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(RABU 20-12-17) External Eye Disease DR Yusran
(RABU 20-12-17) External Eye Disease DR Yusran
, SpM
Department of Ophthalmology
Faculty of Medicine Universitas Lampung
Isinflammation of the eyelid
Blepharitis can be classified according to
anatomic location:
• anterior blepharitis affects the eyelid skin, base
of the eyelashes and the eyelash follicles
• posterior blepharitis affects the meibomian
glands and gland orifices.
Risk Factors
• Dry eyes
• Dermatologic condition
• Demodicosis
• Rosasea
• Isotretinoin
• Giant papilary conjunctivitis
Blepharitis has traditionally been
clinically subcategorized
• Staphylococcal
• Seborrheic
• meibomian gland dysfunction (MGD)
• or a combination thereof
Symptoms and signs (e.g., redness, irritation, burning, tearing,
itching, crusting of eyelashes, loss of eyelashes, eyelid sticking,
blurring or fluctuating vision, contact lens intolerance,
photophobia, increased frequency of blinking)
Time of day when symptoms are worse (worsening of the
symptoms in the morning is typical of blepharitis, whereas
symptoms that worsen later in the day are typical of aqueous
deficient dry eye)
Duration of symptoms
Exacerbating conditions (e.g., smoke, allergens, wind, contact
lenses, low humidity, retinoids, diet and alcohol consumption, eye
makeup)
Symptoms and signs related to systemic diseases (e.g., rosacea,
allergy)
Current and previous systemic and topical medications (e.g.,
antihistamines or drugs with anticholinergic effects, or drugs used
in the past such as isotretinoin that might have an effect on the
ocular surface)
Recent exposure to an infected individual (e.g., pediculosis
palpebrarum [Phthirus pubis])
Staphylococcus Blepharitis
Staphylococcal blepharitis
• History
• Clinical appearance
• Microbiologic work-up
Bacterial Corneal Ulcers
Initial therapy :
• Broad-spectrum antibiotics
• Filamentous
• Septae
• Non-septae
• Yeasts
• Diphasic (rare)
Principal Causes of Fungal Corneal ulcers
Virulent
• Fusarium
• Aspergillus
• C.albicans
Less virulent
• Curvularia
• Alternaria
• Phialophora
• Other Candida
Fungal Corneal Ulcers
Risk Factors :
• Topical 5% suspension
• Poor penetration
• Less efective in deeper keratomycosis
• Topical : hourly for initial 24 hours.
• Maintenance therapy for 5-7 days, and taper
based on clinical response.
Therapeutic Advances in Fungal
Ulcers
Amphotericin B :
• Polyene antibiotic
• Highly toxic to ocular surface
• Topical : 15-30 minutes for 24 hours, then
every hour.
• Maintenance therapy for 5-7 days, and
taper based on clinical response.
HSV
Dendriticlesion
Treatment:
• Topical antivirus
Corneal ulcer can occur due to various
protozoa, of which Acanthamoeba is the
most notorious.
Other protozoa: Microsporidia
Risk factors for Acanthamoeba keratitis:
- Contact lens wearers
- Contaminated water/solutions
- Corneal trauma
Severe pain, radial keratoneuritis
• Stromal infiltrates: pseudodendritic
• Stromal haze: intense immune ring
Diamidines: propamidine, hexamidine
Imidazoles/triazoles: miconazole,
ketoconazole, itraconazole