Anda di halaman 1dari 49

Pemeriks Pemriksaan

aan Visus

Anamnesa

Therapi

Visus N

Konjungtivitis
Viral

Th/ :
Prednisolon
0,5% q.i.d
Obat tetes
mata q.i.d

Penularan di
tempat kerja,
sekolah, kolam
renang
Berair
Kelopak mata
bengkak dan
limphadenopati
periauricular
Konjungtiva
hiperemi dan
terdapat folikel
Inflamasi berat
PP :
Giemsa
Kultur virus (mahal
dan lama)
PCR

KIE :
Jaga
kebersihan
Tidak
menggunakan
kontak lensa
sampai gejala
mereda

Pemeriksa Pemriksaan
an Visus

Anamnesa

Therapi

Visus N

Bakcterial
Konjungtivitis

AB topical q.i.d
(chlorampenicol,
aminoglikosida,
quinolon, polimixin
B, asam fusidic,
bacitracin)

ada discharge
legket-lengket
Saat bangun tidur
susah buka mata
Kelopak mata edema
dan eritema
Injeksi konjungtiva
PP:
Pemeriksaan gram
Kultur
PCR

Gonococal :
cephalosporin gen
3
H. Influenza : oral
amoxicilin + asam
clavulanic
Meningococal : IM
benzilpenisilin,
ceftriaxone,
cefotaxime
KIE :
Tidak
menggunakan
kontak lensa
sampai 48 jam

Pemeri
ksaan
visus

Pemeriksaan

anamnesa

Therapi

Visus N

gundukan berwarna
yellow-white disekitar
konjungtiva bulbi
sampai limbus

Pinguiculum

Tidak
dibutuhkan
Jika terjadi
pinguiculitis
steroid :
Fluorometholo
n

Fibrovaskular
berbentuk segita dari
limbus sampai kornea
Sering terpapar sinar
UV
Iritasi dan grittiness

Pterigyum
Tipe 1 < 2
mm
Tipe 2 4 mm
(primary
/recurrent
following
surgery)
Tipe 3 > 4mm
+ mengenai
visual axis
Pseudopterigyu
m respon

Obat tetes
mata
Topical
steroid
Gunakan
kacamta
hitam
Surgery (bare
sclera
technique)

Pemeri
ksaan
visus

Pemeriksaan

anamnesa

Therapi

Visus N

Kemerahan
difuse/sectoral
(distribusi di
interpalpebral,
kontrast dengan
penyakit sclera, biasa
dimulai dari quadrant
temporal atas

Simple
episcleritis

Merah saat bangun


tidur
2-3 hari kemudian
daerah yang
kemerahan bertambah
besar ukurannya
Terdapat 1/> nodul

Nodul episcleritis

Ringan
tidak perlu
terapi
Tetes air
mata
Steroid
topical q.i.d 12 minggu
Oral NSAID
flurbiprofen
100 mg 3x1
10 hari

Pemeri
ksaan
visus

Pemeriksaan

anamnesa

Visus N

Sakit dan nyeri


menyebar ke muka
dan pelipis
Sakit pada pagi hari
beberapa jam setelah
bangun
Tidak respon jika
diberika analgesik
Kongesti dan dilatasi
vaskuler + edema
Jika eddema
menghilang,
tempatnya akan
bewarna abu/biru

Anterior nonnecrotizing
scleritis difuse

Sakit tidak terasa


Peningkatan
kemerahan
Nodul di sclera

Anterior nonnecrotizing
scleritis nodul

Therapi

Pemeri
ksaan
visus

Pemeriksaan

anamnesa

Visus N

Sakit bertahap
Nyebar ke plipis, jidat,
dau, mengganggu
tidur
Tidak respon
terhaddap analgesik
Tanda :
Vaso occlusive
Granulomatosus
Operasi merangsang
scleritis (3 minggu stlh
operasi)

Anterior nonnecrotizing
scleritis with
inflammation

Exudative retinal
Efusi uveal
Terlipatnya choroidal
Massa di subretinal
Edema disc

Posterior Scleritis

PP :
MRI, CT scan

Therapi

Peme Pemeriksaan
riksaa
n
Visus

Anamnesa

Therapi

Visus
menur
un

Acute
anterior
uveitis

Midriatic :
Tropicamide
0,5%
Atropine 1%
Intraocular
steroid
Periocular
steroid
Steroid sistemic
:
Oral
prednisolon 525mg
IV
methilprednisol
on 1g/hari
(ulang sampai
2-3 hari jika
penyakitnya
berat)

Photopobia
Sakit mendadak di salah
satu mata
Lakrimasi
Pasien datang dengan
keluhan mata kurang enak
beberapa hari sebelum
serangan akut
PP :
Injeksi siliar*
Miosis *
TIO menurun
Hipopion
Aquas humor
sel,flare,exudate

Peme Pemeriksaan
riksaa
n
Visus

Anamnesa

Therapi

Visus
menur
un

Chronic
anterior
uveitis

Midriatic :
Tropicamide
0,5%
Atropine 1%
Intraocular
steroid
Periocular
steroid
Steroid sistemic
:
Oral
prednisolon 525mg
IV
methilprednisol
on 1g/hari
(ulang sampai
2-3 hari jika
penyakitnya
berat)

Inflamasi yang persisten


relaps
< 3bualn setelah tidak
melanjutkan pengobatan
Ada komplikasi seperti
katarak/keratopaty
Mata terlihat putih
Keratic Precipitates
mutton-fat, ground-glass
(ghost KP)

Peme Pemeriksaan
riksaa
n
Visus

Anamnesa

Therapi

Visus
menur
un

Posterior
uveitis

Intraocular
steroid

Floaters
Penglihatan central
terganggu
Meliputi :
Retinitis retina keputihan,
batas tidak jelas karena
dikelilingi edema
Choroiditis nodul
kekuningan
Vasculitis
yellowish/graywhite,
patching, perivascular
cuffing

Pemeriksa
an visus

Pemeriksaan

Anamnes
a

Therapi

Mata Merah, -Anterior Uveitis Endoftalmi -Lens Removal


Visus

tis
(Phacogenic)
menurun
- Antimikroba amikacin
Granulomatosa
87.10%, tobramycin
Abses
80.65%, ciprofloxacin
-IOP tinggi
96.67%, levofloxacin,
-Segmen
gatifloxacin and
Posterior aman
moxifloxacin 100%,
( Phacogenic )
ceftazidime 85.0%, and
gentamicin 80.65%.
Vancomycin sensitivity
among gram-positive
microorganisms was
100%. S. aureus and
CoNS showed 83.33% of
susceptibility to oxacillin,
89.61% to ciprofloxacin
and 100% to gatifloxacin
and moxifloxacin
- Endoftalmitis
yang

Panoftalmi Antibiotiik
tis

Pemeriksaan

Kelainan
Kelopak
Mata

anamnesa

Therapi

Nodul besar tapi


chalazion
tidak sakit
Jika di atas
kelopak mata
penglihatan buram
Nodul di
konjungtiva tarsal

Sembuh
spontan
Persintent
surgery, injeksi
steroid

nodul + nyeri di
kelopak mata
bagian depan

Topikal AB
Kompres
dengan air
hangat

Hordeolum

Kelainan
Kelopak
Mata

Pemeriksaan

anamnesa

Therapi

Burning
Grittiness
Mild photophobia
Memburuk pada pagii
hari biasa berhubungan
dengan mata kering

Blepharitis
chronic
anterior

AB :
Topical : asam
fusidic,
bacitrasin /
chloramphenic
ol
Oral :
azithromicyn
500 mg/hari
selama 3 hari
Steroid topical
lemah ;
fluorometholon
e 0,1% q.i.d 7
hari untuk
pasien yg ada
konjungtivitis
papilary berat,
marginal
keratitis,
phlyctenulosis

Staphilococus
blepharitis :
Sisik kasar dan krusta
di dasar bulu mata
Konjungtivitis papilary
dan cronik conjungtival
hyperaemia
Mata kering dan tear
film instability
Seborhoik blepharitis :
Hyperemic
Berminyak
Lengket-lengket

Kelainan
Kelopak
Mata

Pemeriksaan

anamnesa

Therapi

Gejala = anterior
blepharitis
Tertutupnya lubang
kelenjar meibom oleh
gumpalan minyak
Hyperaemia dan
telangiectasis di lid
maargin posterior
Penekanan keloopak
mata kelenjar
meibom keluar seperti
toothpaste or turbid
Tear film berminyak dan
berbusa

Blepharitis
chronic
posterior

Tetrasiklin
KI : anak2 < 12
thn, ibu hamil
dan ibu
menyusui
Oxytetracyclin
e 250 mg b.d
6-12 minggu
Dpxyxyxline
100 mg b.d 1
minggu dan
selanjutnya 1
kali sehari 6-12
minggu
Minocycline
100 mg perhari
6-12 minggu
Eritromisin
250 mg sehari/
2x1 boleh
untuk anak2

BAKTERIAL KERATITIS
F. RESIKO

Contact lens wear


Trauma
Ocular surface disease
Other factors include local or systemic immunosuppression,
diabetes and vitamin A deficiency.

PATFIS

Ocular defences have


been compromised
Neisseria gonorrhoeae, Neisseria meningitidis, Corynebacterium
diphtheriae and Haemophilus influenzae

TANDA & GEJALA

Pain, photophobia, blurred vision and mucopurulent or purulent discharge.


Signs
An epithelial defect
Stromal oedema
Chemosis and eyelid swelling in moderatesevere cases.
Severe ulceration
Scleritis
Endophthalmitis
Improvement
Subsequent scarring
Reduced corneal sensation
IOP

DD

Keratitis,marginal keratitis, sterile inflammatory corneal infiltrates


associated with contact lens
wear, peripheral ulcerative keratitis and toxic keratitis.

INVESTIGASI

Korneal scrapping
Konjungtiva swab
Kontak lens cases
Gram staining
Sensitivity respon

TREATMEN
T

Hospital
Discontinuation of contact lens wear
A clear plastic eye shield
Decision to treat

THERAPY

Local therapy:
Antibiotic monotherapy :
fluoroquinolone
Ciprofloxacin or ofloxacin
Moxifloxacin, gatifloxacin and besifloxacin
Antibiotic duotherapy:cephalosporin and aminoglycoside
Subconjunctival antibiotics
Mydriatics (cyclopentolate 1%, homatropine 2% or
atropine 1%)
Steroids

ISOLATE

AB

CONCENTRATION

Empirical
treatment

Fluoroquinolone
monotherapy or cefuroxime
+fortified gentamicin
duotherapy

Varies with
preparation 5% 1.5%

Grampositive
cocci

Cefuroxime
vancomycin
teicoplanin

0,3%
5%
1%

Gramnegative
rods

Fortified
gentamicin or
fluoroquinolone or
ceftazidime

1,5%
Varies with
Preparation 5%

Gramnegative
cocci

Fluoroquinolone
ceftriaxone

Varies with
Preparation 5%

Mycobacte
ria

Amikacin
clarithromycin

2%
1%

Nocardia

Amikacin
trimethoprim
sulfamethoxazole

2%
1.6%
8%

Bacterial keratitis. (A) Early ulcer; (B) large ulcer; (C)


advanced disease with hypopyon; (D) perforation
associated with
Pseudomonas infection

Fungal keratitis

PATFIS

Two main types of fungi cause keratitis:


Yeasts (e.g. genus Candida), ovoid unicellular organisms
that reproduce by budding, are responsible for most cases of
fungal keratitis in temperate climates.
Filamentous fungi (e.g. genera Fusarium and Aspergillus),
multicellular organisms that produce tubular projections
known as hyphae. They are the most common pathogens in
tropical climates, but are not uncommon in cooler regions;
the keratitis frequently follows an aggressive course.

F.RESIKO

chronic ocular surface disease, the long-term use of topical steroids contact
lens wear, systemic immunosuppression and diabetes. Filamentary keratitis
may be associated with trauma, often relatively minor, involving plant matter
or gardening/agricultural tools.

T.KLINIS

Symptoms.: Gradual onset of pain, grittiness, photophobia, blurred vision and


watery or mucopurulent discharge.
Candidal keratitis: Yellowwhite densely suppurative infiltrate is typical
Filamentous keratitis
Grey or yellowwhite stromal infiltrate with indistinct fluffy margins
Progressive infiltration, often with satellite lesions
Feathery branch-like extensions or a ring-shaped infiltrate may develop.
Rapid progression with necrosis and thinning can occur.
Penetration of an intact Descemet membrane may occur
and lead to endophthalmitis without evident perforation.
An epithelial defect is not invariable and is sometimes small
Other features include anterior uveitis, hypopyon,
endothelial plaque, raised IOP, scleritis and sterile or
infective endophthalmitis.

DD

bacterial, herpetic, acanthamoebal keratitis. Bacterial infection may


sometimes present subacutely, particularly when atypical organisms

Investigasi

Staining
Culture. Corneal scrapes
Polymerase chain reaction
Corneal biopsy
Anterior chamber tap has been advocated in resistant cases
with endothelial exudate
Confocal microscopy

Treatment

Removal of the epithelium over the lesion may enhance


penetration of antifungal agents.
Topical antifungals should initially be given hourly for 48
hours and then reduced as signs permit. Because most
antifungals are only fungistatic, treatment should be
continued for at least 12 weeks.
Candida infection is treated with amphotericin B 0.15%
or econazole 1%; alternatives include natamycin 5%,
fluconazole 2%, clotrimazole 1% and voriconazole 1 or 2%.
Filamentous infection is treated with natamycin 5% or econazole 1%; alternatives
are amphotericin B 0.15%, miconazole 1% and voriconazole 1 or 2%.
A broad-spectrum antibiotic might also be considered to address or prevent
bacterial co-infection.
Cycloplegia as for bacterial keratitis.
Subconjunctival fluconazole may be used in severe cases.
Systemic antifungals voriconazole 400 mg twice daily for one day then 200 mg
twice daily, itraconazole
200 mg once daily, reduced to 100 mg once daily, or fluconazole 200 mg twice daily.
Tetracycline (e.g. doxycycline 100 mg twice daily) may be given for its
anticollagenase effect when there is significant thinning.
IOP should be monitored.
Perforation actual or impending is managed as for bacterial keratitis.

(A) Severe candidal keratitis;


(B) filamentous keratitis with fluffy
edges there is a large
epithelial defect, and folds in
Descemet membrane; (C) and
(D) satellite lesions; (E) ring infiltrate,
with satellite lesions
and a hypopyon

Acute dakrioadenitis

Etiologi

Bisa disebabkan mumps,


mononukleosis, bakteri

Presentasi

Tidak nyaman fase akut pada


kelenjar lakrimal

Tanda

Bengkak lateral kelopak mata S


ptosis
Distopia kebawah/ kedalem
Sakit dikelenjar lakrimal
Injeksi palpebra dari kel lakrimal
Lakrimal sekresi menurun

CT

Pembesaran kelenjar

DD

Ruptur dermoid kista


menyebabkan inf kel lakrimal
Malignant lakrimal gland tumor

Acute dakriosisitis
Etiologi

Inf sakus lakrimal akibat obstruksi duktus


nasolakrimal krn inf staf/strep

Presentasi

Sakit Onset subakut di medial cantus area dgn


epihora

tanda

Sangat sakit, merah, bengkak di medial kantus


dihub dgn preseptal selulitis
Bisa ada abses

treatment

Initial: kompres hangat & AB oral: flucloxacsilin/


co-amoxiclav
Insisisi& drainage: jika ada abses
DCR: stlh inf akut yg sudah dikontrol
Surgery jangan ditunda jika ada epiphora bisa inf
rekuren

Kronik
drakiosisitis
presentasi

Epiphora, kronik& rekuren unilateral konjungtivitis


Tunda surgery sampai infeksi lakrimal sudah
ditatalaksana

tanda

Bengkak tanpa rasa sakit pada inner kantus krn

Patfis

Bisa disebabkan kronik


blefaritis &H.zooster
Ophtalmikus

Tanda

Misdirestion posterior bulu mata


tp munculnya tetap dari asal
Trauma epitel kornea= erosi
epitel pungtata dengan iritasi
mata yg diperparah dengan
kedipan
Ulserasi kornea dan bentuk
pannus= pada kasus yang sudah
lama

treatment

Epilation: dengan forceps, tp


rekuren 4-6mgg
Electrolisis =bisa menyebabkan
scarring
Cryoterapi: samgat efektif
eliminasi bulu mata