OPHTHALMOLOGYCASE 2:

CORNEAL ULCER

SPECIAL SENSE SYSTEMGROUP 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

Diagnosed: OD CORNEAL ULCER + HYPOPION

CORNEAL

ULCER

Trauma ->painful red eye

ScleritisIritis

Episcleritis

LocalSpecificSystemicSurgical

PerforationVision loss

Complicated cataractAtrophia bulbi

BakteriVirusJamur

Reaksi toksikLuka pada

korneaKontak lens

Hilangnya sebagian permukaan kornea akibat kematian jaringan kornea

FotofobiaMata merah

Pandangan kaburBintik putih dikornea

Kekeruhan putih dikorneaMerasa ada benda asing

Sekret mukopurulen

HipopionHilang jaringan kornea

Adanya infiltrateInjeksi siliar

Penipisan kornea

Tingkat keparahan & akses pertolongan

Tes refraksiSlit lamp

KeratometriRespon reflek pupil

Zat fluoresensi

DIFFERENTIALDIAGNOSIS

ANATOMY

HISTOLOGY

DEFINITION

ETIOLOGYPATHOPHYSIOLOGY

SIGN

DIAGNOSISTREATMENT

COMPLICATION

PROGNOSIS

SYMPTOM

• Transparent • 0.5 mm thick at the center• Avascular• 5 layers

ANATOMY & HISTOLOGY

CORNEA

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

Epithelial layer• Anterior non-pigmented epithelium• Dilator pupillae muscle

• Posterior pigment epithelium• Faces the posterior chamber of the

eye

Anterior limiting membrane• Fibroblastic & melanocyte cells

Stroma• Loose fibrocollagenous support tissue• Blood vessels, nerve, melanin pigment• Sphincter muscle of the pupil

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

PATHOPHYSIOLOGY Trauma

Impaired cornea defense

mechanism

Exposure of naked nerve

ending

Destructive enzyme

released by infectious organism

Wandering cell work as

macrophages

Simple ulcer

Microorganism may adhere to corneal epitel

Ulcer suppurates and necrose to form excavated ulcer

Loss vision

Heal with scar tissue

opacification

Soften the cornea(gelatinous)

Injeksio pericornea

Red eye

Dilatation of blood vesels

in limbus

painful

MANIFESTASI KLINIKGejala 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. Scleritis2. Iritis3. Episcleritis

Corneal ulcer

Iritis Scleritis Episcleritis

Painfull eye + + + +Redness of eye + + + +Decrease vision + + + -Discharge and tearing + - + -Palpebra : edema & blefarospasm + - - -Bulbar & palpebral conjuctiva: hyperemic

+ + + +

Cornea : white lesion + - - -COA : Hypopyon + Posterior

surface- -

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 toa 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.