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What is Internal Hordeolum? Internal hordeolum is a suppurative inflammation of the meibomian gland associated with blockage of the duct, primarily due to Staphylococcal Infection. The differentiating features between Internal Hordeolum and External Hordeolum are: Internal Hordeolum vs External Hordeolum 1. Affected Glands: Internal Hordeolum is associated with Meibomian Gland. External Hordeolum or Stye is associated with Gland of Zeis or Moll. 2. Location: Location of Internal Hordeolum is in the middle of eyelid or away from the Eyelid Margin. Location of External Hordeolum or Stye is in the lid margin. 3. Pus Point: Pus point of Internal Hordeolum is located in conjunctival side. Pus point of External Hordeolum or stye is lid margin. . . From definition of Internal Hordeolum, 3 things need to be understood: What is Infernal Hordeolum 1. It’s a suppurative Inflammation: Suppurative inflammation is a type of inflammation that involves the production of pus. 2. Associated with Meibomian Gland: Meibomian Gland is located in the tarsal plate of eyelid that is in the middle of eyelid. So, location of Internal Hordeolum will be always away from the Lid Margin. 3. It’s a Staphylococcal Infection: Staphylococci are a gram-positive spherically shaped bacteria that cause skin and soft tissue infections. So Remember, In Internal Hordeolum, an abscess will form that will lead to Pus formation when infected and will always be located away from the Lid Margin. What are Causes of Internal Hordeolum? Primary Infection: Primary infection may occur due to staphylococcal infection of the meibomian gland. Secondary Infection: It may occur as secondary infection in an infected chalazion. . . What are the Clinical Features of Internal Hordeolum? What are the Symptoms of Internal Hordeolum? What are the Symptoms of Internal Hordeolum 1. Acute intense pain: Due to pressing on surrounding tissue that triggering pain. 2. Swelling of lid: Due to fluid accumulation, leading to visible swelling of the eyelid. 3. Mild watering: Due to the infection stimulates tear production as a protective response. 4. Photophobia: Acute infection irritates ocular nerves leading to increases sensitivity to light. 5. Sense of heaviness: Due to Swelling and accumulation of fluid, create a sensation of heaviness in the affected lid. Remember: Symptoms of internal hordeolum are similar to external hordeolum, except that pain is more intense, due to the swelling being embedded deeply in the dense fibrous tissue. . . What are the Signs of Internal Hordeolum? What are the Signs of Internal Hordeolum 1. Oedema of the affected lid: Inflammatory mediators increase vascular permeability, allowing fluid to leak into surrounding tissues, resulting in oedema. 2. Appearance of Pus Point: As immune cells accumulate to fight the infection, they form a collection of pus that pushes toward the conjunctival side. 3. Matting of eyelashes: Discharge from the infection dries on the eyelashes, causing them to stick together. 4. Local temperature is raised: Inflammation stimulates blood flow to the area, raising local skin temperature. 5. Enlargement of the pre-auricular lymph node: The nearby lymph nodes react to the infection by swelling as they filter and respond to pathogens. . . What is the Management or Treatment of Internal Hordeolum? What is Treatment of Internal Hordeolum 1. Hot compresses: Applying heat increases blood flow to the affected area, promoting drainage of the infected gland and reducing pain and swelling. 2. Surgical incision: A small vertical incision in conjunctival side allows for the evacuation of pus, directly reducing infection when other methods are inefficient. 3. Antibiotic eyedrops: Regular application of antibiotic (Ciprofloxacin or Moxifloxacin) drops 3-4 times daily helps control bacterial growth on the eyelid surface, preventing further infection of nearby glands. 4. Eye ointment: Applying antibiotic ointment (Ciprofloxacin or Moxifloxacin) at bedtime ensures prolonged exposure to antibiotics, helping control infection during healing. 5. Anti-inflammatory and analgesics: These medications relieve pain and reduce inflammation and swelling, improving comfort during healing. 6. Systemic antibiotics: In severe or persistent cases, systemic antibiotics (Ciprofloxacin or Cefixime) target the infection throughout the body, providing early control and preventing complications. 7. Treatment of predisposing conditions: Addressing underlying causes like uncorrected refractive error, diabetes, alcohol use, and chronic blepharitis prevents recurrence by reducing factors that contribute to Internal Hordeolum formation. . .Conclusion Internal Hordeolum is a painful eyelid lump caused by a Staphylococcal infection of the Meibomian gland, leading to a suppurative inflammation. It is distinguished from External Hordeolum by its location away from the eyelid margin, presence of a pus point on the conjunctival side, and its association with the meibomian gland rather than the glands of Zeis or Moll. The symptoms of Internal Hordeolum include acute intense pain, eyelid swelling, mild watering, photophobia, and a sense of heaviness in the affected eyelid. Key signs of Internal Hordeolum are oedema, appearance of a pus point, matting of eyelashes, raised local temperature, and pre-auricular lymph node swelling. Effective management of Internal Hordeolum involves a combination of hot compresses, antibiotic eyedrops like Ciprofloxacin or Moxifloxacin, eye ointment for prolonged antibiotic exposure, and anti-inflammatory and analgesics to relieve pain and swelling. In severe cases, systemic antibiotics or surgical treatment, such as a small incision for pus evacuation, may be required. Addressing predisposing conditions such as chronic blepharitis, uncorrected refractive error, or systemic issues like diabetes is crucial in preventing recurrence. Adopting proper hygiene and early intervention can effectively manage Meibomian gland abscess and reduce the risks of complications associated with chronic eyelid infections. By understanding the causes of painful eyelid lumps, recognizing the symptoms of Internal Hordeolum, and employing proper treatment for eyelid swelling, patients can achieve effective resolution and prevent further eyelid infection issues. . . 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