CASE PRESENTATION II

“OS PERFORATED CORNEAL ULCER EC FUNGAL INFECTION

”

Pembimbing : dr. Marie Yuni Andari, Sp.M

Feny Cahyani
H1A015023
BACKGROUND
- Corneal ulcer is a discontinuity or partial loss of corneal surface due to corneal
tissue death.
- Corneal ulcer formation is caused by the presence of collagenase formed by
new epithelial cells and inflammatory cells.
- Inflammation in corneal ulcers involves disruption of the epithelial lining and
involvement of the corneal stroma.

Corneal ulcers can cause blindness in which vision problems in men and women in
all age groups in the world
CON’T
Corneal ulcers can be caused by noninfections such as
exogenous infections namely by
•chemicals, radiation, vitamin A deficiency,
 -viruses,
drugs (corticosteroids, idoxiuridine, topical
 Bacterial
anesthesia, immunosuppressive), abnormalities
 fungi
of the basal membrane such as due to
 parasites
trauma, exposure, neurotropic
CON’T

Complications caused by corneal ulcers such as the formation of scar tissue

while also experiencing paracial or complete blindness due to endophthalmitis
and secondary glaucoma

This disease need special treatment and as soon as possible

PATIENT'S IDENTITY

-Name : Mr. H
-Age : 37 years old
-Sex : Male
-Address : Sinah Village
-Religon : Moeslem
-Date of examinations : October 1, 2019
Main complaint  can't see in the left eye
Present medical history :
(In malaysia)
The patient complained that the left eye could not see since ± 3 weeks
ago. The patient's left eye was exposed to palm oil powder ± 1 month
ago while working as a palm oil worker in Malaysia which said the
patient did not wear eye protection like glasses when working,
CON’T
Present medical history :
(In malaysia)

then the patient was taken to the hospital emergency room in

Malaysia and was treated for 1 week. The condition of the patient
at the Malaysian, Hospital said that the patient's left eye had
leaked and had been patched besides that the patient received
antibiotics, analgetic and eye drops.
 CON’T
Present medical history :
(In Praya)

After 1 week of treatment at Malaysia Hospital, the patient returned to

Indonesia (Praya), the next day was taken to Praya Regional Hospital in
ophthalmology with blurry eye complaints, then eye drops were given.
When the patient is at home, the patient says often wash his eyes by
soaking and the patient also says go to a smart person (shaman) to treat
the patient's eyes because the patient's eyesight gets worse
CON’T
Present medical history :
(In RSUP NTB)

A week later, the patient came to the eye clinic at Hospital West Nusa
Tenggara with complaints that the left eye could not see and a yellowish-
white color appeared in the eye besides the patient also complained of
left eye pain especially when flashing, red eyes, watery, glare and can
only see shadows
PAST MEDICAL HISTORY
History of ophthalmologic diseases:
• Patients have a history of ocular trauma,
.

History of systemic disease :

• a systemic history such as hypertension and diabetes mellitus at the denial
Family medical history : -

Allergic history : -

Medication history :
• Artificial tear
• Antibiotic
• Analgetic
PHYSICAL EXAMINATION

General condition : well

consciousness/GCS : Compos mentis / E4V5M6

Vital sign
Blood pressure : 120/80 mmHg
Rr : 17x/menit
Hr : 87x/menit
STATUS LOCALIS
STATUS LOCALIS
STATUS LOCALIS
PHOTOS

OS
PROBLEM IDENTIFICATION
Subjective:
• can't see in the left eye since ± 3 weeks ago
• pain, especially blinking, watering, glare and yellowish-white appearance of
the left eye
• Social history of the patient as a worker in a palm oil plantation in Malaysia
and during work the patient does not wear eye protection
Objective :
• Visus  VOD: 6/6, VOS: 1/300
• On bulb conjunctival inspection hyperemia was found
• On inferior and superior tarsal conjunctival inspection hyperemia is found
• In corneal inspection there is hypopyon
 CASE ANALYSIS
CORNEA
(is the anterior part of the eye through
which light travels in the course of
shading in the retina)
Anamnesis & Eye examination :
• can't see in the left eye since 3 weeks
ago
• history of eye trauma (oil palm powder
in left eye)
• Visus  VOD: 6/6, VOS: 1/300
• inspection of cornea OS  hipopion
Changes in the shape and clarity of the
cornea interfere with the formation of
good shadows in the retina.
Therefore, the slightest abnormality in
the cornea, can cause vision problems
CORNEAL ULCER
(is an inflammation of the cornea
followed by damage to the
corneal lining)
 CASE ANALYSIS
NO ULCER PERFORATION
• If there is severe inflammation ,the
toxin from corneal inflammation can
reach the iris and the ciliary body
through the Descemet membrane,
corneal endothelium and finally to the
COA. Thus the iris and ciliary body
become inflamed and turbidity arises
in the COA fluid followed by the
formation of hypopyon (pus in the
COA).
PERFORATION
• If the ulcer is deeper.
• With the occurrence of COA fluid
perforation can flow outward and the
iris follows this movement forward so
that the iris is attached to the
perforated corneal wound and is
called anterior synechia or the iris can
protrude outward through the
perforation hole and is called an iris
prolapse which clogs the fistula
 CASE ANALYSIS
Anamnesis & Eye examination :
• can't see in the left eye since 3
weeks ago
• history of eye trauma (oil palm
powder in left eye)
• Visus  VOD: 1/60, VOS: 1/60
• inspection of cornea OS 
hipopion
The cause of patient eye complaints
can occur due to fungal infections
FUNGAL INFECTIONS
• fungal infections generally occur due
to trauma associated with organic
matrices such as wood, plants, rice and
others where the fungus enters through
epithelial defects caused by trauma.
• The fungus reproduces and
penetrates rapidly into the stroma even
to the endothelium which will be seen
as endothelial plaque. Fungus in the
stromal tissue cause inflammatory
reactions and necrosis
Assesment

Diagnosis:
• OS Perforated Corneal ulcer ec Fungal Infection

Differential diagnosis:
• OS Perforated Corneal ulcer ec Bacterial infection
Planning
Diagnostic:
• Biometric examination with a B-scan for topographic evaluation of the lesion,
estimation of the dimensions of the lesion and assessing the consistency of the
lesion

Treatment: Treatment:
• Medical • Operative
C-Levofloxacin 6x1 drops Corneal graph with fascialata /
Levofloxacin 2x500 mg amnion / periosteal
Na Diclofenac 2x50 mg
Cefadroxil 2x500 mg
Paracetamol 3x500 mg
EDUCATION
 Provide information to patients about the diagnosis of the patient's disease and
possible risk factors that cause patient complaints.
Provide information for using eye protection such as glasses
PROGNOSIS
Sight Prognosis (ad visum)
 Ad malam.
Life Prognosis (ad vitam)
 Ad bonam
REFERENCES
Farida, Y., 2015. Corneal Ulcers Treatmen. J Majority. Vol 4 No 1. Availabel from
http://juke.kedokteran.unila.ac.id/index.php/majority/article/view/511
Ravinder, K. et al, 2016. Clinical Evaluation of Corneal Ulcer among Patients Attending Teaching Hospital.
International Journal of Contemporary Medical Research. Vol 3 Issue 4, 2454-7379. Availabel from
https://pdfs.semanticscholar.org/d272/293c8d954d1c0bf99a3eb392b935e3f1bce4.pdf
Gandhi, S et al., 2014. Corneal Ulcer: A Prospective Clinical And Microbiological Study. International Journal of
Medical Science and Public Health. Vol 3 Issue 11. Availabel from 10.5455/ijmsph.2014.030820142
Suwal, S, et al., 2016. Microbiological Profile Of Corneal Ulcer Cases Diagnosed In A Tertiary Care
Ophthalmological Institute In Nepal. BMC Ophthalmology. Available from DOI 10.1186/s12886-016-0388-9
Wirata, G., 2017. Ulkus Kornea. Fakultas Kedokteran Universitas Udayana. Availabelfrom
https://simdos.unud.ac.id/uploads/file_penelitian_1_dir/4a55f77bed0b9016cb0e879fea81a340.pdf
Buku Ajar Oftalmologi
THANKYOU