Week 7 : eye & hearing

Red Eye : a cardinal sign of ocular inflammation, which can be

caused by several conditions.
Conjunctivitis
(bacterial/viral/chlamidyal/allergic)
Red eyes, normal vision

Pterygium
Subconjunctival hemorrhage
Episcleritis
Keratitisand scleritis
Cornea Ulcer

Red eyes, visus

Anterior Uveitis (iritis,

iridocyclitis)
Acute Glaucoma
Endophthalmitis

Eyes Anatomy

Limbu

Algorithm

Perbedaan Conjunctival Injection vs Ciliary Injection

Posterior Conjunctival arteries

Mobile, loosely attach in bulbar
conjunctiva
Fornix location

Anterior Ciliary Arteries

Immobile with movement

Corneal circumference

Larger toward periphery

Lesser toward fornix

Blanching in adrenalin drop

No reaction in adrenalin drop

Conjunctivitis (GP Competencies)

Clinical presentation
-Discharge: watery, mucoid, purulent or mucopurulent
-Nonspecific: watery eyes, irritation, stinging, foreign body sensation, photophobia
or itchiness
-Conjunctival injection
-Eyelid swelling
-Tarsal conjunctiva: papillae/follicles/membrane
-Cornea and pupils usually normal
Tx : Eye hygiene, Eyedrops(viral self-limiting, antibiotics,bacterial
Clinical Finding
Bilateral disease at
onset
Conjunctival
response
Conjunctival
discharge
Conjunctival
membrane
Preauricular
adenopathy
Concurrent otitis
media

Bacterial Disease
50-74%

Viral Disease
35%

Papillary or
nonspecific
Mucopurulent (thick
and globular)
Late onset

Follicular

No

Yes

20-73%

10%

Watery or mucoid
Early onset

antibiotics,allergic/vernal antiallergy, steroids) ,3 days w/o improvement:

refer

Gonococcal Conjuctivitis : foreign body sensation; the eye may be

glued shut with severe purulent discharge, dicuci tidak hilang

Vernal Keratoconjunctivitis
Frequently associated with atopy: asthma, hay fever and dermatitis

Recurrent, bilateral

Affects children and young adults

More common in males and in warm climates, seasonal

Itching, mucoid discharge and lacrimation

PF : Cobblestone papillae(Palpebra),
Horner- Trantas dots(Limbus)
Atopic Keratoconjunctivitis

Typically affects young patients with atopic dermatitis

Eyelids are red, thickened, macerated and fissured
Pterygium
Triangular fibrovascular tissue
Episcleritis
Risk factors :hot climate,

common,
benign, self-limiting
chronic dryness and high sunlight exposure
Sailor
Apex always in the cornea side, often with Feyoung
deposit
adult
Subconjunctival Hemorrhage

No pain, no discharge Scleritis:

related to systemic disease

types:
- simple
(sectoral,diffuse), - nodular
-granulomatous inflammation

Well-demarcated

Self-limiting within 2 weeks

-less common

-rheumatoid arthritis, connective tissue disorder

-types: anterior scleritis (non-necrotizing /
necrotizing), scleritis posterior

Red Eye, visus

Keratitis(inflamasi kornea), jika sampai ke
stroma korneal ulcer, dgn gejala
sbb :photophobia, periocular pain, foreign
body sensation, corneal opacity, ciliary flush.
Diagnosis : reduced cornea sensibility,
fluorescein test,assessment of corneal
regularity.

Tanda

Keratiti
s

Iridosiklitis
akut

Glaukoma
akut

Sakit

Ganjel

Sedang -->
N.V

Berat --> N.V

Perikorneal

Konjungtiva,
perikorneal,

Injeksi

Korneal

episclera

Pupil

Miosis,
iregular

Midriasis,
lonjong

Reaksi
cahaya

Kurang

Kurang -->
negatif

Media

Keruh,
infiltrat

KP, flare,
oedem,

oedem,
katarak

katarak,
oklusi,

Anterior
Uveitis(Iridoksilitis) :
inflamasi iris+ciliary body,
usually auto-immune.

Endopthalmitis : inflamasi
intraocular cavities (ie, the
aqueous and/or vitreous
humor).

-Causes : 1. infection
through the cornea
Bacterial/fungal, most
common: staphylococcus
aureus, proteus and
pseudomonas
2. trauma post-surgery
(mainly: cataract surgery),
or endogenous.
-If with extraocular
infection: panophtalmitis
Clinical presentation:

vitreus keruh,
hipopion

Visus

--> 0

Onset

Lamba
t

Lambat

Tiba-tiba

Sistemik

Sedikit

muntahmuntah

Sekret

TIO

N -, N, N +

N +++

periocular pain
chemosis(edema
conjunctiva)
eyelid swelling
corneal opacity
anterior uveitis
hypopion

Hearing Loss : symptom of a disease in the ear, ranging from a simple cerumen
impaction (causing a conductive hearing loss) to middle and inner ear disorders to
problems affecting the eighth cranial (or auditory) nerve (CN VIII) itself (e.g.,
acoustic neuroma or cerebellopontile-angle neoplasm)

Hearing Loss

Salisilat (aspirin)
NSAID(diclofenac ,ibuprofen
,indomethacin ,naproxen ,piroxicam)
Antibiotik(aminoglycoside,
eritromisin)
Diuretic