KERATITIS

Sri Hotnauli Panjaitan I11109021

Introduction: Cornea
The foremost part of eye Main component in refraction To protect the eye against infection and structural damage to the deeper components of the eye

 Corneal consist of 5 layers that are epitel, membrana bowman, stroma, descement membran, and endothel

Introduction: Keratitis
Inflammatory cells infiltration Corneal opacity Superficial / deep Cause: Infection (Viral/bacterial/fungal) Also: Dry eyes, trauma, drug toxicity, UV exposure, contact lens irritation, allergy, immunogenic states, chronic conjunctivitis May progress to cornea ulcer

Bacterial Keratitis
Over 90% of all corneal inflammations are caused by bacteria.

 Symptoms : Patients report moderate to severe pain (except in Moraxella infections), photophobia, impaired vision, tearing, and purulent discharge. Positive identification of the pathogens is crucial. Purulent discharge is typical of bacterial forms of keratitis; viral forms produce a watery discharge

Clinical Features
The clinical signs and symptoms of bacterial keratitis depend greatly on the virulence of the organism and the duration of infection. Key features : Cellular infiltration of the corneal epithelium or stroma, corneal inflammation, and necrosis. Associated features : lid edema, conjunctival inflammation, discharge, anterior chamber reaction, hypopyon.

Treatment
Treatment is initiated with topical antibiotics (such as ofloxacin and polymyxin) with a very broad spectrum of activity against most Grampositive and Gram-negative organisms until the results of pathogen and resistance testing are known.

Treatment
Gram-Negative Gram-Positive

Gentamicin Tobramycin Polimiksin

Cefazolin Vancomycin Basitracin

Mycotic Keratitis
Corneal disease caused by fungal organisms Mycotic/ fungal keratitis was very rare, occurring almost exclusively in farm laborers

Clinical Features
Fungal infection tends to arise in traumatized, diseased, and immunocompromised corneas. Key features : Cellular infiltration of the corneal epithelium or stroma, corneal inflammation, and necrosis. Associated features : long-term steroid use, trauma involving vegetative matter, corneal infiltrate with feathery borders or satellite lesions. Definite diagnosis : laboratory confirmation, by scraping for stains and cultures.

Treatment
Polyenes : amphotericin B, natamycin. Imidazoles : ketoconazole, miconazole. Triazoles : fluconazole Pyrimidines : flucytosine Fail to respond to medical therapy surgical intervention

Viral Keratitis
Viral keratitis is frequently caused by: Herpes simplex virus. Varicella-zoster virus. Adenovirus.

Herpes Simplex Viral Keratitis

Herpes Zoster Viral Keratitis Symptoms: Herpes zoster ophthalmicus also occurs in superficial and deep forms, which in part are similar to herpes simplex infection of the cornea. Corneal sensitivity is usually decreased or absent Treatment : The eye is treated with acyclovir ointment in consultation with a dermatologist. the irritation of the anterior chamber can be carefully treated with steroids immobilization of the pupil and ciliary body therapeutic mydriasis

Symptoms: Herpes simplex keratitis is usually very painful and associated with photophobia, lacrimation, and swelling of the eyelids. Vision may be impaired depending on the location of findings.
Treatment : involving the epithelium are treated with trifluridine as a superficial virostatic agent. Stromal and intraocular herpes simplex infections can be treated with acyclovir, which is available for topical use and systemic use.

Noninfectious Keratitis
Lagoftalmos Keratitis state of the eyelids cant close completely so that there is dryness of the cornea Neuroparalytic Keratitis Trigeminal nerve dysfunction corneal anesthesia with loss of the blink reflex, lack of trophic factors (for epithelial function) dryness of the cornea Keratoconjunctivitis Sicca Happened due to dryness on the corneal surface

Treatment
depending on the cause and artificial tears

CONJUNCTIVITIS

Introduction: Conjunctiva

 Conjunctivitis is an inflammation of the conjunctiva. It is most commonly characterized by conjunctival hyperemia and ocular discharge Two forms of the disorder look from its onset Acute conjunctivitis. Onset is abrupt and initially unilateral with inflammation of the second eye within one week. Duration is less than four weeks. Chronic conjunctivitis. Duration is longer than three to four weeks.

 Symptom:
The important symptoms of conjunctivitis a foreign body sensation, a scratching or burning sensation, a sensation of fullness around the eyes, itching, and photophobia.

 Signs:
Hyperemia Tearing (epiphora) resulting from the foreign body sensation, the burning or scratching sensation, or the itching. Exudation Pseudoptosis is a drooping of the upper lid secondary to infiltration of Mller's muscle. Papillary hypertrophy Chemosis Follicles Pseudomembranes and membranes Preauricular lymphadenopathy

Bacterial Conjunctivitis
Two form of bacterial conjunctivitis:
Acute bacterial conjunctivitis
Usually benign and self-limited, lasting no more than 14 days.

Chronic conjunctivitis
Usually secondary to eyelid disease or nasolacrimal duct obstruction.

BACTERIAL CONJUNCTIVITIS
Etiology:

BACTERIAL CONJUNCTIVITIS
Sign and symptom:
Generally it manifests as bilateral irritation and injection, purulent exudate with sticky lids on waking, and occasionally lid edema. The infection usually starts in one eye and is spread to the other by the hands. There may be a history of contact with a person with similar symptoms.

BACTERIAL CONJUNCTIVITIS
Examination:
The vision should be normal. The discharge usually is mucopurulent Uniform engorgement of all the conjunctival blood vessels. Fluorescein drops there is no staining of the cornea. Microscopic examination of conjunctival scrapings.

BACTERIAL CONJUNCTIVITIS
Complications & Sequelae
Chronic marginal blepharitis. Conjunctival scarring. Corneal ulceration and perforation. Marginal corneal ulceration. Toxic iritis.

BACTERIAL CONJUNCTIVITIS
Treatment:
Specific therapy depends on identification of the microbiologic agent. While waiting for laboratory report start topical therapy with a broad-spectrum antibacterial agent (eg, polymyxintrimethoprim). In any purulent conjunctivitis in which Gram's stain shows gram-negative diplococci (neisseria) systemic and topical therapy should be started immediately. In purulent and mucopurulent conjunctivitis, the conjunctival sac should be irrigated with saline solution as necessary to remove the conjunctival secretions.

CHLAMYDIAL CONJUNCTIVITIS
Symptom and Sign:
The signs and symptoms usually consisting of tearing, photophobia, pain, exudation, edema of the eyelids, chemosis, hyperemia, papillary hypertrophy, tarsal and limbal follicles, superior keratitis, pannus formation, and a small, tender preauricular node.

CHLAMYDIAL CONJUNCTIVITIS
Examination
Giemsa-stained of conjunctival scrapings Inclusions: particulate, dark purple, or blue cytoplasmic masses that cap the nucleus of the epithelial cell. PCR isolation of chlamydial agent in cell culture. Serologically by microimmunofluorescence.

CHLAMYDIAL CONJUNCTIVITIS
Complications & Sequelae
Conjunctival scarring can destroy the accessory lacrimal glands reduce the aqueous component of the precorneal tear film. Corneal ulceration, bacterial corneal infections, and corneal scarring.

CHLAMYDIAL CONJUNCTIVITIS
Treatment
Tetracycline, 11.5 g/d orally in four divided doses for 34 weeks; doxycycline, 100 mg orally twice daily for 3 weeks; or erythromycin, 1 g/d orally in four divided doses for 34 weeks. Topical ointments or drops, including preparations of sulfonamides, tetracyclines, erythromycin, and rifampin, used four times daily for 6 weeks, are equally effective. Surgical correction of inturned eyelashes to prevent scarring from late trachoma.

VIRAL CONJUNCTIVITIS
Sign and Symptom:
Commonly is associated with upper respiratory tract infections and is usually caused by an adenovirus. Both eyes being gritty and uncomfortable, although symptoms may begin in one eye. The discharge is usually watery. Usually lasts longer than bacterial conjunctivitis (may go on for many weeks). Photophobia and discomfort develop discrete corneal opacities.

VIRAL CONJUNCTIVITIS
Examination:
Conjunctival injection Clear discharge. Small white lymphoid aggregations (follicles). Pre-auricular lymphadenopathy.

VIRAL CONJUNCTIVITIS
Treatment:
Patients should avoid touching their eyes, shaking hands, sharing towels, etc. Preservative-free artificial tears 4 to 8 times per day for 1 to 3 weeks. Cool compresses several times per day.

VIRAL CONJUNCTIVITIS
Antihistamine (e.g., epinastine 0.05%) if itching is severe. For membranes/ pseudomembranes use a more frequent steroid dose or stronger steroid (e.g., loteprednol 0.5%) and consider a steroid ointment (e.g., fluorometholone 0.1% ointment or dexamethasone/ tobramycin 0.1%/0.3% ointment) in the presence of significant tearing to maintain longer medication exposure.

VIRAL CONJUNCTIVITIS

ALLERGIC CONJUNCTIVITIS
Sign and Symptom:
Stimulated by direct exposure of the ocular mucosal surfaces to environmental allergens dust, grass, molds, pollens, spores, and animal dander. The main feature itching. Clear discharge. History of atopy or recent contact with chemicals or eye drops.

ALLERGIC CONJUNCTIVITIS
Examination
The conjunctivae diffusely injected and may be oedematous (chemosis). The discharge is clear and stringy. Because of the fibrous septa that tether the eyelid (tarsal) conjunctivae, oedema results in round swellings (papillae). When these are large they are referred to as cobblestones.

ALLERGIC CONJUNCTIVITIS
Treatment
Eliminate the inciting agent. Cool compresses several times per day. Topical drops, depending on the severity.
Mild: Artificial tears 4 to 8 times per day. Moderate: Use olopatadine 0.1% , epinastine 0.05%, nedocromil 2%, or ketotifen 0.025% to help relieve itching. Ketorolac 0.5% (e.g., Acular), pemirolast 0.1% (e.g., Alamast), and lodoxamide 0.1% (e.g., Alomast) can also reduce symptoms. Severe: Mild topical steroid (e.g., loteprednol 0.2% or fluorometholone 0.1% (for 1 to 2 weeks) in addition to the preceding medications.

Oral antihistamine (e.g., diphenhydramine 25 mg or loratadine 10 mg) in moderate to severe cases.

ALLERGIC CONJUNCTIVITIS
Treatment

Differential Of The Common types of conjunctivitis

THANK YOU