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Mata Merah Visus Turun
Mata Merah Visus Turun
decreased vision
dr. Made Susiyanti, SpM(K)
Departemen Ilmu Kesehatan Mata
Fakultas Kedokteran Universitas Indonesia
Minggu, 31 Juli 2016
EYE PROBLEMS
Red eyes with normal and acute decreased
vision
Quiet eyes with acute decreased vision
Chronic and progressive visual loss
Abnormalities ocular alignment and motility
Refractive disorders
Ocular Trauma
Anterior Topography
Lacrimal gland
Superior lid
lateral canthus
Caruncle
medial canthus
Conjunctiva
Limbus
Cornea
Inferior lid
Pupil
Iris
Vascular supply
The anterior
ethmoidal
vessel
The posterior
ethmoidal
vessel
The posterior
ciliary artery
The branch of
ophthalmic
artery
Central retina
artery
Ciliary artery
Ophthalmic artery
Red Eyes
- Pathophysiology
- Clinical assesment :
- red eye , normal vision : if refraction media (cornea, anterior
Endophthalmitis /Panophthalmitis
Cornea
Outermost part of the eye , clear , transparant and avascular
tissue
Main component in refraction (74%)
Tear film lubricate the front part of cornea
5 layers :
Cornea
Epithelium
Bowman
Stroma
Descemet
Endothelium
Endothelium layer :
Na-K pump function to
regulate and balance water
level in stromal cornea
Cornea
Corneal Diameter
11 - 13 mm
Corneal Diameter
Central
5 - 7 mm
{500 - 550
Intra-ocular Pressure
13-19 mm Hg
KERATITIS
Inflammatory cells infiltration on the corneal tissue
corneal ulcer
KERATITIS-CORNEAL ULCER
Clinical presentation
- eyelid swelling and spasm
- photophobia
- periocular pain
- foreign body sensation
- corneal opacity
Diagnosis :
o reduced cornea sensibility
(viral)
: anti-viral
Bacteria
: antibiotic
Fungi
: anti-fungal
no steroid !
Paracyte : anti-paracyte
Corneal Ulcer
Virus
Fungi
Allergy
(shield ulcer)
Central,
peripheral
central
central
central
-/+
greenish-yellow
transparant
white
greyish
white
demarcatedw
hite
purulent
discharge
punctate/
dendrite infiltrate
dense
abcess
demarcated
ulcer
Sensibility
normal
decreased
increased
normal
Perforation
frequent
rare
frequent
none
Cause
Location
Excavation
Color
Hypopion
Appearence
Bacteria
ANTERIOR UVEITIS
Ankylosing spondilitis
Juvenile rheumatoid arthritis
Reiter Syndrome
Sarcoidosis
Herpes simpleks
Herpes zoster
Behet Syndrome (with stomatitis aftosa)
ANTERIOR UVEITIS
Clinical presentation :
periocular pain
photophobia
mild decrease of vision
ciliary injection
small, irregular pupil, due to adhesion to lens
surface (posterior synechiae)
iris nodules ( Koeppe, Bussacca)
ANTERIOR UVEITIS
Normal iris
Posterior synechiae
Iris nodules
Hypopion
ANTERIOR UVEITIS
ANTERIOR UVEITIS
Management
Refer to ophthalmologist
Systemic work-up to find the etiology (spesific blood tests, Thorax
photo, CT-scan etc.)
Medication :
o cycloplegics topical eyedrops (to prevent posterior synechiae)
o steroids topical eyedrops (to reduce inflammation)
o oral corticosteroids oral (if necessary , severe case )
o anti glaucoma topical eyedrop (to reduce intraocular pressure)
PANUVEITIS
Inflammation of all part of uveal tissue include iris, cilliary body,
choroid which triggered by infectious and non-infectious causes
Etiology :
- Infectious : Toxoplasmosis
Tuberculosis
Sarcoidosis
Herpes Simplex
Hepes Zoster
Infectious Panuveitis
Tuberculosis
Sarcoidosis
Non-infectious Panuveitis
VKH
Behcet disease
ENDOPHTHALMITIS
Purulent intraocular infection
Exogenous : caused by infection due to ocular trauma, postsurgery (cataract, glaucoma, retinal surgery)
Endogenous : underlying systemic infection ( kidney, lung,
sepsis etc.)
Etiology : bacterial (most common), fungal, paracytes
Most common : Staphylococcus sp, Pseudomonas sp
Complication to extraocular/adnexa infection :
panophthalmitis, sinus cavernosus , meningitis
Endophthalmitis
Clinical presentation :
- periocular pain
- conjunctival chemosis
- eyelid swelling
- corneal edema
- anterior chamber inflammation
- hypopion
- vitreous inflammation
Hypopyon
Endophthalmitis
Management :
- Immediately refer to ophthalmologist
Differential diagnosis
Of Red Eye with No Injury
CONJUNCTIVITIS
CORNEAL
ULCER
ANTERIOR
UVEITIS
ACUTE
GLAUCOMA
Usually both
eyes
Usually one
eye(unilateral)
Normal
Usually
decreased
Often decreased
Marked decrease
Eye pain
Normal or gritty
Usually painful
Severe pain
(headache and
nausea)
Discharge
Sticky or watery
May be sticky
Watering
Watering
Generalised
(variable)
redness
Redness most
marked around
the cornea
Redness most
marked around the
cornea
Generalised
marked redness
Normal
Grey, white
spot
(fluorescein
staining)
Usually clear,
(keratitic precipitates
may be visible with
magnification)
Eye
Vision
Conjunctiva
Cornea
Contd
CONJUNCTIVITIS
CORNEAL ULCER
ACUTE IRITIS
ACUTE GLAUCOMA
Normal
Usually normal
(occasionally
hypopyon)
Cells will be
visible with
magnification
Shallow or flat
Normal and
round
Small and
irregular
Dilated
Pupil
response to
light
Active
Active
Minimal
reaction as
already small
Minimal or no
reacttion
Intraocular
pressure
(IOP)
Normal (but do
not attempt to
measure IOP)
Normal (but do
not attempt to
measure IOP)
Normal
Raised
Useful
diagnostic
sign/test
Pussy discharge
in both eyes
Fluorescein
stainng of the
cornea
Irregular pupil
as it dilates
with drops
Raised IOP
Anterior
chamber (AC)
Pupil size