keratitis exposure done.pptx keratitis exposure

keratitis exposure

1. DIAGNOSIS AND MANAGEMENT EXPOSURE KERATITIS Suhery STAGE III Infection and Immunology subdivision DEPARTEMENT OF OPHTHALMOLOGY MEDICAL FACULTY OF ANDALAS UNIVERSITY DR. M. DJAMIL HOSPITAL 2024

2. INTRODUCTION Exposure keratitis

3. C linical features

4. Exposure keratitis is one of the ocular surface complications that often found in Thyroid eye disease (TED) due to a combination of proptosis and eyelid retraction Meanwhile, eyelid retraction can also occur in hydrocephalus To protect the cornea it must be treated intensively with topical lubricants, broad spectrum antibiotic drops and ointments. Accurate assessment of clinical signs on the ocular surface, disease onset and diagnosis in patients with exposure keratitis are the modalities to determine the management and visual prognosis of patients.

5. CASE 1

6. Ophthalmological examination RE LE Visual acuity 20/100 20/20 Eyelid Edema (-) , lagoftalmus 3 mm Edema (-), lagoftalmus (-) Conjunctiva Conjunctival injection (+), ciliary injection (+) hyperemia (-) Cornea Infiltrate in paracentral inferior Clear Anterior Chamber deep enough deep enough Pupil Round, rf + /+, D 3 mm Round, rf + /+, D 3 mm Iris Brown Brown Lens Clear Clear Vitreous Clear Clear IOP N (p) N(p) Funduscopi Normal Normal Position exophthalmos exophthalmos Eye movement Free Free

7. Hertel exophthalmometry 25-23/111

8. Ophthalmological examination RE LE Visual acuity 20/40 20/20 Eyelid Edema (-) , lagoftalmus 3 mm Edema (-), lagoftalmus (-) Conjunctiva Conjunctival injection (+), ciliary injection (+) hyperemia (-) Cornea Infiltrate in paracentral inferior Clear

9. ophthalmological examination RE LE Visual acuity 20/20 f 20/20 Eyelid Edema (-) , lagoftalmus 3 mm Edema (-), lagoftalmus (-) Conjunctiva hyperemia (-) hyperemia (-) Cornea cicatric in paracentral inferior Clear

10. Case 2

11. Ophthalmological examination RE LE Visual acuity Blink reflex ( + ) Blink reflex ( + ) Eyelid Edema (-) , lagopthalmos 5 mm Edema (-) , lagopthalmos 6 mm Conjunctiva Conjunctiva inj (+), Siliar Inj (+) Conjunctiva inj (+), Siliar Inj (+) Cornea Ulcer (+) in the center extends to the paracentral cornea at 9-3 o'clock, size 10x5 mm. pus(+) membrane (+) Ulcer (+) in the center extends to the paracentral cornea at 9-3 o'clock, size 10x6 mm. pus(+) membrane (+) Anterior Chamber Difficult to assess Difficult to assess Pupil Difficult to assess Difficult to assess Iris Cannot be assess Cannot be assess Lens Cannot be assess Cannot be assess Vitreous Cannot be assess Cannot be assess Funduscopi Cannot be assess Cannot be assess IOP N (p) N(p) Position Cannot be assess Cannot be assess Eye movement Cannot be assess Cannot be assess

12. ophthalmological examination RE LE Visual acuity Blink reflex ( + ) Blink reflex ( + ) Eyelid Edema (-) , lagopthalmos 5 mm Edema (-) , lagopthalmos 6 mm Conjunctiva Conjunctiva inj (+), Siliar Inj (+) Conjunctiva inj (+), Siliar Inj (+) Cornea Ulcer (+) in the center extends to the paracentral cornea at 9-3 o'clock, size 10x5 mm. pus(+) membrane (+) Ulcer (+) in the center extends to the paracentral cornea at 9-3 o'clock, size 10x6 mm. pus(+) membrane (+)

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14. ophthalmological examination RE LE Visual acuity Blink reflex ( + ) Blink reflex ( + ) Eyelid Edema (-) , lagopthalmos 5 mm Edema (-) , lagopthalmos 6 mm Conjunctiva Conjunctiva inj (+), Siliar Inj (+) Conjunctiva inj (+), Siliar Inj (+) Cornea Ulcer (+) in the center extends to the paracentral cornea at 9-3 o'clock, size 8x5 mm . pus(+) membrane (+) Ulcer (+) in the center extends to the paracentral cornea at 9-3 o'clock, size 9x6 mm . pus(+) membrane (+)

15. ophthalmological examination RE LE Visual acuity Blink reflex ( + ) Blink reflex ( + ) Eyelid Edema (-) , lagopthalmos 5 mm Edema (-) , lagopthalmos 6 mm Conjunctiva Conjunctiva inj (+), Siliar Inj (+) Conjunctiva inj (+), Siliar Inj (+) Cornea Ulcer (+) in the center extends to the paracentral cornea at 9-3 o'clock, size 8x4 mm . pus(+) membrane (+) Ulcer (+) in the center extends to the paracentral cornea at 9-3 o'clock, size 9x5 mm . pus(+) membrane (+) iris prolapse (+)

16. Two cases of exposure keratitis were reported 33 1. Male patient , 43 years old who was consulted from the Oculoplasty Reconstruction and Oncology subdivision of RSUP.Dr M. Djamil Padang on October 4 th 2023 with Thyroid eye disease (TED) 2. Female patient , 1 year old who was consulted from the pediatric department of RSUP Dr. M. Djamil Padang on October 16 th 2023 with complaints of both red eyes and appeared white

17. Common symptoms of exposure keratitis include pain, foreign body sensation, epiphora, photophobia, and blurred vision. Common signs include incomplete blinking, lagophthalmos, decreased tear meniscus, decreased tear break up time, punctate epithelial erosion, and epithelial defects. In severe cases, corneal edema, thinning, and ulceration may occur

18. Tear film Component

19. Punctate Patterns Of The Ocular Surface

20. Proptosis Lagophthalmos

21. Hertel exophthalmometry

22. 40 E sthesiometer

23. Surgical approach ML AMT Tarsorrhaphy MANAGEMENT

24. T arsorrhaphy

25. 43 Amnion Membrane Transplant

26. THANK YOU

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