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8/17/2019 Infections eye (infeksi mata)
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INFECTIONS
T SITI HARILZA ZUBAIDAH
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Infections
• Stye (External Horeol!"#
– Infecte oil $lan at t%e li "ar$in
– Treat"ent&
• 'ar" co"resses
• Eryt%ro"ycin oint"ent for )*+, ays
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Stye
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Infections
• C%ala-ion (Internal Horeol!"#
– Infecte "ei.o"ian $lan (ac!te orc%ronic#
– Treat"ent& sa"e as stye
• 'ar" Co"resses
• Eryt%ro"ycin oint"ent for )*+, ays
• /LUS& Doxycycline for +0*1+ ays inrefractory cases
• Refer to o%t%al"olo$y for ersistent cases
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C%ala-ion
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C%ala-ion
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Infections
• Con2!ncti3itis
• Bacterial
– Eyelas% "attin$4 "!co!r!lent isc%ar$e4
con2!ncti3al in5a""ation (6it%o!t corneallesions#
– Treat"ent& toical anti.iotics• A!lts& Tri"et%ori"*oly"ixin B or eryt%ro"ycin ros
•
Infants& S!lfaceta"ie +,7 – Contact lens 6earers& nee to co3er Pseudomonas
• Ciro4 o5oxacin4 or to.ra"ycin toical co3era$e
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Bacterial Con2!ncti3itis
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Infections
• Con2!ncti3itis
• Bacterial
– If se3ere !r!lent isc%ar$e an %yerac!te
onset (+1*10 %o!rs#4 nee ro"t o%t%o e3alfor 6or8*! of Gonococcal conjunctivitis
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9onococcal Con2!ncti3itis
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Infections
• Con2!ncti3itis
• :iral• ;onoc!lar
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Infections
• Con2!ncti3itis
• Aller$ic – ;onoc!lar
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Infections
• Heres Si"lex :ir!s – Classic& Denritic eit%elial efect
– ED care eens on t%e site of infection• Eyeli an con2!ncti3a
– Toical anti3irals (tri5!orot%y"iine ros ays of infection& Acyclo3ir
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Infections
• Heres Zoster O%t%al"ic!s
– S%in$les 6it% tri$e"inal istri.!tion4 oc!larin3ol3e"ent4 conc!rrent iritis
– ?/se!oentrite@• ;!co!s corneal la!e 6it% eit%elial erosion
– Treat"ent&• Acyclo3ir
• Toical anti3irals
• 'ar" co"resses
• Oral anal$esics or cyclole$ics for ain relief
– O%t%al"olo$y cons!lt "anatory
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Pseudodentrite
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Infections
• /erior.ital Cell!litis (/resetalCell!litis#
– 'ar"4 in!rate4 eryt%e"ato!s eyelis
only – Treat"ent&
• A!$"entin (if oler t%an years# if non*toxic
• Toxic aearin$4 co"or.iities4 yo!n$er t%an – Hosital a"ission for I: Ceftriaxone
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Infections
• Or.ital Cell!litis (/ostsetal Cell!litis#
– 'ar"4 in!rate4 eryt%e"ato!s eyelis only
– Fe3er4 toxicity4 rotosis4 ainf!l oc!lar
"otility4 li"ite oc!lar exc!rsion – Dia$nosis&
• e"er$ent or.ital an sin!s t%in*slice CT 6
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Infections
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Infections
• Corneal Ulcer
– /ain4reness4 %oto%o.ia
– Etiolo$y& esiccation4 tra!"a4 irect in3asion4
contact lens !se – Slitla" exa"&
• Stainin$ corneal efect 6it% %a-y in=ltrate4
• Hyoon
– Treat"ent&• Toical o5oxacin or ciro ros e3ery %o!r
• Toical cyclole$ia
• Ot%o e3al 6it%in 10 %o!rs
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Hyoon
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Tra!"atic Eye In2!ries
• S!.con2!ncti3al He"orr%a$e – Disr!tion of con2!ncti3al .loo 3essel
– Etiolo$y
• Tra!"a• Snee-in$
• 9a$$in$
• :alsal3a
– 'ill resol3e sontaneo!sly 6it%in 1 6ee8sIf ense4 circ!"ferential .looy c%e"osis
is resent4 "!st r!le o!t $lo.e r!t!re
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Tra!"atic Eye In2!ries
• Con2!ncti3al A.rasion
– S!er=cial a.rasions
• Treat"ent& 1*> ays of eryt%ro"ycin
oint"ent
– Oc!lar forei$n .oy s%o!l .e excl!e
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Tra!"atic Eye In2!ries
• Corneal A.rasion
– Tearin$4 %oto%o.ia4 .le%arosas"4 se3ere ain
– Fl!orescein& ye !ta8e at efect site
–R!le o!t forei$n .oy
– Treat"ent&• Cyclole$ic
• Toical To.ra"ycin4 Eryt%ro"ycin4 or
Bacitracin
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Tra!"atic Eye In2!ries
• Corneal Forei$n Boies
– ;ay .e re"o3e 6it% =ne neele ti4 eye s!4or eye .!rr after toical anest%etic alie
– T%en treat as a corneal a.rasion
– Dee corneal sto"a FB or t%ose in central3is!al axis re!ire o%t%o cons!lt for re"o3al
– R!st rin$s can .e re"o3e 6it% eye .!rr4 .!t
not !r$ent – Ot%o follo6 ! in 10 %o!rs for resi!al r!st or
ee stro"al in3ol3e"ent
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Tra!"atic Eye In2!ries
• Li Lacerations
– ;!st excl!e a"a$e to eye annasolacri"al syste"
– Fl!orescein stainin$ in t%e tear layert%at aear in t%e a2acent lac con=r"nasolacri"al in3ol3e"ent
– ;ost re!ire o%t%o cons!lt
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Tra!"atic Eye In2!ries
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Tra!"atic Eye In2!ries
• Bl!nt Tra!"a
– I""eiately assess inte$rity of $lo.ean 3is!al ac!ity
– E3al et% of anterior c%a".er4 !ilsi-e4 "onoc!lar .linness r!t!re$lo.e
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Tra!"atic Eye In2!ries
• Hy%e"a
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Tra!"atic Eye In2!ries
• Hy%e"a – Bloo in t%e anterior c%a".er – Sontaneo!s or ost*tra!"a – Treat"ent&
• /lace t%e t !ri$%t to allo6 inferior settlin$ of .loo• Excl!e r!t!re $lo.e• Dilate t%e !il 6it% atroine• ;eas!re intraoc!lar ress!re if >, ""H$ aly
toical Ti"olol
• E"er$ent Ot%o e3al
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Tra!"atic Eye In2!ries
• Hy%e"a
– Ris8 for 6orse re.lee in t%e next 1*ays is 3ery %i$%
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Tra!"atic Eye In2!ries
• Blo6o!t Fract!res
– Inferior an "eial 6all "ost at ris8
– E3al!ate for•
inferior rect!s entra"ent (iloia on !6ar $a-e#• infraor.ital ner3e arest%esia
• s!.c!taneo!s e"%yse"a (6%en .lo6in$ t%e nose#
– Or.ital c!t CT scan
–
Treat"ent& r!le o!t oc!lar tra!"a an $i3e oralGe5ex
– Isolate .lo6o!t fract!re o%t%o e3al in > +,ays
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Tra!"atic Eye In2!ries
• Blo6o!t Fract!res
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Tra!"atic Eye In2!ries
• /enetratin$ Tra!"a
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Tra!"atic Eye In2!ries
• /enetratin$ Tra!"a
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Tra!"atic Eye In2!ries
• /enetratin$ Tra!"a
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Tra!"atic Eye In2!ries
• /enetratin$ Tra!"a
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Tra!"atic Eye In2!ries
• /enetratin$ Tra!"a
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Tra!"atic Eye In2!ries
• /enetratin$ Tra!"a
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Tra!"atic Eye In2!ries
• C%e"ical Oc!lar In2!ry
– Aci or al8ali treat t%e sa"e
– I""eiately 5!s% (at t%e scene#
– Contin!e to 5!s% !ntil H is nor"al ()J,#
• C%ec8 6it% !rine istic8
– Rec%ec8 H after s6eein$ t%e fornices
for retaine articles – ;eas!re IO/
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Tra!"atic Eye In2!ries
• C%e"ical Oc!lar In2!ry
– Treat"ent&
• Cyclole$ic
• Eryt%ro"ycin oint"ent
• Narcotic ain "es
• Tetan!s
–
I""eiate o%t%o e3al if not co"letelynor"al after initial "eas!res
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Tra!"atic Eye In2!ries
• Cra-y 9l!eK
– In2!ry occ!rs only as a res!lt of %ararticles t%at for" after ryin$
– O%t%o !ses cra-y $l!e as treat"ent inclinic
– Treat"ent&
• Eryt%ro"ycin oint"ent
• Re"o3e ieces t%at are easy to re"o3e
• Ot%o can re"o3e resi!al $l!e 6it%in 0%o!rs
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Tra!"atic Eye In2!ries
• Cra-y 9l!eK
– ;ineral oil "ay %el searate t%e lis
– Ne3er !se acetone or ot%er s!.stance
t%at .rea8s ! $l!e
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Ac!te :ision Loss
• Ac!te An$le Clos!re 9la!co"a
– Eye ain4 %eaac%e4 clo!y 3ision4colore %alos aro!n li$%ts4 con2!ncti3al
in2ection – Fixe4 "i*ilate !il
– Increase IO/ (0,*), "" H$#
•Nor"al ran$e is +, 1, "" H$
– Na!sea4 3o"itin$
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Ac!te :ision Loss
• Ac!te An$le Clos!re 9la!co"a
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Ac!te :ision Loss
• Ac!te An$le Clos!re 9la!co"a – I""eiate treat"ent&
• Ti"olol
• Aracloniine
• /renisolone acetate – If IO/ , "" H$ or se3ere 3ision loss&
• Aceta-ola"ie ,,"$ I:
– If no ecrease in IO/ or 3ision i"ro3e"ent&• I: ;annitol
– /ilocarine +*17 in aMecte eye4 ilocarine,J7 in contralateral eye (after IO/ 0, "" H$#
– I""eiate O%t%o cons!lt
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Ac!te :ision Loss
• Otic Ne!ritis
– In5a""ation of t%e otic ner3e
• Infection4 e"yelination4 a!toi""!ne x
– /resentation&• :ision re!ction (oor color ercetion#
• /ain 6it% extraoc!lar "o3e"ent
•
AMerent !illary efect – S6ellin$ of t%e otic isc "ay .e seen
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Ac!te :ision Loss
• Otic Ne!ritis
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Ac!te :ision Loss
• Otic Ne!ritis
– Dia$nosis
• Re Desat!ration Test
– Stare at .ri$%t re o.2ect 6it% nor"al eye only – O.2ect 6ill aear in8 or li$%t re in aMecte eye
– Treat"ent
• Disc!ss 6it% O%t%o
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Ac!te :ision Loss
• Central Retinal Artery Occl!sion
– Ca!ses• T%ro".osis4 e".ol!s4 $iant cell arteritis4 3asc!litis4
sic8le cell isease4 tra!"a
– /recee .y a"a!rosis f!$ax
– /ainless 3ision loss• ;ay .e co"lete or artial
– AMerent !illary efect
– /ale f!n!s 6it% narro6e arterioles anse$"ente 5o6s (.oxcars# an .ri$%t re"ac!la (c%erry re sot#
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Ac!te :ision Loss
• Central Retinal Artery Occl!sion
– Treat"ent&
• Oc!lar "assa$eK
– + secons of irect ress!re 6it% s!en release
• Toical ti"olol or I: aceta-ola"ie
• E"er$ent Ot%o e3al
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Ac!te :ision Loss
• Central Retinal :ein Occl!sion
– T%ro".osis i!retics an oralcontraceti3es reisose
– /ainless4 rai "onoc!lar 3ision loss – F!noscoy&
• DiM!se retinal %e"orr%a$e
•Cotton 6ool sots
• Otic isc ee"a
• ?Bloo an t%!ner@
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Ac!te :ision Loss
• Central Retinal :ein Occl!sion
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Ac!te :ision Loss
• Central Retinal :ein Occl!sion
– Treat"ent&
• ASA >1
• O%t%o referral
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Ac!te :ision Loss
• Te"oral Arteritis (9iant CellArteritis#
– Syste"ic 3asc!litis t%at can ca!se
isc%e"ic otic ne!roat%y – Us!ally
• , years ol
•Fe"ale
• /oly"yal$ia r%e!"atica
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Ac!te :ision Loss
• Te"oral Arteritis (9iant Cell Arteritis#
– /resentation&
• Heaac%e
• a6 cla!ication• ;yal$ias4 fati$!e
• Fe3er4 anorexia
• Te"oral artery tenerness
• TIA or stro8e
• AMerent !illary efect
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Ac!te :ision Loss
• Te"oral Arteritis (9iant CellArteritis#
– Dia$nosis
• Dont 6aste yo!r ti"e if yo! s!sectia$nosis
• ESR4 CR/
• Te"oral artery .iosy ($ol stanar#
– Treat"ent
• I: sterois an O%t%o cons!lt
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Ac!te :ision Loss
• Te"oral Arteritis (9iant CellArteritis#
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