Case 2 Conjtcts

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KERATOKONJUNGTIVITIS

Case

Dafid Pratama

406147037

Ilmu Penyakit Mata RSUD Ciawi

Priode 20 oktober 2014 22 november 2014

Pembimbing : dr. Nanda L, Sp.M


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Identitas

Nama : Nn. AP Umur : 18 tahun Agama : Islam

Pekerjaan :Mahasiswa

Alamat :

Bendungan Ciawi

Tanggalpemeriksaan:

08 November2014


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AnamnesisAutoanamnesis pada tanggal 27 Oktober 2014 di Poli Mata

RSUD Ciawi

KU : Mata merah penglihatannormal 3 hari yang lalu

KT :berair, perih, gatal, silau, terasa ganjalan,belekan hijau kekunignan di pagi hari


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Berdasarkankeluhantersebut

Kelainan matapasien dapat

dikelompokkandalam kelompok

mata merahpenglihatan

tidak menurun.

Dengankemungkinan-kemungkinanantara lain:

Konjunctivitis

Keratokonjungtivitis

blefaritis


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Riwayat Penyakit Sekarang

Ps datang dengan keluhan mata merah penglihatan tidakmerunun pada kedua mata

Keluhan sejak 3 hari yang lalu setelah memekai contact lenskarena kacamatanya hilang (ps menggunakan kacamata S-9.00)

Kontak lens yang digunakan sudah berumur 3 bulan, tidakpernah mengganti dan mencuci contact lens secara teratur,saat akan di gunakan ps baru membersihkan kontak lenstersebut

Ps mengeluh mata nyeri, berair, silau, gatal minimal, terdapatbelekan warna hijaukekunignan di pagi hari yang melekatdikelopak mata

Ps mengaku merasa seperti ada yang mengganjal di mata

Kelopak mata terasa bengkak dan nyeri, dan tidak terabaadanya pembesaran kelenjar preaurikuler


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Riwayat Penyakit Dahulu

Sebelumnya tidak pernah mengeluh keluhan yang sama

Lingkungan sekitar tidak mempunyai riwayat mata merah

Sebelumnya tidak mengeluh demam, batuk, pilek, sakit

tenggorokan Riwayat alergi di sangkal :

Hidung berair di pagi hari (-)

Gatal setelah makan atau minuman tertentu (-)

Alergi obat (-)

Asma (-)


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Riwayat Penyakit Keluarga

Riwayat alergi di keluarga di sangkal

Di keluarga tidak ada yang sedang menderita mata merah


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Pemeriksaan Fisik

Tandavital

TD:120/80mmHg

RR:20x/menit

N:80x/menit

Suhu:afebris

Keadaan

umum: compos

mentis


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kepala Normocephali, pertumbuhan rambut merata

mulut Tak tampak caries dentis, lidah tidak kotor

THT Septum deviasi (-), faring hiperemis (-), tonsil T1-T1 tenang, sekret

(-/-)

Leher Pembesaran kelenjar getah bening (-), pembesaran tiroid (-)

Jantung BJ I II regular, murmur (-), gallop (-)

Paru Simetris, massa (-/-), suara napas vesikuler, wheezing (-/-), rhonki

(-/-

Abdomen Supel, BU (+) normal, timpani, nyeri tekan (-)

Ekstremitas Edema (-), sianosis (-)


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Status OpthalmologisKETERANGAN

OD

OS

1. Visus 3/60 2/60

2. KEDUDUKAN BOLA MATA

- Eksoftalmus - -

- Endoftalmus - -

- Deviasi - -

- Gerakan bola mata Baik ke segala

arah

Baik ke segala

arah

2. SUPRASILIA

- Warna Hitam Hitam

- Simetris Normal Normal


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2. PALPEBRA SUPERIOR DAN INFERIOR

- Edema + +

- Nyeri tekan + +

- Ektropion - -

- Entropion - -

- Blefarospasme - -

- Trikiasis - -

- Sikatriks - -

- Punctum lacrimal Terbuka Terbuka

- Fissure palpebra Normal normal

- Test anel Tidak dilakukan Tidak dilakukan

2. KONJUNGTIVA TARSAL, SUPERIOR, DAN INFERIOR

- Hiperemis + +

- Folikel + +

- Papil - -

- Sikatriks - -


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6.Konjunctiva Bulbi

- Sekret - -

- Injeksi konjungtiva + +(minimal)

- Injeksi siliar - -

- Pendarahan subkonjungtiva - -

- Pterigium - -

- Pinguekula - -

- Nevus pigmentosus - -

- Kista Dermoid - -

2. SKLERA

- Warna Putih Putih

- Ikterik Tidak Tidak

- Nyeri tekan - -


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2. KORNEA

- Kejernihan Jernih Jernih

- Permukaan Rata Rata

- Ukuran 12 mm 12 mm

- Sensibilitas Baik Baik

- Infiltrate - -

- Keratik presipitat - -

- Sikatriks - -

- Ulkus - -

- Perforasi - -

- Arcus - -

- Edema - -

- Test Placido Tidak dilakukan Tidak dilakukan


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2. BILIK MATA DEPAN

- Kedalaman Dalam Dalam


-Hifema

-

-

- Hipopion - -

- Efek Tyndall - -

2. IRIS

- Warna Hitam Hitam

- Kripte Jelas Jelas

- Sinekia - -

2. PUPIL

- Letak Tengah Tengah

- Bentuk bulat Bulat

- Ukuran 3 mm 3 mm

- Refleks Cahaya Langsung + +

- Refleks Cahaya Tidak Langsung + +


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2. LENSA

- Kejernihan Jernih jernih

- Letak Tengah Tengah

- Test Shadow - -

2. BADAN KACA


2. FUNDUS OKULI

PAPIL N II

- BatasTidak dilakukan Tidak dilakukan

- Warna Tidak dilakukan Tidak dilakukan

- Ekskavasio Tidak dilakukanTidak dilakukan

- Ratio Arteri : Vena Tidak dilakukan Tidak dilakukan

- C/D Ratio Tidak dilakukan Tidak dilakukan


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RETINA

- EksudatTidak dilakukan Tidak dilakukan

- PendarahanTidak dilakukan Tidak dilakukan

- Sikatriks Tidak dilakukan Tidak dilakukan

- AblasioTidak dilakukan Tidak dilakukan

MAKULA LUTEA

- Refleks Tidak dilakukan Tidak dilakukan

2. PALPASI

- Nyeri tekan - -

- Massa tumor - -

- Tensi occuli N/ palpasi N/palpasi

- Tonometri Schiotz Tidak dilakukan Tidak dilakukan

- Test konfontasi Lebih sempit dari

pemeriksa

Sama dengan

pemeriksa


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Resume

Ps datang dengan mata merah penglihatan normal

Perih, silau, berair, nyeri saat palpebra di palpasi

Mata terasa ada yang mengganjal dan terdapat belekan

di pagi hari berwarna hijau kekuningan, dan kelopak matasudah di buka.

Riwayat penggunaan kontak lens 3 hari yang lalu


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Resume

Pada pemeriksaan fisik didapat status generalis dalam

batas normal.

Pemerikaan oftamologi didapat :

Tajam penglihatan OD: 3/60

Tajam penglihatan OS: 2/60

Palpebra ODS edem hiperemis ringan

CTS : hiperemis

CTI : hiperemis dan folikel (+)

CB : injeksi konjungiva Kornea : jernih

Iris, COA,lensa dalam batas normal


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Working Diagnosis

Keratokonjungtivitis

ODS


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Diagnosis Differential

KonjungtivitisbakterialODS


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Pemeriksaan penunjang

Pewarnaan gram

KOH


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PENATALAKSANAAN

AB topikal

Artificial tears : cendolyteers ED 6 dd gtt1 ODS


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Prognosis

OD OS

Ad Vitam Bonam Bonam

Ad Fungsional ad bonam ad bonam

Ad Sanationam ad bonam Ad bonam


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TINJAUAN PUSTAKA


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DEFINITION

Conjunctivitis is an inflammation of the conjunctiva that is

characterized by vascular dilatation, cellular infiltration and

exudation, or inflammation of the mucous membrane covering the

back of the eyelid and eyeball.


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ETIOLOGY

Infecion (viral,bacterial,or chlamydia)

Allergic reactions to dust, pollen, animal dander

Irritation by the wind, dust, smoke and other air pollutants;

ultraviolet rays from sunlight or electric welding.


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Signs & Syptomps

Symptomps:

Red eyes

Feeling of lump

Dirty eyes

Itchy Watery

.

Signs

Conjunctival injection Dicharge/secret

There are patologic structure in conjunctiva

Chemosis


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CONJUNCTIVAL INJECTION

Congestion of conjuctival aa/vv(posterior conjunctiva)

Causes: mechanical, irritation, allergy,

infection

Signs: Mobile from its base

Calibre increases to the periphery

Fresh blood color, constricts with topical

adrenalin


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SILIAR INJECTION

Congestion of pericornea vessels(a. anterior ciliaris)

Causes:- corneal inflammation (keratitis,corneal ulcer)

- uveitis- acute glaucoma- endophthalmitis- panophthalmitis

Signs:- does not follow movement of conjuctiva

- fine, small vessels surrounding the cornea- calibre decreases towards the fornices- dark red color, unchanged with topical adrenalin


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Discharge

Various kind of discharge: Serous (clear liquid)

Mucoid (clear liquid; elastic viscous)

Purulent (cloudy yellow liquid)


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Pathologic Structure


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Classification

Causa

Bacteri

Virus

Chlamydia

Alergic

Iritation

Clinical pattern

Conjungtivitis kataral

Conjungtivitis purulent

Conjungtivitis membran

Conjungtivitis folikel

Conjungtivitis flikten

Conjungtivitis vernal

Trachoma


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Differential Of The Common types of conjunctivitis1


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Differential Of The Common types of conjunctivitis2


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Acute bacterial conjunctivitis

Acute bacterial conjunctivitis is a common and usually

self-limiting condition caused by direct eye contact with

infected secretions. The most common isolates are S.

pneumoniae, S. aureus, H. influenzaeand Moraxella

catarrhalis Diagnosis :

Symptoms

Acute onset of redness, grittiness, burning and discharge.

Involvement is usually bilateral although one eye may becomeaffected 12 days before the other.

On waking, the eyelids are frequently stuck together and may be

difficult to open


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Acute bacterial conjunctivitis

Diagnosis :

Symptoms Acute onset of redness, grittiness, burning and discharge.

Involvement is usually bilateral although one eye may become

affected 1

2 days before the other. On waking, the eyelids are frequently stuck together and may be

difficult to open

Signs Eyelid oedema and erythema may occur in severe infection,

particularly gonococcal Conjunctival injection as previously described

The discharge can initially be watery, mimicking viral conjunctivitis,but rapidly becomes mucopurulent

Superficial corneal punctate epithelial erosions are common


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Treatment

Topical antibiotics(q.i.d. for up to 1 week) are frequently

administered to speed recovery and prevent re-infection

and transmission

Chloramphenicol, aminoglycosides (gentamicin and neomycin),

quinolones (ciprofloxacin, ofloxacin, levofloxacin, lomefloxacin,gatifloxacin and moxifloxacin), polymyxin B, fusidic acid and

bacitracin

Gonococcal and meningococcal conjunctivitis should be treated

with a quinolone, gentamicin, chloramphenicol or bacitracin 12

hourly as well as systemic therapy

Topical steroidsmay reduce scarring in membranous

and pseudomembranous conjunctivitis, although evidence

for their use is unclear


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Treatment

Irrigationto remove excessive discharge may be useful

in hyperpurulent cases

Contact lens wearshould be discontinued until at least

48 hours after complete resolution of symptoms. Contact

lenses should not be worn whilst topical antibiotictreatment continues.


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Viral conjunctivitis

Adenoviral conjunctivitis Viral conjunctivitis is most frequently caused by an

adenovirus

Infection may be sporadic or it may occur in epidemics in

workplaces (including hospitals), schools and swimming

pools.

Transmission is generally by contact with respiratory or

ocular secretions, including via fomites such as

contaminated towels


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Eyelid oedema and tender pre-auricular lymphadenopathy

Prominent conjunctival hyperaemia and follicles

Keratitis in adenoviral disease is characterized by the

following:

Punctate epithelial keratitis (Fig. 5.9D) may develop within 710

days of the onset of symptoms and resolves within 2 weeks

Focal white subepithelial/anterior stromal infiltrates may develop

beneath the fading epithelial lesions, probably as an immune

response to the virus (Fig. 5.9E), and may persist or recur overmonths or years (Fig. 5.9F).


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Acute allergic conjunctivitis

Is a common condition caused by an acute conjunctival

reaction to an environmental allergen, usually pollen.

It is typically seen in younger children after playing

outside in spring or summer

Presentationis with acute itching and watering,

associated with severe chemosis

Treatmentis not usually required and the conjunctival

swelling settles within hours as the acute increase in

vascular permeability resolves. Cool compresses can beused and a single drop of adrenaline 0.1% may reduce

extreme chemosis


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Vernal keratoconjunctivitis

Symptomsconsist of intense itching, which may be

associated with lacrimation, photophobia, a foreign body

sensation, burning and thick mucoid discharge. Increased

blinking is common

Palpebral disease Early-mild disease is characterized by conjunctival hyperaemia and

diffuse papillary hypertrophy on the superior tarsus (Fig. 5.12A).

Macropapillae (


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Vernal keratoconjunctivitis

Limbal disease Gelatinous limbal conjunctiva papillae

that may be associated with transient apically-located

white cellular collections (Horner-Trantas dots Fig.

5.13A-C).


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Case 2 Conjtcts

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