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1.

Bruce

James B &Bron A. Lecture Notes: Ophthalmology. Ed 11. John Wiley & Sons. 2011

The ocular surface us regulary exposed to the external environment and subject to trauma, infection,
and allergic reaction which account for the majority of disease in these tissue.

Follicle: gelatinous oval lesion ussulay in the lower tarsal cunnjunctiva and upper tarsal border. Each
folikel represent a lymphoid collection with its own germinal center. Common in viral and chlamydial
infection.

Papil: raised lesion on the upper tarsal conjunctiva, result from fibrous septa between conjunctiva and
subconjunctiva which allow the intervening tissue to swell with the inflammatory infiltrate. Giant papil:
peleburan beberapa papil. Common in allergic eye disease

Injeksi konjungtiva

Bacterial konjungtivitis:

Redness of the eye, discharge, ocular irritation

Kronis konjungtivitis: chlamydial

Viral konjungtivitis:

Distinguished from bacterial by: a watery and limited purulent discharge, the presence of conjunctival
follicles and enlarged pre-auricular lymph node, lid oedema, and excessive lacrimation

Self limiting diseases but highly contagious. Common cause: adenovirus that could cause
pseudomembran across the conjunctiva. Certain adenovirus serotype also cause a troublesome
punctuate keratitis. Treatment for the conjunctivitis is unnecessary unless ther is a secondary bacterial
infection. Patient must be given hygiene instruction to minimize the spread of infection (e.g using
speerate towel).

Allergic konjungtivitis:

Ada bentuk akut dan kronis:

Akut (hayfever konjungtivitis): ec serbuk sari. Gejala: gatal, conjuctival injection and swelling (chemosis),
lacrimation
Kronis (vernal conjungtivitis? Spring catarrh) often effect male children with a history of atopy, present
all year long. Gejala: gatal, photophobia, lakrimasi, papillary konjungtivitis on the upper tarsal (giant
cobblestone may appear), punctual lesion on the corneal epithelium

EPISKELRITIS:

The inflammation of the superficial layer of the sclera cause mild discomfort. It is rarely associated with
systemic disease. It is usually self limting.

SKLERITIS:

More severe condition than apiskelertitis, and may be assoctiated with the collagen vascular
disease,commonly rheumatoid arthritis. Cause intense ocular pain. Both inflammatory and ischemic
area of the sclera may occur. Biasanya sclera yg terkena akan bengkak.

Keluhan mata merah merupakan keluhan yang sering dijumpai dalam bidang oftalmologi.
Mata merah berarti kemerahan yang terjadi pada bagian putih mata yaitu pada konjungtiva atau
sklera. Mata merah merupakan suatu kelainan yang berkaitan dengan infeksi, inflamasi, trauma,
atau peningkatan tekanan intraokular secara akut.1

If the redness is localized to the limbus cliary flush should be consider: keratitis, uveitis, acute glaucoma

Discharge purulent: kontungtivits bacterial

visual

Mata merah merupakan salah satu keluhan medis tersering yang ditemui oleh seorang dokter.
Gejala utama yang penting yang menyertai keluhan mata merah terutama adalah nyeri dan
pengelihatan kabur. Hal tersebut dapat mengarahkan kepada kondisi yang serius seperti ulkus
kornea, iritis, dan glaukoma akut. Discharge purulen mengarahkan pada diagnosis konjungtivitis
bakterial, discharge yang jernih mengarahkan pada diagnosis konjungtivitis yang disebabkan
oleh virus atau alergi. Sensasi berpasir sering terjadi pada konjungtivitis, namun benda asing
harus dieksklusi, terutama jika hanya satu mata yang terkena. Rasa gatal adalah gejala yang
umum terjadi pada penyakit mata alergi, blefaritis, dan hipersensitivitas obat topikal.4
2. Jane Olver

the four most common cause of a red eye: acute anterior uveitis, subconjuctival hemorrhage, contact
dermatitis, konjungtivitis virus.

Infective conjunctivitis symptom:

Red eye, discomfort or itch, discharge (watery or purulent), crusting of the lid margin, general flu like
symptom in viral case, history of contact with people with red eye.

Generalized redness of conjungtiva especially the tarsal conjunctiva. Cervical lymphadenopathy in viral
cases.

Management: hygiene advice ( avoid sharing towels), in purulent (swab),

UVEITIS: inflamasi of the uveal tract (iris, ciliarry body, and choroid)

Symptom: painful and red, photophobic, blurred vision or floaters.

Sign: ciliary injection, reduced visual acuity, sluggish (lamban) or ireguler pupil due to reflex spinchter
spasme or inflammatory adhesion of iris to the anterior lens surface (posterior sinekia), iris detail may
be hazy (kabur) due to inflammatory cell in the aqueous, peningkatan tio ec anterior sinkeia,

Penyebab mata merah: infeksi, allergy, trauma, inflamasi, glaucoma akut, dan penyebab lain
(pterigium, blefaritis)

GAMBARRRRRRRRRRRRRR

Allergic conjunctivitis: itchy red eye with history of atopy, conjunctival injection, normal vision

Subconjuctival hemorrhage: sudden onset and painless red eye, patient feel something pop,
localized dense red hemorrhage,

Episcleritis: red eye, usually painless or mild dull pain, diffuses episceral injection, nontender,
normal vision, no discharge.

Scleritis: extremely painfull red eye, may have blurred vision, injection sceleral or episcleral, globe
exteremely tender
THE RED EYE

3. Basic ophthalmology
As a primary care physician, you should be able to determine wether a patient with red eye
requires the prompt attention of an ophthalmologist or wether you can appropitely evaluate
and treat the condition.

A primary care physician frequently encounter(bertemu) patient who complain of a red eye.
The condition causing the red eye is often a simple disorder such as subjunctival hemorrhage or
an infectious conjunctivitis. These condition either will resolve spontaneously or can be treated
easily by the primary care physician. Occasionally the condition causing a red eye is a more
serious disorder, such as intraocular inflammation, corneal inflammation, or acute glaucoma.
Patient woth one of these vision-threatening condition requires the immediate attention of an
ophthalmologist.

9 basci diagnostic step??

1. Determine wether the visual acuity is normal or decreased, using a snellen chart
2. Decide by inspection what pattern of redness us present and whether it is due to
subconjuctival hemorrhage, conjunctival hyperemia, cilliary flush, or a combination of
these
3. Detect the presence of a conjunctival discharge and categorize it as to amount and
character (purulen, mukopurulen, dan serous)
4. Detect opacity of the kornea, including large keratic precipitates, or irregularities of the
corneal surface such as corneal edema, corneal leukoma, and irregular corneal
reflection. Examination is done using a penlight.
5. Search the disruption of the corneal epithelium by staining the cornea with flourescein
6. Estimate the depth of anterior chamber as normal or shallow, detsct any layered blood
or pus, which would indicate either hyphema or hypopyon
7. Detect irregularity of the pupils and determine whether one pupil is large than the
other. Observe the reactivity of the pupils to light to determine wether one pupil is
more sluggish than the other or is non reactive
8. If elevated intraocular pressure is suspected, as in angle-closure glaucoma, and reliable
tonometry is available, then measurement of intraocular pressure can help confirm the
diagnosis
9. Detect the presence of proptosis, lid malfunction, or any limitation of the eye
movement
Danger sign of red eye

The presence of one or more of these danger signals should alert the physician that the patient
has a disorder requiring an ophthalmologist attention.

Tanda:

- Reduced visual acuity
Suggest a serous ocular disease, such as inflamed cornea, iridocyclitis, or glaucoma. It
never occur in simple conjunctivitis.
- Cilliary flush
Is an injection of the deep conjunctival and episcleral vessel surrounding the cornea. Is a
danger sign suggest cornea, iridocyclitis, or glaucoma. Usually not present in
conjunctivitis
- Conjucntival hyperemia
Enlargement of more superficial bulbar conjunctival vessel. A non specific sign, it may be
seen in almost any of the condition causing red eye.
- Corneal opacification
- Corneal epithelial disruption
- Papillary abnormalities
Pupil in Iridocyclitis is somewhat smaller than of the other eye, due to reflex spasm of
the iris spinchter muscle. The pupil is also distorted by posterior sinekia (inflammatory
adhesion). In acute glaucoma the pupil is usually fixed, middilated (about 5to 6mm), and
slightly irregular. Conjunctivitis does not affect the pupil.
- Shallow anterior chamber
Posibbely acute glaukoma
- Elevated intraocular pressure
Only cause by iridocyclitis and glaucoma
- Proptosis
- Discharge
Purulen or mukopurulen eksudat suggest a bacterial cause. Serous discharge suggest a
viral infection. Scant (sedikit), white, stringy (sedikit) discharge sometimes occurs in
allergic conjunctivitis.
- Preuricular lymphnode enlargement: frequent sign of viral conjunctivitis. Usually does
not occur in bacterial conjunctivitis.

Gejala:

- Blurred vision
- Sever pain
Indicate keratitis, ulcer, iridocyclitis, or acute glaucoma.
- Photophobia
In iritisalone or secondary to corneal inflammation
- Colored halos
A symptom of corneal edema, often resulting from an abrupt rise in intraocular
pressure.
- Exudation
Typical result of conjunctival or eyelid inflammation and does not occur in iridocyclitis or
glaucoma.
- Itching
Usually indicate an allergic conjunctivitis
- Upper respiratory tract infection and fever
May be assoctiated with conjunctivitis, particularly when tese symptom are due to
adenovirus. Allergic conjunctivitis may be associated with seasonal rhinitis of hay fever.
- Erythema multiforme

What can you manage

Complication of prolong use ED corticosteroid

Red eye refer to hyperemia of the superficially visible vessel of the conjunctiva, episclera, or
sclera. It can be cause by disorder of these structure or of adjoining (berdampingan) structure,
including cornea, iris, cilliary body, and ocular adnexa.
Pada pemeriksaan oftalmologi ODS, didapatkan palpebra edema dan hiperemis,
ada sekret serous mukous, hiperlakrimasi, fotofobia dan terlihat injeksi konjungtiva. Hal ini
sesuai dengan kepustakaan yang menyatakan bahwa gambaran klinis dari konjungtivitis
adalah gejala subjektif mata terasa pedih, seperti ada benda asing, silau dan lakrimasi.2 Pada
konjungtivitis viral ditemukan adanya edema palpebra, hiperemi konjungtiva, sekret serous
serta ada pembesaran kelenjar getah bening preaurikular.7 Diagnosis konjungtivitis viral
umumnya sudah dapat ditegakkan berdasarkan gambaran klinis saja.5
Pada konjungtivitis ketajaman penglihatan (visus) biasanya normal, tapi dapat menurun
akibat adanya sekret dan debris pada tear film.2 Riwayat kontak dengan penderita yang
terinfeksi konjungtivitis penting untuk ditanyakan, karena konjungtivitis akibat infeksi (virus,
bakteri) mudah menular. Penularannya dapat melalui kontak mata – tangan (eye – hand
contact), handuk, saputangan, linen, lensa kontak dan kacamata.
Diagnosis banding dari kasus ini adalah konjungtivitis bakteri dan alergi, karena gejala
subjektifnya sama. Yang membedakan adalah pada konjungtivitis bakteri sekretnya banyak
dan bersifat purulen. Pada konjungtivitis alergi sekretnya sedikit, bersifat mukoid dan gejala
yang khas adalah gatal hebat. Nodul prearikular jarang ditemukan pada konjugtivitis bakteri
dan tidak ditemukan pada konjungtivitis alergi. Dalam pemeriksaan kerokan konjungtiva,
pada konjungtivitis viral ditemukan monosit sedangkan pada konjungtivitis viral terlihat
bakteri dan PMN dan pada konjungtivitis viral ditemukan eosinofil.1
Pengobatan konjungtivitis viral bersifat suportif karena penyakit ini dapat sembuh
sendiri.5 Pengobatan yang dapat diberikan adalah antibiotik untuk mencegah infeksi sekunder,
dan steroid untuk mengurangi gejala.1 Vasokonstriktor dan antihistamin dapat diberikan jika
pasien mengeluh gatal hebat pada matanya.5. Pada pasien diberikan antibiotik oral
ciprofloxacin untuk mencegah terjadinya infeksi sekunder. Pasien diberikan steroid topikal
Cendo Mycosis dan Steroid tetes Polynel Eduntuk mengurangi gejala/ keluhan. Menurut
penelitian yang dilakukan oleh Wilkins, penderita konjungtivitis viral akut menunjukkan
perbaikan lebih baik dengan menggunakan steroid topikal dibandingkan hypromellose.10
Namun pada pemberian steroid yang perlu diingat adalah kemungkinan terjadinya inflamasi
ulangan (rebound inflammation) ketika steroid dihentikan, oleh karena itu pasien harus
diedukasi untuk minum obat teratur. Vasokonstriktor dan antihistamin tidak diberikan karena
tidak ada keluhan gatal hebat dari pasien.
1. Lang, Gerhard K.; Lang, Gabriele E. Conjunctiva. In: Gerhard K.Lang, Ed.
Ophthalmology: A Pocket Textbook Atlas, 2nd Edition. 2006. New York: Thieme; p.67-
83.