Download - Konjungtivitis Win 2
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KONJUNGTIVITIKONJUNGTIVITISS
Winarto & Siti SundariWinarto & Siti Sundari
BAGIAN MATA FK UNDIP - RSUP Dr. KARIADI SEMARANG
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KonjungtivitisKonjungtivitisPenyebabPenyebab::
A. Infeksi :A. Infeksi :1. Virus1. Virus2. Bakteri 2. Bakteri 3. Klamidia (Trachoma)3. Klamidia (Trachoma)4. Jamur (Jarang)4. Jamur (Jarang)
B. Non InfeksiB. Non Infeksi1. Alergi 1. Alergi /Hipersensitivitas/Hipersensitivitas2. Toxic/Iatrogenik2. Toxic/Iatrogenik3. “Dry Eye Syndrome”3. “Dry Eye Syndrome”
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Diagnosis BerdasarDiagnosis Berdasar
AnamnesaAnamnesa
Gejala dan TandaGejala dan Tanda Klinik Klinik
Pemeriksaan Tambahan/LabPemeriksaan Tambahan/Lab
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1. Virus1. Virus- Paling sering : Adenovirus- Paling sering : Adenovirus- Penularan dari sekitar (+)- Penularan dari sekitar (+)- Akut : Merah, bengkak, berair- Akut : Merah, bengkak, berair- Sekret : serous- Sekret : serous- Pembesaran Kel. Lymphe preaurikuler - Pembesaran Kel. Lymphe preaurikuler (+) (+) - Keadaan umum : Lemah, subfebris- Keadaan umum : Lemah, subfebris- Pemeriksaan Lab Sekret : Bakteri (-), - Pemeriksaan Lab Sekret : Bakteri (-), Monosit (+)Monosit (+)
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Konjungtivitis Konjungtivitis virusvirus
Konjungtivitis Konjungtivitis virusvirus– Injeksi Injeksi
konjungtivalkonjungtival– Sekret sereousSekret sereous– Perdarahan Perdarahan
subkonjungtiva subkonjungtiva
( subakut )( subakut )
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Keratitis dendritikKeratitis dendritik
Infiltrat dengan Infiltrat dengan batas seperti batas seperti cabang-cabang cabang-cabang
Disebabkan Disebabkan Herpes simpleksHerpes simpleks
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Terapi Konj. VirusTerapi Konj. Virus
- A. B (-)- A. B (-)
- Steroid : Kontra indikasi- Steroid : Kontra indikasi
- Vasokonstriksor- Vasokonstriksor
- Kompres dingin- Kompres dingin
- Istirahat- Istirahat
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2. Bakteri2. Bakteri
- Paling sering : Stapilokokus- Paling sering : Stapilokokus
- Sekret : Muco purulen/purulen- Sekret : Muco purulen/purulen
- Akut/kronis- Akut/kronis
- Pemeriksaan Lab :- Pemeriksaan Lab :
- Sekret : Bakteri dan PMN (+)- Sekret : Bakteri dan PMN (+)
Kronis Kronis Perlu sensitivity Test Perlu sensitivity Test
Perhatikan :Perhatikan :
- Margo Palpebra- Margo Palpebra
- Pungtum Lakrima- Pungtum Lakrima
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Konjungtivitis Konjungtivitis bakteribakteri
Konjungtivitis bakteri Konjungtivitis bakteri – Sekret Sekret
mukopururulenmukopururulen– Konjungtiva Konjungtiva
kemotikkemotik– Injeksi konjungtivaInjeksi konjungtiva
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Konjungitivitis Konjungitivitis purulentapurulenta
Konjungtivitis Konjungtivitis purulenta purulenta gonorrhoe :gonorrhoe :– Konjungtiva Konjungtiva
kemotik dan kemotik dan kasarkasar
– Sekret purulenSekret purulen
EMERGENCY
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Terapi Konj. BakteriTerapi Konj. Bakteri
- AB yang sesuai- AB yang sesuaiGram (+) :Gram (+) :
- Kloram fenikol/Sulfa - Kloram fenikol/Sulfa cetamidcetamid- Gramisidin- Gramisidin- Cefazolin- Cefazolin- Vancomycin- Vancomycin
Gram (-) :Gram (-) :- Gentamycin/tobramycin- Gentamycin/tobramycin- Dibekacyn- Dibekacyn- Cyprofloksasin- Cyprofloksasin
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3. Klamidia – Trachoma3. Klamidia – Trachoma
Keluhan : Keluhan : ggatalatal –– m meraherah -- k kronisronis
Tanda :Tanda :
- Folikel besar-besar- Folikel besar-besar
- Herbet’s pits- Herbet’s pits
- Panus- Panus
Sekret : - MucSekret : - Mucoousus
- Mucopurulen- Mucopurulen
Lab: Gimsa Lab: Gimsa ssulit : ulit : iinclusion nclusion bbodies odies
yang baru : Eyang baru : ELISALISA
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Trakoma Trakoma Konjungtivitis Konjungtivitis
trakomatrakoma
– Folikel pada Folikel pada
konjungtiva tarsalkonjungtiva tarsal
Panus
• Infiltrat limbus atas
•Neovaskularisasi di
atas
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TerapiTerapi
- Konj. Trachoma :Konj. Trachoma :- Doxycilin 1 x 100 mg/hari 3-4 mingguDoxycilin 1 x 100 mg/hari 3-4 minggu
+ Vitamin B Complek+ Vitamin B Complek- Tetracyclin salep mata 6-8 mingguTetracyclin salep mata 6-8 minggu
- Terbaru :Terbaru :- Azithromycin drop/1 gram singledoseAzithromycin drop/1 gram singledose
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4. 4. Jamur :Jamur :
- Jarang- Jarang
- Penderita DM, Steroid jangka - Penderita DM, Steroid jangka panjangpanjang
- HIV/AIDS- HIV/AIDS
Sifat : KronisSifat : Kronis
Gambaran klinis : Tidak specifikGambaran klinis : Tidak specifik
Terapi ~ Pemeriksaan Lab : Terapi ~ Pemeriksaan Lab : PENTING !PENTING !
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Non Non InfeksiInfeksi
1. Alergi/Hipersensitivitas1. Alergi/Hipersensitivitas
- Konj. Vernal :- Konj. Vernal :
- Limbal- Limbal
- Palpebra- Palpebra
Gatal (++), Sekret seperti benang, kambuh-kambuh.Gatal (++), Sekret seperti benang, kambuh-kambuh.
- Hati-hati penggunaan steroid, pilih yang paling - Hati-hati penggunaan steroid, pilih yang paling
ringan dalam pengaruhi 10P/TIO ringan dalam pengaruhi 10P/TIO fflouro louro
mmetholonetholon
Akut : Mast Cell Stabilizer : + SteroidAkut : Mast Cell Stabilizer : + Steroid
- Cromolyn sodium- Cromolyn sodium
- Lodoxanide- Lodoxanide
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MAST CELL DEGRANULATION
Histamine, Heparin, Tryptase, TNF , TGF , IL 3, 4, 5, 13
Newly formed mediators
PLA2 AA + PAF
C.O 5 L.O
PGD2 LTC4 LTB
LTD4
LTE4
Y
Yallergen
Preformed mediators
Y Y
Y
eosinophil
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The role of mediator in ALLERGIC DISEASES
Mast cell
HistamineLeukotrienesProstaglandinBradykinin,PAF Itch, sneezing
Watery discharge
allergen
Th2 cell
B cell
eosinophils
IL4
IgE
ICAM-1
IL 3, 5, GMCSF
Immediate symptoms
Chronic symptoms
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Konjungtivitis Konjungtivitis alergikalergik
Konjungtiva Konjungtiva kemotikkemotik
Konjungtiva Konjungtiva terpajan terpajan
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Konjungtivitis alergi lensa Konjungtivitis alergi lensa kontakkontak
Konjungtivitis Konjungtivitis alergialergi– Papil pada Papil pada
konjungtiva konjungtiva tarsaltarsal
– Sering terdapat Sering terdapat pada alergi pada alergi lensa kontak lensa kontak
Giant papillary conjungtivitis
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Komplikasi : Shield ulcerKomplikasi : Shield ulcer
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2. Phlictenulosis
“Delayed hypersensitivity”
Terhadap : Protein kuman tuberkolosis,
stapilokokus, Protein
cacing askaris.
Tampak bintik warna putih diameter 1 – 3
mm yang dikelilingi
pembuluh darah dekat limbus.
Terapi : steroid topikal dan cari kausa.
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Konjungtivitis Konjungtivitis FliktenFlikten
Infiltrat di sekitar Infiltrat di sekitar limbus, dikelilingi limbus, dikelilingi pb darahpb darah
Injeksi konjungtivaInjeksi konjungtiva Injeksi siliarInjeksi siliar Bentuk flikten dapat Bentuk flikten dapat
pada konjungtiva, pada konjungtiva, limbus dan kornealimbus dan kornea
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FlictenFlicten
- Hipersentitivitas pada :- Hipersentitivitas pada :
- TB- TB
- Askaris - Askaris
- Stapilocokus- Stapilocokus
Terapi : Terapi :
-Steroid : Yang bekerja di Steroid : Yang bekerja di
permukaan, permukaan,
flourometholonflourometholon
- Cari causa- Cari causa
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3. Degenerasi konjungtiva
Pterigium : Lipatan konjungtiva
berbentuk segitiga dengan puncak
kearah limbus.
Kausa : Rangsangan angin, debu,
dan sinar matahari.
Terapi : Ekstirpasi
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44.Toxic/iatrogenik.Toxic/iatrogenik
Anamnesa : Anamnesa : - Penggunaan obat jangan lamaPenggunaan obat jangan lama- Obat ganti-gantiObat ganti-ganti- Obat terlalu banyakObat terlalu banyak
Gambaran klinis : Hiperemis, khemosis, Gambaran klinis : Hiperemis, khemosis, lakrimasilakrimasi
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Th/ : Toxic/iatrogenikTh/ : Toxic/iatrogenik::
- Hentikan pemaka- Hentikan pemakaiin obatn obat
- Perlu irigasi/bilas dengan BSS/Aqua - Perlu irigasi/bilas dengan BSS/Aqua bidestbidest
- Astringent- Astringent
- Tear subsitusi- Tear subsitusi
- Steroid ringan kalau iritasi berat- Steroid ringan kalau iritasi berat
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5. 5. Defisiensi vitamin Defisiensi vitamin AA
Xerosis konjungtiva Xerosis konjungtiva pada defisiensi vitamin pada defisiensi vitamin A, mukosa konjungtivaA, mukosa konjungtiva– permukaan menebalpermukaan menebal– keringkering
• Bercak putih dengan bentuk segitiga (Bittot spot) :
di konjungtiva, tanpa tanda iritasi
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66. Dry Eye Syndrome. Dry Eye Syndrome
a. Aquous tear deficiency : ATDa. Aquous tear deficiency : ATD
- Produksi airmata kurang- Produksi airmata kurang
b. Evaporasi meningkatb. Evaporasi meningkat
- Kurangnya produksi lipid- Kurangnya produksi lipid
- Lebar permukaan bulbus ber - Lebar permukaan bulbus ber (+)(+)
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Konjungtivitis Konjungtivitis sikasika
- Simblefaron pada - Simblefaron pada konjungtiva jam konjungtiva jam 7-87-8
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Keluhan :Keluhan :- Pedih “Sepet”, ngganjel/sensasi benda Pedih “Sepet”, ngganjel/sensasi benda
asing-kabur-kemengasing-kabur-kemeng- Sukar membuka mata saat bangun tidurSukar membuka mata saat bangun tidur- Kabur-perlu mengedp-ngedipkan mata Kabur-perlu mengedp-ngedipkan mata
supaya jelassupaya jelas
Usia >40 tahun/Usia >40 tahun/♀ ♀ MenopauseMenopausesekarang lebih muda karena lingkungan lebih muda karena lingkungan
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- Gambaran klinis :- Gambaran klinis :
- Tear meniskus < 1mm- Tear meniskus < 1mm
- Pelebaran - Pelebaran pbpb ddarah konjungtivaarah konjungtiva
- Defect epitel - Defect epitel kkornea :ornea :
- Pungtata-letak-interpalp- Pungtata-letak-interpalpebraebra dan dan
bagianbagian bawahbawah
- yang berat bentuk filamen.- yang berat bentuk filamen.
- tidak semua pungtata dan filamen - tidak semua pungtata dan filamen
Keratitis Herpes simplex !Keratitis Herpes simplex !
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Terapi :Terapi :
- ATD : Tear substitusi- ATD : Tear substitusi
- Evaporasi - Evaporasi ↑: - MGD (+) perlu : Doksicyclin 1x100 ↑: - MGD (+) perlu : Doksicyclin 1x100
mg/hari 2-3 minggumg/hari 2-3 minggu
- Lubricant- Lubricant
- Topikal Vitamin A- Topikal Vitamin A
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