KERATITIS - UVEITIS
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Transcript of KERATITIS - UVEITIS
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UVEITIS
• Inflamasi seluruh trek uvea
Disediakan Oleh : Nassruto
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Jenis
•Uveitis anterior•Uveitis posterior
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Etiologi
•Tidak diketahui•Berlaku bersama penyakit•-ankylosing spondylitis•-tibi•-sifilis sekunder•-kusta
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Uveitis anterior
•Definisi• Iritis-inflamasi iris• Iridosiklitis-inflamasi iris dan badan siliari anterior
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Manifestasi klinikal1.Penglihatan-cepat menjadi kabur-dalam beberapa jam/hari sahaja-bilateral2.mata-injeksi konjuntiva-injeksi siliari-sakit berdenyut
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3.fotofobia4.air mata meningkat5.Pupil-mengecut-tak regular6.kamar anterior-flares dan sel-sel
7.Keratic precipitates8.kelopak –kedua-dua bengkak9.hypopyon
Posterior synaechiae
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pengurusan
•Gutt atropin 1% BD•Gutt Prednisolone/betamethasone setiap jam•Analgesik oral prn
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Komplikasi
•Glaukoma sekunder•Hypotony•Katarak•Atrofi iris
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Uveitis posterior
•Definisi• Inflamasi koroid
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Uveitis posterior
•Definisi• Inflamasi koroid
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etiologi
•Sama seperti uveitis anterior
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Manifestasi klinikal1.Penglihatan kabur-simtom utama-retina terganggua/opasiti vitreous-Makula terlibat-penglihatan kurang-piring optik-penglihatan agak teruk2.Floaters –simtom utama-koroidits periferi-kabur penglihatan
ringan
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3.sakit mata-tidak teruk4.Oftalmoskopi-kawasan koroiditis-edema/tompok-tompok kuning/kelabu
-edema retina di bawah-setelah inflamasi reda-parut-perubahan di vitreous-sel-sel-flares
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-opasiti-bahagian posterior terlucut-retinitis-retina nampak putih
-vaskulitis-salur darah nampak kabur
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Pengurusan
•Steroid sistemik untuk kurangkan inflamasi
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keratitis
• Inflamasi kornea
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etiologi
•Bakteria•virus
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Keratitis bakteria
•Etiologi•Stafilokokus aureus•Streptokokus pneumoniae•Pseudomonas sp
Masuk kornea melalui abrasi/luka
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Manifestasi klinikal
1)Mata -merah(injeksi siliari)-sakit2.Discaj-mukopurulen3.mungkin-ulser kornea-hipopion
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Pengurusan
I. Kenalpasti penyebab-Gram stain-kulturII. Antibiotik topikal-Gentamicin(G-ve) atau-Cefuroxime(G+ve)
½ jam sekaliX24 jam
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III. Gutt atropine-1-2 jam sekali(siang sahaja)-kurangkan sakit-cegah posterior
synaechiae(uveitis)IV. Suntikan antibiotik
subkonjunktiva-kes serius yang mungkin buta-Gentamicin 20mg ODX5 hari_cefuroxime 125mgODX5 hari
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V. Antibiotik sistemik-ciprofloxacin 750mg BD oral-mudah masuk ke dalam mata
VI.Steroid topikal-jika kultur steril
VII.-diberi setelah 7-10 hari antibiotik diberi
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Keratitis virus
•Etiologi•Herpes simpleks-HSV1•Virus trakoma-chlamydia•Adenovirus•Virus herpes zoster
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Manifestasi klinikal•Sering berlaku kepada kanak-kanak 6 bulan-5 tahun•Konjunktivitis• -unilateral• -akut• -discaj cecair•Mata• -Sakit berdenyut• -fotofobia
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•Kelopak• -bengkak• -folikel•Keratitis-berlaku dalam beberapa hari•Ulser dendritik• -H simpleks• -superfisial/dalam• -Satu/lebih•Stain +ve dengan flourescein
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•Kornea kebas•Superficial punctate keratitis-adenovirus•Pannus-trakoma virus
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Pengurusan•Keratitis adenovirus-Gutt/occ idoxyuridine 3 jam sekaliX2-3 bulan•Keratitis H simpleks-occ Acyclovir 3% 5 kali sehariX2 minggu atau lebih•Gutt trifourothymidine 1% setiap 2 jam X 2 minggu(siang hari sahaja)•Keratitis trakoma-occ tetracycline/sulphonamide TDS X beberapa bulan
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Ulser kornea
• EtiologiA. Bakteria-masuk epithelium
kornea yang tercedera-staph aureus-pnemococcus-Proteus-pseudomonas
Sangat berbahaya,kornea rosak dalam 24 jam
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2.virus-boleh masuk kornea yang tidak cedera
-herpes simpleks-ulser dendritik-sering berlaku3.fungus-mata merah akut-jarang-jarang berlaku-kecederaan pertanian
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4.Ulser kornea pendedahan-kecacatan kelopak-paralysis muka-proptosis-pengsan5.ulser marginal korneal
Kornea kontang
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Manifestasi klinikal• Ciri-ciri klinikal semua jenis
ulser kornea hampir samaa)Mata-merah-sakit-kebas(H simpleks)-?hipopion dalam KA-Air mata meningkat
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2.fotofobia-sering berlaku3.penglihatan-kabur4.ulser-nampak jika besar dan dalam
-kesan fluorescein + ve jika kecil
5.pupil-sedikit konstrik
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Pencerapan
•Kikisan kornea•-mikroskopi•-kultur dan sensitiviti
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Pengurusan•Rujuk jika serius•Ulser bakteria•Gutt CMC + G gentamicin ½ jam sekali(siang)•Occ CMC + occ gentamicin nocte•Suntikan subkonjunktiva-Gentamicin + methicillin-sangat sakit•Antibiotik-ulser tembus-endothalmitis•Gutt sistemik
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• Jarang pasang pad mata•3.Ulser virus•Gutt CMC setiap jam(siang)•Occ CMC nocte•Gutt atropin OD•Gutt acyclovir setiap jam•Pad mata
Setiap hari sehingga ulser sembuh
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4.ulser fungusGutt natamycin 5-10%
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Komplikasi
•Parut kornea •Uveitis•Kornea tembus
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