Pemicu 2

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Adrian Pratama – 405100018 – Blok Penginderaan
LO 1
 Menjelaskan kelainan kelopak mata
Hordeolum
  infection of the glands of the eyelid
 meibomian glands  large swelling occurs (hordeolum
internum)
 Zeis's or Moll's glands  smaller & superficial swelling
(external hordeolum)

 Etiology
 Staphylococcus aureus
 but culture seldom required

 Principal symptoms
 Pain, redness, and swelling
 Treatment
 warm compresses three or four times a day for 10–15 minutes
 not begin to resolve within 48 hours  incision and drainage of
the purulent material
 vertical incision should be made on the conjunctival surface to avoid
cutting across the meibomian glands
 incision should not be squeezed to express residual pus
 Externally pointed hordeolum  horizontal incision (minimize scar
formation)
Chalazion
  an idiopathic sterile chronic granulomatous
inflammation of a meibomian gland
 Symptoms
 painless localized swelling that develops over a period of weeks
 may begin with mild inflammation and tenderness resembling
hordeolum
 differentiated from hordeolum by the absence of acute inflammatory
signs
 slightly reddened or elevated
 Large  press on the eyeball and cause astigmatism  Th/
excision
 Histologic exam
 proliferation of the endothelium of the acinus and a granulomatous
inflammatory response that includes Langerhans-type gland cells
 Biopsy is indicated for recurrent chalazion  meibomian gland
carcinoma may mimic chalazion

 Treatment
 Surgical excision with vertical incision  careful curettement of
the gelatinous material and glandular epithelium
 Intralesional steroid injections alone may be useful for small
lesions
 combination with surgery in difficult cases
Anterior blepharitis
  common chronic bilateral inflammation of the lid margins
 2 types 
 Staphylococcal (ulcerative)  e/ Staphylococcus aureus
 Seborrheic (non-ulcerative)  e/ Pityrosporum ovale
 Mixed

 Chief symptoms
 irritation, burning, and itching of the lid margins
 “red-rimmed”
 scales or "granulations" can be seen clinging to the lashes of both the
upper and lower lids
 Staphylococcal  dry, the lids are red, tiny ulcerated areas are found along the
lid margins, and the lashes tend to fall out
 Seborrheic  greasy, ulceration does not occur, and the lid margins are less
red
 Other etiologic disease
 hordeola, chalazia, epithelial keratitis of the lower third of the
cornea, and marginal corneal infiltrates

 Treatment
 Seborrheic type 
 scalp, eyebrows, and lid margins must be kept clean (means of soap and
water shampoo)
 scales must be removed from the lid margins daily with a damp cotton
applicator and baby shampoo
 Staphylococcal type 
 antistaphylococcal antibiotic or sulfonamide eye ointment applied on a
cotton applicator once daily to the lid margins
Posterior blepharitis
  inflammation of the eyelids secondary to dysfunction
of the meibomian glands; bilateral, chronic condition
 Seborrheic dermatitis is commonly associated with meibomian
gland dysfunction
 Colonization or frank infection with strains of staphylococci
 Bacterial lipases  inflammation of the meibomian glands and
conjunctiva and disruption of the tear film.

 Anterior and posterior blepharitis may coexist

 Clinical manifestation
 broad spectrum of symptoms involving the lids, tears, conjunctiva, and
cornea
 inflammation of the meibomian orifices (meibomianitis),
 plugging of the orifices with inspissated secretions,
 dilatation of the meibomian glands in the tarsal plates,
 production of abnormal soft, cheesy secretion upon pressure over the glands
 Hordeola & chalazia may also occur
 lid margin shows hyperemia and telangiectasia; rounded and rolled inward as
a result of scarring of the tarsal conjunctiva
  abnormal relationship between the precorneal tear film and the meibomian gland
orifices
 tears may be frothy or abnormally greasy
 epithelial keratitis
 Cornea  peripheral vascularization and thinning, particularly inferiorly,
sometimes with frank marginal infiltrates
 Treatment
 determined by the associated conjunctival and corneal changes
 Frank inflammation  long-term low-dose systemic antibiotic therapy
 doxycycline (100 mg twice daily) or erythromycin (250 mg three times
daily), but guided by results of bacterial cultures from the lid margins
 weak topical steroids, eg, prednisolone, 0.125% twice daily
 Topical therapy with antibiotics or tear substitutes  UNNECESSARY
(lead to further disruption of the tear film or toxic reactions to their
preservatives)

 Periodic meibomian gland expression may be helpful (mild disease

that does not warrant long-term therapy with oral antibiotics or topical
steroids)
LO 2
 Menjelaskan kelainan mata merah dengan visus normal
Conjunctivitis
Symptoms of conjunctivitis
 foreign body sensation
 scratching or burning sensation
  associated with the swelling and papillary hypertrophy that
normally accompany conjunctival hyperemia
 sensation of fullness around the eyes
 Itching
 photophobia
 If there is pain, the cornea is probably also affected
Signs of conjunctivitis
 Exudation
 feature of all types of acute conjunctivitis
 Bacterial  flaky and amorphous; allergic  stringy
 "Mattering" of the eyelids occurs upon awakening
 exudate is copious and the lids are firmly stuck together  bacterial /
chlamydial
 Pseudoptosis
 drooping of the upper lid secondary to infiltration of Müller's muscle 
trachoma and epidemic keratoconjunctivitis
 Papillary hypertrophy
 conjunctiva is bound down to the underlying tarsus or limbus by fine fibrils
 tuft of vessels that forms the substance of the papilla reaches the basement
membrane of the epithelium, it branches over the papilla like the spokes in
the frame of an umbrella
 accumulates between the fibrils  heaping the conjunctiva into mounds
 Chemosis
 suggests acute allergic conjunctivitis, acute gonococcal conjunctivitis,
especially in adenoviral conjunctivitis
 Follicles
 most cases of viral conjunctivitis, all cases of chlamydial conjunctivitis
except neonatal inclusion conjunctivitis, some cases of parasitic
conjunctivitis & toxic conjunctivitis induced by topical medications
 when they are located on upper tarsus  chlamydial, viral, or toxic
conjunctivitis
 Granulomas
 Sarcoid, syphilis, cat-scratch disease, and, rarely, coccidioidomycosis
 Parinaud's oculoglandular syndrome  conjunctival granulomas and a
prominent preauricular lymph node
 Pseudomembranes & membranes
 Pseudomembrane  coagulum on the surface of the epithelium, and when it is
removed, the epithelium remains intact
 Membrane  coagulum involving the entire epithelium, if it is removed, a raw,
bleeding surface remains
 accompany
 epidemic keratoconjunctivitis,
 primary herpes simplex virus conjunctivitis,
 streptococcal conjunctivitis,
 diphtheria,
 cicatricial pemphigoid,
 erythema multiforme major
 Ligneous conjunctivitis
 peculiar form of recurring membranous conjunctivitis
 bilateral, seen mainly in children, and predominantly in females, and it may be
associated with other systemic findings, including nasopharyngitis and
vulvovaginitis
 Phlyctenules
 delayed hypersensitivity reaction to microbial antigen, eg,
staphylococcal or mycobacterial antigens
 perivasculitis with lymphocytic cuffing of a vessel
 When they progress to ulceration of the conjunctiva  ulcer
bed has many polymorphonuclear leukocytes
 Preauricular lymphadenopathy
 large or small preauricular node, sometimes slightly tender 
primary herpes simplex conjunctivitis, epidemic
keratoconjunctivitis, inclusion conjunctivitis, and trachoma
 Small but nontender preauricular lymph nodes 
pharyngoconjunctival fever and acute hemorrhagic
conjunctivitis
Bacterial conjunctivitis
 2 forms
 acute (including hyperacute and subacute)
 benign and self-limited, lasting no more than 14 days
 hyperacute (purulent) conjunctivitis caused by Neisseria gonorrhoeae
or Neisseria meningitidis
 Chronic
 secondary to eyelid disease or nasolacrimal duct obstruction
 General symptoms
 bilateral irritation and
injection
 purulent exudate with
sticky lids on waking
 lid edema
 Hyperacute (purulent) bacterial conjunctivitis
 e/  N gonorrhoeae, Neisseria kochii, and N meningitidis
 Sign & symptoms
 profuse purulent exudate
 immediate laboratory investigation and immediate treatment
 If delayed  severe corneal damage or loss of the eye, or the conjunctiva
could become the portal of entry for either N gonorrhoeae or N
meningitidis  septicemia / meningitis

 Subacute conjunctivitis
 e/  H influenzae and occasionally by Escherichia coli and
proteus species
 Thin, watery, or flocculent exudate
 Acute mucopurulent (catarrhal) conjunctivitis
 acute onset of conjunctival hyperemia and a moderate amount of
mucopurulent discharge
 e/ 
 Streptococcus pneumoniae in temperate climates and Haemophilus
aegyptius in warm climates
 May be accompanied by subconjunctival hemorrhages
 staphylococci and other streptococci

 Chronic bacterial conjunctivitis

 patients with nasolacrimal duct obstruction and chronic
dacryocystitis; usually unilateral
 associated with chronic bacterial blepharitis or meibomian gland
dysfunction
 Laboratory findings
 organisms can be identified by the microscopic examination of
conjunctival scrapings stained with Gram's stain or Giemsa's
stain
  numerous polymorphonuclear neutrophils
 Conjunctival scrapings for microscopic examination and culture
are recommended (especially if purulent, membranous, or
pseudomembranous)
 Antibiotic sensitivity studies
 But empirical antibiotics should be started
 Complications & sequelae
 Chronic marginal blepharitis often accompanies staphylococcal
conjunctivitis
 Conjunctival scarring may follow both pseudomembranous and
membranous conjunctivitis
 Marginal corneal ulceration may follow infection with N
gonorrhoeae, N kochii, N meningitidis, H aegyptius, S aureus,
and M catarrhalis
 toxic products of N gonorrhoeae diffuse through the cornea into
the anterior chamber  toxic iritis
 Treatment
 start topical therapy with a broad-spectrum antibacterial agent
(eg, polymyxin-trimethoprim)
 Neisseria  systemic and topical therapy started immediately
 no corneal involvement  single intramuscular dose of
ceftriaxone, 1 g
 corneal involvement  5-day course of parenteral ceftriaxone,
1–2 g daily
 purulent and mucopurulent conjunctivitis  conjunctival sac
should be irrigated with saline solution + remove the
conjunctival secretions
 Personal hygiene
 Course & prognosis
 almost always self-limited
 Untreated, it may last 10–14 days; if properly treated, 1–3 days
 exceptions are
 staphylococcal conjunctivitis (which may progress to
blepharoconjunctivitis and enter a chronic phase)
 gonococcal conjunctivitis (which, when untreated, can lead to corneal
perforation and endophthalmitis)
 Chronic bacterial conjunctivitis may not be self-limited and
may become a troublesome therapeutic problem
Acute viral follicular conjunctivitis
 Epidemiology
 Pharyngoconjunctival fever  more common in children than
 e/  adenovirus type 3, 4, 7 in adults and can be
 Symptoms transmitted in poorly
 fever of 38.3–40 °C, sore throat, chlorinated swimming pools
and a follicular conjunctivitis in
one or both eyes
 follicles are often very
prominent on both the
conjunctiva & pharyngeal
mucosa
 Injection and tearing
 transient superficial epithelial
keratitis
 Preauricular lymphadenopathy
(nontender)
 Examination
 As the disease progresses, it can also be diagnosed serologically by a
rising titer of neutralizing antibody to the virus
 Conjunctival scrapings 
 predominantly mononuclear cells, and no bacteria grow in cultures

 Treatment
 no specific treatment, but the conjunctivitis is self-limited, usually
lasting about 10 days
 Epidemic keratokonjunctivitis  A tender preauricular node
 e/  adenovirus types 8, 19,  Pseudomembranes
29, and 37  conjunctivitis lasts for 3–4
 Symptoms weeks at most
 Bilateral
 onset is often in one eye only,
however, and as a rule the first
eye is more severely affected
 conjunctival injection, moderate
pain, and tearing
 followed in 5–14 days by
photophobia, epithelial keratitis,
and round subepithelial opacities
 Edema of the eyelids, chemosis,
and conjunctival hyperemia 
follicles and subconjunctival
hemorrhages in 48 hours
 In children
 may be such systemic symptoms of viral infection as fever, sore throat, otitis
media, and diarrhea

 Examination
 Virus can be isolated in cell culture and identified by neutralization tests
 Scrapings from the conjunctiva 
 primarily mononuclear inflammatory reaction
 when pseudomembranes occur, neutrophils may also be prominent

 Treatment
 no specific therapy at present, but cold compresses will relieve some
symptoms
 Antibacterial agents should be given if bacterial superinfection occurs
 danger of contaminated solution bottles should be avoided
 Herpes simplex conjunctivitis  Herpetic vesicles may
sometimes appear on the
 Type 1  major; type 2 
eyelids and lid margins
newborn
 small tender preauricular
 Symptoms
node
 unilateral injection,
 irritation,
 mucoid discharge,
 pain,
 mild photophobia
 associated with herpes simplex
keratitis  single or multiple
branching epithelial (dendritic)
ulcers
 follicular or, less often,
pseudomembranous
 Examination
 No bacteria are found in scrapings or recovered in cultures
 conjunctivitis is follicular  mononuclear inflammatory reaction
 Pseudomembranous conjunctivitis  polymorphonuclear inlf.
reaction
 Intranuclear inclusions (because of the margination of the chromatin)
can be seen in conjunctival and corneal cells if Bouin fixation
 can be readily isolated by gently rubbing a dry Dacron or calcium
alginate swab over the conjunctiva  transferring the infected cells to
a susceptible tissue culture
 Treatment
 conjunctivitis occurs in a child over 1 year of age or in an adult  self
limited
 Topical or systemic antivirals should be given, however, to prevent corneal
involvement
 Corneal ulcers  debridement with a dry cotton swab, applying
antiviral drops, and patching the eye for 24 hours
 Topical antivirals alone should be applied for 7–10 days (eg,
trifluridine every 2 hours while awake)
 Herpetic keratitis may also be treated with 3% acyclovir ointment five
times daily for 10 days / oral acyclovir, 400 mg five times daily for 7
days
 Acute hemorrhagic
conjunctivitis
 e/  enterovirus type 70 and
occasionally by
coxsackievirus A24
 short incubation period (8–48
hours) and course (5–7 days)
 Sign & symptoms
 pain,
 photophobia,
 foreign-body sensation,
 copious tearing,
 redness,
 lid edema,
 subconjunctival hemorrhages
 Punctate at onset; upper to
lower
 Chemosis
 preauricular
lymphadenopathy,
conjunctival follicles, and
epithelial keratitis
 Fever , malaise, and
generalized myalgia
 Anterior uveitis
 transmitted by close person-
to-person contact and by
such fomites as common
linens, contaminated optical
instruments, and water

 Treatment
 no known treatment
Konjungtivitis dry eyes
 ~keratokonjungtivitis sika  suatu keadaan keringnya permukaan
kornea & konjungtiva yg diakibatkan berkurangnya fungsi air mata
 Kelainan ini terjadi pada penyakit yg mengakibatkan
 Def komponen lemak air mata
 Blefaritis menahun, distikiasis, pembedahan kelopak mata
 Def kelenjar air mata
 Sindrom syogren & riley day, alakrimia kongenital, aplasi kongenital saraf
trigeminus, sarkoidosis, limfoma kelenjar air mata, diuretik, atropin, usia
 Def komponen musin
 Benign ocular pempigoid
 Akibat penguapan berlebihan
 Keratitis neuroparalitik, hidup di gurun pasir, keratitis lagoftalmus
 Karena parut kornea / hilangnya mikrovili kornea
 Tanda & gejala
 Gatal, seperti berpasir, silau, penglihatan kabur
 Sekresi mukus >>
 Sukar menggerakan kelopak mata, mata tampak kering,
terdapat erosi kornea
 Konjungtiva bulbi edema, hiperemik menebal & kusam
 Kadang terdapat benang mukus kekuningan pd forniks
konjungtiva bawah

 Pemeriksaan
 Uji Scheimer  resapan < 5 menit  abnormal
 Pengobatan
 air mata buatan yg diberikan selamanya

 Komplikasi
 Ulkus kornea
 Infeksi sekunder oleh bakteri
 Parut kornea
 Neovaskularisasi kornea
Pterygium
  fleshy, triangular
encroachment of a pinguecula
onto the cornea, usually on the
nasal side bilaterally
 e/  thought to be an irritative
phenomenon due to ultraviolet
light, drying, and windy
environments

 Pathologic findings
 Conjunctiva  same as those of
pinguecula
 Cornea  replacement of
Bowman's layer by hyaline and
elastic tissue
 Treatment
 If the pterygium is enlarging and encroaches on the pupillary
area  remove surgically along with a small portion of
superficial clear cornea beyond the area of encroachment
 Conjunctival autografts + surgical excision  < recurrent
Subconjunctival hemorrhage
  occur spontaneously, usually in
only one eye, in any age group
 e/  rupture of a small conjunctival
vessel, sometimes preceded by
(severe coughing or sneezing)

 Clinical manifestation
 sudden onset and bright-red
appearance

 Treatment
 Reassurance (usually absorbs in 2–3
weeks)
 hemorrhages are bilateral or
recurrent  rule out blood dyscrasia
Episcleritis
  relatively common localized inflammation of the
vascularized connective tissue overlying the sclera
 Recurrence is the rule , cause is not known

 Epidemiology
 affect young people, typically in the third or fourth decade of
life
 women three times as frequently as men
 unilateral in about two-thirds of cases
 associated local or systemic disorder
 ocular rosacea, atopy, gout, infection, or collagen-vascular disease
(present in 1/3 patients)
 Symptoms
 redness and mild irritation
or discomfort
 benign, and the course is
generally self-limited in 1–2
weeks

 Examination
 episcleral injection, may be
nodular, sectoral, or diffuse
 no inflammation or edema
of the underlying sclera
 Treatment
 absence of a systemic disease  chilled artificial tears every 4–
6 hours until the redness resolves
 associated with a local or systemic disorder 
 doxycycline, 100 mg twice daily for rosacea
 antimicrobial therapy for tuberculosis, syphilis, or herpesvirus
infection
 local or systemic nonsteroidal anti-inflammatory agents or
corticosteroids for collagen-vascular disease
Scleritis
  uncommon disorder characterized by cellular
infiltration, destruction of collagen, and vascular
remodeling
 may be immunologically mediated or, less commonly, the result
of infection or local trauma

 Epidemiology
 bilateral in one-third of cases and affects women more
commonly than men, typically in the fifth or sixth decades of
life
Etiology
 Symptoms
 pain, which is typically
severe and boring in nature
and tends to wake them at
night
 globe is frequently tender
 Key clinical sign 
 deep violaceous discoloration
of the globe due to dilation of
the deep vascular plexus of
the sclera and episclera,
which may be nodular,
sectoral, or diffuse
 Visual acuity is often
slightly reduced
 intraocular pressure may be
mildly elevated
 Concurrent keratitis or
uveitis occurs (1/3 patients)
 Scleral necrosis in the
absence of inflammation
(scleromalacia)  patients
with rheumatoid arthritis
 Posterior scleritis
 pain and decreased vision
with little or no redness
 Mild vitritis, optic nerve
head edema, serous retinal
detachment, or choroidal
folds may be present
 USG & CT  thickening of
the posterior sclera and
choroid
 Treatment
 systemic nonsteroidal anti-inflammatory agents
 indomethacin, 75 mg daily, or ibuprofen, 600 mg daily, may be used
 no response in 1–2 weeks / if closure or clinically evident
nonperfusion of the episcleral or large vessels of the substantia
propria of the conjunctiva becomes apparent 
 oral prednisone, 0.5–1.5 mg/kg/d, should be started
 severe disease necessitates intravenous pulse therapy with
methylprednisolone 1 g
 Cyclophosphamide is particularly valuable if perforation is imminent
 Specific antimicrobial therapy should be given if an infectious cause
is identified
 Surgery  repair scleral or corneal perforations
LO 3
 Menjelaskan kelainan mata merah dengan penurunan
visus
Acute angle closure / acute glaucoma
  occurs when sufficient iris bombé develops to cause
occlusion of the anterior chamber angle by the peripheral
iris
 blocks aqueous outflow, and the intraocular pressure rises
rapidly  severe pain, redness, and blurring of vision

 May develop in hyperopic eyes with preexisting anatomic

narrowing of the anterior chamber angle, usually when it
is exacerbated by enlargement of the crystalline lens
associated with aging
 Precipitation factors
 pupillary dilation
 occurs spontaneously in the evenings, when the level of
illumination is reduced
 due to medications with anticholinergic or sympathomimetic
activity
 (eg, atropine for preoperative medication, antidepressants, nebulized
bronchodilators, nasal decongestants, or tocolytics)
 occur rarely with pupillary dilation for ophthalmoscopy
 Clinical findings
 sudden onset of visual loss accompanied by excruciating pain,
halos, and nausea and vomiting
 Patients are occasionally thought to have acute gastrointestinal disease
 markedly increased intraocular pressure,
 a shallow anterior chamber,
 a steamy cornea,
 a fixed, moderately dilated pupil,
 ciliary injection

 perform gonioscopy  confirm the anatomic predisposition to

primary acute angle closure
 DD
 Acute iritis
 causes more photophobia than acute glaucoma
 Intraocular pressure is usually not elevated; the pupil is constricted or irregular in shape
and the cornea is usually not edematous
 flare and cells are present in the anterior chamber
 deep ciliary injection
 Acute conjunctivitis
 bilateral, and there is little or no pain and no visual loss
 discharge from the eye and an intensely inflamed conjunctiva but no ciliary injection
 pupillary responses and intraocular pressure are normal, and the cornea is clear

 Complication
 peripheral iris may adhere to the trabecular meshwork  irreversible
occlusion of the anterior chamber angle requiring surgery
 Optic nerve damage
 Treatment
 OPHTHALMIC EMERGENCY
 initially directed at reducing the intraocular pressure
 Intravenous and oral acetazolamide + beta-blockers and apraclonidine
(topical) + hyperosmotic agents (if necessary)
 Pilocarpine 2% should be instilled one-half hour after
commencement of treatment
 laser peripheral iridotomy (neodymium:YAG laser) should be
undertaken to form a permanent connection between the
anterior and posterior chambers (after IOP under control) 
preventing recurrence of iris bombé
Uveitis anterior
  peradangan yg mengenai iris & jaringan badan siliar
(iridosiklitis biasanya unilateral, onset akut
 Merupakan suatu manifestasi klinik reaksi imunologik
lambat, dini, atau sel mediated terhadap jaringan uvea anterior
 Penyebab
 Nongranulomatosa
 Akut  nyeri, fotofobia, penglihatan buram keratik presipitat kecil, pupil
mengecil, sering kambuh (akibat: trauma, diare kronis, herpes simpleks)
 Kronis  disebabkan artritis reumatoid & Fuchs heterokromik iridosiklitis
 Granulomatosa
 Akut  tidak nyeri, fotofobia ringan, buram, keratik presipitat besar (mutton
fat), benjolan koeppe (penimbunan sel pada pupil), benjolan busacca
(penimbunan sel pd permukaan iris)
 Akibat: sarkoiditis, sifilis, TBC, virus, jamur (histoplasmosis), parasit (toksoplasmosis)
 Tanda & gejala
 Mata merah & sakit mendadak / mata merah & sakit ringan
perlahan dengan penglihatan turun perlahan
 Fotofobia
 Mata berair
 Radang otot2 akomodasi  sulit melihat dekat
 Radang otot2 sfingter & edema iris  pupil miosis
 Radang akut 
 miopisasi akibat rangsangan badan siliar & edema lensa,
 fler/efek tyndal di dalam bilik mata depan
 Hifema/hipopion
 Radang kronis  edema makula & kadang katarak
 Sinekia posterior,
 miosis pupil,
 tek bola mata < (hipofungsi badan siliar)
 Tek bola mata > (perlengketan yg tjd pd sudut bilik mata)

 Perjalanan penyakit berlangsung hanya antara 2-4 minggu, dpt

memperlihatkan gejala kekambuhan atau menahun
 Pengobatan
 Segera  cegah kebutaan
 Steroid pd siang hari bentuk tetes & malam hari bentuk salep
 Steroid sistemik bila perlu, dosis tunggal seling sehari tinggi 
diturunkan sampai dosis efektif
 Steroid subkonjungtiva & peribulbar
 Hati2 efek samping katarak, glaukoma, midriasis pupil
 Sikloplegik  < sakit, melepas sinekia, memberi istirahat pd
iris yg meradang
 Pengobatan spesifik jika sebab diketahui
 Komplikasi
 Sinekia posterior & anterior  glaukoma sekunder
 Akibat tertutupnya trabekulum o/ sel radang atau sisa sel radang
 Terapi dapat diberikan asetazolamida
 Radang 1 mata  radang berat pd mata sebelahnya  uveitis
simpatis
Endolftamitis
  peradangan berat dalam bola mata, akibat infeksi
setelah trauma/bedah/endogen akibat sepsis
  radang supuratif di dalam rongga mata & struktur di
dalamnya  abses badan kaca

 Etiologi
 Kuman & jamur yg masuk bersama trauma tembus (eksogen)/
sistemik melalui peredaran darah (endogen)
 Bakteri  stafilokok, streptokok, pneumokok, pseudomonas, bacilus
species
 Jamur  aktinomises, aspergilus, phitomikosis sporothrix,
kokidioides
 Gambaran klinik
 Rasa sakit yg sangat
 Kelopak merah & bengkak
 Kelopak sukar dibuka
 Konjungtiva kemotik & merah
 Kornea keruh
 Bilik mata depan keruh yg kadang disertai hipopion
  prognosa memburuk
 Kekeruhan / abses badan kaca  refleks pupil berwarna putih
 Gambaran seperti retinoblastoma (pseudoretinoblastoma)
 Pengobatan
 Antibiotik
 Ampisilin topikal & sistemik 2g/hari + kloramfenikol 3g/hari
 Stafilokok  basitrasin (topikal), metisilin (subkonjungtiva & IV)
 Pneumokok, streptokok, stafilokok  penisilin G (top, subkonj, & IV)
 Neiseria  penisilin G (top, subkonj, & IV)
 Pseudomonas  gentamisin; tobramisin + karbesilin (top, subkonj, IV)
 Batang gram (-) lain  gentamisin (top, subkonj, IV)
 Sikloplegik 3x/hari tetes mata
 Kortikosteroid
 Gagal pengobatan  eviserasi; enukleasi bila mata sdh tenang & ftisis bulbi
 Jamur  amfoterisin B 150mikrogram subkonjungtiva

 Komplikasi  panoftalmitis (prog buruk jika e/ jamur / parasit)

Keratitis
 Sign & symptoms
 pain and photophobia
 pain is worsened by movement of the lids (particularly the upper lid)
over the cornea
 persists until healing occurs
 blur vision, especially if centrally located
 Tearing
 no discharge except in purulent bacterial ulcers
 Morphologic diagnosis of corneal lesion
 Epithelial keratitis
 Subepithelial keratitis
 often secondary to epithelial keratitis
  ex. the subepithelial infiltrates of epidemic keratoconjunctivitis, caused
by adenoviruses 8 and 19

 Stromal keratitis
 infiltration, representing accumulation of inflammatory cells;
 edema manifested as corneal thickening, opacification, or scarring
 "melting" or necrosis, which may lead to thinning or perforation; and
vascularization

 Endothelial keratitis
 corneal edema
Bacterial keratitis
 Streptococcus pneumoniae
(pneumococcal) Corneal
Ulcer
 gray, fairly well-circumscribed
ulcer that tends to spread
erratically from the original site
of infection toward the center
of the cornea
 advancing border shows active
ulceration and infiltration as the
trailing border begins to heal 
"acute serpiginous ulcer“
 Hypopion is common
 Scrapings  gram-positive
lancet-shaped diplococci
 Pseudomonas aeruginosa  associated with soft contact
Corneal Ulcer lenses—especially extended-
wear lenses
 begins as a gray or yellow
infiltrate at the site of a break
 Scrapings  thin gram-
negative rods that are often
in the corneal epithelium
few in number
 Severe pain
 lesion tends to spread rapidly
in all directions because of the
proteolytic enzymes
 infiltrate and exudate may
have a bluish-green color
 Moraxella liquefaciens  Group A Streptococcus
Corneal Ulcer Corneal Ulcer
 causes an indolent oval ulcer  surrounding corneal stroma
that is often infiltrated and
 affects the inferior cornea and edematous
progresses into the deep stroma
over a period of days
 moderately large hypopyon
 No/small hypopion  Scrapings  gram-positive
 occurs in a patient with cocci in chains
alcoholism, diabetes, or other
causes of immunosuppression
 Scrapings  square-ended
gram-negative diplobacilli
 Staphylococcus aureus, Staphylococcus epidermidis, &
Alpha-Hemolytic Streptococcus Corneal Ulcers
 often indolent but may be associated with hypopyon
 some surrounding corneal infiltration
 often superficial, and the ulcer bed feels firm when scraped
 Scrapings  gram-positive cocci—singly, in pairs, or in chains

 Infectious crystalline keratopathy

  cornea has a crystalline appearance
 has been described in patients receiving long-term therapy with topical
steroids
 often caused by alpha-hemolytic streptococci as well as nutritionally
deficient streptococci
 Mycobacterium fortuitum-chelonei & Nocardia Corneal
Ulcers
 Rare
 often follow trauma and are often associated with contact with
soil
 ulcers are indolent, and the bed of the ulcer often has radiating
lines (look like a cracked windshield)
 Hypopyon may or may not be present
 Scrapings  acid-fast slender rods (M fortuitum-chelonei) or
gram-positive filamentous, often branching organisms
(nocardia)
Fungal Keratitis
 Etiology
 candida, fusarium, aspergillus, penicillium, cephalosporium,
and others

 Epidemiology
 most commonly in agricultural workers
 more common in the urban population since the introduction of
the corticosteroid drugs in ophthalmology
 Sign & symptoms
 Indolent ulcers and have a gray
infiltrate with irregular edges
 often a hypopyon
 marked inflammation of the
globe
 superficial ulceration
 satellite lesions
 Corneal abscesses
 Examination
 Scrapings  hyphal elements;
candida  pseudohyphae or
yeast forms
 Treatment
Keratoconjunctivitis sicca
  Associated with Sjögren's Syndrome
 Triad: keratoconjunctivitis sicca, xerostomia, and connective tissue dysfunction

 Epidemiology
 more common in women at or beyond the menopause than in other groups

 Sign & symptoms

 bulbar conjunctival hyperemia (especially in the palpebral aperture)
 symptoms of irritation that are out of proportion to the mild inflammatory signs
 begins as a mild conjunctivitis with a mucoid discharge
 Blotchy epithelial lesions appear on the cornea (in the lower half)
 Pain builds up in the afternoon and evening but is absent or only slight in the
morning
 tear film is diminished; contain shreds of mucus
 Examination
 Schirmer test are abnormal
 Rose bengal or lissamine green
staining of the cornea and
conjunctiva in the palpebral aperture
 Diagnosis
 lymphocytic and plasma cell
infiltration of the accessory salivary
glands in a labial biopsy obtained by
means of a simple surgical procedure
 Treatment
 Replace tear film  artificial tears,
side shields, moisture chambers, and
Buller shields
 preservative-free, low-dose
corticosteroid preparations and
topical cyclosporine
References
 Paul Riordan-Eva, John PW. Vaughan & Asbury general
ophtalmology. 17th ed. USA: McGraw-Hill, 2008
 Sidarta Ilyas. Ilmu Penyakit mata. Edisi keempat. Jakarta:
FKUI, 2007