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PRESENTASI KASUS

Latifatun Nikmah (1102010149)

KEPANITERAAN KLINIK STASE MATA

UNIVERSITAS YARSI RS PLRI SAI! SUKANT

Periode November - Desember 2014

P"m#im#in$:

Dr. Aga !ad"a#i$ S%.M

Dr. !ar&a&i Ismai#$ S%.M

Dr. 'e(r) A.*$ S%.M

Dr. 'erma(s)a$ S%.M

Dr. M+s&a,a$ S%.M

%&'"&um

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I!ENTITAS PASIEN

No. Ream Medis: 1//

Nama : N(. D

m+r : 22 &a+(

e(is Ke#ami( : Perem%+a(

Agama : Is#am

Ta(gga# #air : 11 Ag+s&+s 1332

Pe(didia( : SMA

Peer"aa( : Pe#a"arMaasis5i

A#ama& : K%. a&i r& 020 Par+(g

S&a&+s : 6e#+m me(iaTa(gga# %emerisaa( : November 2014

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ANA*NESIS

Di#a+a( se7ara a+&oa(am(esis

'ariTa(gga# : Se(i($ November 2014

Tem%a& : Po#i Ma&a RS P8LRI Said S+a(&o

am : 10.00 *I6

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KELU%AN UTA*A

6e("o#a( di e#o%a ma&a a(a( a&as

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KELU%AN TA*+A%AN

N)eri se(&+

!a&a#

Rasa me(gga("a# %ada %ada ma&a a(a(

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6e("o#a( diser&ai rasa sai&$ &er+&ama bi#a be("o#a( &erse(&+

da( &erasa ga&a#.

Pasie( "+ga merasa se%er&i ada )a(g me(gga("a# %ada ma&a

a(a( a&as. Ke#+ar o&ora($ ma&a ab+r da( demam disa(ga# o#e

%asie(.

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RI,AYAT PENYAKIT !A%ULU

Pasie( &ida %er(a me(deri&a %e()ai& )a(g sama se%er&i i(i

sebe#+m()a.

Ri5a)a& %e()ai& diabe&es me#i&+s disa(ga#

Ri5a)a& %e()ai& i%er&e(si disa(ga#

Ri5a)a& %er(a me(ga#ami be(&+ra( a&a+ &ra+ma be(da #ai(

disa(ga#

Ri5a)a& me(gg+(aa( a7ama&a disa(ga#

Ri5a)a& a#ergi disa(ga# Ri5a)a& me(gg+(aa( oba& ()eri %ege# #i(+ da#am "a(ga 5a&+

)a(g #ama disa(ga#

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RI,AYAT KELUAR-A

Tida &erda%a& a(ggo&a e#+arga de(ga( ri5a)a& )a(g sama

de(ga( %asie(.

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RI,AYAT KNSU*SI +AT

Se#ama sai& %asie( memaai oba&-oba&a( )ai&+ sa#e% ma&a

#amesi&i( da( a(&ibio&i 291$ (am+( #+%a (ama oba&()a.

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RI,AYAT TRAU*A

Ri5a)a& &ra+ma$ &ere(a be(da asi(g$ a&a+ baa( imia %ada

ma&a disa(ga# o#e %asie(.

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PE*ERIKSAAN .ISIK

Di%erisa %ada November 2014 %++# 10.00 *I6

S&a&+s ge(era#is:

Keadaa( +m+m : Tam%a sai& ri(ga(

Kesadara( : om%os Me(&is

Ta(da ;i&a#

Tea(a( dara : 120/0

Nadi : /0 a#ime(i&

Res%irasi : 20 a#ime(i&

S++ : a,ebris ?

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STATUS .TAL*L-I

INSPEKSI

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! S

== Vi/u/ !a/a' ==

!eraa( bo#a ma&a baiesega#a ara

P&/i/i %i'/h#"'$

't&f&'ia

!eraa( bo#a ma&a baiesega#a ara

Madarosis

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'i%eremis

6e("o#a(

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6e(&+ b+#a&$ se(&ra#$

reg+#er

Re,#es 7aa)a#a(gs+(g &ida

#a(gs+(g

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RESU*E

Pasie( %erem%+a( ber+m+r 22 &a+( da&a(g de(ga( e#+a( :

6e("o#a( %ada ma&a a(a( a&as se"a 4 b+#a( #a#+ smrs )a(g a5a#()a

ber+%a bi(&i da#am e#o%a ma&a a(a( a&as em+dia( semai( #ama

semai( membesar sei(gga e#o%a ma&a a(a( a&as me("adi mera da(

be(ga.

6e("o#a( diser&ai rasa sai&$ &er+&ama bi#a be("o#a( &erse(&+ da( &erasaga&a#.

Se%er&i ada )a(g me(gga("a# %ada e#o%a ma&a a(a( a&as.

Pada %emerisaa( ,isi : ;is+s 8DS : ==

Pa#%ebra s+%erior : Edema

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!IA-NSIS +AN!IN-

'ordeo#+m es&er(a 8D

'ordeo#+m i(&er(a 8D

Ka#aio( 8D

T+mor %a#%ebra 8D

Se#+#i&is %rese%&a# 8D

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!IA-NSIS KER5A

'ordeo#+m es&er(+m 8D

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TATALAKSANA

Re(7a(a &era%i : I(sisi ordeo#+m es&er(a

A(&ibio&i sis&emi : e,rado9i# 9=00 mg

A(a#ge&i : Asam me,e(ama& 9=00 mg

A(&ibio&i &o%ia# : #oram,e(i7o# a#, =9B.s Kom%res a(ga& 4- a#i seari se#ama 1= me(i& &ia% a#i()a +(&+

memba(&+ drai(ase. La+a( de(ga( ma&a &er&+&+%. a(ga(

me(7oba meme7aa( ordeo#+m$ biara( %e7a se(diri.

6ersia( e#o%a ma&a de(ga( air bersi

Ko(&ro# e %o#i#i(i ma&a ari me(da&a(g

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PR-NSIS

C+o Ad ;i&am : Ad 6o(am

C+o Ad +(gsio(am : D+bia Ad 6o(am

C+o Ad Sa(a7&io(am : D+bia Ad bo(am

C+o Ad osme&i7a( : Ad 6o(am

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TINAAN PSTAKA

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ANAT*I PALPE+RA

Pa#%ebra s+%erior da( i(,erior ada#a modi,iasi #i%a&a( +#i&)a(g da%a& me(+&+% da( me#i(d+(gi bo#a ma&a bagia( a(&erior.

6eredi% me#i(d+(gi or(ea da( o("+(g&iva dari deidrasi.

Pa#%ebra s+%erior berair %ada a#is ma&a %a#%ebra i(,erior

me()a&+ de(ga( %i%i.

Pa#%ebra &erdiri a&as #ima bida(g "ari(ga( +&ama. Dari s+%er,isia#

e da#am &erda%a& #a%isa( +#i&$ #a%isa( o&o& ra(ga

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Te%ia( %a#%ebra di%isaa( o#e garis e#ab+

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Re&ra&or %a#%ebra ber,+(gsi memb+a %a#%ebra. Di %a#%ebra

s+%erior$ bagia( o&o& ra(ga ada#a #eva&or %a#%ebra s+%erior$ )a(gberasa# dari a%es orbi&a da( ber"a#a( e de%a( da( ber7aba(g

me("adi seb+a a%o(e+rosis da( bagia( )a(g #ebi da#am )a(g

me(ga(d+(g sera&-sera& o&o& %o#os dari m+s+#+s M+##er

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is+ra %a#%ebra ada#a r+a(g e#i%s di a(&ara ed+a %a#%ebra )a(gdib+a. is+ra i(i berair di a(&+s media#is da( #a&era#is.

Ka(&+s #a&era#is ira-ira 0$= 7m dari &e%ia( #a&era# orbi&a da(

membe(&+ s+d+& &a"am.

Pemb+#+ dara )a(g mem%erdarai %a#%ebra ada#a a. Pa#%ebra.Persara,a( se(sori e#o%a ma&a a&as dida%a&a( dari ram+s ,ro(&a#

(erv+s ;$ seda(g e#o%a ma&a ba5a o#e 7aba(g ed+a (erv+s ;.

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!E.INISI

'ordeo#+m ada#a i(,esi a&a+ %erada(ga( %ada e#e("ar di &e%i

e#o%a ma&a bagia( a&as ma+%+( bagia( ba5a )a(g disebaba(

o#e ba&eri$ biasa()a o#e +ma( S&a,i#oo+s (Staphylococcus

aureus). 'ordeo#+m da%a& &imb+# %ada 1 e#e("ar e#o%a ma&a a&a+

#ebi. Ke#e("ar e#o%a ma&a &erseb+& me#i%+&i e#e("ar Meibom$e#e("ar Feiss da( Mo##.

'ordeo#+m ada#a i(,esi e#e("ar %ada %a#%ebra. 6i#a e#e("ar

Meibom )a(g &ere(a$ &imb+# %embe(gaa( besar )a(g diseb+&

ordeo#+m i(&er(a. Seda(ga( ordeo#+m es&er(a )a(g #ebi e7i#da( #ebi s+%er,isia# ada#a i(,esi e#e("ar Feiss a&a+ Mo##.

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'ordeo#+m es&er(+m ada#a i(,esi e#e("ar seba7eo+s

dari Feiss di dasar b+#+ ma&a$ a&a+ i(,esi %ada e#e("areri(ga& a%ori( dari Mo##. 'ordeo#+m es&er(+m &erbe(&+

%ada bagia( #+ar %a#%ebra da( da%a& di#ia& sebagai be("o#a(

mera e7i#.

!ambar 'ordeo#+m Es&er(+m

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Pada ordeo#+m es&er(+m be("o#a( i+& bergera de(ga(

%ergeraa( +#i&$ be("o#a( me(o("o# e ara +#i&$ da( bi#a

me(ga#ami s+%+rasi be("o#a( %e7a de(ga( se(diri()a e ara +#i&.

Seda(ga( %ada ordeo#+m i(&er(+m be("o#a( &ida i+& bergerade(ga( %ergeraa( +#i&$ be("o#a( me(o("o# e ara o("+(g&iva da(

are(a #e&a()a da#am &ars+s "ara(g %e7a de(ga( se(diri()a.

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EPI!E*IL-I

Da&a e%idemio#ogi i(&er(asio(a# me()eb+&a( ba5a

ordeo#+m mer+%aa( %e()ai& i(,esi e#o%a ma&a )a(g %a#i(g

seri(g di&em+a(. I(side(si()a &ida berga(&+(g %ada ras da(

"e(is e#ami(. Da%a& me(ge(ai sem+a +sia$ &a%i #ebi seri(g

me()era(g %ada de5asa m+da.

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ETIL-I

'ordeo#+m mer+%aa( i(,esi )a(g disebaba( o#e ba&eri

Staphylococcus da( Streptococcus%ada e#e("ar sebasea e#o%a

ma&a. S&a%)#o7o77+s a+re+s mer+%aa( age(& i(,esi %ada 30-

3=H as+s ordeo#+m.

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PAT.ISIL-I

'ordeo#+m es&er(+m &imb+# dari b#oade da( i(,esi dari

e#e("ar Feiss a&a+ Mo##. Seda(ga( ordeo#+m i(&er(+m &imb+#

dari i(,esi %ada e#e("ar Meibom )a(g &er#e&a di da#am &ars+s.

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Pembe(gaa(

Rasa ()eri %ada e#o%a ma&a

Perasaa( &ida ()ama( da( se(sasi &erbaar %ada e#o%a ma&a

Ri5a)a& %e()ai& )a(g sama

Ta(da

Eri&ema Edema

N)eri bi#a di&ea( di dea& %a(ga# b+#+ ma&a

Se%er&i gambara( abses e7i#

*ANI.ESTASI KLINIS

Ke#+a( +&ama da%a& ber+%a be(ga da( emeraa( %adae#o%a ma&a )a(g &erasa ()eri +(&+ ordeo#+m i(&er(+m$ da(

bis+# a&a+ be("o#a( emeraa( da%a& diser&ai (a(a a&a+ &ida %ada

ordeo#+m es&er(+m.

- 3 t # h

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-"3aa tam#ahan

Se#ai( e#+a( +&ama dia&as$ ordeo#+m "+ga da%a& diser&ai de(ga(

bebera%a ge"a#a &ambaa( se%er&i:

6e("o#a( %ada e#o%a ma&a a&as a&a+ ba5a

Pembe(gaa( #oa# e#o%a ma&a

N)eri #oa# e#o%a ma&a

Kemeraa( %ada e#o%a ma&a

N)eri se(&+

Pe(gerasa( +#i& dari margo e#o%a ma&a

Se(sasi &erbaar di ma&a

Terasa bera& %ada e#o%a ma&a

!a&a# %ada bo#a ma&a

Pe(g#ia& ab+r

Sere& %+r+#e( di ma&a

Iri&asi %ada ma&a

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Diag(osis ordeo#+m di&egaa( berdasara( ge"a#a da(

&a(da #i(is )a(g m+(7+# %ada %asie( da( de(ga(

me#a+a( %emerisaa( ma&a )a(g sedera(a. Kare(a

easa( dari ma(i,es&asi #i(is %e()ai& i(i$ %emerisaa(%e(+("a(g &ida di%er#+a( da#am me(diag(osis

ordeo#+m.

!IA-NSIS

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Ka#aio(

T+mor %a#%ebra

Se#+#i&is %rese%&a#

!IA-NSIS +AN!IN-

PENATALAKSANAAN

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6iasa()a ordeo#+m da%a& semb+ de(ga( se(diri()a da#am 5a&+ =-G

ari.

Umum

Kom%res a(ga& 4- a#i seari se#ama 1= me(i& &ia% a#i()a +(&+

memba(&+ drai(ase. La+a( de(ga( ma&a &er&+&+%.

6ersia( e#o%a ma&a de(ga( air bersi a&a+%+( de(ga( sab+( a&a+ sam%o

)a(g &ida me(imb+#a( iri&asi$ se%er&i sab+( ba)i. 'a# i(i da%a&mem%er7e%a& %roses %e()emb+a(. La+a( de(ga( ma&a &er&+&+%.

a(ga( me(ea( a&a+ me(+s+ ordeo#+m$ are(a em+(gi(a( a# i&+

me("adi #ebi seri+s.

'i(dari %emaaia( mae+% %ada ma&a$ are(a em+(gi(a( a# i&+

me("adi %e()ebab i(,esi.

a(ga( memaai #e(sa o(&a are(a da%a& me()ebaba( i(,esi e

or(ea.

PENATALAKSANAAN

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#at

A(&ibio&i dii(diasia( bi#a de(ga( om%res a(ga& se#ama 24 "am &ida

ada %erbaia($ da( bi#a %roses %erada(ga( me()ebar e sei&ar daera

ordeo#+m.

Anti#i&tik t&ika

6a7i&ra7i( a&a+ &obrami7i( sa#e% ma&a diberia( se&ia% 4 "am se#ama G-10

ari. Da%a& "+ga diberia( eri&romi7i( sa#e% ma&a +(&+ as+s ordeo#+m

es&er(a da( ordeo#+m i(&er(a ri(ga(.Anti#i&tik /i/t"mik

Diberia( bi#a &erda%a& &a(da-&a(da ba&erimia a&a+ &erda%a& &a(da

%embesara( e#e("ar #im,e di %rea+ri7+#ar. Pada as+s ordeo#+m

i(&er(+m de(ga( as+s )a(g seda(g sam%ai bera&$ da%a& diberia(

7e%a#e9i( a&a+ di7#o9a7i#i( =00 mg %er ora# 4 a#i seari se#ama G ari.

6i#a a#ergi %e(isi#i( a&a+ 7e%a#os%ori( da%a& diberia( 7#i(dami7i( 00

mg ora# 4 a#i seari se#ama G ari a&a+ #ari&rom)7i( =00 mg 2 a#i seari

se#ama G ari.

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P"m#"ahan

6i#a de(ga( %e(goba&a( &ida beres%o( de(ga( bai$ maa %rosed+r

%embedaa( m+(gi( di%er#+a( +(&+ memb+a& drai(ase %adaordeo#+m.

Pada i(sisi ordeo#+m &er#ebi da+#+ diberia( a(as&esi &o%ia# de(ga(

%a(&oai( &e&es ma&a. Di#a+a( a(as&esi ,i#&rasi de(ga( %roai( a&a+

#idoai( di daera ordeo#+m da( di#a+a( i(sisi bi#a:

'ordeo#+m i(&er(+m dib+a& i(sisi %ada daera ,#+&+asi %+s$ &ega

#+r+s %ada margo %a#%ebra.

'ordeo#+m es&er(+m dib+a& i(sisi se"a"ar de(ga( margo %a#%ebra.

Se&e#a di#a+a( i(sisi$ di#a+a( eso#easi a&a+ +re&ase se#+r+ isi

"ari(ga( merada(g di da#am a(&o(g()a da( em+dia( diberia( sa#e%

a(&ibio&i.

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Ma&a eri(g

Simb#e,aro(

Abses

Se#+#i&is %a#%ebra

K*PLIKASI

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PR-NSIS

*a#a+%+( ordeo#+m &ida berbaa)a da( om%#iasi()a sa(ga&

"ara(g$ &e&a%i ordeo#+m sa(ga& m+da amb+. 'ordeo#+m

biasa()a semb+ se(diri a&a+ %e7a da#am bebera%a ari sam%ai

mi(gg+. De(ga( %e(goba&a( )a(g bai ordeo#+m 7e(der+(g

semb+ de(ga( 7e%a& da( &a(%a om%#iasi. Prog(osis bai a%abi#a

ordeo#+m &ida di&ea( a&a+ di&+s+ are(a i(,esi da%a& me()ebar

e "ari(ga( sei&ar.

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PEN6E-A%AN

aga ebersia( 5a"a da( membiasaa( me(7+7i &a(ga( sebe#+m

me()e(&+ 5a"a agar ordeo#+m &ida m+da ber+#a(g.

sa% e#o%a ma&a de(ga( #emb+& me(gg+(aa( 5as#a% a(ga&

+(&+ membersia( esresi e#e("ar #ema.

aga ebersia( %ara#a&a( mae+% ma&a agar &ida &ero(&ami(asi

o#e +ma(.

!+(aa( a7ama&a %e#i(d+(g "ia be%ergia( di daera berdeb+.

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RIN-KASAN

'ordeo#+m mer+%aa( i(,esi #oa# a&a+ %roses %erada(ga( %ada

e#o%a ma&a. 6i#a e#e("ar Meibom )a(g &ere(a diseb+& ordeo#+m

i(&er(+m$ seda(ga( bi#a e#e("ar Feiss a&a+ Mo## )a(g &ere(a maa

diseb+& ordeo#+m es&er(+m. Staphylococcus aureus ada#a age(& i(,esi

%ada 30-3=H as+s ordeo#+m. !e"a#a da( &a(da ordeo#+m a(&ara #ai(be(ga$ ()eri %ada e#o%a ma&a$ %erasaa( &ida ()ama( da( se(sasi

&erbaar %ada e#o%a ma&a$ memi#ii ri5a)a& %e()ai& )a(g sama$ eri&ema$

edema$ ()eri bi#a di&ea( di dea& %a(ga# b+#+ ma&a$ se%er&i gambara(

abses e7i#. Pe(a&a#asa(aa( &erdiri dari %era5a&a( +m+m se%er&i om%res

a(ga&$ a(&ibio&i &o%ia# a&a+%+( sis&emi da( %embedaa(.

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PE*+A%ASAN

*"n$aa a/i"n iia$n&/i/ h&'"&um "k/t"'num !7Pasie( didiag(osis ordeo#+m es&er(+m 8D diare(aa( %ada

a(am(esis di&em+a(:

6e("o#a( di e#o%a ma&a a(a( a&as se"a 4 b+#a( smrs )a(g a5a#()a

ber+%a bi(&i da#am e#o%a ma&a a(a( a&as )a(g sai& da( &ida bisa di%e(7e& em+dia( semai( #ama semai( membesar sei(gga e#o%a

ma&a a(a( a&as mera da( be(ga.

6e("o#a( diser&ai rasa sai&$ &er+&ama bi#a be("o#a( &erse(&+ da( &erasa

ga&a#.

Se%er&i ada )a(g me(gga("a# %ada ma&a a(a( a&as.

!e"a#a-ge"a#a dia&as mer+%aa( ma(i,es&asi #i(is %ada ordeo#+m

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Pada %emerisaa( ,isi di&em+a(:

;is+s 8DS : ==

Pa#%ebra s+%erior 8D : Edema

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*"n$aa iia$n&/i/ #anin$ "n$an h&'"&um int"'num8

kaai&n8 tum&' a"#'a an /"uiti/ '"/"ta7

'a# &erseb+& diare(aa( e#+a( )a(g sama &erda%a& %ada

ordeo#+m es&er(+m$ ordeo#+m i(&er(+m$ a#aio($ &+mor

%a#%ebra da( se#+#i&is %rase%&a# ada#a be("o#a( di e#o%a ma&a.

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J 'ordeo#+m i(&er(+m ada#a i(,esi e#e("ar seba7eo+s Meibom )a(g

me#a%isi bagia( da#am e#o%a ma&a. Pe()ai& i(i "+ga me()ebaba(

be("o#a( mera di ba5a %a#%ebra

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Pada ordeo#+m es&er(+m be("o#a( i+& bergera de(ga(

%ergeraa( +#i&$ be("o#a( me(o("o# e ara +#i&$ da( bi#a

me(ga#ami s+%+rasi be("o#a( %e7a de(ga( se(diri()a e ara

+#i&. Seda(ga( %ada ordeo#+m i(&er(+m be("o#a( &ida i+&

bergera de(ga( %ergeraa( +#i&$ be("o#a( me(o("o# e arao("+(g&iva da( are(a #e&a()a da#am &ars+s "ara(g %e7a

de(ga( se(diri()a.

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J Ka#aio( mer+%aa( s+a&+ %erada(ga( gra(+#oma&osa e#e("ar

Meiobom )a(g &ers+mba&. Ka#aio( memberia( ge"a#a be("o#a(

%ada e#o%a ma&a$ &ida i%eremis$ da( &ida ()eri &ea($ ser&a

ada()a %se+do%&osis. 'a# )a(g membedaa( a(&ara a#aio( da(

ordeo#+m ada#a %ada ordeo#+m &erda%a& i%eremis %a#%ebrada( ()eri &ea(.

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J T+mor %a#%ebra mer+%aa( s+a&+ %er&+mb+a( se# )a(g

ab(orma# %ada e#o%a ma&a. Ada%+( ge"a#a )a(g membedaa(

a(&ara &+mor %a#%ebra de(ga( ordeo#+m ada#a &ida ada()a

&a(da-&a(da %erada(ga( se%er&i i%eremis da( a(ga&. T+mor

%a#%ebra ar+s di&egaa( diag(osis()a de(ga( %emerisaa(bio%s).

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J Se#+#i&is %rese%&a# mer+%aa( i(,esi +m+m %ada e#o%a ma&a

da( "ari(ga( #+(a %eriorbi&a# )a(g diara&eris&ia( de(ga(

ada()a eri&ema %ada e#o%a ma&a )a(g a+& da( edema. a(g

membedaa( se#+#i&is %rese%&a# de(ga( ordeo#+m ada#a

%er"a#a(a( %e()ai&()a$ )a(g di&a(dai de(ga( ada()a demam)a(g dii+&i o#e %embe(gaa(.

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Aakah "nataak/anaan aa a/i"n ini /uah t"at7

Pasie( i(i s+da me(go(s+msi oba& se(diri se%er&i sa#e% ma&a #amesi&i(

da( a(&ibio&i 291$ (am+( #+%a (ama oba&()a.

Pasie( dia("+ra( i(sisi ordeo#+m es&er(+m$ (am+( %asie( be#+m

emba#i o(&ro#.

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+a$aimana '&$n&/i/ a/i"n ini7

Prog(osis %ada %e(deri&a i(i ada#a bai$ are(a %ada as+s i(i

ordeo#+m masi ber++ra( 291 7m sei(gga %roses %erada(ga(

%ada ordeo#+m masi bisa me(ga#ami %e()emb+a( de(ga(

se(diri()a. Se7ara ,+(gsio(a#$ %e(deri&a masi da%a& me#a+a(

%eer"aa(()a a&a+ a&i,i&as()a seari-ari de(ga( bai da( masi

da%a& memi#ii +b+(ga( so7ia# )a(g bai de(ga( ora(g #ai(

disei&ar()a.

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