Konjungtivitis

CONJUNCTIVITIS
• Clinical features of conjunctival inflammation :
• Symptoms 
– Non-specific : lacrimation, grittiness (sandy), stinging and burning 
– Allergic: itching
– Significant pain, photophobia or a marked foreign body sensation --> corneal
involvement
• Discharge 
– Watery : serous exudate and tears
• Occurs in acute viral or acute allergic conjungtivitis
– Mucoid : typical of chronic allergic conjunctivitis and dry eye 
– Mucopurulent : occurs in chlamydial or acute bacterial infection 
– Moderately purulent : occurs in acute bacterial conjunctivitis. 
– Severe purulent : gonococcal infection 
• Conjunctival reaction 
– Hyperaemia : diffuse, beefy-red and more intense away from the limbus
 bacterial infection
– Haemorrhages : may occur in viral conjuctivitis (multiple, small and
discrete) and severe bacterial conjunctivitis (larger and diffuse)
– Chemosis  (conjunctival oedema) : severe  protrude through the
eyelids
• Acute chemosis: hypersensitivity response and severe infective conjunctivitis
• Subacute or chronic chemosis causes:
– Local: e.g. thyroid eye disease, chronic allergic conjunctivitis, ocular or eyelid surgery,
trauma 
– Increased systemic vascular permeability : e.g. allergic conditions, infections including
meningitis, vasculitis 
– Increased venous pressure : e.g. superior vena cava syndrome, right-sided heart failure 
– Decreased plasma oncotic pressure : e.g. nephrotic syndrome
• Membranes 
– Pseudomembranes : coagulated exudate adherent to the inflamed
conjunctival epithelium 
– True membranes : involve the superficial layers of the conjunctival
epithelium 
– Causes: severe adenoviral conjunctivitis, gonococcal and some other
bacterial conjunctivitides (Streptococcus spp., Corynebacterium
diphtheriae), ligneous conjunctivitis and Stevens–Johnson syndrome 
• Infiltration 
• Subconjunctival cicatrization (scarring) : occur in trachoma and
other severe conjunctivitides
– Severe scarring  loss of goblet cells and accessory lacrimal glands 
cicatrical entropion
• Follicles : Multiple, discrete, slightly elevated lesions resembling
translucent grains of rice, most prominent in the fornices 
– Causes: viral and chlamydial conjunctivitis, Parinaud oculoglandular
syndrome and hypersensitivity to topical medications 
• Papillae : only in the palpebral conjunctiva and in the limbar bulbar
conjunctiva (attached to the deeper fibrous layer)
– Signs: vascular core 
– Micropapillae : form a mosaic-like pattern of elevated red dots 
– Macropapillae: <1 mm
– Giant papillae: >1 mm, develop with prolonged inflammation 
– Causes: bacterial conjunctivitis, allergic conjunctivitis, chronic blepharitis,
contact lens wear, superior limbic keratoconjunctivitis and floppy eyelid
syndrome 
• Lymphadenopathy 
– Common cause: viral infection (may occur in:
chlamydial and severe bacteral conjunctivitis (esp.,
gonococcal) and Parinaud oculoglandular
syndrome)
– Periauricular is typically affected
• Diagnosis  – Eyelid oedema and erythema :
• may occur in severe infection,
• Symptoms  particularly gonococcal 
– Acute onset of redness, grittiness, – Conjunctival injection (hyperaemia)
burning and discharge 
– discharge
– usually bilateral…one eye may become
affected 1–2 days before the other • Initally: watery (mimicking viral
conjunctivitis) but  mucopurulent
– Waking: eyelids are frequently stuck
together and may be difficult to open  – Hyperacute purulent discharge 
gonococcal or meningococcal
– Systemic symptoms occurs in px with conjunctivitis 
severe conjunctivitis associated with
gonococcus, meningococcus, Chlamydia – Superficial corneal punctate epithelial
and H. influenzae  erosions 
– Peripheral corneal ulceration 
• May occur in gonococcal and
meningococcal infection  perforation
– Lymphadenopathy : usually absent
except in severe gonococcal and
meningococcal infection

• Signs 
 BACTERIAL CONJUNCTIVITIS 
• Acute bacterial conjunctivitis 
– common and usually self-limiting 
– caused by direct contact with infected secretions 
– Most common etiology: Streptococcus pneumoniae,
Staphylococcus aureus, Haemophilus influenzae and
Moraxella catarrhalis 
– Minority cases, usually severe  caused by the STD
organism: Neisseria gonorrhoeae 
– Meningococcal conjunctivitis: rare and affects
children (usually)
• Investigations : not routinely done but
– Indication:
• Severe cases: binocular conjunctival swabs and
scrapings  Gram staining (exclude gonococcal and
meningococcal infection)
• Culture : chocolate agar or Thayer–Martin for N.
gonorrhoeae
• PCR: for less severe cases that fail to respond to
treatment (to rule out the possibility of chlamydial and
viral infection)
• Treatment : About 60% resolve within 5 days without treatment 
• Topical antibiotics : 4x/d up to a week
– Sometimes frequent administration  speed recovery and prevent re-infection and
transmission 
– no evidence that any particular antibiotic is more effective 
– Ointments and gels > drops but daytime use is limited
– Chloramphenicol (aplastic anaemia)
– Aminoglycosides: gentamicin, neomycin, tobramycin 
– Quinolones: ciprofloxacin, ofloxacin, levofloxacin, lomefloxacin, gatifloxacin,
moxifloxacin, besifloxacin 
– macrolides : erythromycin, azithromycin 
– fusidic acid and bacitracin 
– Gonococcal and meningococcal  quinolone, gentamicin, chloramphenicol or
bacitracin 
• 1 – 2 hourly
• Systemic antibiotics 
– Gonococcal infection : 3rd gen cephalosporin: ceftriaxone (alternative:
quinolones and some macrolides)
– H. influenzae infection (in children) : oral amoxicillin with clavulanic acid
– Meningococcal conjunctivitis (in children) : IM benzylpenicillin, ceftriaxone or
cefotaxime, or oral ciprofloxacin 
• Topical steroids : reduce scarring but evidence for its use is unclear
• Irrigation : useful in hyperpurulent cases
• Contact lens wear should be discontinued : at least 48 hours after
complete resolution of symptoms and shouldn’t be worn whilst in
topical antibiotic treatment
• Reduce risk of transmission : hand-washing and avoidance of towel
sharing
 GIANT FORNIX SYNDROME
• Uncommon form causing chronic relapsing pseudomembranous
purulent conjunctivitis
• Due to: retained debris in a voluminous upper fornix  persistent
bacterial colonization in an elderly px with levator disinsertion
• Large protein aggretions in the upper fornix  identify with retractor
• Secondary corneal vascularization and lacrimal obstruction: common
• Unilateral
• Treatment:
– Repeated sweeping of the fornix with a cotton-tipped applicator
– Topical and systemic antiviotics
– Intensive topical steroids
– Surginal forniceal reconstruction in recalcitrant cases
 Adult chlamydial conjunctivitis 
• Transmission is by • Signs
autoinoculation from genital – Watery or mucopurulent
secretions  discharge 
• eye-to-eye spread : about – Tender preauricular
10%.  lymphadenopathy 
– Large follicles : inferior fornix
• incubation period : a week  upper tarsal conjunctiva
• Diagnosis  – Superficial punctate keratitis 
• Symptoms : unilateral or – Perilimbal subepithelial corneal
bilateral redness, watering and infiltrates: after 2-3 weeks
discharge  – Chronic cases: less prominent
– Untreated  chronic follicles and develop papillae
– self-limiting may persist for – Mild conjunctival scarring and
several months  superior corneal pannus
– enquire about sexual exposure
if chlamydial conjunctivitis is
suspected 
• Investigations: – Azithromycin 1 gr repeated after 1
week, single dose
– Tarsal conjunctival scrapings : using
a spatula or the blunt side of a – Doxycycline 100 mg 2x/d for 10
scalpel blade  days (tetracycline: contraindicated
in pregnancy/breastfeeding and in
– Giemsa staining  children <12 years of age)
– Direct immunofluorescence 
– Alternatives: erythromycin,
– Enzyme immunoassay for direct amoxicillin and ciprofloxacin
antigen detection 
• Topical antibiotics : erythromycin
– McCoy cell culture  or tetracycline ointment 
– Swabs for bacterial culture and
serology test – rapid relief 
– insufficient alone 
• Treatment 
• Reduction of transmission risk :
• Systemic therapy : abstinence from sexual contact
until completion of treatment (1
week after azithromycin) 
• Re-testing for persistent
infection : 6–12 weeks after
treatment 
 Neonatal conjunctivitis 
• conjunctival inflammation developing within the first month of
life 
• result of infection transmitted from mother to infant during
delivery 
• Causes 
• Organisms acquired during vaginal delivery 
– C. trachomatis, N. gonorrhoeae 
– herpes simplex virus (HSV, typically HSV-2)
– Other bacterial causes : Staphylococci, streptococci, H. influenzae and
various Gram-negative organisms 
– Topical preparations : cause conjunctival irritation
– Congenital nasolacrimal obstruction 
• Diagnosis  – Features of systemic
illness 
• Timing of onset  • Chlamydial infection:
– Chemical irritation: first pneumonitis, rhinitis
few days  and otitis 
– Gonococcal: first week  • HSV: skin vesicles and
features of
– Staphylococci and other encephalitis 
bacteria: end of the first – Prior persistent
week 
watering  uncanalized
– HSV: 1–2 weeks  nasolacrimal duct 
– Chlamydia: 1–3 weeks  • Signs 
• History  – mildly sticky eye :
– Instillation of a staphylococcal
prophylactic chemical infection or delayed
preparation  nasolacrimal duct
canalization 
– Parental symptoms of
STD – Discharge : watery
(chemical and HSV
– Recent conjunctivitis in infection),
close contacts 
mucopurulent
(chlamydial infection),
purulent (bacterial
infection) hyperpurulent
(gonococcal
conjunctivitis)
– Severe eyelid oedema in
gonoccocal infection
• Investigations : depends to the clinical picture
– The results of any parental prenatal testing for STI should
be obtained 
– Conjunctival scrapings : PSC (Chlamydia and HSV)
– Gram and Giemsa staining : HSV
– Conjunctival swabs are taken with a calcium alginate swab
or a sterile cotton-tipped applicator 
• standard bacterial culture and chocolate agar or Thayer–Martin
(for N. gonorrhoeae) 
– Papanicolaou smear : Epithelial cells infected with HSV may
show eosinophilic intranuclear 
– Conjunctival scrapings or fluid from skin vesicles  viral
culture : HSV
• Treatment  • Moderate to severe 
• Prophylaxis  – chlamydial infection : oral
erythromycin 
– single instillation povidone-
iodine 2.5% solution  – Bacterial infection: broad-
spectrum topical antibiotic
– Erythromycin 0.5% or (e.g. chloramphenicol,
tetracycline 1% ointment 
erythromycin or bacitracin for
– Silver nitrate 1% solution  Gram-positive organisms,
• should be administered in neomycin, ofloxacin or
conjunction with a single gentamicin for Gram-negatives)
intramuscular dose of should be used until
benzylpenicillin when maternal
infection is present  sensitivities are available 
• Chemical conjunctivitis  does • Severe conjunctivitis : hospital
not require treatment apart admission 
from artificial tears  – empirical topical treatment +
parenteral ceftriaxone 
• Mild conjunctivitis : broad-
spectrum topical • Chlamydial infection : oral
antibiotic (chloramphenicol, erythromycin for 2 weeks 
 VIRAL CONJUNCTIVITIS 
• Presentation  – adenovirus serovars 8, 19
and 37 
• Non-specific acute
follicular conjunctivitis  – most severe 
– common clinical form  – Keratitis: 80%
– due to adenoviral • Acute haemorrhagic
infection  conjunctivitis 
– Unilateral watering, – tropical areas 
redness, irritation and/or – enterovirus and
itching, and mild coxsackievirus 
photophobia  – rapid onset 
– contralateral eye : – resolves within 1–2
affected 1–2 days later, weeks 
often less severely 
– Conjunctival
– systemic symptoms : sore haemorrhage is generally
throat or common cold  marked 
• Chronic/relapsing adenoviral conjunctivitis 
– chronic non-specific follicular/papillary clinical picture 
– can persist over years 
– rare and eventually self-limiting 
• Herpes simplex virus (HSV) 
– cause a follicular conjunctivitis, particularly in primary infection 
– usually unilateral and there are often associated skin vesicles 
• Systemic viral infections (e.g. varicella, measles and mumps)
– varicella-zoster virus secondary infection 
– HIV conjunctivitis 
• Molluscum contagiosum 
– Transmission: contact, autoinoculation. 
– chronic follicular conjunctivitis can be associated … due to skin lesion
shedding of viral particles 
– Chronic unilateral ocular irritation and mild discharge
• Signs
• Eyelid oedema 
• Lymphadenopathy : preauricular
• Conjunctival hyperaemia and follicles 
• Severe inflammation may be associated with 
– conjunctival haemorrhages 
– Chemosis
– membranes (rare) and pseudomembranes 
• Keratitis 
• Anterior uveitis : mild
• Molluscum contagiosum 
– pale, waxy, umbilicated nodule on the lid margin 
– associated with follicular conjunctivitis  and mild watery and mucoid discharge 
– Immunocompromised patients: Bulbar nodules and confluent cutaneous lesions
• Investigation : generally unnecessary 
• Giemsa stain 
– Adenoviral conjunctivitis: mononuclear cells 
– Herpetic infection: multinucleated giant cells 
• PCR 
• Viral culture 
• immunochromatography : detect adenoviral antigen
in tears 
• Serology for IgM or rising IgG antibody titres 
• Investigation for other causes such as chlamydial
infection may be indicated in non-resolving cases 
• Treatment  – Symptomatic keratitis
may require weak topical
• Spontaneous resolution : steroids 
2–3 weeks 
• Other measures 
• Reduction of – Discontinuation of
transmission risk  contact lens wear until
– hand hygiene  resolution 
– avoiding eye rubbing and – Artificial tears four times
towel sharing  daily for symptomatic
– There should be relief
scrupulous disinfection of – Cold (or warm)
instruments and clinical compresses 
surfaces after
examination of an – Topical antihistamines
and vasoconstrictors 
infected patient (e.g.
sodium hypochlorite, – Removal of symptomatic
 PARASITIC CONJUNCTIVITIS
• Loa loa Infection
– Habitat: connective tissue of humans and monkeys
– Reservoir: monkey
– Transmission: bite of the horse or mango fly
– Mature worm: lid  conjunctiva or the orbit
– Diagnosis: identifying the worm on removal or by finding microfilariae in blood
examined at midday
– DOC: Diethylcarbamazine
• Ascaris lumbricoides Infection (Butcher’s Conjunctivitis)
– rare type of violent conjunctivitis
– butchers or persons performing postmortem examinations cut tissue containing
ascaris  tissue juice of some of the organisms may accidentally splash in the eye
– violent and painful toxic conjunctivitis, extreme chemosis and lid edema
– Treatment: rapid and thorough irrigation of the conjunctival sac
• Trichinella spiralis Infection
– does not cause a true conjunctivitis
– edema of the upper and lower eyelids
– 50% px: chemosis
• Pale
• Lemon-yellow swelling
• Lateral and medial rectus muscles and fading toward the limbus
• Last a week or more
• Pain on movement of the eyes
• Schistosoma haematobium Infection
– Granulomatous conjunctival lesions: small, sot, smooth, pinkish-yellow tumors occur esp.
in males
– Symptoms: minimal
– Diagnosis: biopsy (granuloma-containing lymphocytes, plasma cells, giant cells, and
eosinophils surrounding bilharzial ova in various stages)
– Treatment: excision of the conjunctival granuloma and systemic therapy such as niridazole
• Taenia solium Infection
– rarely causes conjunctivitis… often invades the
retina, choroid, or vitreous  ocular cysticercosis
– subconjunctival cyst
• inner angle of the lower fornix
• adherent to the underlying sclera and painful on
pressure
– conjunctiva and lid may be inflamed and
edematous
– Diagnosis: complement fixation or precipitin test
or
• Pthirus pubis Infection (Pubic Louse Infection)
– infest the cilia and margins of the eyelids
– lid margin is usually red
– Intense itching
– Diagnose: found the adult organism
– Treatment: lindane 1% or RID (pyrethrins) applied to the pubic area and lash margins
after removal of the nits
• Ophthalmomyiasis
– larvae of flies
– Common targets: Infants and young children, alcoholics, and debilitated unattended
patients
– affect the ocular surface, the intraocular tissues, or the deeper orbital tissues
– Flies deposit their eggs at the lower lid margin or inner canthus  larvae may remain
on the surface of the eye  sing irritation, pain, and conjunctival hyperemia.
– Treatment: mechanical removal of the larvae after topical anesthesia
 Acute allergic
conjunctivitis 
• acute conjunctival reaction to an
environmental allergen 
• Seen in younger children after
playing outside in spring or
summer
• Common: acute itching and
watering
• Hallmark: chemosis
– dramatic and worrying to
the child and parents 
Pterigium
 Pterygium
•  fleshy, triangular encroachment
of a pinguecula onto the cornea,
usually on the nasal side bilaterally
– e/  thought to be an irritative
phenomenon due to ultraviolet light,
drying, and windy environments

• Pathologic findings
– Conjunctiva  same as those of
pinguecula
– Cornea  replacement of Bowman's
layer by hyaline and elastic tissue
• Treatment
– If the pterygium is enlarging and encroaches on
the pupillary area  remove surgically along with
a small portion of superficial clear cornea beyond
the area of encroachment
– Conjunctival autografts + surgical excision  <
recurrent
Episcleritis
 Episcleritis
•  relatively common localized inflammation of the
vascularized connective tissue overlying the sclera
– Recurrence is the rule , cause is not known

• Epidemiology
– affect young people, typically in the third or fourth decade of life
– women three times as frequently as men
– unilateral in about two-thirds of cases
– associated local or systemic disorder
• ocular rosacea, atopy, gout, infection, or collagen-vascular disease
(present in 1/3 patients)
• Symptoms
– redness and mild irritation
or discomfort
• benign, and the course is
generally self-limited in 1–2
weeks

• Examination
– episcleral injection, may be
nodular, sectoral, or diffuse
– no inflammation or edema
of the underlying sclera
• Treatment
– absence of a systemic disease  chilled artificial
tears every 4–6 hours until the redness resolves
– associated with a local or systemic disorder 
• doxycycline, 100 mg twice daily for rosacea
• antimicrobial therapy for tuberculosis, syphilis, or
herpesvirus infection
• local or systemic nonsteroidal anti-inflammatory agents
or corticosteroids for collagen-vascular disease
Scleritis
 Scleritis
•  uncommon disorder characterized by cellular
infiltration, destruction of collagen, and vascular
remodeling
– may be immunologically mediated or, less commonly,
the result of infection or local trauma

• Epidemiology
– bilateral in one-third of cases and affects women more
commonly than men, typically in the fifth or sixth deca
des of life
Etiology
• Symptoms
– pain, which is typically
severe and boring in
nature and tends to wake
them at night
– globe is frequently tender
– Key clinical sign 
• deep violaceous
discoloration of the globe
due to dilation of the deep
vascular plexus of the
sclera and episclera, which
may be nodular, sectoral,
or diffuse
– Visual acuity is often • Posterior scleritis
slightly reduced
– intraocular pressure may
be mildly elevated
– Concurrent keratitis or
uveitis occurs (1/3
patients)
– Scleral necrosis in the
absence of inflammation
(scleromalacia) 
patients with rheumatoid
arthritis
– pain and decreased
vision with little or no
redness
– Mild vitritis, optic nerve
head edema, serous
retinal detachment, or
choroidal folds may be
present
• USG & CT  thickening of
the posterior sclera and
choroid
• Treatment
– systemic nonsteroidal anti-inflammatory agents
• indomethacin, 75 mg daily, or ibuprofen, 600 mg daily, may be used
– no response in 1–2 weeks / if closure or clinically evident nonperfusion
of the episcleral or large vessels of the substantia propria of the
conjunctiva becomes apparent 
• oral prednisone, 0.5–1.5 mg/kg/d, should be started
– severe disease necessitates intravenous pulse therapy with
methylprednisolone 1 g
– Cyclophosphamide is particularly valuable if perforation is imminent
– Specific antimicrobial therapy should be given if an infectious cause is
identified
– Surgery  repair scleral or corneal perforations
Keratokonjungtivitis sicca
 Konjungtivitis dry eyes
• ~keratokonjungtivitis sika  suatu keadaan keringnya permukaan
kornea & konjungtiva yg diakibatkan berkurangnya fungsi air mata
• Kelainan ini terjadi pada penyakit yg mengakibatkan
– Def komponen lemak air mata
• Blefaritis menahun, distikiasis, pembedahan kelopak mata
– Def kelenjar air mata
• Sindrom syogren & riley day, alakrimia kongenital, aplasi kongenital saraf
trigeminus, sarkoidosis, limfoma kelenjar air mata, diuretik, atropin, usia
– Def komponen musin
• Benign ocular pempigoid
– Akibat penguapan berlebihan
• Keratitis neuroparalitik, hidup di gurun pasir, keratitis lagoftalmus
– Karena parut kornea / hilangnya mikrovili kornea
• Tanda & gejala
– Gatal, seperti berpasir, silau, penglihatan kabur
– Sekresi mukus >>
– Sukar menggerakan kelopak mata, mata tampak kering,
terdapat erosi kornea
– Konjungtiva bulbi edema, hiperemik menebal & kusam
– Kadang terdapat benang mukus kekuningan pd forniks
konjungtiva bawah

• Pemeriksaan
– Uji Scheimer  resapan < 5 menit  abnormal
• Pengobatan
– air mata buatan yg diberikan selamanya

• Komplikasi
– Ulkus kornea
– Infeksi sekunder oleh bakteri
– Parut kornea
– Neovaskularisasi kornea
 Keratoconjunctivitis sicca
•  Associated with Sjögren's Syndrome
– Triad: keratoconjunctivitis sicca, xerostomia, and connective tissue dysfunction

• Epidemiology
– more common in women at or beyond the menopause than in other groups

• Sign & symptoms

– bulbar conjunctival hyperemia (especially in the palpebral aperture)
– symptoms of irritation that are out of proportion to the mild inflammatory
signs
– begins as a mild conjunctivitis with a mucoid discharge
– Blotchy epithelial lesions appear on the cornea (in the lower half)
– Pain builds up in the afternoon and evening but is absent or only slight in the
morning
– tear film is diminished; contain shreds of mucus
• Examination
– Schirmer test are abnormal
– Rose bengal or lissamine green
staining of the cornea and
conjunctiva in the palpebral aperture
• Diagnosis
– lymphocytic and plasma cell
infiltration of the accessory salivary
glands in a labial biopsy obtained by
means of a simple surgical procedure
• Treatment
– Replace tear film  artificial tears,
side shields, moisture chambers, and
Buller shields
– preservative-free, low-dose
corticosteroid preparations and
topical cyclosporine
Keratitis
 A. Keratitis
• Radang kornea • Gk/:
• e/ : – Mata merah
– Berkurangnya air mata – Silau
– Keracunan obat – Kelilipan
– Rx alergi pd pemberian • Talaks/:
obat topikal – Antibiotika
– Rx thd konjungtivitis – Air mata buatan
menahun – sikloplegik
• Keratitis Pungtata – Virus
– Vaksinia
– Trakoma
• Terkumpul di daerah M.
– Trauma radiasi
Bowman dg infiltrat – Dry eyes
bercak halus – Lagoftalmus
• e/ : – Keracunan obat :
– Moluscum contagiosum neomisin,tobramisin
– Akne rosasea • GK/:
– Herpes simplex – Bilateral dan berjalan kronis
– Herpes zoster – Tanpa gejala kl
– Blefaritis neuroparalitik konjungtiva/tanda akut
Keratitis Pungtata Superfisial Keratitis Pungtata subepitel
• Terkumpul di daerah
• G/: infiltrat halus bertitik-titik membran bowman
pada permukaan kornea
• Tanpa gejala konjungtiva
• e/ : dry
eye,blefaritis,keratopati • Bilateral dan kronis
lagoftalmus,keracunan obat
topikal,UV,trauma kimia
ringan
• GK/ : sakit,silau,mata merah
dan rasa kelilipan
• Talaks/: air mata
buatan,tobramisin tetes
mata dan sikloplegik
• Keratitis Marginal
• Talaks/ :
• Infiltrat yg tertimbun pd tepi kornea – Antibiotika sesuai
sejajar dg limbus penyebab infeksi lokalnya
• e/ : infeksi lokal konjungtiva dan steroid dosis ringan
• Jika tidak diobati dengan baik  tukak
kornea
– Vit B dan C dosis tinggi
• Recuren • Keratitis Marginalis
• Kemungkinan terdapat : Streptococcus
pneumoniae,Haemophillus aegepty
trakomatosa 
• Gk/ : membran pada kornea
– sakit,kelilipan,lakrimasi,fotofobia berat
– Blefarospasme pada satu mata,injeksi
atas  pannus 
konjungtiva,infiltrat/ ulkus yang keratitis dg neovaskl
memanjang
• Keratitis Interstitial
• Akibat lues kongenital  neovask
dalam usia 5-20 th
• e/ : alergi / infeksi spirochaetta ke
dalam stroma kornea dan TB
• GK/:
– fotofobia,lakrimasi dan visus↓
– Seluruh kornea keruh  iris sukar
dilihat
– Permukaan kornea sprt permukaan
kaca
– Injeksi siliar dg sebukan PD ke dalam
 salmon patch
• Keratitis Bakterial
• e/ :
– Staphylococcus,streptoc
occus,Pseudomonas,Ent
erobacteria
• Faktor predisposisi :
– contact
lens,trauma,kontaminasi
obat tetes
• Keratitis Jamur • D/ : KOH 10% hifa
• o/ : • Talaks/ : natamisin 5% /
candida,aspergillusmFusarium amfoterisin B 0.15 -0.3
dan Curvularia %
• Gk/ :
– Sakit mata yang hebat,berair dan • Sistemik : ketokonazole
silau dan sikloplegik
– Pada mata ada infiltrat kelabu +
hipopion,peradangan,ulserasi • Jika ada TIO ↑ obat
superficial dan satelit bila terletak
di stroma oral anti glaukoma
– Cincin endotel dg plaque tampak
bercabang-cabang dg endothelium
plaque
– Gambaran satelit pd kornea
– Lipatan Descemet
• Keratitis Virus • Talaks :
– IDU : tidak boleh > dr 2
• Keratitis Herpetik
mgu tidak stabil 
• o/ : Herpes simplex dan herpes
zoster hambat DNA virus dan
• Herpes simplex : manusia
– Epitelialdendritik : kerusakan o/ – Acyclovir  selektif thd
pembelahan virus di dalam sel DNA virus salep /4jam
epitel rusak sel dan membentuk
tukak kornea superficial
– Stromaldiskiformis  rx imun
px  Ag dan Ab bereaksi di
stroma kornea dan menarik
leukosit dan sel radang lain 
bahan proteolitik u/ merusak
antigen virus dan jar stromal
sekitarnya
• Keratitis Dendritik
• Keratitis superficial yang
membentuk garis infiltrat pada
permukaan kornea cabang
• o/ Herpes Simplex
• GK :
– fotofobia,kelilipan,tajam
penglihatan turun,konjungtuva
hiperemis,sensibilitas kornea yang
hipestesia
• Sembuh spontan / antivirus
(IDU/ acyclovir) dan siklolegik
• Keratitis Disiformis
• Membentuk kekeruhan
infiltrat yang bulat/
lonjong dlm jar kornea
• o/ herpes simplex
• Rx imun thd virus
H.simplex di permukaan
kornea
• Keratitis Herpes Zoster
• Infeksi pada ganglion Gaseri saraf
Trigeminus
• Pada orang usia lanjut
• GK/:
– rasa sakit pada daerah yang terkena
dan badan terasa hangat,
penglihatan (-) dan merah
– Pada kelopak : vesikel dan infiltrat
pada kornea  terbentuk jar parut
• Talaks/ : asiklovir dan
simptomatik , usia lanjut bisa
diberi steroid
• Keratitis Filamentosa
• Filamen mukoid dan deskuamasi sel
epitel pada pemukaan kornea
• Disertai penyakit lain :
keratokonjungtivitis
sika,sarkoidosis,trakoma,penggunaan
contact lens,edema
kornea,DM,pemakaian antihistamin
• Ditemukan pada gejala : dry eye
synd,DM,pascabedah kataraj dan
keracunan kornea o/ obat ttt
• Gk : kelilipan,sakit,silau,blefarospasme
dan epifora,mata merah dan tdpt
defek epitel kornea
• Talaks/ : NaCl 5%,air mata hipertonik
• Treatment
Ulkus Kornea
 Ulkus Kornea
• Diskontinuitas jaringan kornea akibat terjadinya defek epitel
• Klasifikasi berdasarkan lokasi
– Sentral: hampir selalu diakibatkan oleh infeksi
• Sikatrik yang terbentuk  penyebab kebutaan dan penurunan penglihatan
– Marginal
• Etiologi: infeksi bakteri, virus, jamur
• Manifestasi klinis:
– Mata merah, berair, nyeri tekan
– Sensasi benda asing
– Terdapat sekret
– Kelopak mata bengkak
– Nyeri apabila melihat cahaya terang
– Terdapat infiltrat tergantung dari kedalaman lesi dan etiologi keratitis
– Gejala spesifik dari etiologi
• Diagnosis:
– Pemeriksaan visus penglihatan
– Pemeriksaan TIO
– Pemeriksaan slit-lamp: hipopion, infiltrat dan segmen
anterior
– Pemeriksaan sensibilitas kornea, fluoresens dan tes fistula
– Penilaian tingkat keparahan ulkus
– Pemeriksaan oftalmoskop: bagian posterior mata
– Pemeriksaan gram
• KOH 10%
• Kultur dari spesimen kerokan kornea
• Ulkus kornea marginalis: diakibatkan oleh reaksi hipersensitivitas terhadap eksotoksin
stafilokokus dan protein dinding sel disertai dengan endapan kompleks imun kornea
perifer
• Manifestasi klinik:
– Gejala: sensasi benda asing, lakrimasi, nyeri, dan fotofobia
• Tanda:
– Sering ditemukan Blefaritis kronis marginal
– Berawal sebagai infiltrat linear atau oval marginal subepitel yang terpisah dari limbus oleh zona
yang jernih
– Defek epitel < infiltrat
– Penyebaran sirkumferensial dan sling bersatu
• Diagnosa:
– Pemeriksaan visus
– Pemeriksaan TIO non kontak
– Pemeriksaan dengan slit lamp
– Pemeriksaan sensibilitas kornea dan fluoresen
Xeroftalmia
 XEROPTHALMIA
• spectrum of ocular disease caused by inadequate
vitamin A intake, and is a late manifestation of severe
deficiency 
• Lack vitamin A due to:
– Malnutrition
– Malabsorption
– Chronic alcoholism
– Highly selective dieting
• Mother malnourished  risk in infant is increased
– And by coexisting diarrhoea or measles
• Symptoms : night blindness (nyctalopia), discomfort and loss of vision
• Conjunctiva 
– Xerosis: dryness of the conjunctiva in the interpalpebral zone with loss goblet cells,
squamous metaplasia and keratinization
– Bitot spots: triangular patches of foamy keratinized epithelium in the interpalpebral zone,
caused by Corynebacterium xerosis 
• Cornea 
– Lustreless appearance due to secondary xerosis
– Bilateral punctate corneal epithelial erosions in the interpalpebral zone  reversible with
treatment
– Keratinization
– Sterile corneal melting by liquefactive necrosis  perforation
• Retinopathy
– yellowish peripheral dots 
– decreased electroretinogram amplitude
• Treatment 
• Keratomalacia  severe vitamin A  medical emergency due to
the risk of death (in infants)
• Systemic treatment:
• Keratomalacia:
– oral (oil-based 200 000 IU) or intramuscular (aqueous-based 100 000 IU)
vitamin A 
– vitamin supplements and dietary sources of vitamin A 
• Local treatment :
– intense lubrication,
– topical retinoic acid and
– management of perforation
Uveitis Anterior
 Uveitis anterior
•  peradangan yg mengenai iris & jaringan badan siliar
(iridosiklitis biasanya unilateral, onset akut
• Merupakan suatu manifestasi klinik reaksi imunologik lambat,
dini, atau sel mediated terhadap jaringan uvea anterior
– Penyebab
• Nongranulomatosa
– Akut  nyeri, fotofobia, penglihatan buram keratik presipitat kecil, pupil mengecil,
sering kambuh (akibat: trauma, diare kronis, herpes simpleks)
– Kronis  disebabkan artritis reumatoid & Fuchs heterokromik iridosiklitis
• Granulomatosa
– Akut  tidak nyeri, fotofobia ringan, buram, keratik presipitat besar (mutton fat),
benjolan koeppe (penimbunan sel pada pupil), benjolan busacca (penimbunan sel pd
permukaan iris)
» Akibat: sarkoiditis, sifilis, TBC, virus, jamur (histoplasmosis), parasit (toksoplasmosis)
• Tanda & gejala
– Mata merah & sakit mendadak / mata merah & sakit ringan
perlahan dengan penglihatan turun perlahan
– Fotofobia
– Mata berair
– Radang otot2 akomodasi  sulit melihat dekat
– Radang otot2 sfingter & edema iris  pupil miosis
– Radang akut 
• miopisasi akibat rangsangan badan siliar & edema lensa,
• fler/efek tyndal di dalam bilik mata depan
• Hifema/hipopion
– Radang kronis  edema makula & kadang katarak
– Sinekia posterior,
– miosis pupil,
– tek bola mata < (hipofungsi badan siliar)
– Tek bola mata > (perlengketan yg tjd pd sudut bilik
mata)

– Perjalanan penyakit berlangsung hanya antara 2-4

minggu, dpt memperlihatkan gejala kekambuhan
atau menahun
• Pengobatan
– Segera  cegah kebutaan
– Steroid pd siang hari bentuk tetes & malam hari bentuk
salep
– Steroid sistemik bila perlu, dosis tunggal seling sehari tinggi
 diturunkan sampai dosis efektif
– Steroid subkonjungtiva & peribulbar
• Hati2 efek samping katarak, glaukoma, midriasis pupil
– Sikloplegik  < sakit, melepas sinekia, memberi istirahat pd
iris yg meradang
– Pengobatan spesifik jika sebab diketahui
• Komplikasi
– Sinekia posterior & anterior  glaukoma sekunder
• Akibat tertutupnya trabekulum o/ sel radang atau sisa
sel radang
• Terapi dapat diberikan asetazolamida
– Radang 1 mata  radang berat pd mata
sebelahnya  uveitis simpatis
 Endolftamitis
•  peradangan berat dalam bola mata, akibat infeksi
setelah trauma/bedah/endogen akibat sepsis
–  radang supuratif di dalam rongga mata & struktur di
dalamnya  abses badan kaca

• Etiologi
– Kuman & jamur yg masuk bersama trauma tembus (eksogen)/
sistemik melalui peredaran darah (endogen)
• Bakteri  stafilokok, streptokok, pneumokok, pseudomonas, bacilus
species
• Jamur  aktinomises, aspergilus, phitomikosis sporothrix, kokidioides
• Gambaran klinik
– Rasa sakit yg sangat
– Kelopak merah & bengkak
– Kelopak sukar dibuka
– Konjungtiva kemotik & merah
– Kornea keruh
– Bilik mata depan keruh yg kadang disertai hipopion
•  prognosa memburuk
– Kekeruhan / abses badan kaca  refleks pupil berwarna
putih
• Gambaran seperti retinoblastoma (pseudoretinoblastoma)
• Pengobatan
– Antibiotik
• Ampisilin topikal & sistemik 2g/hari + kloramfenikol 3g/hari
• Stafilokok  basitrasin (topikal), metisilin (subkonjungtiva & IV)
• Pneumokok, streptokok, stafilokok  penisilin G (top, subkonj, & IV)
• Neiseria  penisilin G (top, subkonj, & IV)
• Pseudomonas  gentamisin; tobramisin + karbesilin (top, subkonj, IV)
• Batang gram (-) lain  gentamisin (top, subkonj, IV)
– Sikloplegik 3x/hari tetes mata
– Kortikosteroid
– Gagal pengobatan  eviserasi; enukleasi bila mata sdh tenang & ftisis bulbi
– Jamur  amfoterisin B 150mikrogram subkonjungtiva

• Komplikasi  panoftalmitis (prog buruk jika e/ jamur / parasit)

Glaukoma Akut
 Acute angle closure / acute glaucoma
•  occurs when sufficient iris bombé develops to
cause occlusion of the anterior chamber angle by the
peripheral iris
– blocks aqueous outflow, and the intraocular pressure rises
rapidly  severe pain, redness, and blurring of vision

• May develop in hyperopic eyes with preexisting

anatomic narrowing of the anterior chamber angle,
usually when it is exacerbated by enlargement of the
crystalline lens associated with aging
• Precipitation factors
– pupillary dilation
– occurs spontaneously in the evenings, when the level of
illumination is reduced
– due to medications with anticholinergic or
sympathomimetic activity
• (eg, atropine for preoperative medication, antidepressants,
nebulized bronchodilators, nasal decongestants, or
tocolytics)
– occur rarely with pupillary dilation for ophthalmoscopy
• Clinical findings
– sudden onset of visual loss accompanied by excruciating pain, halos,
and nausea and vomiting
• Patients are occasionally thought to have acute gastrointestinal disease
– markedly increased intraocular pressure,
– a shallow anterior chamber,
– a steamy cornea,
– a fixed, moderately dilated pupil,
– ciliary injection

– perform gonioscopy  confirm the anatomic predisposition to

primary acute angle closure
• DD
– Acute iritis
• causes more photophobia than acute glaucoma
• Intraocular pressure is usually not elevated; the pupil is constricted or irregular in
shape and the cornea is usually not edematous
• flare and cells are present in the anterior chamber
• deep ciliary injection
– Acute conjunctivitis
• bilateral, and there is little or no pain and no visual loss
• discharge from the eye and an intensely inflamed conjunctiva but no ciliary injection
• pupillary responses and intraocular pressure are normal, and the cornea is clear

• Complication
– peripheral iris may adhere to the trabecular meshwork  irreversible
occlusion of the anterior chamber angle requiring surgery
– Optic nerve damage
• Treatment
– OPHTHALMIC EMERGENCY
– initially directed at reducing the intraocular pressure
• Intravenous and oral acetazolamide + beta-blockers and
apraclonidine (topical) + hyperosmotic agents (if necessary)
– Pilocarpine 2% should be instilled one-half hour after
commencement of treatment
– laser peripheral iridotomy (neodymium:YAG laser) should
be undertaken to form a permanent connection between
the anterior and posterior chambers (after IOP under
control)  preventing recurrence of iris bombé
Pinguecula
 PINGUECULA
• asymptomatic elastotic degeneration of the conjunctival stroma 
• yellow–white mound or aggregation of smaller mounds 
– On the bulbar conjunctiva adjacent to the limbus
• Location: nasal limbus > temporal limbus
– Frequently: both
• Occasionally: calcification present
• Cause: actinic damage
– Similar to the aetiology of pterygium
• Distinction: the limbal barrier to extension has remained intact with a
pinguecula
– transformation can occur 
• Occasionally may become acutely inflamed (pingueculitis)
– if the lesion is prominent or overlying calcification leads to epithelial breakdown 
• Treatment : usually unnecessary because growth is
absent or very slow
• Irritation: topical lubrication
• Pingueculitis : lubrication if mild or with a short course
of topical steroid 
• Excision : for cosmetic reasons or for significant
irritation 
– recurrence rate is very low 
– simple excision 
• Thermal laser ablation can be effective
LO 2: 3M Kelainan pada kelopak mata
Blefaritis
 Blefaritis
• Radang pada kelopak mata dan tepi kelopak
• Etiologi
– Infeksi
• Streptococcus alfa atau beta, pneumococcus,
pseudomonas, virus, jamur
– Alergi kronis
• Debu, asap, kimia iritatif, bahan kosmetik
• Tanda dan gejala umum
– Kelopak mata merah, bengkak, sakit
– Eksudat lengket
– Epifora
– Sering disertai konjungtivitis atau keratitis
• Tatalaksana umum
– Diberikan pembersihan dengan garam fisiologik
hangat
– Antibiotik yang sesuai
 Blefaritis bakterial (lanjutan)
• Blefaritis superfisial
• Blefaritis seboroik
• Blefaritis ulseratif
• Blefaritis angularis
 Blefaritis superfisial
• Etiologi
– Biasanya staphylococcus
• Terapi
– Salep antibiotik  sulfasetamid dan sulfasoksazol
– Pengangkatan krusta dengan kapas basah sebelum
pemberian salep
 Blefaritis seboroik
• Epidemiologi
– Laki-laki > perempuan
– Usia lanjut (50 tahun)
• Tanda dan gejala
– Mata kotor
– Panas dan rasa kelilipan
– Keluar sekret
– Air mata berbusa
– Hiperemia dan hipertrofi papil pada konjungtiva
– Bisa terjadi kalazion, hordeoulum, madarosis, poliosis
• Terapi
– Memperbaiki kebersihan dan membersihkan
kelopak dari kotoran dengan kapas lidi hangat
– Pembersihan bisa dengan nitrat argenti 1%
– Salep sulfonamid u/ keratolitik
– Antibiotik oral tetrasiklin 4x250 mg dan topikal
 Blefaritis ulseratif
• Peradangan margo dengan tukak akibat infeksi
staphylococcus
• Etiologi
– Infeksi staphylococcus
• Tanda dan gejala
– Keropeng kekuningan yang bila diangkat akan
terlihat ulkus kecil dan mengeluarkan darah
• Terapi
– Sulfasetamid, gentamisin, atau basitrasin
– Apabila ulseratif luas, ditambah AB sistemik dan roboransia
• Komplikasi
– Madarosis
– Trikiasis
– Keratitis superfisial
– Keratitis pungtata
– Hordeolum
– kalazion
 Blefaritis angularis
• Infeksi staphylococcus pada tepi kelopak di sudut
kelopak atau kantus  gangguan fungsi pungtum
lakrimal
• Etiologi
– Staphylococcus aureus
– Morax axenfekd
• Terapi
– Sulfa, tetrasiklin, sengsulfat
• Komplikasi
– Tersumbatnya duktus lakrimal
 Blefaritis skuamosa
• Blefaritis yang disertai terdapatnya skuama atau
krusta pada pangkal bulu mata yang bila dikupas tidak
mengakibatkan terjadinya luka kulit
• Etiologi
– Kelainan metabolik
– Jamur
• Tanda dan gejala
– Terdapat sisik halus yang mudah dikupas tanpa perdarahan
– Penebalan margo palpebra
– madarosis
• Terapi
– Membersihkan margo dengan shampo bayi
– Salep mata dan steroid topikal
• Komplikasi
– Keratititis
– Konjungtivitis
 Anterior blepharitis
•  common chronic bilateral inflammation of the lid margins
– 2 types 
• Staphylococcal (ulcerative)  e/ Staphylococcus aureus
• Seborrheic (non-ulcerative)  e/ Pityrosporum ovale
• Mixed

• Chief symptoms
– irritation, burning, and itching of the lid margins
– “red-rimmed”
– scales or "granulations" can be seen clinging to the lashes of both
the upper and lower lids
• Staphylococcal  dry, the lids are red, tiny ulcerated areas are found along
the lid margins, and the lashes tend to fall out
• Seborrheic  greasy, ulceration does not occur, and the lid margins are less
red
• Other etiologic disease
– hordeola, chalazia, epithelial keratitis of the lower third of the cornea,
and marginal corneal infiltrates

• Treatment
– Seborrheic type 
• scalp, eyebrows, and lid margins must be kept clean (means of soap and water
shampoo)
• scales must be removed from the lid margins daily with a damp cotton
applicator and baby shampoo
– Staphylococcal type 
• antistaphylococcal antibiotic or sulfonamide eye ointment applied on a cotton
applicator once daily to the lid margins
 Posterior blepharitis
•  inflammation of the eyelids secondary to
dysfunction of the meibomian glands;
bilateral, chronic condition
– Seborrheic dermatitis is commonly associated
with meibomian gland dysfunction
– Colonization or frank infection with strains of
staphylococci
• Bacterial lipases  inflammation of the meibomian
glands and conjunctiva and disruption of the tear film.

• Anterior and posterior blepharitis may coexist

• Clinical manifestation
– broad spectrum of symptoms involving the lids, tears, conjunctiva, and
cornea
– inflammation of the meibomian orifices (meibomianitis),
• plugging of the orifices with inspissated secretions,
• dilatation of the meibomian glands in the tarsal plates,
• production of abnormal soft, cheesy secretion upon pressure over the glands
– Hordeola & chalazia may also occur
– lid margin shows hyperemia and telangiectasia; rounded and rolled inward
as a result of scarring of the tarsal conjunctiva
•  abnormal relationship between the precorneal tear film and the meibomian
gland orifices
– tears may be frothy or abnormally greasy
– epithelial keratitis
– Cornea  peripheral vascularization and thinning, particularly inferiorly,
sometimes with frank marginal infiltrates
• Treatment
– determined by the associated conjunctival and corneal changes
• Frank inflammation  long-term low-dose systemic antibiotic therapy
– doxycycline (100 mg twice daily) or erythromycin (250 mg three times daily), but
guided by results of bacterial cultures from the lid margins
– weak topical steroids, eg, prednisolone, 0.125% twice daily
– Topical therapy with antibiotics or tear substitutes  UNNECESSARY (lead to
further disruption of the tear film or toxic reactions to their preservatives)

• Periodic meibomian gland expression may be helpful (mild disease that

does not warrant long-term therapy with oral antibiotics or topical
steroids)
Hordeolum
 Hordeolum
•  infection of the glands of the eyelid
– meibomian glands  large swelling occurs (hordeolum internum)
– Zeis's or Moll's glands  smaller & superficial swelling (external
hordeolum)

• Etiology
– Staphylococcus aureus
• but culture seldom required

• Principal symptoms
– Pain, redness, and swelling
• Treatment
– warm compresses three or four times a day for
10–15 minutes
– not begin to resolve within 48 hours  incision
and drainage of the purulent material
• vertical incision should be made on the conjunctival
surface to avoid cutting across the meibomian glands
• incision should not be squeezed to express residual pus
• Externally pointed hordeolum  horizontal incision
(minimize scar formation)
 Chalazion
•  an idiopathic sterile chronic granulomatous
inflammation of a meibomian gland
• Symptoms
– painless localized swelling that develops over a
period of weeks
– may begin with mild inflammation and tenderness
resembling hordeolum
• differentiated from hordeolum by the absence of acute
inflammatory signs
– slightly reddened or elevated
– Large  press on the eyeball and cause astigmatism
 Th/ excision
• Histologic exam
– proliferation of the endothelium of the acinus and a granulomatous
inflammatory response that includes Langerhans-type gland cells
• Biopsy is indicated for recurrent chalazion  meibomian gland carcinoma
may mimic chalazion

• Treatment
– Surgical excision with vertical incision  careful curettement of the
gelatinous material and glandular epithelium
– Intralesional steroid injections alone may be useful for small lesions
• combination with surgery in difficult cases
 Trikiasis
• Bulu mata mengarah pada bola mata yang
akan menggosok kornea atau konjungtiva
• Gejala
– Konjungtiva kemotik dan hiperemi
– Kornea terdapat erosi, keratopati dan ulkus
– Fotofobia
– Lakrimasi
– Seperti kelilipan
• Komplikasi
– Erosi kornea
– Tukak kornea
• Terapi
– Epilasi  pencabutan bulu yang salah tumbuh