is a frequent associated finding. When present,

rosacea demonstrates very specific findings, such as
facial erythema; telangiectatic and spider nevi on the
malar, nasal, and lid skin; and rhinophyma.
Causes
Chalazia may arise spontaneously due to blockage of a
gland orifice or due to an internal hordeolum. Chalazia are
associated with seborrhea, chronic blepharitis, and acne
rosacea.

Imaging Studies
Infrared photographic imaging of the meibomian glands
can demonstrate abnormally dilated and inspissated
secretions, which are visible on the tarsal surface of the
everted lid.

Poor lid hygiene is occasionally associated with chalazia,

although its causal role needs to be established. Although
stress is often apparently associated with chalazia, it has
not been proven as a cause, and the mechanism by which
stress acts is unknown.

Other Tests
Pressure directly over the tarsal plate of the lid results in
the extrusion of lipids, especially of thick viscous material
with meibomian gland dysfunction

Differential Dx

Histologic Findings
Actinomycosis
Basal Cell Carcinoma, Eyelid
Blepharitis, Adult
Cellulitis, Orbital
Cellulitis, Preseptal
Conjunctivitis, Bacterial
Contact Lens Complications
Dacryoadenitis
Dacryocystitis
Demodicosis
Dermatitis, Atopic
Dermatitis, Contact
Dermatochalasis
Dermoid, Orbital
Distichiasis
Floppy Eyelid Syndrome
Hemangioma, Capillary
Hemangioma, Cavernous
Herpes Simplex
Herpes Zoster
Hordeolum
Juvenile Xanthogranuloma
Kaposi Sarcoma
Lacrimal Gland Tumors
Melanoma, Conjunctival
Molluscum Contagiosum
Nasolacrimal Duct, Congenital Anomalies
Nasolacrimal Duct, Obstruction
Neurofibromatosis-1
Ocular Manifestations of HIV
Papilloma, Eyelid
Pigmented Lesions of the Eyelid

Histology reveals a chronic granulomatous reaction with

numerous lipid-filled, Touton-type giant cells. Typically, the
nuclei of these cells are arranged around the periphery of
a central foamy cytoplasmic area that contains the
ingested lipid material. Other typical mononuclear cells
(eg, lymphocytes, macrophages) also may occur around
the periphery.
In the event of secondary bacterial infection, an acute
necrotic reaction with polymorphonuclear cells may ensue.
Destruction of the fibrocartilage of the tarsal plate may be
evident. Foreign bodies (eg, embedded polymethyl
methacrylate [PMMA] contact lenses) in the tarsal plate
have been encountered in chronic chalazia.
Medical Care
Small, inconspicuous, asymptomatic chalazia may be
ignored. Conservative treatment with lid massage, moist
heat, and topical mild steroid drops usually suffices.
[1]
Acute therapy with oral tetracycline (eg, doxycycline 100
mg or minocycline 50 mg every day for 10 d) minimizes
the infectious component and decreases the inflammation,
reputedly by inhibiting polymorph degranulation. Chronic
therapy with low-dose tetracycline (eg, doxycycline 100
mg orally every week for 6 mo) frequently prevents
recurrence. If tetracycline cannot be used, then
metronidazole has been used in a similar fashion. In most
cases, surgery should be performed only after a few
weeks of medical therapy.

For local nonsurgical care early in the condition,

blocked glandular orifices may be opened by means of


o
o

o
o
o

vigorous massage between 2 cotton wool buds at the

slit lamp. Local anesthesia may be beneficial to facilitate
a thorough massage.
A wet facecloth, as hot as can be tolerated, can
be applied twice daily to promote drainage by melting
the lipid secretions.
A self-administered technique called
the "4 fingers times 10 massage" can be beneficial.
This technique is performed as
follows: At the conclusion of a bath or shower, the
patient warms his or her hands under hot water. Using
1 drop of baby shampoo (which does not sting the
eyes), the patient works up a lather, places the index
finger over the closed lids at the lid margin, and
vigorously massages the lid back and forth 10 times.
The patient then repeats the procedure with the
middle, ring, and little fingers.
Most marginal chalazia are connected to
another chalazion located deeper in the substance of
the lid.
The contents of a purely marginal
chalazion may be expressed by rolling 2 cotton-tipped
applicators toward the lid margin from both sides of
the lid.
If the contents cannot be expressed,
incise the distal chalazion, and curette the contents.
The management of infected chalazia (ie,
internal hordeolum) includes heat and topical and/or
systemic antibiotics.
In select cases, incision and drainage
may be beneficial.
Evacuate only the pus; overly
aggressive curettage can disseminate the infection by
breaking down tissue barriers.
Topical steroids are necessary to
prevent the chronic inflammatory response, as well as
the acute noninfectious reaction produced by irritants
(eg, free fatty acids liberated by bacterial enzymes)
from causing excessive scarring.
Once the acute inflammation has
subsided, revision and definitive curettage or excision
of the granulomatous mass may be required.

o
o

o
o
o

o
o

Involvement of both skin and

conjunctiva may require offsetting the incisions to
avoid fistula formation.
Cauterization
with
phenol
or
trichloroacetic acid after incision and drainage may
prevent the recurrence of small chalazia.
Large or chronically neglected and excessively
fibrotic chalazia may require more extensive surgical
excision, including removal of parts of the tarsal plate.
Leaving a 3-mm bridge of normal
tarsus near the lid margin prevents notching.
Multiple chalazia may be excised
carefully, without fear of major lid deformity; the
fibrous tarsal plate heals without leaving gaps.
Even complete tarsal plate removal
has been reported not to cause a lid deformity.
A local intralesional corticosteroid injection (0.52 mL triamcinolone acetonide 5 mg/mL) is administered
and can be repeated in 2-7 days.[2]
Soluble aqueous preparations are
preferred to crystalline suspensions to minimize
complications of hypopigmentation, atrophy, or a
visible depot of medication.
A transconjunctival injection route
may also provide a further safeguard.
Injection or cautious surgical drainage
of a chalazion located near the lacrimal drainage
system can prevent serious complications involving
tear flow.
A study by Simon et al compared triamcinolone
acetonide injection with incision and curettage in 94
patients with chalazion.[3] The study determined that
intralesional triamcinolone acetonide injection was as
effective as incision and curettage and may be
considered as an alternative first-line treatment in cases
where diagnosis is straightforward and biopsy is not
required. Biopsy may be performed by simply excising a
section of the remaining edge of the lesion. Do not
overlook the specific request to the pathologist to rule
out sebaceous cell carcinoma and to especially consider
using fat stains (ie, do not have the specimen processed
as usual).

Surgical Care
Drainage by means of a transconjunctival incision and
curettage is optimal. Establish anesthesia by means of a
local infiltration, possibly augmented with topical
anesthetic cream (eutectic mixture of local anesthetics
[EMLAs]) to reduce the pain of the injection in young
patients. With recurrent chalazia, it is imperative that a
biopsy be performed, with histological evaluation using fat
stains (specifically request this on the specimen) to rule
out sebaceous cell carcinoma.

o
o
o
o

o
o
o

Apply a chalazion clamp to evert the lid and to

control bleeding.
Vertically incise the lesion with a
sharp blade, going no closer than 2-3 mm to the lid
margin. Avoid perforating the skin.
Curette the contents, including any
cyst lining.
A few minutes of pressure are usually
sufficient to achieve hemostasis.
A light pressure bandage should be
applied for a few hours to absorb any further oozing.
If previous external drainage (or granuloma
extension) was performed, an external approach may be
recommended.
Make the incision horizontally, at least
3 mm from the lid margin in an existing crease.
Do not sacrifice normal tissue.
After hemostasis, the wound may be
closed with appropriate sutures (eg, 7-0 silk).

Consultations
Referral to a dermatologist may be beneficial to help treat
problems with rosacea or sebaceous dysfunction.
Diet
Dietary modification has not been evaluated.

Similar advice given to manage severe acne

may be appropriate in certain individuals. This advice is
as follows: avoid or decrease the ingestion of coffee,
chocolate, and highly refined foods, as well as fried
foods and those containing saturated fats.
On average, most of the public is not consuming
sufficient amounts of vegetables and fruits, fresh or
cooked, to meet the minimum recommendations of the
American Dietary Association.
Dietary supplements with omega-3 and omega6 fatty acids, available in flax seeds or in flax seed oil,
may be beneficial. A practical and simple intervention is
to use a coffee grinder to grind flax seeds into meal.
One tablespoon per day of fresh meal is an excellent
dietary supplement and quite palatable

Activity

Corticosteroids

Regular habits of sufficient sleep, moderate sun exposure,

exercise, and fresh air may be of benefit to cutaneous
health and hygiene of the skin and glands of the eyelids.
Stress is often associated with episodes of recurrent
chalazia, although a causal role has not been established.

Class Summary
Corticosteroids have anti-inflammatory properties and
cause profound and varied metabolic effects. In addition,
these agents modify the immune response of the body to
diverse stimuli.

Medication Summary
Triamcinolone acetonide (Kenalog, Aristocort)
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 in
dosages of as little as 100 mg every week for 6 months
may result in permanent biochemical change, with the
sebaceous glands producing shorter-chain fatty acids,
which are less likely than longer-chain fatty acids to
congeal and block the gland orifices.
Although probably innocuous, topical antibiotics do not
help this condition, which is not infectious. Systemic
tetracycline may be beneficial, but local drops are unlikely
to help and are more likely to cause a contact dermatitistype reaction. Topical steroids can be helpful in minimizing
inflammation and in reducing edema, thereby facilitating
any drainage that may take place.
Antibiotics
Class Summary
Antibiotics are not indicated as treatment of infection.
Significant benefit may be derived from low-dose, longterm therapy with tetracycline.
Tetracycline (Sumycin)
Useful adverse effect is altering bacterial flora in skin and
altering lipids to produce shorter-chain fatty acids,
lowering melting point of sebaceous secretions, which
may prevent blockage of meibomian glands.
Doxycycline (Bio-Tab, Doryx, Vibramycin)
Inhibits protein synthesis and, thus, bacterial growth by
binding to 30S and possibly 50S ribosomal subunits of
susceptible bacteria. Alters lipids to produce shorter-chain
fatty acids, lowering melting point of sebaceous
secretions, which may prevent blockage of the meibomian
glands.
Minocycline (Dynacin, Minocin)
Adverse effect alters lipids to produce shorter-chain fatty
acids, lowering melting point of sebaceous secretions,
which may prevent blockage of the meibomian glands.
Metronidazole (Flagyl)
Taken PO, may
tetracyclines.

benefit

patients

unable

to

take

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 capillary
permeability. Used to minimize scarring and inflammation.
Further Outpatient Care
Routine follow-up at approximately 1 month should reveal
resolution of the chalazion, with no swelling, redness, or
persistent lump. Any persistence of a nodule suggests the
diagnosis included not simply a chalazion but also
sebaceous cell carcinoma or other lid lesion.
For further evaluation and management, appropriate
specimens of tissue should be obtained for histologic
evaluation.
Because sebaceous cell carcinoma is best evaluated by
using lipid stains, alert the pathologist to perform tissue
processing without dehydration (ie, frozen section).
The specimen should still be prepared in formalin to avoid
autolysis; formalin does not remove the lipid, but rather,
the alcohol baths used in paraffin sectioning remove the
lipid.
Transfer
Urgent transfer to an experienced orbital and/or
ophthalmic plastic surgeon is mandatory after biopsy
results are documented or if the clinical findings suggest
sebaceous cell carcinoma.

Hordeolum (2)
Bintitan disebabkan sering mengintip? Sama sekali
SALAH tuh. Bintitan bukan terjadi sebab sering mengintip
orang, namun bintitan itu sendiri sebenarnya adalah
tergolong infeksi mata. Gejala yang timbul pada bintitan
adalah kelopak mata terasa bengkak dan nyeri (kemeng),
kadang keluar kotoran mata, dan pada perabaan sering
terasa nyeri.
Pada bintitan (hordeolum), terjadi infeksi bacterial pada
kelenjar Meibom maupun kelenjar Zeiss dan Moll.
Penyebab tersering dari bintitan ini sendiri adalah
Staphylococcus aureus and Staphylococcus epidermidis.
Bintitan ini sendiri harus diobati dengan benar, sebab
apabila berlangsung lama, maka infeksi tersebut berubah
menjadi infeksi granulomatus yang disebut Chalazia.
Apabila infeksi bintitan ini tidak diobati dengan baik, juga
dapat menyebabkan penyebaran infeksi ke kelenjar
disekitar kelopak mata yang dapat menimbulkan suatu
preseptal selulitis.
Bintitan ini sebenarnya terdiri dari dua fase, yaitu fase
infiltratif dimana gejalanya masih meradang dan nyeri,
serta fase supuratif yaitu fase dimana kondisi peradangan
sudah reda namun bintitan sudah memasuki tahap untuk
memerlukan incisi dan kuretase.
Pada bintitan yang masih dalam tahap awal, maka
pengobatan dapat dilakukan secara medika mentosa
(konservatif), yaitu berupa kompres dingin untuk
mengurangi inflamasi dan obat-obatan seperti tetes mata,
salep mata, maupun obat oral yang mengandung
antibiotika.
klik gambar untuk melihat lebih jelas

curtailed to avoid spreading the infection between

individuals.[2][3] Styes can last from one to two weeks
without treatment, or as little as four days if treated
properly.[4]
Medical professionals will sometimes lance a particularly
persistent or irritating stye with a needle to accelerate its
draining.[5] A stye's expansion can also be fought
with erythromycin ophthalmic
ointment.[6] Medical
professionals 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 to
concerns about aplastic anemia, which on rare occasions
can be fatal. Erythromycin ointment enjoys widespread
use, and may add to comfort and aid in preventing
secondary infections. However, it is poorly absorbed when
used topically, and usually requires oral dosing to reach
the infection with therapeutic levels inside of a stye.
Azasite, a topical eye drop form of azithromycin, does
appear to penetrate eyelid tissues fairly well, and may be
a topical treatment for styes used in the future.
If a stye bursts, care must be taken to cleanse
the wound to prevent reinfection.

Apabila bintitan sudah memasuki tahap supuratif, maka

pengobatan oral maupun topical sudah tidak dapat
dilakukan. Satu-satunya jalan adalah membuatkan 'jalan'
atau melakukan insisi dan kuretase pada hordeolum
tersebut.

Signs and symptoms

Untuk pencegahan bintitan, hindari menggosok kelopak
mata dengan tangan, terutama apabila tangan kita kotor
karena dapat menyebabkan infeksi pada kelenjar di
kelopak mata tersebut.

STYE
An external stye (pronounced /sta/), also could be
spelled as styor hordeolum (/hrdilm/) is an infection
of the sebaceousglands of Zeis at the base of
the eyelashes, or an infection of theapocrine sweat glands
of 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 the
inside of the eyelids. They also cause a red bump
underneath the lid with only generalized redness and
swelling visible on the outside. Styes are similar
to chalazia, but tend to be of smaller size and are more
painful and usually produce no lasting damage. Styes are
characterized by an acute onset and usually short in
duration (710 days without treatment) compared to
chalazia that are chronic and usually do not resolve
without intervention.

Cause
Styes are commonly caused by a Staphylococcus
aureus bacterial infection, or by the blocking of an oil
gland at the base of the eyelash. Although they are
particularly common in infants, styes are experienced by
people 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 be

The first sign of a stye is a small, yellowish

spot at the center of the bump that develops
as pus expands in the area.[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
Discomfort during blinking[10]
Sensation of a foreign body in the eye
Treatment

Stye on lower part of a person's eye

The 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 warm
compresses are started.
As a part of self-care at home, patients may cleanse the
affected eyelid with tap water or with a mild,
nonirritating soap or shampoo (such as baby shampoo) to
help clean crusted discharge. Cleansing must be done
gently and while the eyes are closed to prevent eye
injuries.[11]

Patients are highly advised to not lance the stye, as

serious infection can occur as a result. The infection could
spread to the surrounding tissues and areas.
Eye stye sufferers should avoid eye makeup (e.g.,
eyeliner), lotions and wearing contact lenses, since these
can aggravate and spread the infection (sometimes to the
cornea).
Medical treatment can also be provided by a doctor and it
is aimed on relieving the symptoms. Pain relievers such
asacetaminophen may be prescribed and in some
cases, antibiotics may be needed. Antibiotics are normally
given to patients with multiple styes or with styes that do
not seem to heal, and to patients who also suffer
from blepharitis orrosacea.
Commonly,
the
ophthalmologist prescribes oral or intravenous antibiotics,
such as doxycycline, only when the infection has spread.
Topical
antibiotic ointments or
antibiotic/steroid
combination ointments can also be administered in stye
treatment.

Upon awakening, application of a warm washcloth to the

eyelids for one to two minutes may be beneficial in
decreasing the occurrence of styes by liquefying the
contents of the oil glands of the eyelid and thereby
preventing blockage. Some studies suggest oral flaxseed
supplementation 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 and
generally practice proper eye hygiene. It is recommended
to remove makeup every night before going to sleep and
discard old or contaminated eye makeup.

Surgery is the last resort in stye treatment. Styes that do

not respond to any type of therapies are usually surgically
removed. Stye
surgery is
performed
by an
ophthalmologist, and generally under local anesthesia.
The procedure consists of making a small incision on the
inner or outer surface of the eyelid, depending if the stye is
pointing externally or not. After the incision is made, the
pus is drained out of the gland, and very small and
unnoticeablesutures are used to close the lesion. It is
common 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, the
most frequent complication of styes is progression to
achalazion that causes cosmetic deformity, corneal
irritation, and often requires surgical removal.
[12]
Complications may also arise from the improper
surgical lancing, and mainly consist of disruption of lash
growth, lid deformity or lidfistula. Styes that are too large
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 few
instances of such spread have been recorded.[13]
Prognosis
Although styes are harmless in most cases and
complications are very rare, styes often recur. They do not
cause intraocular damage, meaning they do not affect the
eye. Styes normally heal on their own by rupturing within
few days to a week, causing the relief of symptoms. Few
people require surgery as part of stye treatment. With
adequate treatment, styes tend to heal quickly and without
arising any type of complications.
The prognosis is better if one does not attempt to squeeze
or puncture the stye, as infection may spread to adjacent
tissues. A stye usually will heal within a few days to a
week, but if it does not improve or it worsens within two
weeks, a doctor's opinion should be sought. Also, patients
are recommended to call a doctor if they encounter
problems with vision, the eyelid bumps becomes very
painful, the stye bleeds or reoccurs or the eyelid or eye
becomes 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.

Ulkus Kornea, Referat.

TINJAUAN PUSTAKA
III.1 Definisi
Ulkus Kornea adalah keadaan patologik kornea yang
ditandai oleh adanya infiltrat supuratif disertai
defek kornea bergaung, diskontinuitas jaringan kornea
dapat terjadi dari epitel sampai stroma.
Ulkus kornea merupakan hilangnya sebagian permukaan
kornea akibat kematian jaringan kornea.
Ulkus kornea yang luas memerlukan penanganan yang
tepat dan cepat uuntuk mencegah perluasan
ulkus dan timbulnya komplikasi seperti desmetokel,
perforasi, endoftalmitis.
III.2 Etiologi
Penyakit kornea adalah penyakit mata yang serius
karena menyebabkan gangguan tajam penglihatan,
bahkan dapat menyebabkan kebutaan. Ulkus kornea
merupakan hilangnya sebagian permukaan
kornea akibat kematian jaringan kornea.
Ulkus biasanya terbentuk akibat; infeksi oleh bakteri
(misalnya stafilokokus, pseudomonas, atau
pneumokokus), jamur virus (misalnya herpes) atau
protozoa akantamuba, selain itu ulkus kornea
disebabkan reaksi toksik, degenerasi, alergi dan
penyakit kolagen vaskuler. Kekurangan vitamin A
atau protein, mata kering (karena kelopak mata tidak
menutup secara sempurna dan melembabkan

kornea).
Faktor resiko terbentuknya antara lain adalah cedera
mata, ada benda asing di mata, dan iritasi akibat
lensa kontak.
III.3 Patofisiologi
Bila pertahanan normal pada mata seperti epitel
kornea mengalami gangguan, resikoterjadinya
infeksi sangat tinggi. Penyebab yang mungkin
seperti trauma langsung pada kornea, penyakit alis
mata yang kronis, abnormalitas tear film yang
mengganggu keseimbangan permukaan bola mata
dan trauma hipoksia akibat pemakaian lensa
kontak.
Koloni bakteri patologi pada lapisan kornea bersifat
antigen dan akan melepaskan enzim dan
toksin. Hal ini akan mengaktifkan reaksi antigen
antibodi yang mengawali proses inflamasi. Selsel PMN pada kornea akan membentuk infiltrat.
PMN berfungsi memfagosit bakteri. Lapisan
kolagen stroma dihancurkan oleh bakteri dan enzim
leukosit dan proses degradasi berlanjut
meliputi nekrosis dan penipisan. Karena penipisan
lapisan ini, dapat terjadi perforasi
menyebabkan endoftalmitis. Bila kornea telah
sembuh, dapat timbul jaringan sikatrik yang
menyebabkan
penurunan
tajam
penglihatan.
Bakteri gram positif lebih banyak menjadi
penyebab
infeksi
bakterialis
di
dunia
bagianselatan.
Psaeudomonas
aeruginosa
paling
banyak
ditemukan
pada ulkus kornea dan keratitis karena lensa
kontak.
Terbentuknya ulkus pada kornea mungkin banyak
ditentukan oleh adanya kolagenase yang
dibentuk
oleh
sel
epitel
baru
dan
sel
radang.Dikenal ada 2 bentuk tukak pada kornea,
yaitu
sentral dan marginal/perifer.
Tukak kornea sentral disebabkan oleh infeksi
bakteri, jamur, dan virus.Sedangkan perifer
umumnya disebabkan oleh reaksi toksik, alergi,
autoimun, dan infeksi.Infeksi pada kornea
perifer biasanya disebabkan oleh kuman Stafilokok
aureus, H. influenza, dan M. lacunata.
III.4 Jenis
III.4.1 Ulkus Kornea Sentral
Ulkus kornea sentral dapat disebabkan oleh
pseudomonas, streptococcus, pneumonia, virus,
jamur, dan alergi. Pengobatan ulkus kornea secara
umum adalah dengan pemberian antibiotika
yang sesuai dan sikloplegik.Pembentukan parut
akibat ulserasi kornea adalah penyebab utama
kebutaan dan gangguan penglihatan di seluruh
dunia. Kebanyakan gangguan penglihatan ini
dapat dicegah, namun hanya bila diagnosis
penyebabnya ditetapkan secara dini dan diobati
secara memadai. Ulserasi supuratif sentral dahulu
hanya disebabkan oleh S pneumonia. Tetapi
akhir-akhir ini sebagai akibat luasnya penggunaan
obat-obat sistemik dan lokal (sekurangkurangnya di negara-negara maju), bakteri, fungi,
dan virus opurtunistik cenderung lebih banyak
menjadi penyebab ulkus kornea daripada S
pneumonia.
Ulkus kornea sentral dengan hipopion
Ulkus sentral biasanya merupakan ulkus infeksi
akibat kerusakan pada epitel. Lesi terletek di
sentral, jauh dari limbus vaskuler. Hipopion
biasanya (tidak selalu) menyertai ulkus. Hipopion
adalah pengumpulan sel-sel radang yang tampak
sebagai lapis pucat di bagian bawah kamera
anterior dan khas untuk ulkus sentral kornea
bakteri dan fungi. Meskipun hipopion itu steril pada

ulkus kornea bakteri, kecuali terjadi robekan pada

membran descemet, pada ulkus fungi lesi ini
mungkin mengandung unsur fungi.
Ulkus Kornea Bakterialis
Ulkus kornea yang khas biasanya terjadi pada
orang dewasa yang bekerja di bidang konstruksi,
industri, atau pertanian yang memungkinkan
terjadinya cedera mata. Terjadinya ulkus biasanya
karena benda asing yang masuk ke mata, atau
karena erosi epitel kornea. Dengan adanya defek
epitel, dapat terjadi ulkus kornea yang disebabkan
oleh mikroorganisme patogen yang terdapat
pada konjungtiva atau di dalam kantong lakrimal.
Banyak jenis ulkus kornea bakteri mirip satu
sama lain dan hanya bervariasi dalam beratnya
penyakit. Ini terutama berlaku untuk ulkus yang
disebabkan
bakteri
oportunitik
(misalnya
Streptococcus alfa-hemolyticus, Staphylococcus
aureus, Staphylococcus epidermidis, Nocardia, dan
M fortuitum-chelonei), yang menimbulkan
ulkus indolen yang cenderung menyebar perlahan
dan superficial.
Ulkus sentral yang disebabkan Streptococcus betahemolyticus tidak memiliki ciri khas. Stroma
kornea disekitarnya sering menunjukkan infiltrat
dan sembab, dan biasanya terdapat hipopion
yang berukuran sedang. Kerokan memperlihatkan
kokus gram (+) dalam bentuk rantai. Obatobat yang disarankan untuk pengobatan adalah
Cefazolin, Penisillin G, Vancomysin dan
Ceftazidime.
Ulkus
kornea
sentral
yang
disebabkan
Staphylococcus
aureus,
Staphylococcus
epidermidis, dan
Streptococcus alfa-hemolyticus kini lebih sering
dijumpai daripada sebelumnya, banyak
diantaranya pada kornea yang telah terbiasa
terkena kortikosteroid topikal. Ulkusnya sering
indolen namun dapat disertai hipopion dan sedikit
infiltrat pada korneasekitar. Ulkus ini sering
superficial, dan dasar ulkus teraba padat saat
dilakukan kerokan. Kerokan mengandung kokus
gram (+) satu-satu, berpasangan, atau dalam
bentuk rantai. Keratopati kristalina infeksiosa telah
ditemukan pada pasien yang menggunakan
kortikosteroid topikal jangka panjang, penyebab
umumnya adalah Streptococcus alfa-hemolyticus.
Ulkus Kornea Fungi
Ulkus kornea fungi, yang pernah banyak dijumpai
pada pekerja pertanian, kini makin banyak
diantara penduduk perkotaan, dengan dipakainya
obat kortikosteroid dalam pengobatan mata.
Sebelum era kortikosteroid, ulkus kornea fungi
hanya timbul bila stroma kornea kemasukan
sangat banyak mikroorganisme. Mata yang belum
terpengaruhi kortikosteroid masih dapat
mengatasi masukkan mikroorganisme sedikitsedikit.
Ulkus kornea akibat jamur (fungi)
Ulkus fungi itu indolen, dengan infiltrate kelabu,
sering dengan hipopion, peradangan nyata pada
bola mata, ulserasi superficial, dan lesi-lesi satelit
(umumnya infiltrat, di tempat-tempat yang
jauh dari daerah utama laserasi). Lesi utama
merupakan plak endotel dengan tepian tidak teratur
dibawah lesi kornea utama, disertai dengan reaksi
kamera anterior yang hebat dan abses kornea.
Kebanyakan ulkus fungi disebabkan organisme
oportunistik seperti Candida, Fusarium,
Aspergillus, Penicillium, Cephalosporium, dan lainlain. Tidak ada ciri khas yang membedakan
macam-macam ulkus fungi ini.
Kerokan dari ulkus kornea fungi, kecuali yang
disebabkan Candida umumnya mengandung

unsur-unsur hifa; kerokan dari ulkus Candida

umumnya mengandung pseudohifa atau bentuk
ragi, yang menampakkan kuncup-kuncup khas.
Ulkus Kornea Virus
A. Keratitis Herpes Simpleks
Keratitis herpes simpleks ada dua bentuk yaitu
primer dan rekurens. Keratitis ini adalah
penyebab ulkus kornea paling umum dan
penyebab kebutaan kornea paling umum di
Amerika.
Bentuk epitelialnya adalah padanan dari herpes
labialis yang memiliki ciri-ciri imunologik dan
patologik sama juga perjalanan penyakitnya.
Perbedaan satu-satunya adalah bahwa perjalanan
klinik keratitis dapat berlangsung lama karena
stroma kurang vaskuler sehingga menghambat
migrasi limfosit dan makrofag ke tempat lesi.
Penyakit stroma dan endotel tadinya diduga
hanyalah respons imunologik terhadap partikel
virus atau perubahan seluler akibat virus, namun
sekarang makin banyak bukti yang menunjukkan
bahwa infeksi virus aktif dapat timbul di dalam

BAB I
PENDAHULUAN
I. 1 Latar Belakang
Bilik mata depan adalah ruang yang terdapat antara
kornea dan iris. Sedangkan bilik matabelakang adalah
ruang yang lebih kecil yang terdapat diantara iris dan
lensa. Keduaruangan ini diisi oleh cairan aqueous.

Berbagai
perubahan
yang
terjadi
pada
mata
dapatmenyebabkan perubahan dari cairan aqueous dan
bilik mata depan. Karena itu gambaranklinis pada bilik
mata depan dapat membantu dalam menegakan diagnosa
penyakit, jugadalam memantau respons pasien terhadap
terapi.
Reaksi inflamasi iris dan badan siliar akan memberikan
gambaranAnterior chamber cell
and flare di bilik mata depan. Diartikan sebagai kumpulan
sel dan peningkatan protein
(flare) di aqueous humor. Kumpulan sel biasanya terdiri
dari sel darah putih, disebut jugahipopion. Kadang bisa
juga terdiri dari sel darah merah, disebut sebagai
hifema.Kumpulan sel ini akan mengendap di bagian
inferior, membentuk lapisan yang dapatterlihat di bilik
mata depan.1
Sel darah di bilik mata depan merupakan hasil pelepasan
sel darah akibat dilatasipembuluh darah di iris dan badan
siliar.
Adanya
sel
di
bilik
mata
depan
memberikangambaran penyakit yang onsetnya akut.
Sedangkan flare adalah akumulasi dari protein dibilik mata
depan. Dapat menetap, bahkan setelah sel darah tidak
ditemukan lagi.Mungkin disebabkan karena adanya
kebocoran persisten dari blood-aqueous barrier.
1

Karena itu, presentasi flare sendiri tidak bisa dijadikan

pegangan sebagai gejala inflamasi
yang masih aktif.2
I. 2 Tujuan Penulisan
Tujuan dari penulisan referat ini adalah untuk mengenal
lebih dalam tentang hipopiondari segi definisi, gambaran
klinis,
faktor-faktor
yang
dapat
menyebabkan
terjadinyahipopion
maupun
terapinya.
Sehingga
dapatdilakukan penanganan yang tepat danmencegah
terjadinya komplikasi lebih lanjut.

Beberapa keadaan yang dapat memberikan gambaran

hipopion, diantaranya5,6:
Ulkus Kornea. Apabila terjadi peradangan hebat tapi
belum terjadi perforasi dari ulkus,
maka toksin dari peradangan kornea dapat sampai ke iris
dan badan siliar, dengan melaluimembran Descemet,
endotel kornea ke cairan bilik mata depan. Dengan
demikian iris danbadan siliar mengalami peradangan dan
timbulah kekeruhan di cairan bilik mata depandisusul
dengan terbentuknya hipopion.
Uveitis Anterior. Peradangan dari iris dan badan siliar.
menyebabkan penurunan
permeabilitas dari blood-aqueous barrier sehingga terjadi
peningkatan protein, fibrin dan
sel radang dalam cairan aqueous.
Rifabutin. Merupakan
terapi
profilaksis
untuk
Mycobacterium avium complex pada
penderita dengan HIV. Uveitis merupakan efek samping
yang dapat terjadi pada
pemakaian Rifabutin.
Trauma. Corpus alienum, toxic lens syndrome, post
operasi.
II. 4Presentasi Klinis
Gejala subyektif yang biasanya menyertai hipopion adalah
rasa sakit, iritasi, gatal danfotofobia pada mata yang
terinfeksi. Beberapa mengalami penurunan visus atau
lapangpandang, tergantung dari beratnya penyakit utama
yang diderita.
5

Gejala obyektif biasanya ditemukan aqueous cell and

flare, eksudat fibrinous, sinekia
posterior dan keratitis presipitat.2,3
II. 5 Diagnosa
Diagnosa hipopion ditegakan berdasarkan anamnesa dan
pemeriksaan menggunakan slitlamp. Pada anamnesa,
ditanyakan adanya riwayat infeksi, pemakaian lensa
kontak,trauma, pemakaian obat serta riwayat operasi.
Pada pemeriksaan dengan slit lamp, ditemukan lapisan
berwarna putih pada bagianinferior dari bilik mata depan.
Jarang sekali hipopion ini ditemukan pada bagian lain
daribilik mata depan.
Hipopion biasanya dinilai berdasarkan tingginya, diukur
dari dasar bilik mata depandengan satuan milimeter. Atau
bisa
juga
dengan
hitungan
kasar,
misalnya.
ringan,moderat, setengah bilik mata depan dan seluruh
mata depan.
Cara terbaik untuk menilai hipopion adalah dengan
terlebih dahulu meminta pasienduduk beberapa saat
supaya
hipopion
dapat
mengendap
sempurna.
Selanjutnya pasiendiminta melihat ke bawah dan sinar
diarahkan dari bagian atas-depan iris.1,4
II. 6 Diagnosa Banding
Hipopion harus dibedakan dari7:

Pseudohipopion yang ditemukan pada retinoblastoma,

injeksi steroid okular dan
ghost cell glaucoma. Pseudohipopion termasuk dalam
kelompok sindrommasquerade. Untuk membedakan harus
dilakukan pemeriksaan dengan pupil yangtelah dilebarkan
dengan 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 iris
Gambar
diambil
dari
http://www.sarawakeyecare.com/Atlasofophthalmology
Ghost Cell Glaucoma merupakan glaukoma sekunder
sudut terbukadimanatrabecular meshwork mengalami
obstruksi oleh sel darah merah yangterdegenerasi,
disebut ghost cells. Biasanya didahului oleh trauma.

Metastasis ke bilik mata depan, misalnya dari leukemia

dan Ca mammae.
II. 7 Komplikasi Klinis
Struktur dari hipopion yang mengandung fibrin,
merupakan reaksi tubuh terhadainflamasi. Tetapi fibrinfibrin ini dapat menyebabkan terjadinya perlengketan
antara irisdan lensa (sinekia posterior) Bila seluruh pinggir
iris melekat pada lensa disebut seklusiopupil, sehingga
cairan dari cop tidak dapat melalui pupil untuk masuk ke
coa, iristerdorong ke depan, disebut iris bombe dan
menyebabkan sudut coa sempit sehinggatimbul glaukoma
sekunder.
Kepaniteraan
Klinik
Ilmu
Penyakit
Mata
Fakultas
Kedokteran
Universitas
Tarumanagara
Rumah
Sakit
Umum
Daerah
Kota
Semarang
Periode 07 Juni 2010 10 Juni 2010
7

Peradangan di badan silier dapat juga menyebabkan

kekeruhan dalam badan kaca olehsel-sel radang, yang
tampak sebagai kekeruhan seperti debu. Peradangan
inimenyebabkan metabolisme lensa terganggu dan dapat
menimbulkan kekeruhan lensa,hingga terjadi katarak.
Pada kasus yang sudah lanjut, kekeruhan badan kaca pun
mengalami jaringan organisasidan tampak sebagai
membrana yang terdiri dari jaringan ikat dengan
neovaskularisasiyang berasal dari sistem retina, disebut
retinitis proliferans.
Bila membrana ini mengkerut, dapat menarik retina
sehingga robek dan cairan badankaca melalui robekan itu

masuk ke dalam celah retina potensial dan

mengakibatkan ablasi retina.5,6
II. 8 Penatalaksanaan
Penatalaksanaan hipopion tergantung dari ringan atau
beratnya penyakit. Sel darah putihbiasanya akan di
reabsorpsi. Tetapi bila hipopion memberikan gambaran
yang berat,maka bisa dilakukan drainase.1,3
Terapi yang lebih spesifik biasanya tergantung dari
penyakit utama yang menyebabkan
hipopion. Apabila terjadi inflamasi, dapat diberikan
kortikosteroid.
Anti inflamasi yang biasanya digunakan adalah
kortikosteroid, dengan dosis sebagai
berikut:
Dewasa : Topikal dengan dexamethasone 0,1 % atau
prednisolone
1
%.
Bila radang sangat hebat dapat diberikan subkonjungtiva
atau
periokuler
:
dexamethasone
phosphate
4
mg
(1
ml)
prednisolone succinate 25 mg (1 ml)

triamcinolone acetonide 4 mg (1 ml)

methylprednisolone acetate 20 mg
Cycloplegic dapat diberikan dengan tujuan untuk
mengurangi nyeri dengan memobilisasiiris, mencegah
terjadinya perlengketan iris dengan lensa anterior ( sinekia
posterior ),yang akan mengarahkan terjadinya iris bombe
dan peningkatan tekanan intraocular,menstabilkan bloodaqueous barrier dan mencegah terjadinya protein leakage
(flare) yanglebih jauh. Agent cycloplegics yang biasa
dipergunakan adalah atropine 0,5%, 1%, 2%,homatropine
2%, 5%, Scopolamine 0,25%, dan cyclopentolate 0,5%,
1%, dan 2%.8
II. 9 Prognosa
Hipopion adalah gejala klinis yang muncul sebagai respon
inflamasi. Sel darah putihakan diabsorpsi sepenuhnya.
Tetapi prognosis tergantung dari penyakit dan
komplikasiyang dapat terjadi.1
Kepaniteraan
Klinik
Ilmu
Penyakit
Mata
Fakultas
Kedokteran
Universitas
Tarumanagara
Rumah
Sakit
Umum
Daerah
Kota
Semarang
Periode 07 Juni 2010 10 Juni 2010
9

BAB III
KESIMPULAN
Hipopion adalah pus steril yang terdapat pada bilik mata
depan yang terlihat sebagai
lapisan putih yang mengendap di bagian bawah bilik mata
depan.
Bangunan yang berhubungan dengan hipopion adalah iris
dan badan siliar. Radang irisdan badan siliar
menyebabkan penurunan permeabilitas dari blood-

aqueous barriersehingga terjadi peningkatan protein, fibrin

dan sel radang dalam cairan aqueous,sehingga
memberikan gambaran hipopion.
Hipopion merupakan reaksi inflamasi di bilik mata depan.
Karena itu semua penyakit
yang berhubungan dengan uveitis anterior dapat
menyebabkan terjadinya hipopion.
Diagnosa hipopion ditegakan berdasarkan anamnesa dan
pemeriksaan menggunakan slit
lamp.
Hipopion harus dibedakan dengan pseudohipopion yang
merupakan tanda keganasan.
Apabila berkelanjutan, hipopion dapat menyebabkan
komplikasi berupa glaukomasekunder, katarak, retinitis
proliferans dan pada kasus yang berat dapat
menyebabkan ablasi retina
Penatalaksanaan hipopion biasanya tergantung dari
banyaknya lapisan pus di bilik matadepan. Bila proses
inflamsi akut sudah diatasi, biasanya hipopion akan
direabsorpsi. Bilapresentasi pus sangat banyak, bisa
dilakukan drainase.
Prognosa dari hipopion tergantung dari penyakit yang
menjadi keluhan utama.