LAPORAN JAGA RESIDEN MATA

Selasa, 7 Agustus 2018, pkl 07.00 s/d

Rabu, 8 Agustus 2018, pkl 07.00 WIB

Konsulen Jaga : Dr. H. Ibrahim, SpM (K)

Residen jaga
Jaga 2 : dr. Fera Yunita
Jaga 1 : dr. Nafila Mahida
: dr. Desfri Angraini

Department of Ophthalmology Sriwijaya University

Mohammad Hoesin Hospital Palembang
2018
Data Dasar Permasalahan Assesment Planning
Ny. W/ Pr /42 VODS: 1/300 • Blefarokerat - Informed consent
th/ Luar kota TIODS : Belum dapat dilakukan okonjungtiviti - Polivinil Pirolidone 1 gtt/jam
s ODS ODS
Konsul dari ODS: • Lagoftalmus - Levofloxacin 1gtt/jam ODS
bagian DV GBM : Hambatan ke segala ODS - Kloramfenikol 3 x1 ue ODS
dengan arah (-1) • Ektropion - Carbomer + Retinol
diagnosis Palpebra: palpebra Palmitate gel 3 x1 ue ODS
TEN superior et
• Eritema, krusta (+), inferior ODS - Kompres dengan kassa
ekskoriasi (+) yang dibasahi RL tiap 5
KU/ Kedua • Margo palpebra superior et menit ODS
mata merah inferior berputar ke arah luar ICD 10 : - Rawat bersama subdivisi IIM
disertai H. 10.503
kelopak mata • Lagoftalmus (+) 15 mm H. 02.209
yang sulit Konjungtiva: Terapi DV :
H. 02.109
menutup • Kemosis (+) - Metil prednison 62,5 mg/24
sejak 14 hari • Mixed Injeksi (+) jam
SMRS Assesment DV: - IVFD RL : NaCL : D5 =1:1:1
• Sekret (+) mukopurulen
Toxic Epidermal gtt XX/mnt
Kornea : Necrolysis
• OD : Keruh, FT (+) di seluruh - Ranitidin 1 ampul / 24 jam
permukaan kornea, infiltrat - Gentamicin 80 mg/ 12 jam
(+) ICD 10 : - Cetrizine 10 mg/12 jam
• OS :Keruh, FT (+) di sentral L . 51.2 - Kompres terbuka NaCl/12
kornea ukuran 8x6 mm, jam
infiltrat (+)
 Riwayat Perjalanan Penyakit
Sekitar 16 hari SMRS, pasien mengeluh timbul bercak
kemerahan pada wajah dan badan. Pasien kemudian berobat ke dokter
diberi obat amoxicillin. Keluhan kemerahan pada kulit semakin
bertambah, disertai kulit yang mengelupas. Keluhan mata merah (-),
sekret (-), pandangan kedua mata kabur (-), sulit menutup .
Sekitar 14 hari SMRS, pasien mengeluh bercak kemerahan pada
wajah dan badan bertambah banyak. Pasien juga mengeluhkan kulit
mengeras dan semakin kaku, kedua kelopak mata sulit menutup.
Keluhan mata merah (+), kotoran mata (+), pandangan kedua mata
kabur (+), berair-air (+), silau (+). Pasien kemudian berobat ke RSUD
Jambi dan dirujuk ke RSMH
Riwayat penyakit dengan keluhan yang sama sebelumnya disangkal
Riwayat kacamata disangkal
Riwayat hipertensi dan DM disangkal
Riwayat alergi sebelumnya tidak ada
Riwayat Pengobatan minum obat tablet amoxicilin
 Status Generalis

• Sensorium : Compos mentis

• TD : 120 / 70 mmHg
• Nadi : 86 x/menit
• Laju napas : 20 x/menit
• Temperatur : 38,3°C
 Status Oftalmologikus
OD OS
VOD : 1/300 ph(-) VOS 1/300 ph(-)

TIOD : TIOS :
Belum dapat Belum dapat
dilakukan dilakukan
KBM Ortophoria
GBM -1 -1 -1 -1
-1 -1 -1 -1
-1 -1 -1 -1
Palpebra Eritema, krusta (+), ekskoriasi (+) Eritema, krusta (+), ekskoriasi (+)

Margo palpebra superior et inferior Margo palpebra superior et inferior

berputar ke arah luar berputar ke arah luar

Lagoftalmus (+) 15 mm Lagoftalmus (+) 15 mm

Skleral show (+) Skleral show (+)

Konjungtiva Kemosis (+) Kemosis (+)

Mixed injeksi (+) Mixed injeksi (+)

Sekret (+) mukopurulen Sekret (+) mukopurulen

Kornea Keruh, FT (+) di seluruh permukaan Keruh, FT (+) di sentral ukuran 8 x

kornea, Infiltrat (+) 11 mm, Infiltrat (+)

BMD Sedang Sedang

Iris Gambaran baik Gambaran baik

Pupil Bulat, sentral, RC (+) ø 3 mm Bulat, sentral, RC (+)ø 3 mm

SEGMEN POSTERIOR
RFODS (+)

FODS : Tidak dilakukan

Foto Pasien
Corneal Drawing
 Hasil Laboratorium
Pemeriksaan Nilai Normal
Darah Rutin
Hemoglobin 15,8 g/dL 13, 2-17,3 g/dL
RBC 5.15 10⁶/mmᶟ 4,20-4,8 10⁶/mmᶟ
WBC 13.2 10ᶟ/mmᶟ 4,5-11,0 10ᶟ/mmᶟ
Hematokrit 45 % 43-49 %
Trombosit 174 10ᶟ/μL 150-450 10ᶟ/μL
Hitung jenis
-Basofil 0% 0-1 %
-Eosinofil 3% 1-6%
-Neutrofil 78 % 50-70%
-Limfosit 15 % 20-40 %
-Monosit 4% 2-8 %
 Pemeriksaan Nilai Normal
Kimia Klinik
SGOT 45 μL 0-31 μL
SGPT 31 μL 0-41 μL
Ginjal
-Ureum 47 mg/dL 16,6-48,5 mg/dL
-Creatinin 0.76 mg/dL 0,70-1,20 mg/dL
Elektrolit
-Natrium 132 mEq/L 135-155 mEq/L
-Kalium 5,5mEq/L 3,5-5,5 mEq/L
-Clorida 99 meq/L
Gula Darah sewaktu 142 mg/dl 80-120 mg/dl
Follow Up Kamis 9 Agustus 2018
S/ Mata merah berkurang + kedua kelopak mata
belum dapat menutup
O/
OD OS
VOD : <1/60 ph(-) VOS <1/60 ph(-)

TIOD : TIOS :
Belum dapat Belum dapat
dilakukan dilakukan
KBM Ortoforia
GBM -1 -1 -1 -1
-1 -1 -1 -1
-1 -1 -1 -1
Palpebra Eritema, krusta (+), ekskoriasi (+) Eritema, krusta (+), ekskoriasi (+)

Margo palpebra superior et inferior Margo palpebra superior et inferior

berputar ke arah luar berputar ke arah luar

Lagoftalmus (+) 15 mm Lagoftalmus (+) 15 mm

Skleral show (+) Skleral show (+)

Konjungtiva Kemosis (+) Kemosis (+)

Mixed injeksi (+) Mixed injeksi (+)

Sekret (+) mukopurulen Sekret (+) mukopurulen

Kornea Keruh, FT tidak dilakukan Keruh, FT tidak dilakukan

Infiltrat (+) Infiltrat (+)

BMD Sedang Sedang

Iris Gambaran baik Gambaran baik

Pupil Bulat, sentral, RC (+) ø 3 mm Bulat, sentral, RC (+)ø 3 mm

SEGMEN POSTERIOR
RFODS (+)

FODS : Tidak dilakukan

Foto Pasien
A:
- Blefarokeratokonjungtivitis ODS
- Lagoftalmus ODS
- Ektropion palpebra superior + inferior ODS

P:
- Polivinil Pirolidone 1 gtt/jam ODS
- Levofloxacin 1gtt/jam ODS
- Kloramfenikol EO 1 ue/8 jam ODS
- Carbomer + Retinol Palmitate gel = 1ue/ 8
jam ODS
- Kompres basah dengan kasa + RL/5 menit
ODS
Follow Up Jumat, 10 Agustus 2018
S/ Mata merah berkurang + kedua kelopak mata
belum dapat menutup
O/
OD OS
VOD : <1/60 ph(-) VOS <1/60 ph(-)

TIOD : TIOS :
Belum dapat Belum dapat
dilakukan dilakukan
KBM Ortoforia
GBM -1 -1 -1 -1
0 0 0 0
-1 -1 -1 -1
Palpebra Eritema, krusta (+), ekskoriasi (+) Eritema, krusta (+), ekskoriasi (+)
Status Oftalmologikus
Margo palpebra superior et inferior Margo palpebra superior et inferior
berputar ke arah luar berputar ke arah luar

Lagoftalmus (+) 15 mm Lagoftalmus (+) 15 mm

Skleral show (+) Skleral show (+)

Konjungtiva Kemosis (+) ↓ Kemosis (+) ↓

Mixed injeksi (+) Mixed injeksi (+)

Sekret (+) mukopurulen ↓ Sekret (+) mukopurulen ↓

Kornea Keruh, FT (+) di sentral ukuran ± 8 Keruh, FT (+) di sentral ukuran ±

x 8 mm, infiltrat (+) ↓ 6x 8 mm , infiltrat (+) ↓

BMD Sedang Sedang

Iris Gambaran baik Gambaran baik

Pupil Bulat, sentral, RC (+) ø 3 mm Bulat, sentral, RC (+)ø 3 mm

Lensa Jernih Jernih

SEGMEN POSTERIOR
RFODS (+)

FODS : Tidak dilakukan

Foto Pasien
A:
- Blefarokeratokonjungtivitis ODS
- Lagoftalmus ODS
- Ektropion palpebra superior + inferior ODS

P:
- Polivinil Pirolidone 1 gtt/jam ODS
- Levofloxacin 1gtt/jam ODS
- Kloramfenikol 1 ue/8 jam ODS
- Carbomer + Retinol Palmitate gel = 1ue/ 8
jam ODS
- Kompres basah dengan kasa + RL/5 menit
ODS
Follow Up Sabtu, 11 Agustus 2018
S/ Mata merah berkurang + kedua kelopak mata
belum dapat menutup
O/
OD OS
VOD : 1/60 ph(-) VOS 1/60 ph(-)

TIOD : TIOS :
Belum dapat Belum dapat
dilakukan dilakukan
KBM Ortoforia
GBM 0 0 0 0
0 0 0 0
0 0 0 0
 Status Oftalmologikus
Palpebra Eritema, krusta (+), ekskoriasi (+) Eritema, krusta (+), ekskoriasi (+)

Margo palpebra superior et inferior Margo palpebra superior et inferior

berputar ke arah luar berputar ke arah luar

Lagoftalmus (+) 15 mm Lagoftalmus (+) 15 mm

Skleral show (+) Skleral show (+)

Konjungtiva Mixed injeksi (+) ↓ Mixed injeksi (+) ↓

Sekret (+) mukopurulen ↓ Sekret (+) mukopurulen ↓

Kornea Keruh, FT (+) tidak dilakukan Keruh, FT (+) tidak dilakukan

Infiltrat (+) Infiltrat (+)

BMD Sedang Sedang

Iris Gambaran baik Gambaran baik

Pupil Bulat, sentral, RC (+) ø 3 mm Bulat, sentral, RC (+)ø 3 mm

SEGMEN POSTERIOR
RFODS (+)

FODS : Tidak dilakukan

Foto Pasien
A:
- Blefarokeratokonjungtivitis ODS
- Lagoftalmus ODS
- Ektropion palpebra superior + inferior ODS

P:
- Polivinil Pirolidone 1 gtt/jam ODS
- Levofloxacin 1gtt/jam ODS
- Kloramfenikol 1ue/8 jam ODS
- Carbomer + Retinol Palmitate gel 1ue/8 jam
ODS
- Kompres basah dengan kasa + RL/5 menit
Follow Up Minggu, 12 Agustus 2018
S/ Mata merah +
Kedua kelopak mata belum dapat menutup
O/ OD OS
VOD : 1/60 ph(-) VOS: 1/60 ph(-)

TIOD : TIOS :
Belum dapat Belum dapat
dilakukan dilakukan
KBM Ortoforia
GBM 0 0 0 0
0 0 0 0
0 0 0 0
 Status Oftalmologikus
Palpebra Eritema, krusta (+), ekskoriasi (+) Eritema, krusta (+), ekskoriasi (+)

Margo palpebra superior et inferior Margo palpebra superior et inferior

berputar ke arah luar berputar ke arah luar

Lagoftalmus (+) 15 mm Lagoftalmus (+) 15 mm

Skleral show (+) Skleral show (+)

Konjungtiva Mixed injeksi (+) ↓ Mixed injeksi (+) ↓

Sekret (+) mukopurulen ↓ Sekret (+) mukopurulen ↓

Kornea Keruh, FT (+) di sentral uk ± Keruh, FT (+) di parasentral uk ±

6x8 mm, infiltrat (+) 6x4 mm, infiltrat (+)

BMD Sedang Sedang

Iris Gambaran baik Gambaran baik

Pupil Bulat, sentral, RC (+) ø 3 mm Bulat, sentral, RC (+)ø 3 mm

Lensa Jernih Jernih

SEGMEN POSTERIOR
RFODS (+)

FODS : Tidak dilakukan

Foto Pasien
A:
- Blefarokeratokonjungtivitis ODS
- Lagoftalmus ODS
- Ektropion palpebra superior + inferior ODS

P:
- Polivinil Pirolidone 1 gtt/jam ODS
- Levofloxacin 1gtt/jam ODS
- Kloramfenikol 1 ue/ 8 jam ODS
- Carbomer + Retinol Palmitate gel 1 ue/ 8
jam ODS
- Kompres basah dengan kasa + RL/5 menit
Follow Up Senin, 13 Agustus 2018
S/ Mata merah + kedua kelopak mata belum dapat
menutup
O/
OD OS
VOD : 1/60 VOS: 1/60

TIOD : TIOS :
Belum dapat Belum dapat
dilakukan dilakukan
KBM Ortoforia
GBM 0 0 0 0
0 0 0 0
0 0 0 0
Palpebra Eritema, krusta (+), ekskoriasi (+) Eritema, krusta (+), ekskoriasi (+)

Margo palpebra superior et inferior Margo palpebra superior et inferior

berputar ke arah luar berputar ke arah luar

Lagoftalmus (+) 15 mm Lagoftalmus (+) 15 mm

Skleral show (+) Skleral show (+)

Konjungtiva Mixed injeksi (+) ↓ Mixed injeksi (+) ↓

Sekret (+) mukopurulen ↓↓ Sekret (+) mukopurulen ↓↓

Kornea Keruh ↓, FT tidak dilakukan Keruh ↓, FT tidak dilakukan

Infiltrat (+) Infiltrat (+)

BMD Sedang Sedang

Iris Gambaran baik Gambaran baik

Pupil Bulat, sentral, RC (+) ø 3 mm Bulat, sentral, RC (+)ø 3 mm

Lensa Jernih Jernih

SEGMEN POSTERIOR
RFODS (+)

FODS : Tidak dilakukan

Foto Pasien
A:
- Blefarokeratokonjungtivitis ODS
- Lagoftalmus ODS
- Ektropion palpebra superior + inferior ODS

P:
- Polivinil Pirolidone 1 gtt/jam ODS
- Levofloxacin 1gtt/jam ODS
- Kloramfenikol 1 ue/8 jam ODS
- Carbomer + Retinol Palmitate gel 1 ue/8 jam
ODS
- Kompres basah dengan kasa + RL/5 menit
 Konjungtivitis

gejala bakteri virus alergi

1. Injeksi +++ ++ +
konjungtiva
2. Sekret +++ ++ +
3. Inflamasi papil folikel papil
konjungtiva
tarsal
 Konjungtivitis

gejala bakteri virus alergi

1. Injeksi +++ ++ +
konjungtiva
2. Sekret +++ ++ +
3. Inflamasi papil folikel papil
konjungtiva
tarsal
• Papillae
• Papillae are vascular changes seen most
easily in the palpebral conjunctiva where
fibrous septae anchor the conjunctiva to
the tarsus. With progression, these dilated
vessels sprout spokelike capillaries that
become surrounded by edema and a
mixed inflammatory cell infiltrate,
producing raised elevations under the
conjunctival epithelium
• Folikel : Focal lymphoid nodule with
accessor vascularization
• Follicular conjunctivitis involves red ness
and new or enlarged follicles (Fig 2- 11 ).
Vessels surround and encroach on the
raised surface of follicles but are not
prominently visible within the follicle
 Conjuctiva histology

1 The epithelium is non-keratinizing and around five cell layers deep Basal cuboidal cells
evolve into flattened polyhedral cells before they are shed from the surface. Goblet cells
are located within the epithelium and are densest inferonasally and in the fornices.

2 The stroma (substantia propria) consists of richly vascularized loose connective tissue.
The adenoid superficial layer does not develop until about 3 months after birth, hence the
inability of the newborn to produce a follicular conjunctival reaction. The deep fibrous layer
merges with the tarsal plates. The accessory lacrimal glands of Krause and Wolfring are
located deep within the stroma. Mucus from the goblet cells and secretions from the
accessory lacrimal glands are essential components of the tear film.
3 Conjunctiva-associated lymphoid tissue (CALT) is critical in the initiation and
regulation of ocular surface immune responses. It consists of lymphocytes within the
epithelial layers, lymphatics and associated blood vessels, with a diffuse stromal
component of lymphocytes and plasma cells, including follicular aggregates.
Conjunctiva
• Patients with Stevens-Johnson syndrome
are at higher risk of infection due to loss of
the epithelial barrier and hence may
develop severe ocular infection concurrent
with the ocular surface disease
 conjunctiva
• The conjunctiva is a mucous membrane
consisting of a non keratinizing squamous
epithelium with numerous goblet cells and a thin,
richly vascularized substantia propria containing
lymphatic vessels, plasma cells, macrophages,
and mast cells.
• Specialized aggregations of conjunctiva-
associated lymphoid tissue (CALT) correspond
to l11ucosaassociated lymphoid tissue (MALT)
elsewhere and comprise collections of T and B
lymphocytes underlying a modified epithelium.
These regions are concerned with antigen
processing
 Bacterial Conjunctivitis

• Although the ocular surface resists bacterial infection

through a variety of mechanisms, conjunctival infection
can occur when an organism is able to overcome the
host's resistance. Host resistance can be impaired in
disease states, in immunocompromised patients, or
following trauma. Most common bacterial pathogens
can cause conjunctivitis. These pathogens include
Staphylococcus species, Haemophilus species,
Streptococcus pneumoniae, and Moraxella species.
Streptococcus and Haemophilus infections occur more
frequently in children.9 Bacterial conjunctivitis can be
classified as hyperacute, acute, and chronic
 Hyperacute Bacterial Conjunctivitis

•Hyperacute (purulent) bacterial conjunctivitis is commonly caused by

Neisseria gonorrhoeae, microorganisms that can penetrate an intact
corneal epithelium, or, less frequently, by Neisseria meningitides.
Other bacteria that are less common causes of hyperacute
conjunctivitis include Staphylococcus aureus, Streptococcus species,
Haemophilus species, and Pseudomonas aeruginosa.
•Most commonly acquired by autoinoculation from infected genitalia
and most often seen in neonates, adolescents, and young adults,
hyperacute bacterial conjunctivitis may also be more common during
warmer months of the year.
•Rapid onset of copious purulent discharge, severe conjunctival
hyperemia, conjunctival chemosis, and lid edema. The conjunctivitis
may be unilateral or bilateral, accompanied by pain, globe
tenderness, and preauricular lymphadenopathy.
 Acute Bacterial Conjunctivitis

•A common infectious condition that can affect all ages and races and
both genders, acute (mucopurulent) bacterial conjunctivitis is caused by
a number of microbial agents, primarily Staphylococcus aureus,
Streptococcus pneumoniae, and Haemophilus species. The condition
is self-limiting, generally lasting less than 3 weeks.
•Acute onset of unilateral discharge, irritation, and diffuse conjunctival
hyperemia. The tarsal conjunctiva usually features a papillary
response. Mucopurulent/purulent discharge is common in acute
bacterial conjunctivitis; preauricular lymphadenopathy is generally
absent. The fellow eye typically becomes involved within 48 hours. In
children 6 months to 3 years old, conjunctivitis accompanied by bluish
discoloration and swelling of the periorbital skin suggests potential
progression to orbital cellulitis from a Haemophilus influenzae infection.
This infection, which may be associated with fever and upper
respiratory tract infection, can progress to include septicemia,
metastatic meningitis, septic arthritis, or endophthalmitis
 Chronic Bacterial Conjunctivitis

•Bacterial conjunctivitis lasting longer than 4 weeks can be considered

chronic and usually has a different etiology than acute bacterial
conjunctivitis. Chronic bacterial conjunctivitis is frequently associated
with continuous inoculation of bacteria associated with blepharitis. The
most common cause of chronic bacterial conjunctivitis is
Staphylococcus aureus. Angular blepharoconjunctivitis can result from
chronic staphylococcal or Moraxella infections
•A variety of nonspecific symptoms and clinical finding. Patients often
experience chronic (longer than 4-week) irritation, foreign body
sensation, and lowgrade conjunctival hyperemia. A papillary or
follicular reaction can occur, and mucoid discharge may be present.
Chronic conjunctivitis is often accompanied by lid hyperemia and eyelid
crusting that are typically present in the morning
 Bacterial Conjunctivitis
•The ideal method of treating bacterial conjunctivitis is to identify the
causative organism and initiate specific antimicrobial treatment known
to be effective against the offending organism. Table 7 lists the
commonly available topical antimicrobial drugs and the spectrum of
activity and recommended dosage for each. In the absence of a
culture or smear, the etiologic agent should be considered in the
context of the patient's age, environment, and related ocular findings.
In most cases, a broad-spectrum topical antibiotic is the treatment of
choice.10 Although most cases of bacterial conjunctivitis are self-
limited, treatment with effective antibiotics can lessen the patient's
symptoms, decrease the duration of the infection, and reduce the
chances of its recurrence.
• Hyperacute conjunctivitis requires special consideration because of
potential blinding from inadequately treated gonococcal infections.
Conjunctival smears and cultures should be obtained before
beginning treatment. The administration of systemic antibiotics that
are effective against the identified organisms should be started
immediately. Saline lavage may be beneficial in removing purulent
discharge. In the case of gonococcal infection, the Centers for
Disease Control and Prevention (CDC) recommends the
administration of a single dose of intramuscular ceftriaxone.71
Although the CDC does not recommend topical treatment,
practitioners may wish to consider the addition of a topical
fluoroquinolone as adjunctive therapy. Patients should also be
evaluated for co-infection with other sexually transmitted diseases.
Care of the patient with sexually transmitted disease should be
coordinated with the patient's primary care physician.
• In most cases, a combination of
aminoglycoside and cephalosporin is used,
1 gtt qh during first 24 hours, e.g.
tobramycin 14 mg/mL and cephazolin 50
mg/mL; amikacin 25 mg/mL and
ceftazidime 25 mg/mL. Vancomycin 25
mg/mL may be added
1st Cinoxacin · Flumequine§ · Nalidixic acid · Oxolinic acid · Pipemidic acid ·
generation Piromidic acid · Rosoxacin
2nd Ciprofloxacin · Enoxacin · Fleroxacin‡ · Lomefloxacin · Nadifloxacin ·
generation Ofloxacin · Norfloxacin · Pefloxacin · Rufloxacin

3rd Balofloxacin · Grepafloxacin‡ · Levofloxacin · Pazufloxacin ·

generation Sparfloxacin · Temafloxacin‡ · Tosufloxacin

4th
Fluoroquin Clinafloxacin† · Garenoxacin · Gemifloxacin · Moxifloxacin · Gatifloxacin ·
generation
olones Sitafloxacin · Trovafloxacin‡/Alatrofloxacin‡ · Prulifloxacin

Danofloxacin§ · Difloxacin§ · Enrofloxacin§ · Ibafloxacin§ ·

Veterinary
Marbofloxacin§ · Orbifloxacin§ · Pradofloxacin§ · Sarafloxacin
• Vit C: menambah hidroksilasi prolin sbg
Cofaktor utk sintesa kolagen dan
penyembuhan luka—mencegah koagulasi
di stroma
• Antibiotik topikal/sistemik: sbg
profilaksis untuk mencegah infeksi
sekunder/mengurangi resiko terjadinya
ulkus
• Kortikosteroid:masih kontroversi—
membantu menekan reaksi radang
intraokular tetepai dapat menghambat
proses penyembuhan pd kornea

• Reepithel: Utk mempercepat

reepithelisasi
• Vit A: retinol---membantu penyembuhan
luka di kornea,mempercepat pengaktifan
sel fibroblas
 Konjungtivitis

gejala bakteri virus alergi

1. Injeksi +++ ++ +
konjungtiva
2. Sekret +++ ++ +
3. Inflamasi papil folikel papil
konjungtiva
tarsal