ASPEK KLINIS &

PENANGANAN MATA MERAH

Oleh : dr. Sugijanto, Sp.M
IDI CAB. TUBAN/dibacakan juga utk kuliah DM FK
UWKS Kelompok F Tahun 2014
5 Agustus 2009

MATA MERAH
Sering terjadi
Sering mengecoh

SALAH DIAGNOSA

SALAH Tx

FATAL

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DIAGNOSA KLINIS

Mudah
Kapan saja
Dimana saja
Alat-alat sederhana

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ANAMNESA, INSPEKSI, PALPASI

Palpebra/bulu mata
Konjungtiva
Kornea
Pupil

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KORNEA
Benda Asing/Corpus Alienum
Lesi infektif bentuk
infiltrat/ulcus (Borok/Tukak)
Tes Fluresin
sangat menolong
Udem ?

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BILIK MATA DEPAN

CAMERA OCULI ANTERIOR/COA

Apakah ada flare (efek tyndall)

biasanya sel-sel radang?
Hyphopion?

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PUPIL

Miosis
Midriasis
Reflek cahaya
Synechia
Bentuk : - bulat?
- lonjong?
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SECARA MUDAH MATA MERAH

BISA DIBEDAKAN

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Dx KONJUNGTIVITIS
Klinis lebih cepat/mudah
# Discharge/Sekret
# Conyuctinal Reaction:
# Penyulit kornea/lymphadenopathy
Lab: - Scrapping
- Pengecatan
* Gram
* Giemsa
* Kort
* Papaniculau
- Biakan

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Tx. BACT CONJUCTIVITIS

Antibiotika Spect luas
Boleh diberikan kombinasi dengan
steroid
Pastikan kornea intak & waspadai
glaukoma

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CONJUNCTIVITIS
Symptoms
1. Redness
2. Stickiness
3. Grittiness
4. Photophopia
5. Lacrimation
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Signs
1. Discharge
a. Serous (viral, toxic)

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2. Conjunctival reaction
a. Hyperaemia
b. Oedema
c. Follicular reaction
d. Papillary reaction

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Classification of conjuctivitis
1. According to cause
a. Bacterial
b. Viral
c. Fungal
d. Parasitic

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2. According to exudate
a. Purulent
b. Mucopurulent
c. Membranous
d. Psedomembranous

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BACTERIAL CONJUNCTIVITIS
1. Staph. Aureus purulent
2. Streptococcus pneumoniae purulent and
petechial

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VIRAL CONJUNCTIVITIS
Adenoviral infections
a. DNA Viruses

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g. Keratitis
(i) Diffuse punctate epithelial
(ii) Subepithelial
(iii) Anterior Stromal
h. Investigations
(i) HeLa cell culture

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Chlamydial infections
- Chlamydia trachomatis

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TRACHOMA
The worlds 2nd major blinding condiion
6 9 million people blind (<3/60) from
trachoma (1984 WHO estimate)
Infection re-infection cycle
Secondary infection cycle (h.aegyptus)
Lack of immunity to infecting agent
Predominantly women and children
affected
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Classification
(i)

MacCallan classification of conjunctival findings:

Stage simple conjunctivitis
immature follicles
incubation = 4 dys
Stage 2a folicles predominate
Stage 2 b papilae predominate
Stage 3 cicatrizing : trichiasis
entropion
ArltS line
Stage 4 inactive
varying degrees of scarring
ptosis
xerosis
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(ii) News proposed WHO grading

TF trachomatous inflammation (follicular). > 5
follicles of > 0,5 mm on upper tarsus
TI trachomatous inflammation (intense).
Inflammatory thickening obscuring > 50% of large
deep tarsal v, bandessels
TS trachomatous (conjunctival) cicatrization.
Visible white lines, band or sheets of fibrosis
TT trachomatous trichiasis
At least 1 eyelash or evidence of recent removal
CO corneal opacity.
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DEGENERATION
1. Lithiasis concretion, Resulting from prolonged
conjunctivitis
2. Pinguecula
a. Yellow/white perilimbal plaques
b. Histology
(i) Epithelial thining
(ii) Elastoid stromal degeneration
3. Pterygium
a. Wing-shaped fibrovascular overgrowth
onto cornea in interpalpebral space
b. Related to chronic exposure to ultraviolet light and
dryness
c. Histology
(i) Epithelial thining
(ii) Elastoid degeneration
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CORNEAL INFECTION
Clinical presentations
a. Keratitis
b. Keratoconjunctivitis
c. Hypopyon ulcer
Predisposing factors
a. Adnexal infection
b. Entropion
c. Exposure
d. Dry eyes
e. Contact lens wear
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CLAMYDIA
TRACHOMATIS
1. Adult inclusion conjunctivitis (TRIC)
a. Serovars D to K
b. Superficial punctate keratitis in 75%

2. Trachoma
a. Serovars A, B, or C
b. Superficial keratitis in acute stage
c. Later superior pannus formation
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HERPES SIMPLEX VIRUS

Viral characteristics
Dendritic ulcer
Geographic ulcer
Trophic keratitis
Stromal infiltrative keratitis
Disciform keratitis
Complication
Management
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HERPES ZOSTER
KERATITIS
1.
a.
b.
c.

Viral characteristitics
Varicella zoster (DNA) virus
Previous systemic infection (chickenpox)
Virus lies dormant in sensory nerve root
ganglion
d. Affect older age group and immunosuppresed
e. Diagnose with EM, viral culture, monoclonal
antibody staining, serial serum antibody titres.
f. Herpes zoster opthalmicus account for 7% 0f
all shingles
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2. General features
a. Painful, red, vesicular rash, progessing
to crusting and resolution often with
scarring
b. General malaise, lethargy, depression
c. Occasional dehydration
d. Post-herpetic neuralgia

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3. Ocular features
a. Occur in 50% Ocular involvement more
common if nasociliary branch of 5a
affected
b. Mucopurulent conjunctivitis
c. Episcleritis
d. Scleritis
e. Keratitis
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FUNGAL AND YEAST INFECTIONS

1.
2.
3.
4.
5.
6.
7.
8.

Rare
Usually aspergillus, fusarium or candida
In immunocompromised host: with topical
steroids; in trauma with organic contamination
Suspect in suppurative/necrotic keratitis
Identify with Giemsa staining
Culture with Sabourauds agar and brain-heart
infusion medium
Treat fungi with topical 5% natamycin
Treat yeast with topical and oral flucytosine
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GLAUCOMA ACUTE
Definition
A group of condition characterized by
optic disc cupping and field loss, in which
the intraocular pressure is sufficiently
raised to impair normal function of the
optic nerve

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1. Incidence
a. 1 in 1000 people over 40 years
b. Male to female ratio is 1:4
2. Symptoms
a. Pain
b. Coloured haloes
c. Headache
d. Nausea, vomiting
e. Previous history of subacute attacks
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3. Signs
a.
b.
c.
d.
e.
f.
g.
h.
i.

Reduced vision
Cilliary injection
Corneal oedema
Mid-dilated , vertically oval pupil
Shallow anterior chamber
Flare and cells in anterior chamber
Chongested iris vessels
Iris stromal oedema
Central retinal artery pulsation
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4. Treatment
Initial

Initial
(i) Acetazolamid 500 mg i.v., then 250 mg four
times a day orally
(ii) Pilocarpine 4% every 15 min for one hour,
then four times a day.
(iii) Topical steroids
(iv) Osmotic agents, e.g.glycerol 1 2 g/kg
body weight orally in lemon juice and/or
mannitol 1 2 g/kg body weight (20%
solution) given i.v.over 30 min

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Late
(i) Medical therapy if infirm
(ii) Surgery
- Peripheral iridectomy
- Laser iridotomy
- Filtration surgery
- Iridectomy/iridotomy on fellow eye
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MATA MERAH
Gambaran luas,bukan diagnosa,tetapi gejala
Bisa penggambaran peny. Mata ringan s/d berat
(kebutaan)
Ax penting,apakah visus turun?,mata nyeri?,apakah
silau dan disertai melihat pelangi disekeliling lampu?
bila jawaban YA RUJUK
Bila hanya disertai tahi mata saja SEDIKIT AMAN
Periksa hipereminya perikornea atau konjungtival / dari
tepi konjungtiva
Kornea udem atau tidak
Keadaan pupil miosis/midriasis,bulat atau
lonjong,reguler atau tidak
Kadang kadang perlu pengukuran tekanan bola mata.
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Macam macam penyakit

dengan gejala MATA MERAH

Konjungtivitis akut
Iritis akut (uveitis anterior akut)
Glaukoma akut
Keratitis

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Diagnosa banding peny. dg MATA - MERAH

Konjungti Iritis akut Glukoma Keratitis

vitis akut
akut
insidensi Sangat
srgwabah

sering

jarang

sering

Tahi
mata

Sedang- Tdk ada

banyak

Tdk ada

Encerpurulen

Visus

Tdk
berubah

kabur

Sangat
kabur

kabur

Nyeri

Tdk adsdkt

sedang

Sangat
nyeri

Sedangberat
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Hiperemi Difus lbh

perikornea Perikornea perikornea
tebal ditepi
kdg
khemosis

Kornea

jernih

jernih

berkabut

situasional

Ukr pupil normal

kecil

Dilatasi/
lonjong

normal

Resp.chy normal
pupil

buruk

Tdk ada

normal

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