Case Report

ODS Bacterial Conjunctivitis

Presented By:
Kurnia Idris
111 2016 2090
Supervisor:
dr. Marliyanti N. Akib, Sp.M
(K), M.Kes
OPTHALMOLOGY DEPARTMENT FACULTY OF
MEDICINE
UNIVERSITAS MUSLIM INDONESIA
MAKASSAR
2018
 Patient Identity

 Name : Mrs. R
 Sex : Female
 Age : 79 y.o
 Address : Jl. Paccerekang No.3
 Religion : Islam
 Ethnic / Nation : Makassar / Indonesia
 Occupation : Housewife
 No Medical Record : 12.70.21
 Date of Examination : December 13th, 2018
History Taking
 Main complaint : Red eyes
 Guided history :
A 79 years-old female patient came to the
BKMM with red in both of eyes. This complaint
has been experienced about 2 days ago.
Complaints are accompanied by excessive
secretions, especially in the morning on both
eyes, excessive tears, but not feeling of itchi,
pain, glares in both eyes, blurred vision, and no
dirt found on both eyes.
There were no history of the same complaint,
treatment, history of contact with an infected
individual, trauma and glasses. There were no
history of DM and hypertension.
Ophthalmology Examination
Overview
 Inspection
OD OS
Palpebral Oedema (-) Hyperemia (-), Crusta (-) Oedema (-) Hyperemia (-), Crusta (-)

Cilia Normal, Secret purulen(+), Madarosis Normal, Secret purulen(+), Madarosis (-)
(-)
Lacrimal Apparatus Lacrimation (+) Lacrimation (+)

Conjunctiva Tarsalis Hyperemia (+), papillae (-), follicles Hyperemia (+), papillae (-), follicles
(-) (-)
Conjunctiva Bulbi Conjunctiva injection (+), cilliary Conjunctiva injection (+), cilliary injection
injection (-) (-)
Cornea Clear Clear
 OD OS

Anterior Chamber Normal Depth Normal Depth

Iris Brown Brown

Pupil Round, Central Round, Central

Lensa Pseudofakia Pseudofakia

Eyeball Movement Full Full

 Palpation
OD OS
Ocular pressure Tn Tn
Tumor/Mass (-) (-)
Pre Auriculer gland Not palpable Not palpable
Examination of Visual Acuity
OD Visus OS
Uncorrected visual acuity
20/60 20/40

- Correction -
Best corrected visual acuity
- -

Near visual acuity

- -

- Correction -
Best corrected near visual acuity
- -
Slit Lamp
• SLOD: Conjuctival Hyperemia (+), Opacity of cornea (-), anterior
chamber normal, brown iris, visible crypt, round and central
pupil, positive light reflex.

• SLOS: Conjuctival Hyperemia (+), Opacity of cornea (-), anterior

chamber normal, brown iris, visible crypt, round and central
pupil, positive light reflex.
Intraocular Pressure : NCT Tonometry

 OD : 15 mmHg
 OS : 10 mmHg
Resume

A 79 years-old female patient came to the

BKMM with red in both of eyes. This complaint
has been experienced about 2 days ago.
Complaints are accompanied by excessive
secretions, especially in the morning on both
eyes, excessive tears
 On inspection, conjunctiva hyperemia,
lacrimation, purulent secretions and
pseudophakia lenses were found in ODS. On
palpation and tonometry examination ODS is
within normal limits. On the visual examination,
VOD = 20/40, VOS = 20/60. On slit lamp
examination, SLODS = hyperemic conjunctiva
and pseudophakia lens are obtained
Diagnosis
ODS Bacterial Conjunctivitis

Differential Diagnosis
Episcleritis
Dry eye
Treatment

 Polynel ED 4 x 1 drops (Fluorometholone,

Neomycin sulfate, Neomycin base)
 C. Lyteers 6 x 1 drops (Sodium chloride,
Pottasium chloride)
Prognosis

• Quad Ad vitam : Bonam

• Quad Ad Sanam : Bonam
• Quad Ad Visam : Bonam
• Quad Ad Cosmetican : Bonam
Discussion
Anatomi
Histology
Definision

Bacterial conjunctivitis is an infection of the

eye’s mucous membrane, the conjunctiva,
which extends from the back surface of the
eyelid to the fornices, and onto the globe until it
fuses with the cornea at the limbus.
Epidemiology

 The prevalence of conjunctivitis varies

according to the under- lying cause
 Bacterial conjunctivitis is the second most
common cause and is responsible for the
majority (50%-75%) of cases in children
 It is observed more frequently from December
through April.
 The incidence of bacterial conjunctivitis is
difficult to determine, because most patients
with conjunctivitis are treated empirically
without cultures
Ettiology

 Acute : Staphylococcus aureus, Streptococcus

pneumoniae, and Haemophilus influenzae
 Hyperacute : Neisseria gonorrhoeae,
Nesisseria meningitidis.
 Chronic : Clamydia trachomatis,
Staphylococcus aureus and Moraxella
lacunata.
Risk Factor

 Contact with an infected individual

 Poor drainage of tears
 Lid malposition
 Severe tear deficiency
Physiology
First line
defense, as a
TLRs
trigger and
modulator
Flush the ocular
surface, kill
Tears microorganisms, and
prevent bacterial
adhesion
Reduce the Conjunctival
Indigenoius colonization of defense
Bacteria more pathogenic mechanism
microorganisms against bacteria

Lymphoid
Cellular imune
Tissue

Acute
PMN and
inflammatory
Machropagh
effector cells
Pathophysiology

The conjunctival Secondary

Systemic Affect
bacterial flora and infection
conditions
epithelial integrity

Hospitalized
patient,
Normal
immunodeficie More pathogenic
conjunctival
ncy bacterial
bacterial flora
syndromes,
severe burns

Disrupting the
Virulent intact conjunctival Conjunctival
bacteria epithelial surface infections
integrity.
Manifestation of Conjunctivitis

 Discharge
After bacterial invasion of
the conjunctiva, there is non
specifik PMN respone.
 Membranes and pseudomembranes
A true membrane is formed after
more severe inflammation .
A pseudomembrane consist of
coagulation of exudate in the surface
of the epithelium.
 Papillae and follicles

Papillae wich are found

more frequently on the
palpebral than on the bulbar,
have a velvety appereance
 Follicles
Slightly larger (1-2 mm),
may be seen along the
superior tarsal border
conjunctiva
Classification
Hyperacute bacterial conjunctivitis
• N. gonorrhoae and N. meningitidis
• Rapidly progressive condition
• Characterized by lid edema, marked
conjunctival hyperemia, chemosis, and copious
amount of purulent discharge.
• Usually starts unilaterally
• Membrane/pseudomembran (+/-)
• Preauriculer adenopathy
Acute conjunctivitis
• Most cases are caused by gram positive cocci,
S. Pneumoniae, S. aureus, and H. Influenzae.
• Has rapid onset
• Symptoms usually have been present less
than a week
• The discharge is mucopurulent
• Bulbar conjunctiva is more inflamed than the
palpebral conjunctiva
• Symptoms generally subside in 10 to 14 days
Chronic Conjunctivitis
• S. aureus and M. lacunata
• More indolent and prolonged course
• Foreign body sensation, mild sticness and
matting of the lashes, minimal discharge.
• Symptoms characteristicaly : diffuse
conjunctival huperemia, papillae formation,
mild mucopurulen discharge.
Diagnosis

Symptoms
• Acute onset of redness, grittiness, burning and
discharge.
• Involvement is usually bilateral
• On waking, the eyelids ere frequently stuck
togehter and may be difficult to open
• Systemic symptoms
Signs
• Eyelid edema and eythema
• Conjunctival injection
• The dischargecan initially be watery but
rapidly becomes mucopurulent
Hyperacute Conjunctivitis
• A gram strain and confirmatory culture
• Gonococci may be more readily identified from crapings
of the inferior tarsal conjunctiva
Acute Conjunctivitis
• Usually made by observing clinical sypmtoms
and sign without the laboratory studies.
• Blood cultures
Chronic Conjunctivitis
• Based most often on the history adn clinical
findings.
• Culturing of the lid margin and conjunctiva in
refractory situation.
• Gram and giemsa staining of conjunctival
scrapings
• Bacterial cultures
Suggested Algorthm of Clinical Approach
to suspected Conjunctivitis
Treatment

Hyperacute Conjunctivitis
• Gonococcal conjunctivitis : Ceftriaxone,
Cefotaxime, Spectinomycin, Norfloxacin
• N. meningitidis conjunctivitis : Penicilin (IM/IV),
Chloramphenicol
Acute Conjunctivitis
• Many milder cases of acute conjunctivitis are
self limited.
• Topycal antibiotics
Chronic Conjunctivitis
• Should be base on similar principles as in
acute conjunctivitis.
• Lid involvement : lid hygiene, lid margin
cleansing, nightly appliction of an antibiotic
ointment
Komplikasi

• Serious corneal involvement

• Keratokonjunctivitis
• Xerosis
• Symblepharon formation
• Trichiasis
• Entropion
Thank You