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Referat

KERATITIS

By:
Widya Melianita ( 17360158)

Perceptor:
dr. Rahmat Syuhada, Sp.M
Anatomy and Physiology of the
Cornea
Keratitis
Definition

Keratitis is inflammation of the cornea due to


infiltration of inflammatory cells in the cornea
which will cause the cornea to become turbid. So
the vision is decreases.
1. Virus
2. Bacteria
3. Fungal
4. Exposure to ultraviolet light
5. Irritation of contact lenses
6. Dry eyes
7. The presence of a foreign object in the eye
8. Reactions to drugs such as neomycin, tobramycin,
pollution, or airborne particles such as dust, pollen

Etiology
Pain light-heavy
Photophobia
Watery eyes and dirty
Lesions in the cornea
Vision decreases

Common symptoms of keratitis


Corneal injury
Pathophysiology
Stromal cells into macrofag

Perichornea injection occurs Dilatation of blood vessels in


the limbus

Arising infiltrates such as dark grey


patches with non-slippery surfaces

Corneal epithelial damage occurs and


ulcers arise that spread to the surface
in the stroma

If inflammation is great

Toxins from the cornea can spread to


the iris and ciliary bodies

Inflamed and arising turbidity If it continues to deeply


in the CoA, followed by the arise protrusion membrane
formation of hypopion decement (descementocele)
Classification

Pungtata Keratitis
(Superficial
Pungtate Keratitis
and Subepithitary
Pungtate Keratitis)

The affected layer


Marginal keratitis

Interstitial keratitis
Bacterial Keratitis

Fungal Keratitis

etiology

Virus Keratitis

Allergy Keratitis
Bacterial Keratitis
Etiology
Clinical Manifestations
red eyes
Watery eyes
Pain in the infected eye
Photophobia
The presence of secretions
Vision decreases
Management
Fungal Keratitis
Most fungi are caused by Fusarium, Filamentous,
Yeast, Candida, Aspergillus

Symptoms: severe eye pain, watery eye, decreased


vision and photophobia

Visible grey infiltrates, accompanied by hypopion,


inflammation, superficial ulceration and satellites
Management
Anti-fungal medicines that can be given
include :
Polyenes include natamycin, nystatin, and
amphotericin B.
Azoles (imidazoles and triazoles) include
ketoconazole, Miconazole, fluconazole,
itraconazole, econazole, and clotrimazole
Virus Keratitis
Etiology

Herpes Simplex Virus (HSV) is one of the


most common viral infections of the
cornea
Keratitis caused by herpes simplek divided into
2 forms:

In Damage occurs due to


Causing damage to
epithelial cells and
intraepithelial virus
forming superficial
epitelial: breeding
cornea ulcers.

The body's
immunologic reaction This inflammatory cell
In to the attacking virus
is the antigen-
secretes proteolytic
materials to damage

stromal: antibody reaction that the virus but will also


attracts inflammatory damage the
cells into the stroma. surrounding stroma.
Clinical Manifestations

pain
Photophobia
Blurred vision
watery eyes
Red eyes
Vision goes down especially if the central part is
affected
Management
Debridement

Drug Therapy
IDU (Idoxuridine) pyrimidine analogue (found in 1% solution
and given every hour, 0.5% ointment given every 4 hours)
Vibrabin: same as IDU but only available in ointment form
Trifluorotimetidine (TFT): same as IDU, given 1% every 4
hours
Acyclovir (3% ointment), given every 4 hours.
Oral aciclovir may be useful for severe eye-ophthalmia,
particularly in atopic people who are prone to aggressive eye
and skin diseases.

Surgical Therapy
Penetrans keratoplasty may be indicated for vision
rehabilitation of patients with severe corneal scarring
Allergy Keratitis
Etiology

Type I hypersensitivity reactions that affect both


eyes,
Usually patients often show symptoms of allergy
to grass pollen
Clinical Manifestations
The shape of palpebra: cobble stone (large
papillary growth), covered by mukoid
secretions.
Limbus shape: tantras dot (protrusion grey,
like a candle)
Itchy
Photophobia
Sensation of foreign object
Watery eyes and blefarospasme
Management
It usually heals itself untreated
Topical and systemic steroids
Cold compress
Vasoconstrictor medicine
Topical sodium cromolyn
Small surgery (excision).
Antihistamines
Contraindications for the installation of
contact lenses
Classification

Flikten
Keratitis

Sika Keratitis

Clinical form
Neuroparalytic
Keratitis

Numuralis
Keratitis
Flikten Keratitis
It is an inflammation of the cornea and conjunctiva as an
immune reaction that cells may be mediated in tissues that
are already sensitive to antigens.

Symptoms:
Lacrimation & photophobia accompanied by pain,
conjunctival hyperemia, thickened corneal epithelium, heat
sensation as well as itching and diminished vision.

In the limbus there is a white grey lump surrounded by a


hyperemic conjunctival area.
Sika Keratitis
It is an inflammation of the conjunctiva and cornea due to the dry
surface of the cornea and conjunctiva.
This disorder occurs in the resulting disease:

Reduced fat components, such as blepharitis

Reduced tears, as in the syndrome of syrogen, after taking


diuretic drugs, atropine or reached in old age.

Reduced components of mucin

Excessive evaporation such as in desert life, lagoftalmus,


neuroparalitic keratitis.

The presence of sikatrik on the cornea.


Numularis Keratitis
Clinically, the signs of inflammation are unclear, There is a
subepithelial round infiltrate in the cornea, where the center is
clearer, called halo (presumably due to resorption of the
infiltrates that begin in the middle).

Fluorescent test (-).

This keratitis when healed leave a mild sikatrik


It is keratitis due to trigeminal nerve activity in
the presence of an insensitive corneal clouding
with corneal drought.

Symptoms: decreased vision, photophobia, no


pain. Loss of flashing reflex, ciliary injection,
cornea cloudy surface, infiltrates and vesicles in
the cornea.

Neuroparalitik
Keratitis
Complications

Refraction Permanent Corneal


disorder scarring ulcers

Corneal Secondary
perforation glaucoma
Prognosis

Handled appropriately
Keratitis can Not treated properly can cause
heal properly ulcers that will become sikatriks and
may result in lost vision forever

The visual
Virulence of the organism
prognosis
Area and location of keratitis
depends on
Result of vascularization and
several factors, collagen deposition
depending on: