kuliah mata 1 - keratitis

8/12/2019 Kuliah Mata 1 - Keratitis

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Dr. RITA HENDRAWATI,SpM


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1. INFECTIONBACTERIALVIRALF N AL

ACANTHAOMEBA


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Common causative agents :

(affecting corneal epithelial integrity)

Staph. epidermidis

Staph. AureusStrept. PneumoniaH.infleunza

P.aeruginosaN.gonorrhea


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Predisposing factors:contact lens userskeratoconjunctivitis sicca (dry eye)prolonged use of topical steroids

Trauma (breach in a corneal epithelium)use of contaminated ocular medicationsRecent corneal disease (herpetic keratitis,neurotrophic keratopathy)


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Symptoms:Reduced visionPain in the eye (often sudden)Purulent dischargeExcessive tearingIncreased light sensitivity

gns:Hypopyon ( a mass white cells collected in antchamber)White corneal opacityConjuctival injection (redness of eyes)


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Complications:Corneal ulcerCorneal perforation 2ndary endopthalmitisVision lossIrregular astigmatism (uneven healing of stroma)Corneal leukoma (scar tss formation w cornealvascularization)

Beware:Sight-threatening process

Rapid progression infection; corneal destruction maybe complete in 24-48 hours


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Treatment:Initiate topical broad-spectrum antibiotics :

tobramycin (aminoglycoside gram -ve) alternating with

fortified cefazolin (cephalosporin).If the corneal ulcer is small, peripheral and noimpending perforation is present, intensivemonotherapy with fluoroquinolones is an

alternative treatment.Corneal graft ( in severe cases) .


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HERPES SIMPLEX KERATITISHERPES ZOSTER OPTHALMICUS


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HSV 1 : common viral cause of ocular diseases

HSV 2: genital dis. Rarely can cause ocularmanifestations (rarely) such as keratitis & infantilechorioretinitis.HSV

Primary infx is usually early in lifeEnters a latent period in the trigeminal ganglion,When activated it moves along the sensory partof the N. toward the target epith. causingdamage & ulceration.Factors leading to activation :psychiatric dis. ,systemic illnesses, immunocompromised pt.


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Symptoms:

-Typically unilateral red eye-Variable degree of pain-Occular irritation

-Tearing-Vision may or may not be affected-Vesicular skin rash and follicular conjunctivitis


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Signs:A dendritic corneal ulcer (hallmark sign of HSV

infection)Ulcer may heal without scar but may progressedto stromal keratitis

edemaLoss of corneal transparency in more severepresentations.

Uveitis and glaucoma may accompany disease


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Because the virus invades and compromises theepithelial cells surrounding the ulcer, the leadingedges (the so-called "terminal end-bulbs") will stainwith rose bengal or lissamine green.


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Diagnosed with a slit lamp examinationTreatment :

topical antivirals acyclovir ointment

DONT USE TOPICAL STEROIDS as theyworsen the ulcer to geographic ulcerIf recur more than twice a year give oral acyclovir


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Varicela zoster virus -affect the ophthalmicdivision of the trigeminal N. (15% )Increases with age (6 th-7 th decades).

nasocillary N is involved >>lid swelling (maybebilateral), keratitis ,iritis, secondary glaucoma.Other ocular manifest. :ptosis, mucus secreting

conjunctivitis, neuralgia& scleritis which may leadto scleral atrophy.


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Symptoms:Have prodromal period, typically presents withnondescript facial pain, fever and generalmalaise .About four days after onset, a unilateral vesicularskin rash over forehead, upper eyelid, nose (1 stdiv of 5 th CN) , characteristically respecting the

.begin to scab over after about one week. The pain isextreme during the inflammatory stage, and patientsare tremendously symptomatic.


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Signs:Cornea : Punctate epithelial keratitis (swollenepithelium, 1-2 d); dendritic keratitis (treebranchlike epithelial defects, 4-6 d); stromal keratitis(fine infiltrates beneath the surface, 1-2 wk); deepstromal keratitis (lipid infiltrates and cornealneovascularization, 1 month to years); neurotrophickeratopathy (erosions, persistent defects, cornealulcers, months to years)Ocular involvement ma include follicular

conjunctivitis, epithelial and/or interstitialkeratitis, dendritic keratitis, ant chamber uveitis,scleritis or episcleritis, chorioretinitis, opticneuropathy, and even neurogenic motilitydisorders (especially fourth cranial nerve palsy).

Prognostic indicator: Hutchinsons Sign


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Hutchinsons Sign

Lesions at tip, side, root ofnoseInnervated by ant ethmoidal

branch of nasociliary N.Nasociliary N. also innervatescornea n ciliary body


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Treatment:

Oral and topical antiviral : acyclovir , valcycloviror famcyclovir ( prevent post-infective neuralgia-severe chronic pain over the rash)

- .


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Infxs r rare , but they very severe & devastatingas they cause stromal necrosis.They r capable of penetrating the descemetsmembrane reaching the ant. chamber where wecannot do anything because of the poorpenetration of antimycotic agents to the ant.

Chamber.Most common causative pathogens :

Filamentous (aspergillus & fusarium) fungi

Candida albicansProgression is much slower & less painful than inbacterial.


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Keratomycosis in consideration when we findlack of response to antibacterial therapy ofcorneal ulceration.

Signs include :Filamentous infx: grayish infiltrate with indistinct margins

Candidal infx: yellow to white ulcer with suppuration

similar to bacterial keratitis.Treatment : topical antifungals pimaricin 5%


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kuliah mata 1 - keratitis

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