Definition
Ulcerative keratitis better known as corneal ulceration, namely the presence of destruction (damage) on the corneal epithelium. (Darling, Vera H, 2000, p 112)
Causes
The reasons include:
- Abnormalities of the eyelashes (trichiasis) and systems tears (tears insufficiency, lacrimal duct blockage), and so on.
- External factors, namely: wounds in the cornea (corneal erosio), due to trauma, contact lens use, burns on the face.
- Corneal abnormalities caused by: chronic corneal edema, keratitis-exposure (on lagophtalmus, general anesthesia, coma); keratitis due to vitamin A deficiency, neuroparalytic keratitis, superficial keratitis virus.
- Systemic disorders; malnutrition, alcoholism, Stevens-Jhonson, acquired immune deficiency syndrome.
- Drugs that lower the immune mekaniseme, eg corticosteroids, IUD, local anesthetics and immunosuppressive group.
In etiologic corneal ulcers can be caused by:
- Bacteria: Germs that can cause corneal ulcers pure is streptokok pneumoniae, whereas other bacterial corneal ulcers caused by trigger factors above.
- Viruses: herpes simplex, zooster, vaccinia, variola.
- Fungi: Candida group, Fusarium, Aspergillus, Cephalosporium.
- Hipersensifitas reaction: The reaction to staphylococcus (marginal ulcers), tuberculosis (keratoconjunctivitis flikten), unknown allergens (ulcers ring). (Sidarta Ilyas, 1998, 57-60)
Pathophysiology
- Progressive : In the process of progressive corneal be terihat, infiltration of leukocytes and lymphocytes cells that eat bacteria or necrotic tissue is formed.
- Regressive
- Establish scarring : In the formation of scar tissue there will be epithelial, new collagen tissue and fibroblasts.
Severity of illness was also determined by the physical state of the patient, a large inoculum and virulence.
Clinical symptoms:
- Red eyes.
- Mild to severe eye pain.
- Photophobia.
- Decreased vision.
- White opacities in the cornea.
Symptoms that may accompany is the presence of corneal thinning, Descemet folds, corneal tissue reaction (due to interference iris vascularization), a flare, hypopyon, hyphema and posterior synechiae. In corneal ulcers caused by fungi and bacteria are surrounded PMN epithelial defect. When infections caused by viruses, will be seen surrounding hypersensitivity reaction. Usually gram-positive cocci, Staphylococcus aureus and Streptococcus pneumoniae would provide a limited picture of ulcer, round or oval, white gray suppurative ulcers in children. The area that is not exposed cornea will remain clear and no visible color inflammatory cell infiltration. If the peptic ulcer caused by Pseudomonas then be stretched quickly, green yellow purulent material seen attached to the surface of the ulcer.
When ulcers caused by fungi, it will infiltrate surrounded grayed infiltrates surrounding smooth (satellite phenomenon). When the dendrite-shaped ulcer there will be hypesthesia of the cornea. Ulcers can form a fast running descemetocele or corneal perforation which ended by making a form adherent leucoma. When the process of the ulcer is reduced it will show less pain, photophobia, reduced infiltration of ulcers and corneal epithelial defects become increasingly small.
Signs and Symptoms
In ulcers that destroy membranes and stromal bowman, will lead to corneal cicatrix.
Subjective symptoms such as corneal ulcers symptoms of keratitis. Objective symptoms such as ciliary injection, and partial loss of corneal tissue infiltrates. In more severe cases may occur iritis accompanied by hypopyon.
Photophobia.
Pain and lacrimation.
(Darling, Vera H, 2000, p 112)
Diagnostic Examination:
- Cards eye / Snellen telebinocular (test visual acuity and central vision)
- Tomography measurements: assessing IOP, normal 15-20 mmHg.
- Ophthalmoscopy examination.
- Blood examination, LED.
- EKG.
- Glucose tolerance test.
Assessment
- Activity / rest: activity changes.
- Neurosensory: blurred vision, glare.
- Pain: discomfort, pain sudden / severe persistent / pressure in and around eyes.
- Security: fear, anxiety.
Nursing Diagnosis and Interventions for Corneal Ulcer
1. Fear or anxiety related to sensory impairment and lack of understanding of post-operative care, drug delivery.
Intervention:
- Assess the degree and duration of visual disturbance.
- Orient the patient to the new environment.
- Describe the perioperative routine.
- Suggest to run the day-to-day living habits when able.
- Encourage participation of family or people who mean to patient care.
2. Acute pain related to trauma, increased IOP, surgical intervention or administration inflammatory eye drops
Intervention:
- Give medication to control pain and IOP as prescribed.
- Give cold compress on demand for blunt trauma.
- Reduce lighting levels.
- Encourage the use of sunglasses in strong light.
3. Risk for Self-Care Deficit related to impaired vision.
Intervention:
- Give instructions to the patient or the person nearest the signs and symptoms, complications should be immediately reported to the doctor.
- Give oral and written instructions for the patient and the person who means the right techniques in delivering drugs.
- Evaluation of the need for assistance after discharge.
- Teach the patient and family guide vision techniques.
4. Disturbed Sensory Perception: Visual related to impaired vision.
Goal: Patient is able to adapt to changes.
Outcomes:
- Patients receive and resolve in accordance with the limits of vision.
- Using existing vision or other senses adequately.
- Introduce the patient to the environment.
- Tell patient to optimize other sensing devices that are not impaired.
- Visit frequently to determine the needs and eliminate anxiety.
- Involve people in the care and activities nearby.
- Reduce noise and provide a balanced break.
5. Knowledge Deficit related to lack of information about self-care and disease processes.
Goal: Patients have enough knowledge about the disease.
Outcomes:
- Patients understand medication instructions.
- Patients using verbal communication to express the symptoms to be reported.
- Tell the patient about the disease.
- Teach self-care during illness.
- Teach hatching procedure eyedrops and replacement bandage on the patient and family.
- Discuss the symptoms of the rise in IOP and visual impairment.
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