KERATITIS DAN

KONJUNGTIVITIS

Gilang Pramanayudha
I4061172059
 Konjungtivitis
Semua insiden peradangan yang terjadi pada
daerah konjungtiva
 Konjungtivitis

Symptoms Virus Bakteri Klamidia Alergi

Gatal minimal minimal minimal Hebat
Hiperemi umum umum umum Umum
Air mata banyak sedang sedang Sedang
Eksudasi Minimal banyak banyak Minimal
Adenopati Sering jarang Pada konjungtivitis -
preaurikuler inkusi
Kerokan eksudat monosit PMN PMN, sel plasma, Eosinofil
inklusi
Sakit tenggorokan, kadang kadang Tak pernah Tak pernah
demam
Pengobatan Sulfonamide, Antihistamin,
gentamicin 0,3%, kortikosteroid
kloramfenikol 0,5%
 Viral Conjunctivitis Treatment

Adenoviral conjunctivitis:
• Although no effective treatment exists, artificial tears, topical antihistamines, or cold compresses may be useful
in alleviating some of the symptoms
• Topical antibiotics should not be indicated in due they do not protect against secondary infections, and their use
may complicate the clinical presentation by causing allergy and toxicity, leading to delay in diagnosis of other
possible ocular diseases and they can even increase the risk of spreading the infection to the other eye from a
contaminated dropper.
• Complications should be investigated if symptoms do not resolve after 7 to 10 days because of the risk of
complications

Herpes virus conjunctivitis:

• Topical and oral antivirals are recommended to shorten the course of the disease.
• Acyclovir:
– 3% ophthalmic ointment 200, 400, 800 mg 5x/day for 10 days.
– 200 mg/5 mL suspensión, 400 mg 5x/day for 10 days
– 5% dermatologic ointment, 6x/day for 7 days.
• Ganciclovir: 0.15% topical ophthalmic gel, 5x/day until epithelium heals; then 3x/day for 7 days
• Topical corticosteroids should be avoided because they potentiate the virus and may cause harm.

Herpes Zoster conjunctivitis

• Treatment usually consists of a combination of oral antivirals and topical steroids.
 Bacterial Conjunctivitis Treatment

• Most cases are self-limiting within 1 to 2 weeks of presentation, but in cases caused by highly virulent bacteria,
such as S. pneumoniae, N. gonorrhoeae, and H. influenzae might be beneficial reducing the duration of
conjunctivitis.
• There are no significant differences among all broad-spectrum antibiotic eyedrops in achieving clinical cure.
Factors that influence antibiotic choice are local availability, patient allergies, resistance patterns, and cost.
• Initial medical therapy dosing schedule for acute non-severe bacterial conjunctivitis is 4 times daily for
approximately 5- 7 days of any of the following:
– Polymixin combination drops
– Aminoglycosides or fluoroquinolone (ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, or gatifloxacin)
drops
– Bacitracin or ciprofloxacin ointment.
• Topical steroids should be avoided because of the risk of potentially prolonging the course of the disease and
potentiating the infection.
• Treatment for hyperacute conjunctivitis secondary to N. gonorrhoea consists of 1 gr intramuscular Ceftriaxone,
only dose and patient should be instructed on how to lavage the infected eye.
• Concurrent chlamydial infection should be managed with either of the following:
– Azithromycin 1000 mg single dose
– Doxycycline 100 mg bid for 7 days
– Tetracycline 250 mg qid for 7 days
– Erythromycin 500 mg qid for 7 days
 Gonococci Ophtalmic Treatment

• Neonatal Prophylaxis
– Erythromycin (0.5%) ophthalmic ointment, or
– Tetracycline (1%) ophthalmic ointment
• Symptomatic or High-Risk (mother with untreated gonorrhea) neonate
– Ceftriaxone (25 mg/k to 50 mg/kg, max 125 mg intravenously (IV) or intramuscularly (IM),
single dose, or
– Cefotaxime (100 mg/kg IV/IM), single dose, which may be preferred if available due to the
risk of increasing bilirubin levels associated with ceftriaxone
– Hourly saline lavage
• Non-Neonate with Symptoms (generally, can be managed on an outpatient
basis)
– Ceftriaxone (1 gm IM), single dose, and
– Azithromycin (1 gm oral), single dose, which is added on due to the frequent co-infection
with Chlamydia trachomatis
– Saline lavage can be considered but is not a necessity
 Keratitis
Semua insiden peradangan yang terjadi pada
daerah kornea
 Bacterial Keratitis Treatment

Topical broad spectrum antibiotic therapy should be

used until culture results are available. Treatment may
be selected according to the risk of potential visual loss.
• Small non-staining peripheral ulcers may be started
on fluoroquinolone drops every 2 to 6 hours.
• For ulcers with epithelial defects and an anterior
chamber reaction, a fluoroquinolone drop every hour
around the clock is recommended.
• Large or vision threatening ulcers (with moderate to
severe anterior chamber reaction and/or involving
the visual axis) are usually treated with fortified
tobramycin or gentamicin (15mg/ml) every hour
around the clock alternating with fortified
vancomycin (25mg/ml) every hour around the clock.
 Viral Keratitis Treatment

The mainstay of therapy is antiviral treatment either in the form of

topical therapy with
• trifluridine 1% eight to nine times a day or oral administration of
acyclovir or valacyclovir for 10 to 14 days. If trifluridine drops are
used, care is to be taken to ensure antiviral drops are
discontinued within 10-14 days due to corneal toxicity.
• Epithelial debridement of the dendrites may also be utilized in
conjunction with antiviral therapy to help reduce viral load.
Topical corticosteroids are contraindicated in the treatment of
active HSV epithelial keratitis.
 Fungal Keratitis Treatment

• Prior to the development of natamycin the most commonly used antifungal was
amphotericin b, a polyene, in a 0.15% dilution in sterile water (one 50mg vial of
amphotericin b diluted in 30cc sterile water gives a 0.166% dilution). It is still used today
alone and in combination with natamycin with relatively good results. Since they both are
readily available is a good choice as initial therapy.
• Voriconazole, a triazole antifungal agent derived from fluconazole, can be used either
topically at 1% dilution, orally at 400 mg twice a day and even has being injected in the
corneal stroma around the fungal lesion (50 micrograms/0.1 ml)
• Oral posaconazole, a new generation triazole has been successful eradicating deep
infections of resistant Fusarium. Subconjuctival antifungals are not generally used because
the produce severe pain and some might even induce tissue necrosis.
• Other antifungals available include the azoles like miconazole, clotrimazole ketoconazole,
posaconazole, and fluconazole and the echinocandin antifungal agents caspofungin, and
micafungin. The echinocandins are not active against Fusarium.
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