CASE REPORT

SESSION
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:

Riwayat adanya kulit kering dan terkadang gatal diakui pasien.

Riwayat alergi terhadap makanan seafood juga diakui pasien. Riwayat
penggunaan kacamata, lensa kontak, operasi, dan trauma tidak ada. Keluhan
yang sama pada keluarga tidak ada. Riwayat penyakit sistemik seperti
tekanan darah tinggi, kencing manis pada pasien dan keluarganya tidak ada.
Riwayat batuk lama disangkal pasien.
III. Status
Oftalmologis
III. Status Oftalmologis
Oculi Dextra Oculi
(OD) Sinistra (OS)
VISUS 0.15 0.15
VISUS PH - -
Koreksi Tidak dilakukan Tidak dilakukan
Posisi bola mata Ortotropia
Gerak bola mata Gerak bola mata normal ke segala arah
TIO Normal Normal
Tenang, Tenang,
Edema ada, Edema ada,
hiperemis, hiperemis,
Tidak ada nodul, Tidak ada nodul,
Palpebra Tidak ada spasme, Tidak ada spasme,
Tidak entropion, Tidak entropion,
Tidak ektropion Tidak ektropion
Dennice morgan Dennice morgan
fold (+) fold (+)
 III. StatusOculi
Oftalmologis
Dextra (OD)
Oculi Sinistra
(OS)
Tenang Tenang
Silia krusta (-), trikhiasis krusta (-), trikhiasis
(-) (-)
hiperemis (+), sekret hiperemis (+), sekret
K. Tarsal Superior (-), papilla (+), (-), papilla (+),
pseudomembrane (-) Pseudomembrane (-)
hiperemis (+), sekret hiperemis (+), sekret
K. Bulbar (-), injeksi (+) (-), injeksi (+)
hiperemis (+), sekret hiperemis (+), sekret
K. Tarsal Inferior (-), papilla (-), (-), papilla (-),
pseudomembrane (-) pseudomembrane (-)
Sklera Merah merata Merah merata
Erosi epitel pungtata Erosi epitel pungtata
Kornea FT (+) FT(+)
COA dalam dalam
 Oculi Dextra Oculi Sinistra
(OD) (OS)

Iris Coklat, sinekia(-) Coklat, sinekia(-)

Bulat, sentral, Bulat, sentral,

reflex cahaya reflex cahaya
Pupil
direk/indirek direk/indirek
(+)/(+) (+)/(+)

Lensa Jernih Jernih

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

Quo ad vitam: Ad bonam

Quo ad functionam: Ad bonam
Pembahasan
Perbedaan Jenis-jenis Konjungtivitis
Penemuan Virus Bakteri Klamidia Alergi
klinis dan
sitologis

Gatal-gatal minimal minimal minimal berat

Hiperemia menyeluruh menyeluruh menyeluruh menyeluruh
Lakrimasi amat banyak sedang sedang sedang

Eksudasi minimal amat banyak amat banyak minimal

Adenopati biasanya ada langka biasanya tidak ada

aurikuler hanya
ada pada
Konjungtivitis
inklusi
pewarnaan monosit bakteri sel PMN, eosinofil
kerokan PMN plasma,
konjungtiva badan
dan eksudat inklusi

kaitan kadang ada kadang ada tidak tidak

dengan pernah ada pernah ada
sakit
kerongkong
an dan
demam
 Allergic Conjunctivitis
Inflammation of conjunctiva due to allergic or hypersensitivity reactions
which may be immediate (humoral) or delayed (cellular).

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)

It is a recurrent, bilateral, interstitial, self-limiting, allergic inflammation

of the conjunctiva having a periodic seasonal incidence.
Etiology
a hypersensitivity reaction to some exogenous allergen, such as grass pollens.
VKC is thought to be an atopic allergic disorder in many cases, in which IgE-
mediated mechanisms play an important role.

Clinical Picture
Symptoms
• Marked burning and itching Signs
sensation which is usually • Palpebral Form
intolerable and accentuated • Bulbar Form
when patient comes in a warm • Mixed Form
humic atmosphere
• Mild photophobia
• Lacrimation
• Ropy discharge
• Heaviness of lids
Vernal Keratoconjunctivitis
 Vernal Keratoconjunctivitis
Treatment Systemic Therapy
Local Therapy  Oral antihistaminics
 Topical steroids  6x/day for 2  Oral steroids
days and then 3-4x/day for 2
weeks
Giant Papillae
 Mast cell stabilizers: Sodium
cromoglycate 2% drops 4-5x/day  Supratarsal injection of steroid
 Topical antihistaminics  Surgical excision
 Acetyl cysteine 0,5%
 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 • Cornea may show punctate epithelial

• Itching, soreness, dry sensation keratitis
• Mucoid discharge Clinical course
• Photophobia or blurred vision Has a protracted course with
Signs exacerbations and remissions
• Lid margins are chronically inflamed
• Tarsal conjunctiva has milku Association
appearance, there are very fine Keratoconus and atopic cataract
papillae, hyperaemia, and scarring.
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
Characteristic nodular affection occurring as an allergic response of the
conjunctival and corneal epithelium to some endogenous allergens to which
they have become sensitized.

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