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Kuliah Blok Mata

MATA MERAH,
KELAINAN BENTUK &
STRUKTUR MATA

dr. Naziya, Sp.M


Bagian Ilmu Penyakit Mata
FK UNS RS.Dr. Moewardi Surakarta
Anatomi Segment Anterior
Palpebra/
Eyelid
Conjunctiva
Sclera
Cornea
Camera Oculi
Anterior
Iris
Pupil
Lensa
Palpebra/ Eyelid
1. Infections & Inflammations
Hordeolum
Chalazion
Blepharitis
2. Anatomic Deformities of the lids
Entropion
Ectropion
Ptosis
Hordeolum
Internal hordeolum External hordeolum (stye)

Staph. abscess of meibomian Staph. abscess of lash follicle and


glands associated gland of Zeis or Moll
Tender swelling at lid margin
Tender swelling within tarsal plate
May discharge through skin May discharge through skin
or conjunctiva
Treatment
Warm compresses (3-4x/day for 10-15 minutes)
Antibiotic ointment
Incision & drainage
Chalazion (meibomian cyst)
An idiopathic sterile chronic granulomatous
inflammation of meibomian gland

Painless, roundish, firm lesion May rupture through conjunctiva


within tarsal plate and cause granuloma

Treatment Incision & curettage


Injection of local anaesthetic Insertion of clamp Incision and curettage
Blepharitis
Staphylococcal blepharitis

Chronic irritation worse in mornings Hyperaemia and telangiectasia of anterior


lid margin
Scales around base of lashes
(collarettes) Scarring and hypertrophy if longstanding
Seborrhoeic blepharitis

Shiny anterior lid margin Greasy scales


Hyperaemia of lid margin Lashes stuck together
Meibomianitis

Inflamed and blocked Toothpaste-like plaques


meibomian gland orifices from meibomian glands

Thickened posterior lid margin Meibomian cyst formation


Treatment of Chronic Blepharitis

1. Lid hygiene - with 25% baby shampoo

2. Tear substitutes - for associated tear film instability

3. Systemic antibiotic - for severe posterior blepharitis

4. Warm compresses - to melt solidified sebum


in posterior blepharitis
Entropion
Turning inward of the lid
Etiology : Involutional
cicatricial
congenital
Involutional entropion and trichiasis

Affects lower lid because upper lid If longstanding may result in corneal
has wider tarsus and is more stable ulceration
Ectropion
Sagging and eversion of the lower lid
Etiology : Involutional
Cicatricial
Paralytic
Mechanical
Ectropion involutional

Affects lower lid of elderly patients

May cause chronic conjunctival inflammation


and thickening
Ptosis
The condition in which one or both upper eyelids
assume an abnormal low position
Congenital, acquired
CONJUNCTIVA
Simple bacterial conjunctivitis

Signs

Crusted eyelids and conjunctival Subacute onset of mucopurulent


injection discharge

Treatment - broad-spectrum topical antibiotics


Gonococcal keratoconjunctivitis
Signs Complications

Acute, profuse, purulent discharge, Corneal ulceration, perforation


hyperaemia and chemosis and endophthalmitis if severe

Treatment
Topical cyprofloxacin/levofloxacin
Intravenous cefuroxim or cefotaxime
Conjunctivitis viral

Usually bilateral, acute watery Subconjunctival haemorrhages and


discharge and follicles pseudomembranes if severe

Treatment - symptomatic
Trachoma
Infection with serotypes A, B, Ba and C of Chlamydia
trachomatis
Fly is major vector in infection-reinfection cycle
Progression

Acute follicular Conjunctival Herbert pits


conjunctivis scarring (Arlt line)

Pannus formation Trichiasis Cicatricial entropion


Treatment - systemic azithromycin and topical levofloxacin
Vernal keratoconjunctivitis
Frequently associated with atopy: asthma, hay fever and dermatitis

Recurrent, bilateral
Affects children and young
adults
More common in males
and in warm climates
Itching, mucoid discharge
and lacrimation
Types
Palpebral
Limbal
Mixed

Treatment
Topical mast cell stabilizers
Topical steroids
Progression of vernal conjunctivitis
Diffuse papillary hypertrophy, most marked on superior tarsus

Formation of cobblestone papillae Rupture of septae - giant papillae


Limbal vernal

Mucoid nodule Trantas dots


Sclera
Kelainan Sklera :
1. Blue Sclera suatu kelainan kongenital, Sklera tipis
sehingga uvea membayang.

2. Sklerektasia (Scleral ectasia): Sklera menipis akibat


kenaikan tekanan intra okuler sejak usia dini (glaukoma
kongenital)atau akibat radang dan trauma.
3. Stafiloma Sklera :Tampak penonjolan sklera
disertai uvea.

4. Radang : Episkleritis dan Skleritis


Episkleritis
-Kausa tidak diketahui, diduga hipersensitifitas
-Patofisiologi juga masih belum jelas
-Self limited disease of adults (20-50y)
-Inflamasi dari jaringan episklera (sektoral), dilapisan
pembuluh darah
diantara konjungtiva dan sclera
-Karakteristik warna merah terang atau salmon pink
-Gejala klinis : mata merah, tdk ada sekret, kadang nyeri
-Penatalaksanaan : topical atau oral NSAID
Simple episcleritis
Common, benign, self-limiting but frequently recurrent
Typically affects young adults

Simple sectorial episcleritis Simple diffuse episcleritis

Treatment
Topical steroids/ NSAID
Nodular episcleritis
Less common than simple episcleritis
May take longer to resolve

Localized nodule which can be moved over scleraDeep scleral part of slit-beam
not displaced
Skleritis

Inflamasi (localized or diffuse) sclera


Berhubungan dengan sistemic immunologic disease,
seperti :
- Rematoid Artritis
- Tuberkolosis
- Sifilis
- Gout
- Hiperuricemia
Gejala klinis : merah, nyeri (terutama malam
hari),fotofobia,lakrimasi
Tanda : gambaran khas pembuluh darah crisscross
pattern,menempel pada sklera
3 type : diffuse, nodular dan necrotizing (most
destructive)
Terapi : Steroid topikal
Cari kausa (sistemik)
Diffuse anterior non-necrotizing scleritis
Relatively benign - does not progress to necrosis
Widespread scleral and episcleral injection

Treatment
Oral NSAIDs
Oral steroids if unresponsive
Nodular anterior non-necrotizing scleritis
More serious than diffuse scleritis

On cursory examination resembles Scleral nodule cannot be moved over


nodular episcleritis underlying tissue

Treatment - similar to diffuse non-necrotizing scleritis


Anterior necrotizing scleritis with inflammation
Painful and most severe type
Complications - uveitis, keratitis, cataract and glaucoma
Progression

Avascular patches Scleral necrosis and Spread and coalescence


visibility of uvea of necrosis

Treatment
Oral steroids
Immunosuppressive agents (cyclophosphamide, azathioprine, cyclosporin)
Combined intravenous steroids and cyclophosphamide if unresponsive
Anterior necrotizing scleritis with inflammation
(scleromalacia perforans)
Associated with rheumatoid arthritis
Asymptomatic and untreatable

Progressive scleral thinning with exposure of underlying uvea


Kornea
Anatomi / Histologi
5 lapisan : - Epitel
- Membrana Bowman
- Stroma
- Membrana Descement
- Endotel.

FISIOLOGI
- Sebagai media refrakta (+ 45 D )
- Pelindung / dinding bola mata.
- Kejernihan kornea dipertahankan oleh :
* Kondisi dehidrasi relatif
* Susunan sel / serat kolagen yang teratur
* Tidak adanya pembuluh darah (Avaskuler)
Kelainan Kornea
1. Erosi : Lepasnya epitel tanpa / belum ada infeksi
2. Infiltrat : Sebukan sel radang
a. Superfisial : Disertai kerusakan epitel Fluorescein tes (+)
b. Profunda : Didaerah stroma Fluorescein tes (-)
Warna putih abu-abu, bentuk bervariasi,
batas tidak tegas, disertai tanda radang.
3. Edema : Kornea tampak suram
Penyebab : - Radang / Infeksi
- Kerusakan Endotel
- Tekanan bola mata tinggi.
4. Sikatriks : Jaringan parut
Warna putih, Batas tegas, tanpa tanda radang.Fluorescein tes (-)
Nebula
Makula
Leukoma
Keratitis bakteri
Visus turun
Infiltrat pada kornea
Perikorneal injeksi
Sering berlanjut menjadi
ulkus
Etiologi:
stafilokokus,streptokokus,
pneumokokus,
pseudomonas
Penyulit: uveitis, hipopion,
glaukoma sekunder,
endoftalmitis, panoftalmitis
Keratitis oleh karena jamur
- Banyak didaerah pedesaan / pertanian
- Pada penderita pengguna steroid topikal jangka panjang
- Klinis
Tidak begitu sakit
Warna infiltrat abu-abu
Sering disertai hipopion ( terjadi uveitis anterior yang berat )
Lesi Satelit
Khas : bercak di endotel batas tak tegas pada dasar ulkus,
disertai uveitis anterior yang berat dan abses kornea.
Laboratorium dari scraping ditemukan :
- Candida ( bentuk pseudohifa / yeast ) : seperti untaian
manik-manik.
- Fusarium / aspergilus : bentuk hifa seperti benang.

Terapi :
- Candida / aspergilus : Ampotericin B 0.15 %
- Fusarium : Natamicin 5 %
Oral : Flukonazole 200400 mg/hari
atau ketokonazole 200600 mg/hari.
Acanthamoeba keratitis
Terjadi pada pengguna
kontak lens
Berkembang cepat,
berlanjut menjadi ulkus
Berakibat kebutaan
Tx: Topical Amoebicides
- Propamidine isethionate 0,1 %
-Polyhexamethylene biguanide 0,02%
Herpes simpleks keratitis
Infiltrat berbentuk
dendritika dan geografika
Kesembuhan lambat
Reaksi radang minimal
Sensibilitas kornea menurun
Terapi: antiviral
Penyulit: ulkus kambuh2 an
Herpes Zooster Oftalmikus

Infeksi Virus Herpes Zooster pada daerah Dermatom Nervus Oftalmikus


(cabang pertama N. Trigeminus)

Gambaran Klinis : Vesikel daerah kelopak mata sampai dahi dan hidung
disertai rasa nyeri hebat.

Waspada bila lesi sampai ujung hidung N. Nasosiliaris Patognomonies


Hutchinsons sign
Komplikasi Uveitis Anterior.

Terapi : - Acyclovir oral 5 x 800 mg selama 10 hari sedini mungkin.


(3 hari sesudah ada makulo papula)
- Steroid topikal bila ada keratitis stromal/uveitis
Vaughan&Asburys 17th edition General Ophthalmology
Terima kasih
Selamat belajar!