Keratitis Case Tjia
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Case keratitis
bakterialisPembimbing : dr Bennadi,
SpM
Petricia – 11-2013-134
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Identitas pasien
• Nama : Tn. !
• "m#r : 2$ ta%#n
•
!&amat : Tana% Tinggi, a'arta P#sat• enis (e&amin: )a'i-&a'i
• Pe'er*aan : TNI - !+
•
!gama : Is&am• Tangga& peri'sa: 1$ September 201
• N M: 411$4/
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!namnesis
• +i&a'#'an secara !#t-anamnesispada p#'#& 11.00 IB di P&i mata.
• Keluhan Utama : mata 'iri terasaperi% se*a' 4 %ari ang &a&#
• Keluhan tambahan : mata 'irimera% dan peng&i%atan b#ram
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!namnesis
• Pasien datang 'e p&i'&ini' mata SP!+ attS#brt dengan 'e&#%an mata 'iri peri% se*a' 4 %ariang &a&#.
• (e&#%an *#ga disertai peng&i%atan b#ram,mera% dan
menge&#ar'an 'tran berarna p#ti%.
• Pasien mengata'an 'e&#%an terseb#t m#nc#& saatpasien p#&ang ber'endara nai' mtr dan terasaada deb# ang mas#'. (em#dian pasien berbat 'e
'&ini' dan diberi bat tetes mata er&amcetin.• (e&#%an tida' membai', dan pasien merasa'an
mata 'irina sema'in si&a# *i'a me&i%at ca%aa danberair.
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!namnesis
• Pasien menga'# tida' perna%meng&ami tra#ma pada mata, tida'perna% mengg#na'an bat – bat
tetes mata ang r#tin, tida' perna%mengg#na'an &ensa 'nta'. +antida' mengg#na'an 'acamata
sebe&#mna. Tida' ada riaatpena'it t#ber'#&sis, %erpessimp&e', ata#p#n pena'it sistemi'
&ainna
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!namnesis
• Riwayat Penyakit Terdahulu : – Tida' ada riaat pena'it ser#pa sebe&#mna
– iaat tra#ma disang'a&
–iaat %ipertensi disang'a&
– iaat diabetes me&&it#s disang'a&
• Riwayat penyakit keluarga : – Tida' ada 'e&#arga ang menderita 'e&#%an
ang sama dengan pasien
• Riwayat alergi : – Tida' ada riaat a&ergi sebe&#ma
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Permeri'saan si'
• (eadaan "m#m : tampa' sa'it ringan
• (esadaran : 5mps mentis
• Te'anan dara% : 1206$0 mm7
• Nadi : $4 'a&i6menit
•S#%# : 38,5
• :20 'a&i6menit
• (epa&a : nrmcep%a&i
• )e%er : (B tida' membesar
• 5r : B1 dan B2 reg#&ar tida' ada m#rm#r dan ga&&p
• P#&m : S#ara napas 9esi'#&er, tida' ada rn'i dan %eeing
• !bdmen : bent#' datar, s#pe& tida' ada neri te'an, bising#s#s nrma&.
• ;'stremitas : tida' ada edema, dan a'ra& %angat
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Stat#s p%t%a&m&gisKETERANGAN O O!
"# $%!U!
A&'uity (isus dan k)reksi 20620 2060 <P7 ma*#=
istansia Pupil
Addisi
$68
-
$68
-
Ka&a mata lama - -
"# KEUUKAN +O,A -ATA
Eks).talmus Tida' ada Tida' ada
End).talmus Tida' ada Tida' ada
e(iasi Tida' ada Tida' ada
Gerakan mata Bai' 'esega&a ara% S#&it dini&ai
"# !UPRA !%,%A
/arna 7itam 7itam
,etak Simetris Simetris
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Stat#s p%t%a&m&gis"# PA,PE+RA !UPER%OR AN %N0ER%OR
Edema Tida' ada Tida' ada
Nyeri tekan Tida' ada Tida' ada
Ektr)pi)n Tida' ada Tida' ada
Entr)pi)n Tida' ada Tida' ada
+le.ar)spasme Tida' ada Tida' ada
Trikiasis Tida' ada Tida' ada
!ikatriks Tida' ada Tida' ada
0isura palpebral Tida' ada Tida' ada
1)rde)lum Tida' ada Tida' ada
Kala2i)n Tida' ada Tida' ada
Pt)sis Tida' ada Tida' ada
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Stat#s p%t%a&m&gis
"# KON3UNGT%$A TAR!A, !UPER%OR AN %N0ER%OR
1iperemis Tida' ada Tida' ada
0)likel Tida' ada Tida' ada
Papil Tida' ada Tida' ada
!ikatriks Tida' ada Tida' ada
Anemia Tida' ada Tida' ada
Kem)sis Tida' ada Tida' ada
"# KON3UNGT%$A +U,+%
%n4eksi k)n4ungti(a Tida' ada Tida' ada
%n4eksi siliar Tidak ada Ada
Perdarahan sub5k)n4ungti(a Tida' ada Tida' ada
Pterigium Tida' ada Tida' ada
Pinguekula Tida' ada Tida' ada
Ner(us pigment)sus Tida' ada Tida' ada
"# !%!TE- ,AKR%-A,%!
Pun&tum lakrimal Terb#'a Terb#'a
Tes Anel Tida' di&a'#'an Tida' di&a'#'an
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Stat#s p%t%a&m&gis
"# !K,ERA
/arna P#ti% P#ti%
%kterik Tida' ada Tida' ada
"# KORNEA
Ke4ernihan erni% erni%
Permukaan )icin )icin
Ukuran 12mm 12mm
!ensibilitas n)rmal menurun
%ln6ltrat Tida' ada Tida' ada
Ulkus Tida' ada Tida' ada
Per.)rasi Tida' ada Tida' ada
Arkus senilis Tida' ada Tida' ada
Edema Tida' ada Tida' ada
Tes Plasid) Tampa' baangan
'nsentris
Tampa' baangan
'nsentris
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Stat#s p%t%a&m&gis"# +%,%K -ATA EPAN
Kedalaman +a&am +a&am
Ke4ernihan erni% erni%
1i.ema Tida' ada Tida' ada
1ip)pi)n Tida' ada Tida' ada
E.ek Tyndall Tida' diperi'sa Tida' diperi'sa
"# %R%!
/arna 5'&at 5'&at
Kripte e&as e&as
+entuk B#&at B#&at
!inekia Tida' !da Tida' !da
K)l)b)m) Tida' !da Tida' !da
"# PUP%,
,etak +itenga% +itenga%
+entuk B#&at B#&at
Ukuran 3 mm 3 mm
Re7eks &ahaya langung ? ?
Re7eks &ahaya tidak langsung ? ?
"# ,EN!A
Ke4ernihan erni% erni%
,etak 5entra& 5entra&
!had)w Test - -
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Stat#s p%t%a&m&gis
"# +AAN KACA
Ke4ernihan erni% erni%
"# 0UNU! OKU,%
Re7eks .undus Psiti@ Psiti@
a# Papil
+atas Tegas Tegas
+entuk B#&at B#&at
/arna (#ning 'emera%an (#ning 'emera%an
C rati) A 0,3 A 0,3
a# Arteri $ena Nrma&, rasi 263 Nrma&, rasi 263
a# Retina
Perdarahan Tida' !da Tida' !da
!ikatrik Tida' !da Tida' !da
Ne)(askularisasi Tida' !da Tida' !da
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Stat#s p%t%a&m&gis
"# PA,PA!%
Nyeri tekan Tida' !da Tida' !da
-assa tum)r Tida' !da Tida' !da
Tensi )kuli Perpa&pasi nrma& Perpa&pasi nrma&
T)n)meteri 10.1 mm7g , mm7g
"# KA-PU! $%!%
Tes k)n.r)ntasi Sama dengan pemeri'sa Sama dengan pemeri'sa
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es#me
• Pasien &a'i – &a'i, Tn !, #sia 2$ ta%#n, datang 'ep&i'&ini' mata SP!+ att S#brt dengan 'e&#%an#tama mata 'iri per% se*a' 4 %ari ang &a&#. (e&#%an
*#ga diserti peng&i%atan b#ram, mera%, menge&#ar'an
'tran bearna p#ti%, si&a#, dan berair.• Pada pemeri'saan si' didapat'an stat#s genera&is
da&am batas nrma&. Pada pemeri'saan @ta&m&gididapat'an 9is#s CDS 2060 dengan pin %&e 20620,'re'si 5 4,0 E 110, pada 'n*#ngti9a terdapatpe&ebaran pemb#&#% dara%, edema 'rnea. CD+didapat'an 20620, 're'si S 1,00. Tida' terdapat'e&ainan pada mata 'anan.
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• iagn)sis +anding – (eratitis ba'teria&is
– 'n*#ngti9itis
– #9eitis anterir
• iagn)sis Ker4a – (eratitis ba'teria&is DS
• Pemeriksaan An4uran – F#resent test
– pemeri'saan '#&t#r ba'teri
– bipsi 'rnea
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Penata&a'sanaan
• N)n medika ment)sa – 7indari terpapar &angs#ng sinar mata%ari, deb#
dan angin dengan mema'ai 'aca mata.
–
(mpres mata dengan air dingin
• -edika ment)sa : – ''#s gram psiti@ : 9an'misin 2-0 mg6m&
– batang gram negati@ : tbramicin /-14 mg6m&
– ''#s gram negati@ : ce@triaEne 0mg6m)
– mcbacteria : 5&arit%mcin 10mg6m) 0,03G
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Prgnsis
• H# ad Citam : +#bia adbnam
• H# ad #nctinam: +#bia adbnam
• H# ad Sanatinam : +#bia adbnam
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Tin*a#an p#sta'a
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Penda%#&#an•
(e&ainan 'rnea ang pa&ing seringditem#'an ada&a% 'eratitis
• (eratitis mer#pa'an s#at# prsesperadangan 'rnea ang dapat bersi@at
a'#t ma#p#n 'rnis ang disebab'an &e%berbagai @a'tr antara &ain ba'teri, *am#r,9ir#s ata# 'arena a&ergi.
• (eratitis dapat dibagi men*adi beberapag&ngan berdasar'an 'eda&aman &esi pada'rnea <tempatna=, penebab dan bent#''&inisna
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+;INISI
(eratitis ada&a% radang pada'rnea ata# in&trasi se& radang
pada 'rnea ang a'anmenga'ibat'an 'rnea men*adi'er#% se%ingga ta*am
peng&i%atan men#r#n
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;TID)DI
• Cir#s
• Ba'teri
• am#r
• Mata 'ering
• Benda asing
• Iritasi
• Sinar #&tra9i&et• !&ergi
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•InFamasi b&a mata ang *e&as
• Terasa benda asing di mata
• 5airan m#'p#r#&en dengan 'e&pa'
mata sa&ing me&e'at saat bang#n• "&serasi epite&
• 7ippin <ter'#mp#&na nana%
da&am 'amera anterir=
M!NI;ST!SI ()INIS
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• +apat ter*adi per@rasi 'rnea
• ;'str#si iris dan end@ta&mitis• t@bia
• Mata berair
• (e%i&angan peng&i%atan bi&a tida'ter'ntr&
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TI!S (;!TITIS
• t@bia
• )a'rimasi
•
B&e@arspasme
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(eratitis
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()!SII(!SI
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(;!TITIS P"NT!T!
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(;!TITIS M!IN!)
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(;!TITIS INT;STITI!)
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(;!TITIS B!(T;I
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(DMP)I(!SI
• angg#an re@ra'si
• aringan par#t
• "&'#s 'rnea
• Per@rasi 'rnea
• &a#'ma se'#nder
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PDNDSIS
(eratitis dapat semb#% dengan bai'
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!ekian
danTerimaKasih