lapkas mata-keratitis numularis.doc

8/13/2019 lapkas mata-keratitis numularis.doc

1/13


2/13

CHAPTER II

LITERATURE REVIEW

". C#$%&"

Cornea is clear avascular anterior part of the eyes. Cornea consist of five

layers (epithelium, bo man's membrane, stroma, decemet membrane, and

endothel). Cornea is the part of visual a is ith the greatest refractive inde , so

any abnormality of this part of the eyes, especially in centre part, ill greatly

disturb the visual acuity.

ince the cornea is avascular, it is nourished by tear, a*ueous humour, and

pericorneal blood vessels.

&phitelium

o +he outmost layer of cornea ith - um thickness, consist of

layers of nonceratini ed s*uamous epithelial.

o Provide primary protection to the deeper layer of cornea from outer

environment and selectively inhibits transport of ater and

electrolyte.

o +his part can regenerate perfectly after in/ury

0o man membrane

o "nterior part of stroma

o 1nable to regenerate

troma

o +he thickest layer of cornea

o Consist of ell arranged fine collagen fiber

2ecement membrane

o Produced by endotel

o trongest layer in cornea

o &lastic

3


3/13

&ndothel

o

4onolayero +he most important part in hydration of cornea

o 1nable to regenerate

o 2amage to this part can cause corneal edema

Cornea innervated by ophthalmic branch of +rigeminal %erve. +his branch

terminates in second layer of epithelium. In/ured nerve in cornea can heal in 5

months.

0. K&$"+I+I

Keratitis is an inflammatory process in cornea. Keratitis is classified based

on location of lesion in corneal layer and cause6

0ased on location6

!. uperficial keratitis6

&pithelial keratitis (flouresence test 7)

o Keratitis pungtata superficialo Keratitis 8erpes simpleks

o Keratitis 8erpes oster

ubepithelial keratitis (flouresence test 9)

o %ummular keratitis of 2immer

o 2isiform keratitis of Westhoff

tromal keratitis (flouresence test 9)

o %europaralitik keratitis

o Keratitis et lagoftalmus

3. Profound Keratitis6

Keratitis Interstitial

Keratitis klerotikans

Keratitis 2isiformis

5


4/13

0ased on cause6

0actery6 2iplococcus pneumonia, treptococcus hemolyticus,

Pseudomonas aeroginosa, etc

:irus 6 8erpes simpleks, 8erpes ooster, etc

fungi 6 Candida, "spergillus sp.

"llergic reaction

"vitaminosis "

%.: damage

2irect trauma

2ry eye

Patophysiology

ince the cornea is avascular, inflammatory process ill not as effective

and immediate as other ell vasculari ed tissues. Wandering cell in corneal

stroma ill be the first immunologic cell hich response to inflammatory process.

It ill become tissue macrophage. +his process ill then follo ed by

vasodilatation of blood vessels in limbus (this ill be seen as pericorneal

in/ection). Infiltration of P4%, macrophages, and plasma cell ill cause cornea

looks cloudy.

Corneal epithelium can be destroyed and form ulcer. uperficial ulcer ill

resolve perfectly, but the deeper one ill leave scar. If the iris involved in this

inflammatory response, inflammatory cell ill be accumulated in anterior

chamber and can be seen as hypopion.

ymptoms of keratitis include, but are not limited to6

;


5/13

+earing

Pain

ensitivity to light

Inflammation of the eyelid

2ecrease in vision

$edness.

C. %1441halo? appearance. It is usually caused by

viral invasion to epithelial layer of cornea secondary to trauma in cornea.

$eplication of virus in epithel follo ed by spread of to in to stroma causes

subepithelial infiltrate formation. +his type of keratitis usually happens unilateral.

%ummular keratitis


6/13

CHAPTER III

CASE

!. Patient identity

%ame 6 4s. 4

e 6 =emale

"ge 6 !- years old

"ddress 6 ungai Purun 0esar

&thnic 6 4elayu

@ob 6 9 (student)

$eligion 6 4oslem

Patient as e amined on "pril !; th, 3-!!

3. "namnesis

a. 4ain complaint6 hitish spots on left eye.

b. 8istory of disease 6

Patient complain ithish spots on left eye hich is painless. =our months

ago patient has her left eye entered by bug. =or about one eek she felt

slight pain, tearing, and redness in her left eye. When the symptoms

A


7/13

resolved, her mother reali ed that some ithish spots formed in her left

eye. Patient complain no blurry vision since then.

c. Past clinical history6 Patient claims that there is no history of the same

symptoms before.

d. =amily history 6 +here are no one of her family have the same complaint.

5. Beneral Physical "ssessment

Beneral condition 6 good

" areness 6 composmentis

:ital igns6

8eart $ate 6 - Dminute

$espiration fre*. 6 ! Dminute

0lood Pressure 6 !--DA- mm8g

+emperature 6 5A,E oC

;. #phthalmological status

:isual acuity6

a. #2 6 ADA

b. # 6 ADA

$ight eye


8/13

ptosis (9), lagoftalmos

(9), edema (9)

Palpebra ptosis (9), lagoftalmos

(9), edema(9)

$edness (9), discharge

(9), in/ection(9)

Conjungtiva $edness (9), discharge

(9), in/ection(9)

Clear, edema ((9) Cornea Clear, edema (9),

in iltrate !"#

clear, deep COA Clear, deep

Iris colour 6 bro n

Pupil6 circular, isokor,

reactive to light

Iri$ an% pupil Iris colour 6 bro n

Pupil6 circular, isokor,

reactive to light

Clear Len$ Clear

Clear Vitreou$ Clear

%ormal &un%u$ %ormal

&ye ball movement

hado test 6 positive for both eye

Ishihara test 6 not measure

++

+

+

+

+

+

+

++

+

+

+

+

+

+

OD OS


9/13

:isual field test (confrontation) 6 normal

&loure$en'e te$t( not 'on%u'te%

. $esume

Patient complains painless hitish spots on her left eye. =our months

ago patient has her left eye entered by bug that cause slight pain, redness and

tearing hich resolved in a eek. Patient complains no blurry vision.

:ital signs of this patient are in normal range. :isual acuity of both

eyes are ADA. &yelids are normal. Cornea of the left eye has some hitish

grouped coin shaped spots. +he anterior chamber, lens, and vitreous body of

both eyes are clear. Iris and pupil look normal. +he flourosence test as not

conducted because patient's mother refused.

A. 2iagnose

Working 2iagnose6

%ummular keratitis #

E. Plan for e amination

9 =louresence test

. +reatment6

9 %on medicamentous6 using of protective glasses

F


10/13

9 4edicamentous6

o Bentamycin eye drop -,5G ;9A ! gtt

o Prednisolon eye drop -, G 39; !gtt

F. Prognosis

#2

"d vitam 6 bonam

"d functionam 6 bonam

"d sanactionam 6 bonam

#

"d vitam 6 bonam

"d functionam 6 bonam

"d sanactionam 6 bonam

CHAPTER IV

DISCUSSION

!-


11/13

" girl, !- years old complained hitish spots in her left eyes. +here

as history of bug entered her left eye four months ago. he felt slight pain,

tearing, and redness for about one eek. 8er mother then reali ed that some

hitish spots formed in her cornea.

+he only abnormality found in physical e amination is the hitish

grouped coin shaped spots in patient left eye. =rom anamneses there is history of

bug entered the eye. In this case it can cause trauma hich is possibly follo ed by

secondary viral infection to the epithelial lining of cornea. Infiltration that

happens in subepithelial layer cause the coin shaped spots appearance.

Working diagnose of this patient is nummular keratitis based on the

appearance of corneal abnormality.

$ecommended therapy for this patient includes nonmedicamentous

such as earing protective glasses to prevent recurrent trauma. 4edicamentous

therapy for this patient aims to prevent secondary bacterial infection ith

antibiotic (gentamycin) and to reduce inflammatory process ith corticosteroid

(prednisolone).

C8"P+&$ :

C#%C


12/13

" girl !- years old ith complaint of hitish painless grouped coin shaped

spots in the left eyes and history of eye trauma. Working diagnose for this patient

is nummular keratitis. +he therapy included non medicamentous ( earing

protective eye glasses) and medicamentous (gentamycin and prednisolone eye

drop).

$&==&$&%C&

Ilyas, . 3--E. Ilmu Penyakit Mata edisi ketiga . @akarta6 0alai Penerbit =K1I.

!3


13/13

hann, =. 3-- . Drug Doses . ! th edition.

:aughan 2B, et al. 3---. Oftalmologi umum edisi 14 . @akarta6 Widya 4edika.

!5

lapkas mata-keratitis numularis.doc

Documents