KONJUNGTIVITIS

Afi Falizia
Winanda Denis
Eveline

DOKTER MUDA KEPANITERAAN KLINIK 2

DEPARTEMEN ILMU KESEHATAN MATA
FAKULTAS KEDOKTERAN UNIVERSITAS AIRLANGGA
SURABAYA
 Definisi:
Suatu keradangan pada konjungtiva yang
disebabkan bakteri, virus, jamur, chlamidia,
alergi atau iritasi dengan bahan-bahan kimia
Keluhan:
o Mata merah, rasa mengganjal (Sandy Feeling),
gatal, panas, mata berair, yang dpat disertai
disertai secret, nyeri di sekitar mata.

Faktor Risiko:
o Daya tahan menurun, riwayat atopi,
penggunaan lensa kontak dengan perawatan
yang kurang baik, kurang menjaga kebersihan
diri.
PEMERIKSAAN FISIK
o Hiperemia o Hipertrofi papil
konjungtiva o Hipertrofi folikel
o Epifora o Limfadenopati
preaurikuler
o Sekret
o Pseudomembra
o Pseudoptosis n
o Kemosis o Membran
Hiperemia Kemosis
Sekret mukopurulen Sekret purulen
Hipertrofi papil Hipertrofi folikel
Hipertrofi papil
Membran
Pseudomembran
Limfadenopati preaurikuler
PEMERIKSAAN PENUNJANG

Sediaan Swab atau Scrapping Langsung

dengan pewarnaan Gram, KOH, atau Giemsa.
TIPE KONJUNGTIVITIS
Klinik & Sitologi Viral Bakteri Klamidia Alergi Jamur

Gatal Minim Minim Minim Hebat Tidak ada

Hiperemia Umum Umum Umum Umum Lokal
Air mata Profus Sedang Sedang Sedang Sedikit
Eksudasi Minim; Profus; Profus; berserabut Minim Minim
air purulen/mukopurule (lengket)
n
Adenopati Lazim Jarang Lazim hanya Tak ada Lazim
preaurikuler konjungtivitis inklusi
Pewarnaan Monosit Bakteri, PMN PMN, Plasma sel badan Eosinofil Negatif
kerokan & inklusi
eksudat
Sakit Kadang Kadang Tidak ada Tidak ada Tidak ada
tenggorok,
panas yang
menyertai
Allergic Conjunctivitis

Type 1 hypersensitivity (MOST COMMON): IgE

(crosslinking)  Mast Cell degranulation 
inflammatory mediators  increase of vascular
permeability, migration of eosinophils and
neutrophils

Type 3 hypersensitivity: antigen antibody immune

complex

Type 4 hypersensitivity: cell-mediated response

(PHLYCTENULAR KERATOCONJUNCTIVITIS)
Allergic Conjunctivitis

Seasonal Allergic Conjunctivitis (SAC)-Perennial Allergic

Conjunctivitis (PAC)
(Dibedakan dengan waktu dari gejalanya)  Common
airborne antigens

Vernal Keratoconjunctivitis (VKC)

Chronic bilateral inflammation  juga ada hubungan
dengan riwayat atopi

Atopic Keratoconjunctivitis (AKC)

Memiliki hubungan erat dengan dermatitis atopi

Giant Papillary Conjunctivitis (GPC)

Kombinasi antara hipersensitivitas tipe I dan tipe IV
Horner Trantas Spots/Dots Cobblestones
Grouping Type Risk Factors
Without
Environmental allergens, particularly if they are known; an
corneal Acute 
example is cat dander.
involvement 
Environmental allergens that are often associated with changes in
Seasonal 
seasons; examples include grass and weed pollens.
Environmental allergens that occur throughout the year;
Perennial  examples include Indoor allergens: dust mites, mold, animal
dander.
Environmental allergens may incite an acute exacerbation. Most
commonly present during the springtime with the associated
With corneal
Vernal  increase in pollen. Increased presence in hot and dry
involvement 
environments with a decrease in inflammation and symptoms
during the winter months.
Genetic predisposition to atopic reactions with comorbid asthma
and atopic dermatitis commonly present. Increased risk with
Atopic 
positive family history. Environmental allergens may cause an
acute exacerbation as well. No changes with seasons.
Commonly seen in individuals wearing soft contact lens who
infrequently replace their lenses, wear their lenses for prolonged
Giant papillary
periods of time, have poor lens hygiene, have poor contact lens
conjunctivitis
fitting, or are allergic to the various contact lens solution.
(GPC) 
Similarly, irritation from exposed sutures or prostheses increase
the risk for developing GPC.
Allergic
Natural History Potential Sequelae
conjunctivitis
Seasonal/Perenn Recur seasonally with the changes in pollens Minimal or local inflammation that often
ial conjunctivitis and allergens present. resolves and remits.
The onset of symptomatology begins in Untreated VKC can lead to eyelid
childhood and peaks at about 11-13 with thickening that ultimately leads to ptosis.
Vernal acute exacerbations occurring more Severe corneal involvement can cause
keratoconjunctiv frequently during the spring and summer corneal neovascularization, thinning,
itis (VKC) months. Commonly patients will “grow out” ulceration, and infection. This can lead to
of the disease with decreased symptoms vision loss or development of keratoconus.
ranging from 2-30 years of age. Conjunctival scarring can also occur.
The natural sequelae is similar to VKC with
eyelid thickening or tightening.
Conjunctival scarring can occur and
Similar to VKC, the onset of symptoms occurs
Atopic involvement of the cornea can lead to
during childhood but peaks during young
keratoconjunctiv scarring, neovascularization, thinning,
adult and continues into the fifth decade of
itis ulceration and infection. This can also
life. The course remains chronic with
(AKC) develop into keratoconus or cause vision
periodic acute exacerbations.
loss. There can also be development of
concurrent anterior or posterior
subcapsular cataracts.
This disease process is directly correlated
with presence of risk factors. Therefore,
Giant papillary
continued contact lens wear, exposed If left untreated, GPC can cause acquired
conjunctivitis
corneal or scleral sutures, or ocular ptosis.
(GPC)
prosthesis cause worsening or increasing in
symptoms.
 Konjungtivitis Virus
 Pharyngoconjunctival Fever
 Penyebab : Adenovirus tipe 3, 4, 7

 Epidemic Keratoconjunctivitis
 Penyebab : Adenovirus tipe 8, 19, 29, 37

 Herpes Simplex Virus Conjunctivitis

 Penyebab : HSV
Viral Conjunctivitis
 Konjungtivitis Bakteri
 Konjungtivitis Bakteri Akut
 Penyebab : H. influenza, S. pneumoniae, S. aureus,
Moraxella

 Konjungtivitis Bakteri Hiperakut

 Penyebab : Neisseria gonottheae

 Konjungtivitis Bakteri Kronis

 Terjadi pada pasien dengan obstruksi duktus lakrimalis,
dakriosistitis kronis
Staphylococcus, Streptococcus, Corynebacterium, Haemophilus, Pseudomonas, and Moraxella species
 Konjungtivitis Chlamydia
 Trakoma
 Penyebab : Chlamydia trachomatis serotipe A, B, dan C
 Inclusion Conjunctivitis
 Penyebab : Chlamydia trachomatis serotipe D dan K
 Perbedaan trakoma dan inclusion conjunctivitis secara
klinis:
 Trakoma
Pada anak-anak dan komunitas yang terekspos trakoma secara
endemik
Terdapat Herbet’s pits  folikel pada limbus
 Inclusion conjunctivitis
Pada remaja atau dewasa yang seksual aktif
Jarang terjadi conjuctival scarring
CHLAMYDIA
DIFFERENTIAL DIAGNOSIS

Keratitis akut
Uveitis akut
Glaukoma akut
Pendarahan subkonjungtiva
TATALAKSANA
Konjungtivitis Virus
 Pharyngoconjunctival Fever
 Self-limited→ 10 hari
 Epidemic Keratoconjunctivitis
 Kompres dingin
 Antibiotik jika ada infeksi sekunder
 Herpes Simplex Virus Conjunctivitis
 Pada anak > 1 tahun dan dewasa
 Self limited
 Antiviral topikal/sistemik diberikan untuk mencegah keterlibatan
pada kornea
 Bila ada ulkus kornea
 Corneal debridement → menghapus sekret dengan cotton swab
 Antiviral topikal → Trifluridine eye drop tiap 2 jam selama 7-10
hari
Konjungtivitis Bakteri
 Tergantung bakteri penyebab
 Sambil menunggu dapat diberi antibiotik broad spectrum topikal →
Polymixin-trimethoprim
 Sekret purulen dan mukopurulen → irigasi dengan normal saline
 Konjungtivitis Bakteri Akut
 Self limited dalam 5 hari
 Antibiotik untuk mempercepat penymbuhan dan mencegah reinfeksi
 Konjungtivitis Bakteri Hiperakut
 Topikal → Gentamycin / Bacitracin / Ciprofloxain tiap jam
 Sistemik
 Kornea (-) → Ceftriaxone 1 g IM single dose
 Kornea (+) → Ceftriaxone 1-2 g per hari IV selama 5 hari
 Konjungtivitis Bakteri Kronis
 Atasi penyebab → obstruksi duktus lakrimalis, dakriosistis kronis
Konjungtivitis Chlamydia
 Trakoma
Sistemik
 Tetrasiklin 1-1,5 g PO 4 kali sehari selama 3-4 minggu atau
 Doxycycline 100 mg PO 2 kali sehari selama 3 minggu atau
 Erithromycin 1 g PO 4 kali sehari selama 3-4 minggu
 Azithromycin 1 g PO single dose → untuk anak-anak
Topikal
 Sulfonamid/Tetrasiklin/Eritromisin/Rifampin 4 kali sehari
selama 6 minggu
 Inclusion Conjunctivitis
 Doxycycline 100 mg PO 2 kali sehari selama 7 hari atau
 Erithromycin 2 g PO selama 7 hari
 Azithromycin 1 g PO single dose
Konjungtivitis Jamur
 Candida
 Amphotericin B 3-8 mg/ml in aqueous solution
 Nystatin dermatologic cream 100.000 U/g 4-6 kali sehari

Konjungtivitis Alergi
 Konjungtivitis Atopi = Vernal
 Ringan

 Vasokonstriktor-antihistamin topikal
 Kompres dingin
 Sedang-berat

 Sodium cromolyn 2% topikal

 Kortikosteroid → Dexamethasone 0,5%
PENYULIT
 Phlycten
(Plikten)
 Keratitis epitelial
 Ulkus kataralis
PROGNOSIS
 DUBIA AD BONAM
» Konjungtivitis pada umumnya self-limiting disease
» Tanpa pengobatan dapat sembuh dalam 10-14 hari
» Dengan pengobatan dapat mempercepat penyembuhan, dalam waktu 1-3 hari
EDUKASI
1. Menjelaskan bahwa konjungtivitis merupakan penyakit menular
2. Menggunakan obat yang diberikan secara teratur untuk mempercepat penyembuhan
3. Membersihkan sekret sesering mungkin
4. Kompres hangat atau dingin
5. Tidak mengucek-ngucek mata
6. Cuci tangan sebelum dan sesudah menyentuh mata untuk mencegah penularan
penyakit