Dr.

Devi Handayani Putri, SpM

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Phisiology

-Eyelid : Protection Stimulus Blinking 5-10 w/ contact N VIII wo/ contact : aff N V, eff N VII Spread the tear meniscus

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- Precorneal Tear Film ; Lipid, Aqueous,Mucin

nutrients,O2,leucocytes,growth factors,lactoferrin,Ig A,etc. -- Refraksi, Infeksi - Ocular Surface Epitel Kornea : desmosomes,tight junction limbal epitelium

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Epitel konjungtiva mucosal immune defense system dendritic, lymphocytes, pmn,sel plasma, sel mast.

Blood Supply

: limbal barrier function

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Blepharitis Seborrheic Anterior eyelid margin Crusting, oily or greasy on eyelids,eyelashes Redness eyelid, burning, foreign body sensation 15% w/ keratitis or conjunctivitis 1/3 aqueous tear deficiency

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Management

eyelid hygiene topical steroid systemics antibiotics topical antibiotics oinment

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Chalazion lipogranulomatous inflammation of meibom or zeis glands Spontan Nodul slowly, painless Erythematous 2nd Blurr vision Ca sebaceous

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Management Hot compresses Intralesion steroid injection Incision or drainage Systemic tetracyclines Recurrent Ca meibomian gland

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Hordeolum Eyelid Inflammatory or infections nodul Ext : Zeis or lash follicles Int : Meibomian Localized purulent abscess Sta.aureus Painfull, tender,redness Self limited Internal chalazia

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Management Warm Compresses + massage Topical < Systemic AB Incision and drainage Steroid Injection

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Conjunctivitis Allergic Rx hypersensitive type I Alergen : airborne Symptoms : itching, eyelid swelling, conj.hyperemia, chemosis, mucoid discharge Short lived, episodic

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Management

Avoidance alergen exposure Cold compresses Artificial tears Topical antihistamine and mast cell stabilizers Topical NSAID Topical Steroid Topical Vasokonstrictors

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Vernal Keratokonjuctivitis

Rx hypersensitive type I and IV seasonally, bilateral male children, atopic history itchy, blefarospasme, photophobia, blurred vision, mucoid discharge

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Management Topical antihistamines Mast cell stabilizers Topical NSAID Topical steroid / immunomodulator Supratarsal injection of steroid

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Bacterial

Spontan and epidemic Direct contact, aerogen, Sight threatening : Virulency, Conjunctival inflammmation, purulent discharge

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Onset Slow Severity Mild-moderate Organism Staph. Aureus Moraxella lacunata Proteus sp Enterobacteriaceae Pseudomonas

Acute / subacute

Moderate-severe

H.Influenzae Strep.pneumonia Staph.aureus

N.Gonorrhoeae N. Meningitidis

Hyperacute

Severe

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Management Topical AB therapy, qid, 5-7 days Gram stained, culture

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Gonococcal conjunctivitis

explosive onset, severe purulent discharge, chemosis untreated corneal infiltrates melting perforation STD, direct contact Neonatal bilateral, 3-5 days postpartus Complication : corneal ulcer, perforation, endophthalmitis

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Management AB systemic, singledose Frequent Topical AB eo Lavages

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Viral

Adenoviral keratokonjunctivitis simple follicular conjunctivitis Pharyngoconjunctival fever Epidemic keratokonjunctivitis Unilateral or bilateral Pseudomembrane/ membran

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Management Supportive Cold compress Artificial tears Topical AB 2nd infection Steroid topical

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Herpes Simplex Direct contact Unilateral blepharoconjunctivitis Follicular inflammatory Palpable preauricular lymph node Cutaneous eyelid margin vesicles

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Management Primer Self limited 2nd AV systemic, topical

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Corneal Ulcer Bacterial Sight threatening Explosive onset, rapidly progressive Untreated corneal perforation Risk factor : Contact lens wear Trauma Contaminated ocular medications Impaired defense mechanism

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Pathogenesis

S aureus adhesins bind to corneal stromal P aeruginosa injured epithelial cellsmolecular receptor proliferation Clinical presentation pain, photophobia, decreased vision sharp epithelial demarcation, dense, supurative,stromal edema

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Management Broad spectrum topical AB Cyclopegics Corticosteroid controversial! Surgery : Keratoplasty

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Fungal Corneal trauma w/ plant or organic material Contact Lens wear Prolonged used of steroid topical & systemic Gray white, dry infiltrat, feathery/filamentous margins Multifocal, satellite infiltrates Endothel plaque, hypopion

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Cause: Candida spp

Aspergillus spp, Fusarium Management Anti fungal, topical & systemic Fusarium Natamycin 5% Aspergillus Amphotericin B Candida Cyclopegic