CHAPTER I INTRODUCTION Keratitis is an inflammation of the cornea, the transparent membrane that covers anterior part of eye.

Patognomonic symptom of keratitis is infiltrate in cornea. Infiltrate can deposit in any layer of cornea. Cornea is avascular compartment of eye, so the defense mechanism in inflammatory process in cornea could not occur immediately. Inflammatory process in cornea can cause farther damage to cornea itself. When the inflammatory process in cornea happens superficially (epithelial) it macula, or leucoma. ill heal perfectly, but hen it happens in the deeper layer, there ill be a great chance of scar tissue development hich can be nebula,

CHAPTER II LITERATURE REVIEW

". C#$%&" Cornea is clear avascular anterior part of the eyes. Cornea consist of five layers (epithelium, bo man's membrane, stroma, decemet membrane, and endothel). Cornea is the part of visual a(is disturb the visual acuity. )ince the cornea is avascular, it is nourished by tear, a*ueous humour, and pericorneal blood vessels. &phitelium o +he outmost layer of cornea ith ,- um thickness, consist of , ith the greatest refractive inde(, so ill greatly any abnormality of this part of the eyes, especially in centre part,

layers of nonceratini.ed s*uamous epithelial. o Provide primary protection to the deeper layer of cornea from outer environment and selectively inhibits transport of electrolyte. o +his part can regenerate perfectly after in/ury 0o man membrane o "nterior part of stroma o 1nable to regenerate )troma o +he thickest layer of cornea o Consist of ell arranged fine collagen fiber 2ecement membrane o Produced by endotel o )trongest layer in cornea o &lastic 3 ater and

&ndothel o 4onolayer o +he most important part in hydration of cornea o 1nable to regenerate o 2amage to this part can cause corneal edema Cornea innervated by ophthalmic branch of +rigeminal %erve. +his branch

terminates in second layer of epithelium. In/ured nerve in cornea can heal in 5 months. 0. K&$"+I+I) Keratitis is an inflammatory process in cornea. Keratitis is classified based on location of lesion in corneal layer and cause6 0ased on location6 !. )uperficial keratitis6 &pithelial keratitis (flouresence test 7)
o o o

Keratitis pungtata superficial Keratitis 8erpes simpleks Keratitis 8erpes .oster

)ubepithelial keratitis (flouresence test 9)

o o

%ummular keratitis of 2immer 2isiform keratitis of Westhoff

)tromal keratitis (flouresence test 9)

o o

%europaralitik keratitis Keratitis et lagoftalmus

3. Profound Keratitis6

Keratitis Interstitial Keratitis )klerotikans Keratitis 2isiformis

0ased on cause6

0actery6 2iplococcus pneumonia, )treptococcus hemolyticus, Pseudomonas aeroginosa, etc :irus 6 8erpes simpleks, 8erpes .ooster, etc fungi 6 Candida, "spergillus sp. "llergic reaction "vitaminosis " %.: damage 2irect trauma 2ry eye

Patophysiology )ince the cornea is avascular, inflammatory process and immediate as other It ill not as effective

ell vasculari.ed tissues. Wandering cell in corneal ill then follo ed by ill cause cornea

stroma ill be the first immunologic cell hich response to inflammatory process. ill become tissue macrophage. +his process vasodilatation of blood vessels in limbus (this looks cloudy. Corneal epithelium can be destroyed and form ulcer. )uperficial ulcer resolve perfectly, but the deeper one chamber and can be seen as hypopion. )ymptoms of keratitis include, but are not limited to6 ; inflammatory response, inflammatory cell ill ill be seen as pericorneal

in/ection). Infiltration of P4%, macrophages, and plasma cell

ill leave scar. If the iris involved in this ill be accumulated in anterior

+earing Pain )ensitivity to light Inflammation of the eyelid 2ecrease in vision $edness.

C. %1441<"$ K&$"+I+I) (K&$"+I+I) %1441<"$ #= 2I44&$) %ummular keratitis is a type of subepithelial keratitis ith grouped coin shaped infiltrates. +hese infiltrates have >halo? appearance. It is usually caused by viral invasion to epithelial layer of cornea secondary to trauma in cornea. $eplication of virus in epithel follo ed by spread of to(in to stroma causes subepithelial infiltrate formation. +his type of keratitis usually happens unilateral.

%ummular keratitis

CHAPTER III CASE

!.

Patient identity %ame )e( "ge "ddress &thnic @ob $eligion 6 4s. 4 6 =emale 6 !- years old 6 )ungai Purun 0esar 6 4elayu 6 9 (student) 6 4oslem

Patient as e(amined on "pril !;th, 3-!!

3. "namnesis a. 4ain complaint6 hitish spots on left eye. b. 8istory of disease 6 Patient complain ithish spots on left eye hich is painless. =our months eek she felt

ago patient has her left eye entered by bug. =or about one

slight pain, tearing, and redness in her left eye. When the symptoms

resolved, her mother reali.ed that some

ithish spots formed in her left

eye. Patient complain no blurry vision since then. c. Past clinical history6 Patient claims that there is no history of the same symptoms before. d. =amily history 6 +here are no one of her family have the same complaint.

5. Beneral Physical "ssessment Beneral condition " areness :ital )igns6 8eart $ate $espiration fre*. 0lood Pressure +emperature 6 C-(Dminute 6 !C(Dminute 6 !--DA- mm8g 6 5A,EoC 6 good 6 composmentis

;. #phthalmological status :isual acuity6 a. #2 b. #) 6 ADA 6 ADA

$ight eye

<eft eye

ptosis (9), lagoftalmos (9), edema (9) $edness (9), discharge (9), in/ection(9) Clear, edema ((9)

Palpebra

ptosis (9), lagoftalmos (9), edema(9)

Conjungtiva

$edness (9), discharge (9), in/ection(9)

Cornea

Clear, edema (9), in iltrate !"#

clear, deep Iris colour 6 bro n Pupil6 circular, isokor, reactive to light Clear Clear %ormal

COA Iri$ an% pupil

Clear, deep Iris colour 6 bro n Pupil6 circular, isokor, reactive to light

Len$ Vitreou$ &un%u$

Clear Clear %ormal

&ye ball movement

OD + + OS + + +

)hado test 6 positive for both eye Ishihara test 6 not measure

:isual field test (confrontation) 6 normal &loure$en'e te$t( not 'on%u'te%

,. $esume Patient complains painless hitish spots on her left eye. =our months

ago patient has her left eye entered by bug that cause slight pain, redness and tearing hich resolved in a eek. Patient complains no blurry vision. :ital signs of this patient are in normal range. :isual acuity of both eyes are ADA. &yelids are normal. Cornea of the left eye has some hitish

grouped coin shaped spots. +he anterior chamber, lens, and vitreous body of both eyes are clear. Iris and pupil look normal. +he flourosence test conducted because patient's mother refused. as not

A. 2iagnose Working 2iagnose6 %ummular keratitis #)

E. Plan for e(amination 9 =louresence test

C. +reatment6 9 %on medicamentous6 using of protective glasses

4edicamentous6 o Bentamycin eye drop -,5G ;9A ( ! gtt o Prednisolon eye drop -,,G 39; ( !gtt

F. Prognosis #2 "d vitam "d functionam 6 bonam 6 bonam

"d sanactionam 6 bonam

#) "d vitam "d functionam 6 bonam 6 bonam

"d sanactionam 6 bonam

CHAPTER IV DISCUSSION

!-

" girl, !- years old complained

hitish spots in her left eyes. +here

as history of bug entered her left eye four months ago. )he felt slight pain, tearing, and redness for about one hitish spots formed in her cornea. +he only abnormality found in physical e(amination is the hitish eek. 8er mother then reali.ed that some

grouped coin shaped spots in patient left eye. =rom anamneses there is history of bug entered the eye. In this case it can cause trauma hich is possibly follo ed by secondary viral infection to the epithelial lining of cornea. Infiltration that happens in subepithelial layer cause the coin shaped spots appearance. Working diagnose of this patient is nummular keratitis based on the appearance of corneal abnormality. $ecommended therapy for this patient includes nonmedicamentous such as earing protective glasses to prevent recurrent trauma. 4edicamentous ith

therapy for this patient aims to prevent secondary bacterial infection antibiotic (gentamycin) and to reduce inflammatory process (prednisolone).

ith corticosteroid

C8"P+&$ : C#%C<1)I#%

!!

" girl !- years old ith complaint of hitish painless grouped coin shaped spots in the left eyes and history of eye trauma. Working diagnose for this patient is nummular keratitis. +he therapy included non medicamentous ( earing protective eye glasses) and medicamentous (gentamycin and prednisolone eye drop).

$&==&$&%C&) Ilyas, ). 3--E. Ilmu Penyakit Mata edisi ketiga. @akarta6 0alai Penerbit =K1I. !3

)hann, =. 3--C. Drug Doses. !,th edition. :aughan 2B, et al. 3---. Oftalmologi umum edisi 14. @akarta6 Widya 4edika.

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