CASE 2:

CORNEAL
ULCER
SPECIAL SENSE SYSTEM
GROUP 6

CASE REVIEW
45 year old female
Chief complaint: painful red eye on the right eye (suddenly, 3
days earlier)
Decreased of vision, profound discharge and tearing
History of trauma: right eye into contact with sand (4 days prior
to visit)
Ophthalmolgy findings :
Visual Acuity : VOD 2/60, uncorrected; VOS : 6/6
Intraocular Pressure (palpation): TODS : Tn
Anterior segment (right eye)
- Palpebra: Edema (+), Blefarospasm
- Bulbar conjunctiva/ Palpebral conjunctiva: Chemosis/ Hyperemic(+)
Injeksio ciliaris (+)
- Cornea: White lesion (+), Ulcer (+) on the central

Hilangnya sebagian
permukaan kornea akibat
kematian jaringan kornea
DEFINITION Trauma ->
painful red
eye

Bakteri
Virus
Jamur
Reaksi
ANATOMY
toksik
Tingkat
HISTOLOGY
PATHOPHYSIOLOGY ETIOLOGY Luka pada
keparahan &
kornea
CORNE
akses
Kontak lens
Fotofobia
pertolongan
AL
PROGNOSIS
Mata merah
Perforation
Pandangan kabur
Vision loss
Bintik putih dikornea
COMPLICATION
SIGN
Complicated
ULCER
Kekeruhan putih
cataract
dikornea
Atrophia bulbi
Merasa ada benda
asing
SYMPTOM
Local
DIAGNOSIS
Sekret mukopurulen
Specifi TREATMENT
c
Hipopion
DIFFEREN
Tes refraksi
System
Hilang jaringan
TIAL
Slit lamp
Scleritis
ic
kornea
DIAGNOSI
Keratometri
Iritis
Surgica
Adanya infiltrate
S
Respon reflek
Episcleri
l
Injeksi siliar
pupil
tis
Penipisan kornea
Zat fluoresensi

ANATOMY &
HISTOLOGY

CORNEA
Transparent
0.5 mm thick at the
center
Avascular
5 layers

IRIS
The most anterior part of the
vascular
tunic,
forms
a
contractile diaphragm in front
of
the
lens,
a
circular
apperture (pupil) changes in
size in response to the light
intensity.
Eye colour is determined by
the
relative
number
of
melanocytes

Anterior limiting membrane

Fibroblastic & melanocyte cells
Stroma
Loose fibrocollagenous support tissue
Blood
vessels,
nerve,
melanin
pigment
Sphincter muscle of the pupil
Epithelial layer

Anterior non-pigmented
epithelium
Dilator pupillae muscle
Posterior pigment epithelium
Faces the posterior chamber of
the eye

DEFENISI
Ulkus kornea adalah hilangnya sebagian
permukaan kornea akibat kematian
jaringan kornea.
Ditandai dengan adanya infiltrat supuratif
disertai defek kornea bergaung dan
diskontinuitas jaringan kornea yang dapat
terjadi dari epitel sampai stroma.

ETIOLOGI
Bakteri (staphylokokus, pseudomonas,
pneumokokus)
Virus
Jamur
Reaksi toksik
Luka pada kornea
Penggunaan kontak lens

PATHOPHYSIOL
OGY

Traum
a
Impaired
cornea
defense
mechani
sm
Wandering
cell work
as
macrophag
es
Dilatatio
n of
blood
vesels in
limbus
Red
eye
Injeksio
pericornea

Microorgan
Simple
ism may
ulcer
adhere to
corneal
epitel
Destructiv
e enzyme
released
by
infectious
organism
Heal
with
scar
tissue
opacifica
tion
Loss
vision

Soften the
cornea(gelati
nous)

Ulcer suppurates and

necrose to form
excavated ulcer
Exposure
of naked
nerve
ending
painful

MANIFESTASI KLINIK
Gejala subjektif :
Mata merah
Fotofobia
Kekeruhan putih dikornea
Sekret mukopurulen
Pandangan kabur
Mata berair
Merasa ada benda asing di mata
Silau
Nyeri
Bintik putih dikornea sesuai
lokasi ulkus

Gejala objektif :
Hilangnya
sebagian
jaringan
kornea
dan
adanya infiltrat
Injeksi siliar
Penipisan kornea
Hipopion

DIFFERENTIAL DIAGNOSIS
1. Scleritis
2. Iritis
3. Episcleritis

Painfull eye
Redness of eye
Decrease vision
Discharge and tearing
Palpebra : edema &
blefarospasm
Bulbar & palpebral conjuctiva:
hyperemic
Cornea : white lesion
COA : Hypopyon

Corne
al
ulcer
+
+
+
+
+

Iritis

Sclerit Episcleri
is
tis

+
+
+
-

+
+
+
+
-

+
+
-

+
+

Poster

DIAGNOSIS
Anamnesis
Pemfis
Ketajaman penglihatan
Tes refraksi
Pemeriksaan slit lamp
Keratometri
Respon reflek pupil
Pewarnaan kornea dengan zat fluoresensi

TREATMENTS & MANAGEMENTS

Local cycloplegic ( atrophine 0.5%)
Specific antibiotic
- antifungal
- antibiotic drop (tobramycin)
- immunosuppresive drop (azathioprine)
Systemic IV antibiotic
Corticosteroid
Surgical Amnion Membrane Transferation (AMT)
- penetrating keratoplasty
- conjuctive graft bridge

Bridges Flap

COMPLICATIONS
Perforation
Vision loss
Atrophia bulbi
Complicated cataract

AtrophiaBulbi
The dense white pupil is due to
a cataracta complicata related
to longstanding uveitis with
longstanding
retinal
detachment. New bloodvessels
can be seen traversing the
pupil. The linear indentations in
relation to the recti muscles are
pathognomonic of shrinkage of
the eyeball - atrophia bulbi.

Scar of healed cornea ulcer can cause vision

totally loss

Perforation of corneal ulcer

PROGNOSIS
Semakin tinggi tingkat keparahan dan lambatnya
mendapat pertolongan dan komplikasi maka
prognosisnya menjadi lebih buruk.