corneal ulcer 2.pdf
TRANSCRIPT
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 1/34
CORNEAL ULCER
Z A L D I
DEPARTEMEN ILMU KESEHATAN MATA
FAKULTAS KEDOKTERANUNIVERSITAS MUHAMMADIYAH SUMATERA UTARA
MEDAN
2011
1
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 2/34
Dengan menyebut nama Allah
Yang Maha Pengasih Maha Penyayang.
2
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 3/34
I. TUJUAN INSTRUKSIONAL UMUM
• Setelah Proses Belajar Mengajar mahasiswa
mampu menegakkan diagnosa penyakit-penyakit
mata bagian kornea dengan melakukan
pemeriksaan sederhana yang akan dipelajari
selama masa perkuliahan secara baik dan benar .
3
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 4/34
II. TUJUAN INSTRUKSIONAL KHUSUS
• Setelah Proses Belajar Mengajar mahasiswa
mampu mengetahui gejala-gejala penyakit mata
bagian kornea , faktor resiko, menegakkan
diagnosa , prinsip pengobatan, komplikasi, dan
mengatasi komplikasi secara garis besar secara
baik dan benar sesuai dengan kompetensinya
4
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 5/34
THE CORNEA
• Anatomy of the adult cornea
• Ø 11 –12 mm horizontally
and 9 –11 mm vertically
• ± 0.5mm thick centrally and
0.65 –
0.70 mm peripherally• Curvature is 7.5 –8.0 mm centrally
and flatter peripherally.
• The central 4 mm of the diameteris optical zone.
• Refractive power : ± 44 dioptres
• Refractive index : 1,3375
5
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 6/34
6
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 7/34
HISTOLOGY
• Five layers
1. Epithelium
2. Bowman’s membrane
3. Stroma
4. Descemet’s membrane
5. Endothelium.
7
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 8/34
Epithelium
• The corneal epithelium comprises5 –6 layers of non-keratinisingsquamous epithelium.
• There is a basal monolayer of columnar cells, two or threelayers of wing cells, and two or
three layers of superficial non-keratinising squamous epithelialcells.
•
Only the basal columnar cellsshow mitotic activity
8
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 9/34
Epithelium
• Dendritic cells are also found in theperipheral corneal epithelium, butnot centrally.
• The collagen fibrils formapproximately 300 distinct lamellae,each covering the entire area of thecornea parallel to the surface.
• Transparency of the cornea isattributed to the extremely regularspacing of the collagen fibrils whichare separated by glycosaminoglycans,which are macromolecules with arole in maintaining even hydration of the stroma.
9
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 10/34
Bowman’s layer
• Bowman’s layer is at theinterface between theepithelium and the stroma
and comprises a compactionof collagen fibres (mainlytypes I and III) andproteoglycans.
• It is best considered as the
anterior layer of stroma andhas no regenerative powers.
10
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 11/34
Stroma
• The stroma provides 90% of thecorneal thickness.
• It comprises collagen, principallycollagen I, and lesser amounts of typeIII,V, and VI glycosaminoglycans,
mainly keratin sulphate.• It also comprises chondroitin and
dermatan sulphate, and cells mainlycorneal fibroblasts or keratocytes,which synthesise collagen andglycosaminoglycans, as well ascollagen degradative enzymes, such
as metalloproteases.
11
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 12/34
Descemet’s membrane
• About 5 –7 microns thick, itincreases in thickness fromabout 2 to 3 microns at birth
to 10 or 11 microns in oldage.
• It comprises, principally,collagen type IV and laminin,but at least five types of
collagen have been reported.
12
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 13/34
Endothelium
• The endothelium is amonolayer of hexagonalcells which have animportant role inpumping water from thecornea and thus a majorrole in maintaining
corneal transparency.
13
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 14/34
PHYSIOLOGY
• WINDOW OF THE
EYEBALL
• REFRACTIVE MEDIA
• BARRIER FROMMICROORGANISMS
14
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 15/34
LOSS OF TRANSPARANCY
• EPITHELIAL DAMAGE
• ENDOTHELIAL DAMAGE
15
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 16/34
DEFINITION
Inflammation of cornea ,caused by
• microorganism infection
• antigen antibodies / allergicreaction.
• Descemet’s membrane as barrier forbacterial infection to COA .(but not for
fungus)
16
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 17/34
ETIOLOGY
– Exogenous :
bacteria ,fungus , virus, parasite
– Endogenous :
allergic reaction.
17
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 18/34
ETIOLOGY
• Bacteria :-Pure Pathogen : Streptococcus pneumoniae,
Pseudomonas aeroginosa
-Opportunistic bacteria : -Staphylococcus,Moraxella, Serratia(as flora atconjunctiva
18
. Alcoholic/ B6 deficiency
.Topical steroid >>>
. Corneal abrasion
Pathogen bacteria Corneal infection
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 19/34
ETIOLOGY
• Fungus (usually opportunistic)
• Candida, Fusarium, Aspergillus
• Virus – VHS
– VVZ
• Parasite : Acanthamoeba
in Contact lens user
19
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 20/34
SIGNS AND SYMPTOMS
• Subjective (patient’s history ) – pain – glare (photophobia) – blur vision –
tearing (lacrimation)
• Objective - loupe or slit lamp examination – blepharospasme – ciliary injection – tearing (lacrimation) – superficial infiltrate or corneal ulcer – hypopyon- in advanced cases.
20
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 21/34
21
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 22/34
SPECIAL EXAMINATION
– Flourescein test for corneal ulcer
– Seidel test for perforating cornea
22
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 23/34
LABORATORIUM EXAMINATION
– Etiologic diagnosis.
– Scraping from:
•
infiltrate / edge of the ulcer• fornices of conjunctiva
– Slide Staining :
• Gram ( for bacteria)• Giemsa (for fungus )
23
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 24/34
24
CLINICAL COURSE
Subepithelial /epithelialkeratitis
Recover
without scar
Become
corneal ulcer
Recoverwith scar
Nebula
MakulaLeukoma
Perforating cornea,accompanied bulging of the
cornea & iris prolaps
Recover with scar :
Leukoma adherentstaphyloma cornea
Corneal blindness
Advancedinflamation
-endophtalmitis-panophtalmitis
recover Extirpationof theglobe
Abulbi
Phtysis bulbi
Permanent blindness
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 25/34
TREATMENT
• Anti microorganisms depend on laboratoryfinding (scraping & culture)
– Antibiotic for bacteria
– Anti fungus for fungal infection – Antiviral for viral infection
• High dose Vit. A for keratomalacia
• Steroid for Mooren’s ulcer
• eye bandage
• atropine eye drops
25
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 26/34
• Prognosis depends on : – depth & width of the ulcer
Corneal scar
26
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 27/34
PROGNOSIS
• Prognosis depends on : – depth & width of the ulcer
corneal scar
27
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 28/34
NebulaMakulaLeukomaLeukoma adherent
Central ,-->cornealblindness
-Periphery (No visual
disturbance )
28
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 29/34
29
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 30/34
30
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 31/34
31
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 32/34
PREVENTION
• Avoid corneal trauma
•
Avoid overuse of topical steroid• Cure external eye infection as soon as
possible.
•
Avoid trigger factor for relapsingH.simplex keratitis.
32
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 33/34
REFFERENCES
• Vaughn D, Asbury T; General
Ophthalmology, 15th edition, Appleton &
Lange
• Miller S; Parson’s Diseases of the eye, 17 thEdition, Churcill Livingstone, 1984
• Kanski JJ, Clinical Ophthalmology, 4th
edition,Oxford Butter Worth Heineman Ltd,
1999
33
7/21/2019 CORNEAL ULCER 2.pdf
http://slidepdf.com/reader/full/corneal-ulcer-2pdf 34/34
Segala puji bagi Allah, Tuhan semesta alam.
34