Upload
kartikaekawulandari
View
227
Download
0
Embed Size (px)
Citation preview
8/10/2019 Con Jung Tiva
1/61
fkk umj sri fulina 20 Nop.09
CONJUNGTIVA
FK. UMJ
8/10/2019 Con Jung Tiva
2/61
fkk umj sri fulina 20 Nop.09
The conjunctiva
A transparent mucous membrane that
lines the inner surfaces of the eyelids and
the front surface of the eyeball.
8/10/2019 Con Jung Tiva
3/61
fkk umj sri fulina 20 Nop.09
The conjunctiva is composed of 3
sections Palpebral conjunctiva
(covers the posteriorsurface of the eyelids).
Bulbar conjunctiva
(coats the anteriorportion of the eyeball).
Fornix (the transitionportion forming the
junction between theposterior eyelid andthe eyeball).
8/10/2019 Con Jung Tiva
4/61
fkk umj sri fulina 20 Nop.09
Conjunctiva
Conjunctivitis
Ophthalmia neonatorum
Subconjunctival hemorrhageDry Eyes (keratoconjunctivitis sicca)
8/10/2019 Con Jung Tiva
5/61
fkk umj sri fulina 20 Nop.09
Conjunctivitis
History and symptoms can help determine
the etiology
Correct diagnosis has direct implications
for treatment and possible spread to close
contacts
8/10/2019 Con Jung Tiva
6/61
fkk umj sri fulina 20 Nop.09
Conjunctivitis Contd
History
Any recent contact with some one with ared eye (within the past 2-3 weeks)?
How did it start?
Has it spread from one eye to the other?
Any tearing or discharge?
Any changes in vision?
Does it itch?
Has the child been rubbing their eyes?
8/10/2019 Con Jung Tiva
7/61
fkk umj sri fulina 20 Nop.09
Conjunctivitis - Discharge
Discharge Cause
Purulent Bacteria
Clear Viral
White mucous Allergies
8/10/2019 Con Jung Tiva
8/61
fkk umj sri fulina 20 Nop.09
Bacterial Conjunctivitis
Common causes
Staphylococcus
Streptococcus
Hemophilus
Pneumococcus
8/10/2019 Con Jung Tiva
9/61
fkk umj sri fulina 20 Nop.09
Pathogenesis
Staph.epidremidis,staph aureus, strept.
pneumoniae or H.influenzae transmitted
by direct contact with infected secretions.
8/10/2019 Con Jung Tiva
10/61
fkk umj sri fulina 20 Nop.09
Bacterial Conjunctivitis
Erythema of conjunctiva
Purulent discharge
May be monocular (one eye) or binocular(both eyes)
Hemophilis may cause hemorrhage on the
conjuctiva and occasionally the lids
8/10/2019 Con Jung Tiva
11/61
fkk umj sri fulina 20 Nop.09
Bacterial conjunctivitis: note the purulent
discharge and conjunctival hyperemiaPicture taken from Basic Ophthalmology for Medical Students and Primary Care Residents published by the American Academy of
Ophthalmology
8/10/2019 Con Jung Tiva
12/61
fkk umj sri fulina 20 Nop.09
Bacterial Conjunctivitis - treatment
Broad spectrum topical antibiotics
Polytrim, Ocuflox, Ciloxan
Warm compresses
Children may return to school once
antibiotic therapy is instituted
Refer if not markedly improved within 4days
8/10/2019 Con Jung Tiva
13/61
fkk umj sri fulina 20 Nop.09
Viral Conjunctivitis
Adenovirus
May be associated with systemic viral
infections
Herpetic
Picornavirus and enterovirus type 70
cause a hemorrhagic conjunctivitis
8/10/2019 Con Jung Tiva
14/61
fkk umj sri fulina 20 Nop.09
Viral Conjunctivitis (non-herpetic)
HIGHLY CONTAGIOUS
Usually starts in one eye and progresses
to the second eye
Often a history of recent contact with
another person with a red eye or pink
eye
Children must be kept out of school until
tearing stops (up to two weeks)
8/10/2019 Con Jung Tiva
15/61
fkk umj sri fulina 20 Nop.09
Viral conjunctivitis - symptoms
Often bilateral
Often with diffuse, marked hyperemia
Watery dischargeChemosis ( swelling of conjunctiva)
Some itching and foreign body sensation
Preauricular adenopathyURI, sore throat, fever common
8/10/2019 Con Jung Tiva
16/61
fkk umj sri fulina 20 Nop.09
Viral conjunctivitis: note the diffuse redness and watery
discharge
8/10/2019 Con Jung Tiva
17/61
fkk umj sri fulina 20 Nop.09
Viral conjunctivitis - treatment
Cold compresses
Good hygienewash hands, do not share
wash cloths, pillows, towels etc.
Topical treatment for symptom relief only
(will not shorten the course of the disease)
Patanol, Zaditor, Acular, Artificial tears
No role for topical antibiotics
8/10/2019 Con Jung Tiva
18/61
fkk umj sri fulina 20 Nop.09
Viral Conjunctivitis - Herpetic
Profuse watery discharge
May have eyelid margin ulcers and
vesicles
Corneal involvement may result in
permanent scarring and visual loss
Urgent referral to ophthalmologist fortreatment with topical antivirals
8/10/2019 Con Jung Tiva
19/61
8/10/2019 Con Jung Tiva
20/61
fkk umj sri fulina 20 Nop.09
Typical herpetic corneal lesion stained with rose bengal.
Note the branching (dendritic) pattern.
Picture from Section 6 of the Basic and Clinical Science Course published by the Foundation of the American Academy of Ophthalmology
8/10/2019 Con Jung Tiva
21/61
fkk umj sri fulina 20 Nop.09
Allergic Conjunctivitis
Associated with hay fever, asthma,
eczema
Often bilateral and seasonal
Milder conjunctival hyperemia
Chemosis
Itching (primary symptom)Not contagious, children may return to
school
8/10/2019 Con Jung Tiva
22/61
fkk umj sri fulina 20 Nop.09
Allergic conjunctivitis: note the conjunctival
erythema but no watery discharge
8/10/2019 Con Jung Tiva
23/61
8/10/2019 Con Jung Tiva
24/61
fkk umj sri fulina 20 Nop.09
Ophthalmia Neonatorum
Chemical
Gonococcal
ChlamydialHerpetic
8/10/2019 Con Jung Tiva
25/61
fkk umj sri fulina 20 Nop.09
Chemical conjunctivitis
Onset: first 24 hours
Cause: silver nitrate (90%)
Signs & Sxs: bilateral, mild eyelid edema,clear discharge, conjunctival injection
Treatment: supportive, spontaneous
resolution in a few days
8/10/2019 Con Jung Tiva
26/61
fkk umj sri fulina 20 Nop.09
Gonococcal conjunctivitis
Onset: 48 hours
Cause: Neisseria gonorrheavia birth
canal
Signs & Sxs: severe, purulent discharge,
chemosis, eyelid edema
Dx: gram staining is negative.
Treatment: systemic cefriaxone or Pen G,
topical erythromycin and irrigation
8/10/2019 Con Jung Tiva
27/61
fkk umj sri fulina 20 Nop.09
Gonococcal conjunctivitisnote the copious amounts of
purulent dischargePicture from Section 6 of the Basic and Clinical Science Course published by the Foundation of the American Academy of Ophthalmology
8/10/2019 Con Jung Tiva
28/61
fkk umj sri fulina 20 Nop.09
Neonatal chlamydial conjungtivitis
Pathogenesis :
Chlam trachomatosis serotypes D to K
acquired from the mother during delivery
Diagnosis :
Presentation is 512 days postpartum.
Signs :
Mucopurulent discharge associated with
papillary conjungtivitis.
8/10/2019 Con Jung Tiva
29/61
fkk umj sri fulina 20 Nop.09
8/10/2019 Con Jung Tiva
30/61
fkk umj sri fulina 20 Nop.09
Neonatal Chlamydial conjunctivitis
Investigations :
conjungtival and maternal vaginal swabs
for Gram and Giemsa staining.
Signs & Sxs: more indolent, eyelidedema, pseudomembrane formation
Treament:
- topical tetracyclin and oral erythromycin
- parents should also be treated.
8/10/2019 Con Jung Tiva
31/61
fkk umj sri fulina 20 Nop.09
Differential diagnosis
Bacterial conjungtivitis:
typically occurs more than 5 days
postpartum.
Gonococcal conjungtivitis :
typically within 2 days postpartum and
is associated with profuse creamy disch
Primary herpes conjungtivitis :
develop 3-15 days postpart ,and watery
discharge.
8/10/2019 Con Jung Tiva
32/61
fkk umj sri fulina 20 Nop.09
Herpetic conjunctivitis
Onset: 12 weeks
Cause: HSV 2 via birth canal
Signs & Sxs: serous discharge,conj
injection and geographic keratitisDx: Gram stain (multinucleated giantcells), Papanicolaou stain, viral cultures
Treatment: topical antiviraltrifluorothymidine and systemic acyclovir
8/10/2019 Con Jung Tiva
33/61
8/10/2019 Con Jung Tiva
34/61
fkk umj sri fulina 20 Nop.09
Subconjunctival hemorrhage
If associated with trauma inspect globe
carefully to rule out other injuries
Corneal abrasions (discussed later)
Open globe (emergency requiring immediate
referral to ophthalmologist)
Hyphema (discussed later)
8/10/2019 Con Jung Tiva
35/61
fkk umj sri fulina 20 Nop.09
Subconjunctival hemorrhage
8/10/2019 Con Jung Tiva
36/61
fkk umj sri fulina 20 Nop.09
TRACHOMA
Trachoma is one of the mayor blinding
diseases of the world.
It is the most common infectious causes of
the blindness.
Trachoma is caused by a recurrent chronic
eye infection.
The organism involved is Chlamydia
trachomatis.
8/10/2019 Con Jung Tiva
37/61
fkk umj sri fulina 20 Nop.09
Episode of infection usually begin in
childhood,while blindness from corneal
scarring occurs after repeated infection,
Scarring of the eyelids,distortion of the
eyelashes,associated trauma and
secondary bacterial infection.
8/10/2019 Con Jung Tiva
38/61
fkk umj sri fulina 20 Nop.09
What is the cause of trachoma
Is caused by the organism Chlamydia
trachomatis.
Is a highly infectious agent wich can easily
be transmitted from eye to eye.
Using the microscope,a Giemsa stain of a
conyungtival smear highlight the typical
chlamydia inclusions.
8/10/2019 Con Jung Tiva
39/61
fkk umj sri fulina 20 Nop.09
8/10/2019 Con Jung Tiva
40/61
fkk umj sri fulina 20 Nop.09
Risk factors for trachoma
Which environmental factors influence thetransmission of infection with chl.trach:
- sanitation
- fresh water supplies- the presence of animals kept near to
dwelling and piles of animal.
A cycle of re-infection within this populationneeds to be broken by treatment, health
education & preventive measures
8/10/2019 Con Jung Tiva
41/61
fkk umj sri fulina 20 Nop.09
8/10/2019 Con Jung Tiva
42/61
fkk umj sri fulina 20 Nop.09
The picture shows an eye-seeking fly
attracted to the purulent discharge from
the eyes of an infected child may containthe infective organism which can be
transmitted (carried) to the eyes of another
child by flies.Un washed fingers may also transmited
the organism.
Clothes and towels which are incontactwith the face or eyes of a child may carry
chlamydia trachomatis.
8/10/2019 Con Jung Tiva
43/61
fkk umj sri fulina 20 Nop.09
8/10/2019 Con Jung Tiva
44/61
fkk umj sri fulina 20 Nop.09
How does the water supply for a
community influence the transmission of
infection with chlamidia trachomatis ?A dry,dusty area with exposed dung and
poor sanitation is likely to have endemic
trachoma.Clearly,available water increases the
likelihood of good sanitation and good
personal hygiene.
8/10/2019 Con Jung Tiva
45/61
fkk umj sri fulina 20 Nop.09
8/10/2019 Con Jung Tiva
46/61
fkk umj sri fulina 20 Nop.09
Age and trachoma
8/10/2019 Con Jung Tiva
47/61
fkk umj sri fulina 20 Nop.09
All age groups may be affected by
trachoma but there is a progression of thediseases which may continue over many
years,beginning very young,with the later
scarring complication evident in olderchildren and in all ages adult life.
8/10/2019 Con Jung Tiva
48/61
fkk umj sri fulina 20 Nop.09
Clinical examination for trachoma
8/10/2019 Con Jung Tiva
49/61
8/10/2019 Con Jung Tiva
50/61
fkk umj sri fulina 20 Nop.09
TF=Trachomatous Infl Follicle
8/10/2019 Con Jung Tiva
51/61
fkk umj sri fulina 20 Nop.09
TI=Trach.Inflam Intense
8/10/2019 Con Jung Tiva
52/61
fkk umj sri fulina 20 Nop.09
TS=Trachom Scarring
8/10/2019 Con Jung Tiva
53/61
fkk umj sri fulina 20 Nop.09
TT=Trachom Trichiasis
8/10/2019 Con Jung Tiva
54/61
fkk umj sri fulina 20 Nop.09
CO=Corneal Opacity
8/10/2019 Con Jung Tiva
55/61
fkk umj sri fulina 20 Nop.09
Dif i l Di i
8/10/2019 Con Jung Tiva
56/61
fkk umj sri fulina 20 Nop.09
Diferential Diagnosis
M di l T t t
8/10/2019 Con Jung Tiva
57/61
fkk umj sri fulina 20 Nop.09
Medical Treatment
T i hi i d E il ti
8/10/2019 Con Jung Tiva
58/61
fkk umj sri fulina 20 Nop.09
Trichiasis and Epilation
S f lid t i
8/10/2019 Con Jung Tiva
59/61
fkk umj sri fulina 20 Nop.09
Surgery of upper eylid entropion
P ti
8/10/2019 Con Jung Tiva
60/61
fkk umj sri fulina 20 Nop.09
Prevention
1. Good personal hygiene ,daily face and
hand washing.
2. A good water supply near the comm
3. Ventilated pit latrines4. Animals housed at a distance from
comm homes.
5. Health Education
8/10/2019 Con Jung Tiva
61/61
TERIMA KASIH
WASSALAM
JAKARTA, 20 NOP 2009