CRS Allergic Conjungtivitis
CRS Allergic Conjungtivitis
Konjungtivitis Alergi
Agnesya
Awilia Fargi Hidayati
Muhammad Ananta Winarto
Preseptor:
Dr. Andhika Prahasta, dr., SpM (K), M.Kes
Ine Renata Musa, dr., SpM (K)
I. IDENTITAS
Nama : Nn. E
Usia : 19 tahun
Alamat : Bandung
Pekerjaan : Karyawan
Status Perkawinan : Belum Kawin
Pendidikan Terakhir : SMA
Tanggal Pemeriksaan : 15 Maret 2018
II. ANAMNESIS
Keluhan Utama:
Penglihatan buram
Riwayat penyakit sekarang:
Pasien mengeluh penglihatan buram sejak 1 tahun SMRS. Penglihatan buram
dirasakan semakin lama semakin memburuk. Pasien juga mengeluh mata merah
dan gatal di kedua mata sekitar 10 tahun SMRS. Keluhan juga disertai dengan mata
berair. Pasien juga mengeluhkan kelopak mata yang bengkak dan merah. Keluhan
tersebut muncul setiap kali pasien makan seafood .
Pasien menyangkal adanya rasa mengganjal setiap kali pasien berkedip.
Keluhan silau ketika melihat cahaya disangkal pasien. Keluhan tidak disertai
dengan demam, batuk dan pilek, nyeri menelan dan pembengkakan pada daerah
leher ataupun nyeri tekan di sekitar telinga. Pasien menyangkal adanya kontak
dengan penderita sakit mata.
Riwayat pengobatan:
Pasien merasakan keluhan seperti ini sejak 10 tahun yang lalu dan
hilang timbul. Setiap keluhan muncul, pasien biasanya berobat ke puskesmas
dan diberikan obat tetes mata.
Riwayat penyakit dahulu:
Tenang Tenang
Silia krusta (-), trikhiasis (-) krusta (-), trikhiasis (-)
hiperemis (+), sekret (-), hiperemis (+), sekret (-),
K. Tarsal Superior papilla (+), papilla (+),
pseudomembrane (-) Pseudomembrane (-)
Pupil distance 60 mm
DIAGNOSIS BANDING
1. Atopic Keratoconjunctivitis alergi ODS + refractive
error ODS
2. Vernal Keratoconjunctivitis alergi ODS + refractive
error ODS
DIAGNOSIS KERJA
Atopic Keratoconjunctivitis alergi ODS +
refractive error ODS
TATALAKSANA
Umum
• Menghindari pajanan alergen
• Memberikan kompres dengan air dingin
• Menjaga kebersihan mata
• Istirahat dan makan cukup
• Kontrol 7 hari kemudian
Farmakalogis
• Artificial tear drops (6dd 1gtt sampai habis)
• Mast cell stabilizer (alegysal) 2 dd ODS
• Antibiotik Ofloxacin (6dd 1gtt sampai habis)
Prognosis
Types
1. Simple allergic conjunctivitis
Hay fever conjunctivitis
Seasonal allergic conjunctivitis (SAC)
Perennial allergic conjunctivitis (PAC)
2. Vernal keratoconjunctivitis (VKC)
3. Atopic keratoconjunctivitis (AKC)
4. Giant papillary conjunctivitis (GPC)
5. Phlyctenular keratoconjunctivitis (PKC)
6. Contact dermoconjunctivitis (CDC)
Simple Allergic Conjunctivitis
It is a mild, non-specific allergic conjunctivitis characterized by itching,
hyperaemia and mild papillary response. Basically, it is an acute or
subacute urticarial reaction.
Etiological Form:
1. Hay Fever Conjunctivitis
2. Seasonal Allergic Conjunctivitis
3. Perennial Allergic Conjunctivitis
Clinical Picture:
Symptoms
• Intense itching and burning sensation in the eyes
• Watery discharge
• Photophobia
Signs
• Hyperaemia and chemosis swollen and juicy appearance
• May show mild papillary reaction
• Edema of lids
Simple Allergic Conjunctivitis
Diagnosis:
Typical symptoms and signs
Normal conjunctival flora
Presence of abundant eosinophils in the discharge
Treatment
• Elimination of allergens if possible
• Local palliative measures provide immediate relief
o Vasoconstrictors (adrenaline, ephedrine, and naphazoline)
o Sodium cromoglycate
o Steroid eye drops should be avoided. (may be prescribed for
short duration in severe and non-responsive patients.
• Systemic antihistaminic drugs
• Desensitization
Vernal Keratoconjunctivitis (VKC)
Systemic Therapy
Oral antihistaminics
Oral steroids
Atopic Keratoconjunctivitis (AKC)
It can be thought of as an adult equivalent of vernal keratoconjunctivitis and is often
associated with atopic dermatitis. Most of the patients are young atopic adults, with male
predominance.
Symptoms keratitis
• Itching, soreness, dry sensation Clinical course
• Mucoid discharge Has a protracted course with
• Photophobia or blurred vision exacerbations and remissions
Signs
• Lid margins are chronically inflamed Association
• Tarsal conjunctiva has milku Keratoconus and atopic cataract
appearance, there are very fine
papillae, hyperaemia, and scarring.
• Cornea may show punctate epithelial
Atopic Keratoconjunctivitis
Treatment
Treat facial eczema and lid margin disease
Sodium cromoglycate drops, steroids and tear
supplements.
Giant Papillary Conjunctivitis (GPC)
Inflammation of conjunctiva with formation of very large sized papillae.
Etiology
Localized allergic response to a physically rough
or deposited surface (contact lens, prosthesis, left
out nylon sutures).
Symptoms
• Itching
• Stringy discharge
• Reduce wearing time of contact lens or
prosthetic shell
Signs
• Papillary hypertrophy (>1 mm) of upper tarsal
conjunctiva
Giant Papillary Conjunctivitis
Treatment
Offending cause should be removed
Disodium cromoglycate
Steroids are not much use in this condition
Phlyctenular Keratoconjunctivitis
Etiology
• Tuberculous proteins were considered, previously, as the most common cause.
• Staphylococcus proteins are now thought to account for most of the cases.
• Other allergens may be proteins of Moraxella Axenfeld bacillius and certain
parasites (worm infestation).
Clinical Pictures
Symptoms
• Mild discomfot in the eye, irritation, and eye watering
• Associated mucopurulent conjunctivitis due to secondary bacterial infection.
Phlyctenular Keratoconjunctivitis
Simple
Typical pinkish white nodule surrounded by
hyperaemia on the bulbar conjunctiva usually
near the limbus.
Necrotizing
Presence of very large phlycten with necrosis
and ulceration.
Milliary
Multiple phlyctens, may be arranged hapzardly
or in a ring around the limbus
Phlyctenular Keratoconjunctivitis
Treatment
Local Therapy
Topical steroids (dexamethasone or betamethasone)
Antibiotic drops for secondary infection
Atropine 1% should be applied 1x/day when cornea is involved
Specific Therapy
Tuberculous infection
Septic focus
Parasitic infestation
Contact Dermoconjunctivitis
An allergic disorder, involving conjunctiva and skin of lids along with surrounding
area of face.
Etiology
A delayed hypersensitivity (type IV) response
to prolonged contact with chemicals and
drugs (atropine, penicillin, neomycin,
soframycin and gentamycin)
Clinical Picture
• Cutaneous involvement
o Eczematous reaction, involving all
areas with which medication comes in
contact
• Conjunctival response
o Hyperaemia with generalized papillary
response.
Contact Dermoconjunctivitis
Treatment
Discontinuation of the causative medication
Topical steroid eye drops
Steroid ointment on the involved skin
Terima Kasih