8/12/2019 Kuliah Mata 1 - Keratitis

1/30

Dr. RITA HENDRAWATI,SpM

8/12/2019 Kuliah Mata 1 - Keratitis

2/30

1. INFECTIONBACTERIALVIRALF N AL

ACANTHAOMEBA

8/12/2019 Kuliah Mata 1 - Keratitis

3/30

Common causative agents :

(affecting corneal epithelial integrity)

Staph. epidermidis

Staph. AureusStrept. PneumoniaH.infleunza

P.aeruginosaN.gonorrhea

8/12/2019 Kuliah Mata 1 - Keratitis

4/30

Predisposing factors:contact lens userskeratoconjunctivitis sicca (dry eye)prolonged use of topical steroids

Trauma (breach in a corneal epithelium)use of contaminated ocular medicationsRecent corneal disease (herpetic keratitis,neurotrophic keratopathy)

8/12/2019 Kuliah Mata 1 - Keratitis

5/30

Symptoms:Reduced visionPain in the eye (often sudden)Purulent dischargeExcessive tearingIncreased light sensitivity

gns:Hypopyon ( a mass white cells collected in antchamber)White corneal opacityConjuctival injection (redness of eyes)

8/12/2019 Kuliah Mata 1 - Keratitis

6/30

8/12/2019 Kuliah Mata 1 - Keratitis

7/30

8/12/2019 Kuliah Mata 1 - Keratitis

8/30

8/12/2019 Kuliah Mata 1 - Keratitis

9/30

Complications:Corneal ulcerCorneal perforation 2ndary endopthalmitisVision lossIrregular astigmatism (uneven healing of stroma)Corneal leukoma (scar tss formation w cornealvascularization)

Beware:Sight-threatening process

Rapid progression infection; corneal destruction maybe complete in 24-48 hours

8/12/2019 Kuliah Mata 1 - Keratitis

10/30

Treatment:Initiate topical broad-spectrum antibiotics :

tobramycin (aminoglycoside gram -ve) alternating with

fortified cefazolin (cephalosporin).If the corneal ulcer is small, peripheral and noimpending perforation is present, intensivemonotherapy with fluoroquinolones is an

alternative treatment.Corneal graft ( in severe cases) .

8/12/2019 Kuliah Mata 1 - Keratitis

11/30

HERPES SIMPLEX KERATITISHERPES ZOSTER OPTHALMICUS

8/12/2019 Kuliah Mata 1 - Keratitis

12/30

HSV 1 : common viral cause of ocular diseases

HSV 2: genital dis. Rarely can cause ocularmanifestations (rarely) such as keratitis & infantilechorioretinitis.HSV

Primary infx is usually early in lifeEnters a latent period in the trigeminal ganglion,When activated it moves along the sensory partof the N. toward the target epith. causingdamage & ulceration.Factors leading to activation :psychiatric dis. ,systemic illnesses, immunocompromised pt.

8/12/2019 Kuliah Mata 1 - Keratitis

13/30

Symptoms:

-Typically unilateral red eye-Variable degree of pain-Occular irritation

-Tearing-Vision may or may not be affected-Vesicular skin rash and follicular conjunctivitis

8/12/2019 Kuliah Mata 1 - Keratitis

14/30

Signs:A dendritic corneal ulcer (hallmark sign of HSV

infection)Ulcer may heal without scar but may progressedto stromal keratitis

edemaLoss of corneal transparency in more severepresentations.

Uveitis and glaucoma may accompany disease

8/12/2019 Kuliah Mata 1 - Keratitis

15/30

Because the virus invades and compromises theepithelial cells surrounding the ulcer, the leadingedges (the so-called "terminal end-bulbs") will stainwith rose bengal or lissamine green.

8/12/2019 Kuliah Mata 1 - Keratitis

16/30

8/12/2019 Kuliah Mata 1 - Keratitis

17/30

Diagnosed with a slit lamp examinationTreatment :

topical antivirals acyclovir ointment

DONT USE TOPICAL STEROIDS as theyworsen the ulcer to geographic ulcerIf recur more than twice a year give oral acyclovir

8/12/2019 Kuliah Mata 1 - Keratitis

18/30

Varicela zoster virus -affect the ophthalmicdivision of the trigeminal N. (15% )Increases with age (6 th-7 th decades).

nasocillary N is involved >>lid swelling (maybebilateral), keratitis ,iritis, secondary glaucoma.Other ocular manifest. :ptosis, mucus secreting

conjunctivitis, neuralgia& scleritis which may leadto scleral atrophy.

8/12/2019 Kuliah Mata 1 - Keratitis

19/30

8/12/2019 Kuliah Mata 1 - Keratitis

20/30

Symptoms:Have prodromal period, typically presents withnondescript facial pain, fever and generalmalaise .About four days after onset, a unilateral vesicularskin rash over forehead, upper eyelid, nose (1 stdiv of 5 th CN) , characteristically respecting the

.begin to scab over after about one week. The pain isextreme during the inflammatory stage, and patientsare tremendously symptomatic.

8/12/2019 Kuliah Mata 1 - Keratitis

21/30

Signs:Cornea : Punctate epithelial keratitis (swollenepithelium, 1-2 d); dendritic keratitis (treebranchlike epithelial defects, 4-6 d); stromal keratitis(fine infiltrates beneath the surface, 1-2 wk); deepstromal keratitis (lipid infiltrates and cornealneovascularization, 1 month to years); neurotrophickeratopathy (erosions, persistent defects, cornealulcers, months to years)Ocular involvement ma include follicular

conjunctivitis, epithelial and/or interstitialkeratitis, dendritic keratitis, ant chamber uveitis,scleritis or episcleritis, chorioretinitis, opticneuropathy, and even neurogenic motilitydisorders (especially fourth cranial nerve palsy).

Prognostic indicator: Hutchinsons Sign

8/12/2019 Kuliah Mata 1 - Keratitis

22/30

Hutchinsons Sign

Lesions at tip, side, root ofnoseInnervated by ant ethmoidal

branch of nasociliary N.Nasociliary N. also innervatescornea n ciliary body

8/12/2019 Kuliah Mata 1 - Keratitis

23/30

Treatment:

Oral and topical antiviral : acyclovir , valcycloviror famcyclovir ( prevent post-infective neuralgia-severe chronic pain over the rash)

- .

8/12/2019 Kuliah Mata 1 - Keratitis

24/30

8/12/2019 Kuliah Mata 1 - Keratitis

25/30

Infxs r rare , but they very severe & devastatingas they cause stromal necrosis.They r capable of penetrating the descemetsmembrane reaching the ant. chamber where wecannot do anything because of the poorpenetration of antimycotic agents to the ant.

Chamber.Most common causative pathogens :

Filamentous (aspergillus & fusarium) fungi

Candida albicansProgression is much slower & less painful than inbacterial.

8/12/2019 Kuliah Mata 1 - Keratitis

26/30

Keratomycosis in consideration when we findlack of response to antibacterial therapy ofcorneal ulceration.

Signs include :Filamentous infx: grayish infiltrate with indistinct margins

Candidal infx: yellow to white ulcer with suppuration

similar to bacterial keratitis.Treatment : topical antifungals pimaricin 5%

8/12/2019 Kuliah Mata 1 - Keratitis

27/30

8/12/2019 Kuliah Mata 1 - Keratitis

28/30

8/12/2019 Kuliah Mata 1 - Keratitis

29/30

8/12/2019 Kuliah Mata 1 - Keratitis

30/30