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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
- Kejernihan Jernih Jernih
-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
- Kejernihan Jernih Jernih
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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