1h.

What is the patophysiology of pain, swollen eye lids and fidding sensation on
the left eyes?
Risk factor : contact with a person with an eyes disease → transmittion of
infection→invasion of microorganisms in conjunctiva→ Microorganisms penetrate
tear film on the surface of the conjunctiva serves to dissolve dirt and impurities
toxic ingredients → inflamation of conjunctiva (Conjunctivitis)

irritate the nerves of the conjunctiva mechanism of protecting the

that have painful nerve fibers surface of the eye from
external substances, such as
↓ tears (containing anti-
Stimulate inflamattory mediators microbial form of lysozyme).

↓ ↓

Pain In the tear film, the aqueous

element dilutes the bacterial
infection, the mucus catches the
debris and the pumping
mechanism of the palpebra will
constantly drain tears to the tear
duct.
↓
Conjunctiva injury to the Accumulation inflamation
←
stroma edema ← conjunctival cells, lisozim
(chemosis) epithelium (antimicrobial), mucus and
debris in conjungtiva
↓ ↓
Swollen papilla hypertrophy
eyes ↓

Fidding sensation

Synthesis :
Microorganisms (viruses, bacteria, fungi), allergens, irritants cause the
eyelids to become infected so that the eyelids cannot close and open completely.
Because the eyes become dry so irritation causes conjunctivitis. Dilation of blood
vessels caused by inflammation is characterized by red conjunctiva and sclera,
edema, pain and the presence of mucopurulent secretions (Silverman, 2010).
 The conjunctiva is always in contact with the outside world, but under
normal circumstances it is almost always sterile, this is trivial because of the
presence of the conjunctival defense mechanism mainly by the presence of tear film
on the conjunctival surface which functions to dissolve dirt and toxic substances
and then lacrimalis into the inferior rice meatus. (Corwin,2009). The conjunctiva
receives innervation from the first (ophthalmic) branching of the fifth nerve. This
nerve has relatively little pain fibers. (Vaughan, 2011)
Conjunctiva, because its position is exposed to many organisms and other
environmental factors that interfere. There are several mechanisms to protect the
surface of the eye from external substances, such as tears. In the tear film, the
aqueous element dilutes the bacterial infection, the mucus catches the debris and
the pumping mechanism of the palpebra will constantly drain tears to the tear duct.
Tears contain anti-microbial substances including lysozyme. The presence of a
destructive agent, causing injury to the conjunctival epithelium followed by
epithelial edema, cell death and exfoliation, epithelial hypertrophy or granuloma.
There may also be edema of the conjunctival stroma (chemosis) and lymphoid
stromal layer hypertrophy or follicle formation. Inflammatory cells migrate through
the epithelium to the surface. These cells then merge with fibrin and pus from goblet
cells, forming conjunctival exudates that cause palpebral edge adhesions upon
awakening (Bielory, 2010&Majmudar, 2010).
The presence of inflammation in the conjunctiva causes dilation of the
posterior conjunctival eye vessels, causing hyperemia which is most evident in the
formiks and decreasing towards the limbus. In conjunctival hyperemia is usually
found swelling and hypertrophy of the papillae which is often accompanied by a
sensation of foreign bodies and the sensation of scratches, heat or itching. This
sensation stimulates tear secretion. Mild transudation also arises from hyperemic
blood vessels and increases the amount of tears (Moore, 2009)
Source:
Silverman, Sallan.(2010). Buku Saku Dokter. Edisi 3. Jakarta :EGC.

Vaughan, Daniel, G. dkk. (2011). Oftalmologi Umum. Dalam : Vaughan, Daniel,

G. dkk (eds) General Opthalmology. Edisi 14. Jakarta : Penerbit Widya Medika.
Elizabeth J. Corwin. (2009).Buku Saku Patofisiologi Corwin. Jakarta:
AdityaMedia.
Bielory,Perez. (2010). Treatment of Seasonal Allergic Conjunctivitis with
Ophthaimic Cortico Steroids in the Treatment of Allergic Conjunctivities.
Lippincott Williams & Wilkins.
Majmudar. (2010). Conjunctivitis, Alergic, Departement of Ophthalmology: Rush.
Presbytarian-St. Luke’s Medical Center.
Moore Keith L., Dalley Arthur F., Agur Anne M.R.. 2009. Clinically Oriented
Anatomy. Philadelphia : Lippincott Williams & Wilkins

4c. What is the meaning history of making contact with a person with an eyes
disease (+), approximately one week ago?
The meaning is a risk factor for transmission of keratoconjuntivitis
infection, which is an infection that causes inflammation of the cornea (keratitis)
and conjunctiva (conjunctivits). Conjunctiva caused by microorganisms (especially
virus and germs or a mixture of both) are usually transmitted through contact and
air (Vaughan, 2010).
Bacterial conjunctivitis is easily transmitted from one eye to the next and
also easily transmitted to other people through direct contact and objects that come
in contact with the eye (Ilyas, S., Yulianti, S., 2014).
Source :
Vaughan, A. 2010. Oftalmologi Umum Edisi 17. Jakarta:EGC.
Ilyas, S., Yulianti, S. (2014). Ilmu Penyakit Mata. Edisi 5. Jakarta : FKUI

9b. risk factor of keratokonjungtivits?

Risk Factors Keratitis
Factors that can increase the risk of keratitis are as follows:
1. The use of contact lenses
2. Vitamin A deficiency
3. Tear deficiency
4. Ocular surface disease
5. Corneal erosion / abrasion
6. Immunocompromise
7. History of autoimmune diseases
8. History of eye surgery
Source :
Upadhyay MP, Srinivasan M, Whitcher JP. Diagnosing and managing microbial
keratitis. Community Eye Heal J. 2015;28(89) :3–6.
Green M, Apel A, Stapleton F. Risk factors and causative organisms in microbial
keratitis. Cornea. 2008;27(1):22–7.
Mascarenhas J, Lalitha P, Prajna NV, Srinivasan M, Das M, D’Silva SS, et al.
Acanthamoeba, fungal, and bacterial keratitis: A comparison of risk factors and
clinical features. Am J Ophthalmol. 2014;157(1):56–62.
Risk Factors Conjunctivits
Some risk factors that cause the occurrence of conjunctivitis in terms of
the environment are the level of public awareness of behavior of clean and healthy
life, distance of residence, population density, number of factories around the
residence, and the level of community education (Azizahet al, 2015).
The high occupancy density and interaction or physical contact between
individuals facilitates the transmission of disease-causing agents. Generally the
incidence of conjunctivitis is found to be high in environments with high occupant
densities and interpersonal contact (Lopezet al, 2011).

Source:
Azizah, Z.et al. 2015. Pemodelan Jumlah Penderita Konjungtivitis di Lamongan
Berdasarkan Pendekatan Model Regresi Generalized Poisson. Vol. 1.No. 3, Mei
2015. Available from:
http://jurnal.unimus.ac.id/index.php/statistik/article/view/1440/1493/pdf
Lopez, H. M., Melendez, C. A. P., Flores, A. C., &de Lucio,V. M. B. 2011.
Epidemiological Aspects of Infectious Conjunctivitis, Conjunctivitis –A
Complex and Multifaceted Disorder. Prof. Zdenek Pelikan (Ed.), InTech,
Available from: http://www.intechopen.com/books/conjunctivitis-a-complex-and-
multifaceted-disorder/epidemiological-aspects-of-infectious-conjunctivitis

1i. How is the relation between the complaints 4 days ago with complaints one
week ago?
The relationship is the main complaint is reddish eyes and complaints 4 days ago
in the form of pain, swollen eye lids and fidding sensation on the left eyes are the
progression of inflammation / conjunctiva and clinical manifestations of
conjunctivits. Blood vessel dilation caused by inflammation is characterized by red
conjunctiva and sclera, edema, pain and fidding sensation. (Azariet al,2013).

Source:
Azari, Amir A. & Barney, Neal P. 2013. Conjunctivitis: A Systematic Review of
Diagnosis and Treatment. doi:10.1001/jama.2013.280318. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049531/pdf/nihms-574949.pdf

9d. Epidemiology keratokonjungtivitis?

Keratitis
Epidemiologically, keratitis is generally in the form of infectious keratitis with the
main causes of Staphylococcus and Streptococcus. Incidence is increased in contact
lens wearers.
Global

The incidence of microbial keratitis globally is around 0.4 to 5.2 per 10,000 people
annually. This incidence is higher in developing countries than in developed
countries.

Source:
Al-mujaini A, Al-kharusi N, Thakral A, Wali UK. Bacterial Keratitis: Perspective
on Epidemiology, Clinico-Pathogenesis, Diagnosis and Treatment.
2009;9(August):184–95.
Conjunctivitis
Epidemiological data show that conjunctivitis can be found globally and is one of
the common eye diseases. Viral conjunctivitis is the main cause, followed by
bacterial conjunctivitis in the second position.
Global
Globally, cases of conjunctivitis can occur in all age groups, from neonates to the
elderly. Cases of conjunctivitis are found in 1% of patient visits to first-level health
facilities. In the United States there are an estimated 6 million new cases of viral
conjunctivitis annually. Viral conjunctivitis can be sporadic or epidemic (for
example at school, at the hospital, at the clinic). Adenovirus is the cause in almost
90% of cases of viral conjunctivitis. The incidence of bacterial conjunctivitis in the
United States is 135 cases per 10,000 population per year.

Source:

Karpecki, P. M. (2015). Kanski’s Clinical Ophthalmology : A Systematic

Approach. Optometry and Vision Science, 92(10),
e386.doi:10.1097/opx.0000000000000737
Scott IU, Dahl AA. Viral conjunctivitis (pink eye).
https://emedicine.medscape.com/article/1191370-overview#a4
Azari, A. A., & Barney, N. P. (2013). Conjunctivitis. JAMA, 310(16),
1721.doi:10.1001/jama.2013.280318