CASE

PRESENTATION I
KERATITIS
OPTHALMOLOGY DEPARTMENT ec
INFILTRAT
OS
Supervisor : Fulqy Fatmala Saesal
dr. Siti Farida Sp.M H1A013025

FACULTY OF MEDICINE, MATARAM UNIVERSITY

NTB PROVINCE GENERAL HOSPITAL
2018
 KERATITIS

Infective Non – Infective

• Viral
• Exposure keratitis
• Bacterial
• Photokeratitis
• Fungal
• Contact lens acute red eye (CLARE)
• Amoebic
• Parasitic

“corneal pathologic condition that develop with suppurative infiltrates

without corneal defects”
 2nd 3000/ More than
leading 1 million 10.000
Cause of In the population
blindness in with good economy In low income
indonesia and health care settings

“Keratitis with complications of corneal ulcer has the potential to cause

monocular blindness”
Most of these visual impairments can be prevented, only when the cause and the diagnosis
is established early and treated appropriately.
• Name : Mr. Z
• Age : 29 years old
• Sex : Male
• Religion : Moeslem
• Occupation : Welder
• Address : Sesela, Gunung Sari
• Marital status : Married
• Date of examination : August, 30th 2018
 Autoanamnesis

Main complaint

• REDNESS OF EYE
LEFT EYE PAIN

Recent Disease History • 20 day ago

• 1 day become worse
• Continuously pain
• REDNESS OF EYE
• 1 day ago BLURRED VISION

• Suddenly
• 1 day ago

OVERFLOW OF TEARS

• 1 day ago
 Felt pain
Red eye
Blurred vision
Overflow of tears
Felt pain Felt pain Dazzled

10 days Work as usual 29 day

1 month
Work as usual
Reduced Symptoms

Goes to Come to NTB

Exposed to
Primary General hospital
Gram
Health Care
Treated with
paracetamol and
vitamin B1
Past Disease History
Past eye disease
The patient did not have any past eye disease
The patient had never used eyeglasses before
The patient had never undergone surgery
Past systemic disease
There is no history of hypertension, and other chronic/systemic diseases

Family disease history

There is none of patient’s family member who has got similar
complaint.

History of allergy
Foods (-)
Drugs (-)
Past Medical History
Patient went to primary helat care 10 day after the incidence, he was
given paracetamol and vitamin B 1, the complaint was improved but a
few days later the complaint resurfaced.

Social and personal history

Patients is a welder. He rarely uses a protective
glass when cutting iron.
 PHYSICAL
EXAMINATION

General state : Moderate

Consciousness/GCS : Compos mentis / E4V5M6

Vital sign
• Blood Pressure : 110/70 mmHg
• Heart rate : 84 bpm
• Respiration rate : 18 times per minute.
• Temperature : 36.6 oC
No Eye Examination Okuler Dekstra (OD) Okuler Sinistra (OS)

1. Visus Naturalis 6/6 6/12

Pinhole 6/6 6/12
2. Ocular Hirschberg Orthophoria Orthophoria

Position Cover-uncover Orthotropia Orthophoria

3. Ocular motility Normal in all the vision Normal in all the vision
directions directions

4. Visual field The patient can see the The patient can see the
examiner’s hand moving examiner’s hand moving in
in all the visual fields all the visual fields
 5. Superior Eyelid Edema (-) (-)
Hematoma (-) (-)
Entropion (-) (-)
Ectropion (-) (-)
Ptosis (-) (-)
6. Inferior eyelid Edema (-) (-)
Hematoma (-) (-)
Entropion (-) (-)
Ectropion (-) (-)
7. Superior palpebral Hyperemia (-) (+)
conjunctiva Scar (-) (-)
8. Inferior palpebral Hyperemia (-) (+)
conjunctiva Scar (-) (-)
9. Cnjunctival layer of bulb Conjungtival injection (-) (+)
Ciliary injection (-) (+)
10 Cornea Shape convex convex
.
Clarity Clear There is an infiltrate at 4 o'clock
with a distance of 2 mm from the

Surface Smooth limbus with a diameter of ± 2 mm

and not about the axis of the axis
Scar (-) (-)
Mass (-) (-)
Corneal reflex (+) (+)
12 Anterior chamber Depth Seems normal in depth Seems normal in depth
.
13 Iris Colour Brown Brown
. Shape Reguler Reguler
Anterior Synechia (-) (-)
Posterior synechia (-) (-)
14 Pupil Shape Round, Ø ± 3 mm Round, Ø ± 3 mm

. Direct reflex (+) (+)

Indirect (+) (+)

15 Lens Clarity Clear Clear
. Iris Shadow (-) (-)
Subluxation (-) (-)

Dislocation (-) (-)

16 Intraocular Palpation N/P N/P

. pressure
17 Funduscopy -Papil: firm, round, reddish. - Papil: firm, round, reddish.
. - Retinal arteries and veins - Retinal arteries and veins
appear normal, there is no appear normal, there is no
retinal exudate / bleeding. retinal exudate / bleeding
 Cilliary
OD OS injection

Conjuctival
injection

Normal eye
Infiltrat of
the cornea
 Epitel

Infiltration

Stroma
Bowman

SAGITAL PROJECTION OF THE CORNEA

 PROBLEM IDENTIFICATION

SUBJECTIVE OBJECTIVE
VISUAL ACUITY OS 6/12
LEFT PAIN EYE
RED EYE
an infiltration on the
OVERFLOW OF TEARS corneal suface of left
SUDDEN BLURRY VISION eye, at 4 o'clock with a
distance 2 mm from the
PHOTOPHOBIA limbus, in size ± 2 mm
and not about the axis
 RED EYE WITH SUDDEN BLURRED VISION

KERATITIS KERATOMYCOSIS CORNEAL ULCER

ACUTE ANTERIOR
ENDOPHTALMITIS
GLAUCOMA UVEITIS
 ACUTE
GLAUKOMA

RED EYE
PAIN IMPROVED WHEN THE PATIENT GET REST
THE PATIENT SEES A RAINBOW (HALO) DOES NOT
PAIN IMPROVED WHEN THE PATIENT GET REST MATCH WITH
HEADACHE, NAUSEA VOMMITING
DECREASE OF FISUAL FIELD
THE PATIENT
SIGNS OF INFLAMATION OF THE EYE
HIGH OCULAR PRESSURE
 KERATITIS
CORNEAL ULCER NO CORNEAL DEFECT:
ANTERIOR UVEITIS HAS A SIMILAR EPITEL KERATITIS
ENDOPHTALMITIS SYMPTOM FLUORESCENCE:
PANOPTHALMITIS ????????????

Examination of the posterior chamber, fundus reflex

is positive, Papil: firm, round, reddish. Retinal arteries
and veins: appear normal, there is no retinal exudate /
bleeding.
 PANOPHTHALMITIS

CORNEAL ULCER

ANTERIOR UVEITIS
 According to anamnesis and physical examination,
this patient’s condition meets the criteria for
bacterial keratitis

The fungal corneal infection is associated with long

consumption of corticosteroid, and the redness of
the eye is much minimal than bacterial ulcer
DIFFERENCES OF BACTERIAL
FUNGAL AND VIRUS KERATITIS
Virus corneal ulcer, pain is relatively minimal
compared to bacterial, because anesthetic effect
to the cornea. Besides, viral ulcer (which is mainly
caused by herpes virus) usually has recurrent
infection
Fungal This case
Keratitis

Fungal Bacterial
Ulcer Ulcer
Other case This case

Bacterial keratitis Bacterial keratitis

 ASSESMENT SUPPORTIVE EXAM

• OS Keratitis susp bacterial – Fluorescent examination:

– DD / Fungal keratitis • to see a defect in the corneal
epithelium.
Corneal ulcer ec bacterial

Corneal ulcer ec fungal – Swab Culture:

• to know microorganisms
cause infection.
 THERAPEUTIC
PLANNING

 Cravit eye drop 1 drip every 2 hour OS

 Lyteers Eye drop 1 drip every 2 hour OS

 C. Xitrol eye drop 4 x 1 drip OS

 C. Tropin 0,5% eye drop 2 x 1 drip OS

COUNSELING, INFORMATION
AND EDUCATION

Explain that the disease He suffered was abnormalities in the structure of the cornea that
is in the form of wounds and infections have occurred

Encourage the patient to keep his hand clean.

Inform the patient about how to wipe the eyes with clean cloths, and not to use the cloths
with the other family members

Encourage the patient to keep regulary use the drugs as recommended by the physician
Inform the patient about the complication of the disease, including the scar of the cornea

Inform the patient about the complication of the disease, including the scar of the cornea
 PROGNOSIS

• Quo ad functionam
– dubia ad bonam.

• Quo ad vitam
– bonam.