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MATA MERAH MATA MERAH MATA TENANG MATA TENANG

VISUS NORMAL VISUS TURUN VISUS TURUN VISUS TURUN
MENDADAK PERLAHAN
Mengenai mengenai media
struktur yang refrakta (kornea, LENSA: luksasi, KORNEA:
bervaskular aquous humor, lensa, subluksasi kelainan kontur
Media refrakta vitreous body) VITROUS: COA: glaukoma
intak pendarahan sudut terbuka
KORNEA: keratitis, (DM, HT, primer
PALPEBRA: ulkus
blepharitis, leukemia, dll) LENSA: gang
COA: uveitis
hordeolum, RETINA: ablasio, refraksi,
anterior, glaukoma
kalazion, tumor, akut
oklusi a/v katarak
trauma VITREOUS: N.OPTICUS: Uveitis
KONJUNGTIVA: endoftalmitis, neuritis optik posterior
konjungtivitis, panoftalmitis toksik RETINA:
pterygium, Tumor intra dan (methanol, retinopati DM,
flikten, tumor, retrobulbar ethambutol) HT, retinitis
trauma trauma2
SCLERA: skleritis, OTAK: stroke pigmentosa,pe
©Bimbel UKDI MANTAP
episkleritis occipitalis nyakit makula
Eye Lid Disorder Foxit Advanced PDF Editor

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BLEFARITIS
MATA MERAH VISUS NORMAL
Radang pada kelopak
Etiologi
Alergi akibat debu, asap, iritan atau infeksi kuman dapat oleh streptococcus
alfa/beta, pneumococcus, pseudomonas, staphylococcus
Gejala
Kelopak mata merah, edema, nyeri, eksudat lengket, epiforia, dapat disertai
konjungtivitis dan keratitis
Pengobatan
Dibersihkan dengan garam fisiologik hangat, diberi antibiotik lokal yang sesuai,
dan antibiotik sistemik bila infeksi berat, dan kompres hangat
Penyulit
Konjungtivitis, keratitis, hordeolum, kalazion, madarosis
Tipe
Blepharitis typically comes in two forms, anterior (Staphylococcal or
Seborrheic) and posterior (Meibomian Gland Dysfunction). These are both
common, and an individual can develop both of these at one time.
Ilmu Penyakit Mata, Sidarta Ilyas, 2005
KLASIFIKASI BLEFARITIS ANTERIOR To remove this notice, visit:

SEBOROIK STAFILOKOKAL/ULSERATIVA
Penyebab Gangguan pd gld. Zeis dan Moll Infeksi kronik stafilokokus, biasanya pd
(seboroik anterior) atau gld Meibom anak-anak.
(seboroik posterior) yg berkaitan dg
dermatitis seboroik (kulit kepala,
nasolabial folds, preauricula,
sternum)
Patofisiologi Overproduksi Infeksi kronik pd dasar bulu mata abses
Corynebacterium acnes jd asam intrafolikular ulserasi dermis dan
lemak yg iritatif epidermis
Manifestasi Sisik putih, halus, biasanya pd ujung Sisik2 pd dasar bulu mata, bila diusap
bulu mata, penebalan palpebra, biasanya meninggalkan keropeng
madarosis, dasar hiperemis, ulkus - berdarah, sisik lbh lengket. Komplikasinya
bs menyebabkan trichiasis, madarosis,
poliosis.
Terapi -Higien sisik dgn salep salisil 1% dan -Higien sisik 2x1 dgn 25% sampo bayi,
merkuri amoniak (tdk boleh masuk usap dgn cottonbud.
mata. -Salep antibiotik (basitrasin atau
- eritromisin) stlh sisik dibersihkan.
bakteri: tetrasiklin 2x250 mg 1 bulan; -Steroid topikal lemah (fluorometolon
KLASIFIKASI BLEFARITIS ANTERIOR

Blefaritis seboroik Blefaritis ulseratif

Terapi Blefaritis
Treatment depends on the specific type of blepharitis. The key to treating most
types of blepharitis is keeping the lids clean and free of crusts.
Warm compresses can be applied to loosen the crusts, followed by gentle
scrubbing of the eyes with a mixture of water and baby shampoo or an over-the-
counter lid cleansing product. In cases involving bacterial infection, an antibiotic
may also be prescribed.
If the glands in the eyelids are blocked, the eyelids may need to be massaged to
clean out oil accumulated in the eyelid glands.
Artificial tear solutions or lubricating ointments may be prescribed in some cases.
Use of an anti-dandruff shampoo on the scalp can help.
Limiting or stopping the use of eye makeup is often recommended, as its use will
make lid hygiene more difficult.
If you wear contact lenses, you may have to temporarily discontinue wearing
them during treatment.
Some cases of blepharitis may require more complex treatment plans. Blepharitis
seldom disappears completely. Even with successful treatment, relapses may
occur.
MATA MERAH
VISUS NORMAL
Hodeolum vs Khalazion
HORDEOLUM KHALAZION
Definisi Peradangan pada kelenjar Zeiss, Moll, dan Inflamasi kronik pada kelenjar
Meibom karena infeksi bakteri Meibom.
Lokasi defek -Gld. Sebasea (Zeiss), Gld. Siliaris (folikel Gld. Tarsalis (Meibom).
rambut bulu mata/Moll): H. EXTERNUM Biasanya pada palpebra
-Gld. Tarsalis (Meibom): H. INTERNUM superior.
Etiologi dan PA Infeksi bakteri. Sekumpulam sel-sel PMN Reaksi granulomatosa,
dan jaringan nekrotik. biasanya idiopatik.
Manifestasi Nyeri, hangat, bengkak. Nodul tak nyeri.
Terapi -Kompres hangat 4x10 menit Apabila gagal diobati dgn tx
-Antibiotik topikal (salep eritromisin atau obat selama 3-4 minggu dan
basitrasin 2x1). Pikirkan utk tx sistemik dg pasien menghendaki removal,
doksisiklin 2x100 mg utk efek antibakteri maka dpt dilakukan insisi dan
dan antiinflamasinya. kuretase menggunakan inj.
-Bila memburuk, pikirkan insisi drainase Steroid (0,2-1 ml triamsinolon
40 mg/ml) dan lidocaine 2%
(1:1)

Internal Hordeolum Treatment External Hordeolum Treatment
The infection is deep within the lid tissue Hot compresses several times a day
antibiotics topical usually ineffective accelerate the pointing of the lesion
and its spontaneous drainage
Apply hot compresses for five to 10
minutes, two to four times a day, in order to If an eyelash is seen to extend from the
liquefy the stagnant secretions and facilitate
involved lesion, then epilation of the
lash can initiate drainage of the lesion
drainage through the meibomian orifice by creating an effective drainage
Lidscrubs with a mild shampoo also helps to channel
remove any debris, which may have Bacitracin or erythromycin antibiotic
accumulated on the eyelid margin surface, ointment, applied four times a day
and in those patients with blepharitis during the acute phase and continued
Staphylococcus species primary medical twice daily for one week thereafter,
therapy should consist of a penicillinase- may prove helpful, especially in
resistant penicillin such as dicloxacillin.
preventing the infection spreading to
the surrounding lash follicles
Dosages of 125mg to 250mg every six hours,
usually result in prompt resolution of the Systemic antibiotics such as oral
erythromycin or dicloxacillin may be
infection necessary if there is severe preseptal
Patients who are allergic to penicillin can try cellulitis
oral erythromycin, chloramphenicol or the Finally, for resistant lesions, an incision
aminoglycosides can be made with a sterile needle or
Finally, in cases which resist medical blade into the area of pointing, which
therapy, incision and drainage using a sterile allows the abscess cavity to drain.
needle or blade may be necessary

www.optometry.co.uk/hordeolum and chalazion treatment
Chalazion Treatment
Topically /systemically administered antibiotics are ineffective because the lesion is
not infectious in origin
Hot compresses followed by gentle massage evacuate stagnant secretions. This

prevents further chalazion formation and encourages drainage along the duct of the
involved gland which may be of benefit if the lesion is small .
Vigorous massage can cause further extravasation of the meibomian secretions into
the surrounding tissue, spreading the granulomatous inflammation.
Intralesional injection of steroid. Since the chalazion is encapsulated by connective

tissue, there is little room for space-occupying steroid medication. Therefore, a
steroid of increased concentration such as triamcinolone acetomide (Kenalog-40), a
40mg/ml concentration works well since only a 0.10-0.20cc dose needs to be injected
The most reliable therapy involves surgical excision of the affected meibomian gland.
The eye is treated with antibiotic ointment, which the patient should continue to use
two times a day for five to seven days. On rare occasions, the chalazion may recur if
the surgical excision was incomplete

MATA MERAH
Pterygium To remove this notice, visit:

VISUS NORMAL
Definisi
Pertumbuhan jaringan fibrovaskular subepitelial
berbentuk segitiga pada jaringan konjungtiva
bulbar meliputi limbus hingga kornea.
Mekanisme
Respon terhadap kekeringan kronik dan pajanan
ultraviolet
DD
Pinguecula (yellow-white deposit pd konjungtiva
bulbi di nasal/temporal limbus krn degenerasi
kolagen pd stroma konjungtiva, penipisan epitel,
dan kalsifikasi. Eksisi jarang diperlukan
Tanda dan gejala

Mata iritatif, merah, 90% di nasal, dapat terjadi
astigmat
Terapi
Hindari asap, debu, dan sinar UV; lubrikan
topikal; vasokonstriktor dan kortikosteroid
topikal . Operasi bila terjadi gangguan
penglihatan ©Bimbel UKDI MANTAP
Derajat Pterigium
(Youngson)
Derajat 1
Jika pterigium hanya terbatas pada limbus kornea
Derajat 2
Jika pterigium sudah melewati limbus kornea tetapi
tidak lebih dari 2 mm melewati kornea
Derajat 3
Jika pterigium sudah melebihi derajat dua tetapi
tidak melebihi pinggiran pupil mata dalam keadaan
cahaya normal (diameter pupil sekitar 3-4 mm)
Derajat 4
Jika pertumbuhan pterigium sudah melewati pupil
sehingga mengganggu penglihatan

Pterygium vs Pseudopterygium
Sonde (+): dapat menembus bagian
bawah jaringan pseudopterygium
Tes Sonde Sonde (-): tidak dapat menembus
bagian bawah jaringan pterygium
Pulau-pulau Pulau-pulau fusch pada kornea di

puncak pterygium (+) pterygium
fusch pada Pulau-pulau fusch pada kornea (-)
kornea pseudopterygium
Riwayat Riwayat kerusakan permukaan

kerusakan kornea (+) pseudopterygium
permukaan Riwayat kerusakan permukaan
kornea (-) pterygium
kornea
Pembuluh Pembuluh darah lebih menonjol

darah pterygium

MATA MERAH
KONJUNGTIVITIS Foxit Advanced PDF Editor
VISUS NORMAL
Evaluasi REAKSI- REAKSI INFLAMASI KONJUNGTIVAL

konjungtivitis adalah inflamasi
jenis sekret
pada konjungtiva, bisa terjadi
WATERY: eksudat serosa+air mata, ec viral inflamasi
pada konjungtiva bulbi, toksik
konjungtiva forniks, ataupun MUKOID: vernal, keratokonjungtivitis sicca
konjungtiva palpebra. PURULEN: bakteri akut berat
MUKOPURULEN: bakteri ringan, klamidia
jenis reaksi konjungtiva
FOLIKULAR: hiperplasi jar limfoid, bentuk kyak butir2
PAPILAR: hiperplasi epitel konjungtiva, bentuk poligonal,

ec blefaritis kronis, vernal, infeksi bakterial, lensa
kontak, SLK
ada tidaknya pseudomembran atau membran
PSEUDOMEMBRAN: koagulasi eksudat, ec adenovirus
berat, konjungtivitis ligneus, konjungtivitis gonorea,
dan konjungtivitis autoimun
MEMBRAN: penetrasi eksudat ke epitel konjungtiva, ec
Streptococcus beta hemolyticus dan difteri
ada tidaknya limfadenopati preaurikular atau
submandibular, ec viral, klamidia, gonokokus berat
Konjungtivitis akut To remove this notice, visit:

FOLIKEL
lnn preaurikular lnn preaurikular

+ -
PAPILLA
tanda herpetik + toxic,

molluscum, purulen
HSV purulen berat: watery: alergi,
pediculosis ringan: bakteri
GO atopi
selain GO
tanda hepretik -
adenovirus,
klamidia
Pathology Etiology Feature Treatment

Viral (akut) Adenovirus Mata merah, gatal, panas, discar 4-7 hari berat
herpes berair, mengganjal.pre-auricular 2-3 minggu membaik
simplex virus lymphadenopathy, reaksi folikular Higiene, krn sgt menular
or varicella- pseudomembrane (+/-) Artificial tears relieve
zoster virus, dryness and inflammation
coxackie (swelling)
virus, ©Bimbel UKDI MANTAP
Kompres dingin
enterovirus Antiviral herpes simplex
Pathology Etiology Feature Treatment Foxit Advanced PDF Editor
Bakterial S.aureus Mata merah, sensasi benda asing, topical antibiotics
non S.epidermidis, discar mukopurulen/purulen, trimetoprim/polimiksin B

gonokokal H.influenzae, fotofobia dijumpai apabila kornea atau fluorokuinolon tetes
(akut) Streptococcus terlibat, papila konjungtiva, qid
pneumoniae, kemosis, limfadenopati Artificial tears
M.catarrhalis preaurikular jarang tapi sering
muncul pada konjungtivitis
gonokokal.
Gonokokal N.gonorrheae Discar purulen berat, hiperakut (dalam Seftriakson 1 gr i.m single
(hiperakut) 12-24 jam), papila konjungtiva, kemosis dose.
berat, lnn preaurikular, edema Irigasi untuk membersihkan
palpebra, pseudomembran. Dapat
sekret.
terjadi keratitis akibat penumpukan sel-
Siprofloksasin topikal
ointment qid atau tetes q2h.
Tx partner seksual
Klamidial Chlamydia riwayat vaginitis, servisitis, atau Azitromisin 1 gr p.o single

(kronis) trachomatis uretritis. dose.
serotipe D-K Folikel konjungtival pada tarsal Eritomisin topikal atau
atau bulbar, pannus, teraba tetrasiklin ointment bid-tid
lnn.preaurikular. Biasanya terjadi selama 2-3 minggu.
unilateral,©Bimbel
kronis,UKDI
sekret
MANTAP
mukopurulen.

Pathology Etiology Feature Treatment
Alergika Allergy Gatal biasanya bilateral namun Removal allergen
dapat asimetrik, discar tebal, Topical antihistamine

umumnya pada laki-laki. Vasoconstrictors
Rekurensi musiman, riwayat
atopi, usia muda. papila
konjungtiva besar, terlihat di balik
palpebra superior atau sepanjang
limbus (limbal vernal). superior
corneal shield ulcer
Horner-Trantas dots
Trachoma Chlamydia trachomatis TF (trachomatous inflammation: Azitromisin 20 mg/kg
serotipe A, B, Ba, dan C folikular): >5 folikel pada tarsal atas. p.o single dose,
TI (trachomatous inflammation: doksisiklin 100 mg p.o
intens): inflamasi dengan penebalan
bid, eritromisin 500 mg
vasa tarsal >50%.
TS (trachomatous scarring); sikatrik p.o qid, atau tetrasiklin
pada konjungtiva tarsal dengan pita 250 mg p.o qid 2
fibrosis putih. minggu.
TT (trachomatous trichiasis): trichiasis Tetrasiklin, eritromisisn,
pada paling tidak satu bulu mata. atau sulfasetamid salep
CO (corneal opacity): opasitas paling bid-qid selama 3-4
tidak melibatkan batas pupil. minggu.
http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/Bacterial-
Conjunctivitis.aspx (Bacterial Conjunctivitis : A review of therapies and approaches, 2012)

Konjungtivitis Viral www.foxitsoftware.com/shopping
Adenoviral
Pharyngoconjunctival fever (PCF): tipe 3 dan

7, ISPA +, 30% ada keratitis
Epidemic keratoconjuntivitis: tipe 8 dan 19,
sistemik -, keratitis 80%
Enterovirus 70 (Acute hemorrhagic

conjunctivitis)
Sering di daerah kumuh padat, self-limiting,
pendarahan sc, folikel+
Pox virus
Molluscum contagiosum
Ciri: molluscum lid lesion, folikular kronik,
limfadenopati-. Bisa ada keratitis. Tx: eksisi
lesi
Konjungtivitis Alergika
1. Konjungtivitis Musiman/hay fever 4. Konjungtivitis Vernal
Trigger: pollen, bulu, dll. Hipersensitivitas Spring catarrh, jarang, bilateral, anak,
tipe 1 olh IgE di subs propria konj. Gatal, remaja, laki2>, reaksi alergi oleh IgE,
akut, nyrocos, merah, papilar. Tx: mast- berkaitan dgn RPD/K atopi. RPD asma,
cell stabilizer (2% Na kromoglikat tts, eksema. Eosinofil +. Bisa kena kornea:
lodoksamid 0.1% tts) epiteliopati punctata, makroerosi dan
ulkus, plak, parut subepitel,
2. Konjungtivitis Alergika akut pseudogerontokson (seperti arcus
Trigger: dust mite, bulu hewan, dll dlm senilis). Ocular signs of VKC commonly
jumlah besar masuk ke saccus are seen in the cornea and conjunctiva.
konjungtiva. SS: Kemosis berat akut, In contrast to atopic keratoconjunctivitis
blefaritis. Cepat sembuh dlm hitungan (AKC), the eyelid skin usually is not
jam. Tx involved. 3 tipe:
palpebral: kemosis, cobble stone
3. Konjungtivitis Atopik papillae,
Limbal: konj edem, hiperemik, tebal;
Laki2 muda, dermatitis atopik, area kulit
pd leher, fossa poplitea, antecubiti, asma,
Mixed
dll. Palpebra menebal, berkrusta, fisur.
Tx: steroid topikal short term, MCS, 5. Konjungtivitis Giant-Papilar

antihistamin po ec korpal (lensa kontak, prothesa,
jahitan)
Konjungtivitis Alergika
Konj. atopik Konj. vernal

SUMMARY KONJUNGTIVITIS
Evaluasi REAKSI- REAKSI Tabel 1. Gambaran beberapa jenis konjungtivitis
INFLAMASI KONJUNGTIVAL
Klinis Virus Bakteri Klamidia Alergi
jenis sekret (serosa: alergika,
viraL; purulenta: bakteri, Gatal Min Min Min +++
mukoid: vernal; mukopurulen: Hiperemia Generalisat Generalisat Generalisat Generalisat

bakteri ringan, klamidia) a a a a
jenis reaksi konjungtiva Lakrimasi +++ ++ ++ ++
(folikular,papilar) Eksudasi Min +++ +++ Min
ada tidaknya pseudomembran
Lnn Lazim Tak lazim Pd konj. -
(adenovirus berat, konjungtivitis
Inklusi
ligeneus, konjungtivitis gonorea,
dan konjungtivitis autoimun) Sel Monosit Bakteri, PMN, Eosinofil
atau membran (Streptococcus PMN badan
beta hemolyticus dan difterii). inklusi sel
ada tidaknya limfadenopati plasma
preaurikular Faringitis, Kadang Kadang Tidak Tidak
demam
©Bimbel UKDI MANTAP pernah pernah
Aminoglycosides Foxit Advanced PDF Editor
Bactericidal & effective against gram-negative organisms,
incomplete coverage against gram-positive bacteria
The emergence of resistant bacterial strains has
decreased the usefulness of aminoglycosides for
conjunctivitis
Polymyxin B Combination Therapies
Bactericidal for gram-negative organisms, no coverage
for gram-positive organisms.
Combined with other antimicrobial agents to expand
effectiveness against a wider range of pathogens.
Polymyxin B combinations penetrate tissue poorly and
are not reliably bactericidal.
Macrolides
Bacteriostatic and inhibit protein synthesis but do not
affect nucleic acid synthesis.
Fluoroquinolones
Potent, broad-spectrum, bactericidal antibiotics with a
dual mechanism of action that inhibits the bacterial
enzymes DNA gyrase (topoisomerase II) and/or
topoisomerase IV, enzymes that are essential in the
synthesis and replication of DNA.
The fluoroquinolones are active against gram-positive
and gram-negative bacteria and have been well tolerated
in clinical trials. They are frequently prescribed as first-
line therapy because of their greater efficacy compared
with other classes of ocular antibacterial agents
The fluoroquinolones are currently the most effective &
potent agents against most bacterial pathogens (broad
spectrum of activity, demonstrate rapid bactericidal
activity, achieve high concentrations in the eye, have a long
©Bimbel UKDI residence
MANTAP time at the infection site, and are well tolerated)
Subconjunctival Hemorrhage To remove this notice, visit:




Subconjunctival hemorrhage (cont.)

Characterized by red, flat discoloration due to bleeding from the small
blood vessels that run through the conjunctiva
The most common cause for spontaneous subconjunctival hemorrhage is

idiopathic in nature
The condition is painless, clearing itself within 7 to 14 days
In a few cases, the redness may be associated with bleeding disorders, the
use of anticoagulants, conjunctivitis, scleritis, or trauma to the eye
Warm compresses may be useful in symptomatic relief. Treatment involves

the identification and appropriate management of the underlying cause

MATA MERAH
Episkleritis vs Skleritis
VISUS NORMAL
Tipe Etiologi Manifestasi klinis Terapi
EPISKLERITIS Idiopatik Mata merah (pelebaran vasa) Pembuluh darah yang
(Reaksi radang (mostly), reaksi Nyeri ringan melebar akan mengecil
jaringan ikat hipersensitivitas Dewasa muda (perempuan>>) bila diberi fenilefrin 2,5%
vaskular di terhadap Visus normal topikal (vasokonstriktor)
antara penyakit Mengganjal Artificial tears
konjungtiva & sistemik, infeksi: Khas : Kemerahan biasanya Pada keadaan yang berat
permukaan zooster, dll sektoral (jarang difus), tonjolan diberi kortikosteroid tetes
sklera, setempat, batas tegas, dan mata topikal, sistemik atau
umumnya berwarna merah ungu dibawah salisilat
unilateral) konjungtiva yang sakit jika ditekan Prognosis :
Pada episkleritis luas, gambaran Episkleritis dapat sembuh
klinis mirip dengan konjungtivitis. sempurna/residif
Bedanya adalah pada episkleritis Dengan pengobatan
tidak terdapat hiperemi adekuat, episkleritis dapat
konjungtiva tarsal, tidak ada sembuh dalam 1 minggu,
sekret, serta terasa nyeri saat atau lebih (episkleritis
penekanan ringan bola mata nodular)
Komplikasi : penyulit yang dapat
timbul adalah terjadinya
peradangan yang lebih dalam pada
sklera yang disebut sebagai
Skleritis
MATA MERAH
Episkleritis vs Skleritis
VISUS NORMAL
Tipe Etiologi Manifestasi klinis Terapi
SKLERITIS 50% berkaitan Mata merah gradual, nyeri sedang- Tergantung tipe!
dgn penyakit berat menyebar hingga ke kepala, 1. Nodular difus: NSAID,
sistemik: peny. wajah. Rekuren. Inflamasi sklera, steroid sistemik, tx
Jar ikat (RA, episklera, dan konjungtiva. Bluish imunosupresif k/p.
scleral hue pd px dgn cahaya biasa. 2. Nekrotikans: steroid
polyarteritis Vasa menetap walau diberi fenilefrin sistemik, tx imunosupresif
nodosa, AS), 2,5%, nodul sklera 3. Posterior: kontroversial
sifilis, gout, tb, Nb. Skleritis posterior: nyeri, 4. Infeksius: sesuai sebab
dll proptosis, retinal detach n hem

episkleritis skleritis To remove this notice, visit:


MATA MERAH
Keratitis
VISUS TURUN
Keratitis: peradangan kornea
nyeri, injeksi perikornea, sekret sedikit/-, kekeruhan kornea

(infiltrat, edema, ulkus: apabila ada kerusakan stroma).
Tipe Etiologi Anamnesis Manifestasi klinis
Bakterial Stafilokokus, Pengguna lensa kontak, Opasitas putih (infiltrat) pada
Pseudomonas, riwayat penyakit dan kornea, defek epitel, discar
Streptokokus, operasi pd kornea, trauma, mukopurulen, edema stroma,
Moraksella, korpal reaksi pd COA dgn/tanpa
Serratia hipopion.
Viral HSV, Herpes HSV: 6 bln-5 th, self limited HSV: dendritik, geografika,
zooster Zooster: vesikel +/- tidak dermatomal
immunocompromised, usia Zooster: nyeri dermatomal,
lbh tua vesikel2 di kulit sekitar mata
sesuai dermatom unilateral,
Fungal Aspergillus, Riwayat trauma terkena Infiltrat dengan batas kabur, lesi
Fusarium, Candida tanaman
©Bimbel UKDI MANTAP satelit, hipopion.
Keratitis Bacterial
Normal corneal layers
Viral
Fungal

Keratitis viral
HSV Zooster


AAO, 2013
Viral Keratitis tx
HSV Zooster
Since most cases of herpes simplex virus (HSV) Oral acyclovir 800 mg po five times daily for 7 to 10
epithelial keratitis resolve spontaneously days is the standard treatment. Alternatively, a
within 3 weeks, the rationale for treatment is provider could use famciclovir 500 mg po tid or
to minimize stromal damage and scarring. valacyclovir 1000mg po tid. If the systemic condition
Gentle epithelial débridement may be
performed to remove infectious virus and viral warrants or if the patient is unable to tolerate food
antigens that may induce stromal keratitis. by mouth then acyclovir 5-10 mg/kg iv q8 for 5 days
Antiviral therapy, topical or oral, is an effective may be utilized.
treatment for epithelial herpes infection.
Topical steroids (e.g. prednisolone acetate 1%)
Treatment options for primary ocular herpes should be used for interstitial keratitis and uveitis.
infection include the following: For episodes of scleritis, retinitis, choroiditis, and
Ganciclovir ophthalmic gel 0.15% - 5 times optic neuritis, systemic steroids by mouth or
daily
Trifluridine 1% drops - 9 times daily
intravenous administration should be strongly
Vidarabine 3% ointment - 5 times daily considered.
Oral acyclovir 400 mg - 5 times daily for 10 For increased intraocular pressure commonly found
[19]
days ; oral acyclovir is the preferred in herpes trabeculitis, topical steroids should be
treatment in patients unable to tolerate
topical medications and with good renal administered as well as aqueous suppressants (e.g.
function timolol, brimonidine, dorzolamide, acetazolamide).
A cycloplegic agent may be added to any of Pain should be treated with narcotics if warranted.
the above regimens for comfort from ciliary
spasm. Neuropathic pain responds well to amitriptyline 25
mg po qhs and can decrease the incidence of
postherpetic neuralgia. Capsaicin cream applied to
the rash may decrease pain as well. [13]
Keratitis bakterial

Keratitis bakterial tx


Keratitis fungal
Tx
- Mondok
- Natamisin 5% tetes atau
amfoterisin B 0.15% (esp
utk Candida) q1-2 jam
lalu t.o 4-6 minggu
- Sikloplegik
- Topikal steroid - No!
- Antifungi sistemik
(flukonazol 200-400 mg
po loading, lalu 200 mg
p.o bid)

AAO, 2014 ©Bimbel UKDI MANTAP



How to Diagnose Corneal Ulcers?

Direct observation under magnified view of slit lamp revealing the ulcer on
the cornea
The use of fluorescein stain, which is taken up by exposed corneal

stroma and appears green, helps in defining the margins of the corneal
ulcer, and can reveal additional details of the surrounding epithelium.
Rose-Bengal dye is also used for supra-vital staining purposes, but it may
be very irritating to the eyes
Doing a corneal scraping and examining under the microscope with stains
like Gram's and KOH preparation may reveal the bacteria and fungi
respectively. Microbiological culture tests may be necessary to isolate the
causative organisms for some cases
Other tests that may be necessary include a Schirmer's test for

keratoconjunctivitis sicca and an analysis of facial nerve function for facial
nerve paralysis.
MATA MERAH
Uveitis To remove this notice, visit:

VISUS TURUN
Uveitis: inflamasi pada uvea (iris, badan silier, koroid)

Manifestasi: bergantung pd lokasinya.
Tipe Etiologi Anamnesis Manifestasi klinis Terapi
ANTERIOR Idiopatik, peny Akut: merah, nyeri, Injeksi siliar, sel (inflamasi Sikloplegik,
(iris) sistemik (AS, fotofobia, aktif +), flare (protein steroid
RA, IBD, SLE, leakage) / efek tyndall pada topikal, bl
Behcet), lens- COA, keratic precipitates tdk
induced, eksaserbasi-remisi. (KP), hipopion, sinekia membaik
postOP, herpes, berikan
sifilis, TB glaukoma. sistemik.
INTERMEDI Idiopatik (>70%), Sensasi benda Infiltrasi sel ke vitreous Steroid
ATE (badan sarkoidosis, MS, apung tidak (vitritis), tampak topikal, bl
silier) Lyme, sifilis, nyeri, fotofobia dan snowbanking di inferior tdk membaik
toxocariasis inflamasi eksterna berikan
vitrous.
minimal, bilateral, usia sistemik.
15-40 th.
POSTERIOR Toxo, CMV, benda apung. Vitreous: sel, hazy; Tx
(koroid) histoplamosis Umumnya tidak nyeri. koroiditis, retinitis, penyebab
Nyeri, merah, fotofobi vaskulitis
jk inflamasi COA (+)
Diagram uvea

Uveitis
Keratic
precipitate
Koeppe nodules
(infeksi
granulomatosa)
Buasacca nodule
(infeksi
granulomatosa)
Uveitis posterior

MATA MERAH
Glaukoma
VISUS TURUN
Definisi: neuropati optik yang disebabkan oleh TIO yg relatif tinggi, ditandai dgn
kelainan lapang pandang dan atrofi papil saraf optik. TIO N 8-21 mmHg.
Klasifikasi
PENYEBAB: primer (idiopatik), sekunder, kongenital
KEADAAN SUDUT: open, closed
Mekanisme: gangguan aliran humor akuos akibat kelainan sistem drainase shg
penggaungan/cupping diskus optikus

PX:
1. PAPIL: atrofi (pucat, batas tegas, lamina kribrosa jelas), penggaungan (tepi
temporal menipis, D vertikal>horizontal, vasa menggantung di pinggir dan
terdorong ke nasal).
2. TONOMETRI: palpasi, Tonometri Schiotz, aplanasi Goldmann, NCT
3. GONIOSKOPI: px sudut iridokornea
4. LAPANG PANDANG: perimetri
MATA MERAH
Glaukoma
VISUS TURUN

Glaukoma

Glaukoma

Glaukoma Primer To remove this notice, visit:

SUDUT NAMA ETIOLOGI MANIFESTASI TERAPI
OPEN Primary Open Idiopatik Kronis, asimptomatik hingga Menurunkan TIO dgn medikasi
Angle Glaucoma tingkat lanjut, progressive (first line) atau trabekuloplasti
(POAG) visual field loss, TIO atau trabekulektomi
Normotension sebagian meningkat, sudut
glaucoma normal, funduskopi: atrofi,
penggauangan/cupping.
CLOSED Acute Angle Closure Pupillary block Nyeri, - Tx topikal utk -
Glaucoma di skliling cahaya, nyeri blocker (timolol 0,5% tdk boleh
kepala berat, mual muntah. pd COPD atau asma) / alfa2
agonis (brimonidin 0,15%) / Pg
edema kornea, mata merah, analog / carbonic anhydrase
injeksi konjungtiva, pupil inhibitor (dorzolamid).
terfiksasi middilatasi. -Steroid topikal
-CAI sistemik (asetazolamid 250-
500 mg iv atau po).
-Ulangi ukur TIO dan visus 1 jam
kemudian, bila tdk membaik
berikan manitol 1-2 gr/kg iv
selama 45 menit.
Chronic Angle- Prolonged acute Asimptomatik, progressive iridotomi
Closed Glaucoma angle-closure
glaucoma sudut tertutup

Glaukoma

NAMA
Pigmentary
glaucoma
ETIOLOGI GLAUKOMA SEKUNDER
open-angle galucoma
Glaukoma Sekunder MANIFESTASI
Pandangan kabur, nyeri, halo pelangi,
dilatasi pupil, dpt
asimptomatik. Dewasa muda, laki2, bilateral.
Exfoliative Penyakit sistemik krn adanya material eksffoliasi putih-keabuan yg Asimptomatik pd awal. Tampak material ptih-abu pd
glaucoma terdeposit di lensa, iris, eptiel siliar, dan trabecular meshwork. tepian pupil.
Phacogenic PHACOLYTIC GLAUCOMA Nyeri unilateral, visus LP atau NLP, fotofobia, nyrocos,
glaucoma Krn ada material lensa yg keluar dr lensa (katarak hipermatur) katarak matur/hipermatur, edema kornea, cell and flare
pd COA.
LENS PARTICLE GLAUCOMA Nyeri, visus turun, merah, nyrocos, fotofobia, material
Krn ada material yg mengobstruksi aliran akuos stlh trauma atau putih di COA.
operasi mata
PHACOANAPHYLAXIS Idem, riwayat uveitis

Chronic granulomatous uveitis in response to lens material liberated
trabekula
PHACOMORPHIC GLAUCOMA Idem, sudut tertutup
block
Inflammato Uveitis (anterior, intermediate, posterior, panuveitis), keratouveitis, Nyeri, visus turun, fotofobia, TIO naik, inflamasi pd COA.
ry open- post trauma, intraocular surgery
angle
glaucoma
Steroid- Riwayat penggunaan steroid lama (terutama topikal, periokular, TIO meningkat, tanda2 POAG
response
glaucoma ©Bimbel UKDI MANTAP
Medikamentosa glaukoma

Terapi Glaukoma Sudut Terbuka (OAG)

Primary goal of therapy : Menurunkan TIO
sehingga mengurangi progresi penurunan
lapang pandang penglihatan
Inisiasi terapi : TIO >25 mmHg (most
clinicians), sebagian lain >22 mmHg. Alternatif
lain, TIO 18mmHg + cupping & field loss
harus ditx
Modalitas terapi : farmakologik, laser
(trabeculoplasty), operasi (trabeculotomy)

Farmakologik Foxit Advanced PDF Editor

Prostaglandin
Prostaglandin topikal lebih dipilih dibanding betabloker topikal sebagai first line tx
pada OAG
Menurunkan TIO lebih besar dibanding betabloker, lebih efektif, lebih ditoleransi, efek
samping sistemik paling kecil
Durasi aksi kerja panjang 1x/hari
Contoh : Latanoprost (efek samping paling kecil dibanding prostaglandin lainnya),
bimatoprost, tafluprost
Ocular S.E. : conjunctival hyperemia, eye irritation, bulu mata tambah
panjang/banyak, perubahan iris dan pigmentasi bulu mata
Betablocker
Dahulu, dianggap sebagai first line tx u/ OAG
Menurunkan TIO, durasi aksi kerja panjang 1-2x/hari, efek samping okular sedikit
Contoh : timolol, betaxolol
Systemic S.E. : Worsening of heart failure, bradycardia, heart block, and increased
airway resistance
Topikal beta bloker : Kontraindikasi pada pasien dengan cardiac/pulmonary disease
Alpha adrenergic agonists To remove this notice, visit:

Efektivitas mirip dgn betabloker dalam menurunkan TIO pada OAG

Contoh brimonidine
Ocular side effects >> : allergic conjunctivitis, hyperemia, & ocular
pruritus.
Nonselective agents (epinephrine) arrhythmia, hypertension, and
tachycardia
Systemic carbonic anhydrase inhibitors
Mulai ditinggalkan, diganti dengan preparat topikal yang lebih baru dan
memiliki S.E. lebih kecil
Preparat topikalnya tidak lebih baik dibandingkan preparat topikal jenis
lain
Contoh : Acetazolamide oral
Cholinergic agonists
Adverse effects << dibanding betabloker
Memiliki ocular side effects >>seperti fixed, small pupils (miotikum),
myopia, and increased subjective visual disturbance yang berkaitan
dengan katarak koeksis menurunkan popularitas obat ini
Contoh : Pilokarpin
©Bimbel UKDI MANTAP Uptodate, 2015
Terapi Glaukoma Sudut Tertutup (CAG)
Dalam 1 jam sebaiknya langsung dirujuk ke Sp.M. Tetapi apabila

tidak memungkinkan, mulai dengan tx empiris
For an acute primary angleclosure attack, initial management

involves prompt administration of pressure lowering eye drops.
A possible regimen would be one drop each, one minute apart
0.5% timolol maleate (Timoptic)

1% apraclonidine (Iopidine), dan
2% pilocarpine (Isopto Carpine)
Systemic medications (oral or IV acetazolamide, IV www.foxitsoftware.com/shopping
mannitol, or oral glycerol or isosorbide) to control the

intraocular pressure are often given
We suggest giving the patient two 250 mg tablets of
acetazolamide in the office
The eye pressure should be checked 30 to 60 minutes
after giving pressure lowering drops and oral
acetazolamide.
If medical treatment is successful in reducing
intraocular pressure, as is most often the case, corneal
edema and eye pain will typically lessen or resolve
Once the attack is broken, the treatment of choice is a
peripheral iridotomy. If laser peripheral iridotomy fails
to remain patent, or the cornea is too cloudy to
visualize the iris, surgical peripheral iridectomy may be
necessary.
Uptodate, 2015 ©Bimbel UKDI MANTAP

Uptodate, 2015 ©Bimbel UKDI MANTAP

GOLONGAN MEKANISME AKSI CONTOH To remove this notice, visit:
Beta-blocker Berguna utk Timolol 0.25% dan 0.5%,
semua jenis glukoma, first line. SE: Betaxolol 0.5%, Levobunolol
bronkospasme, bradikaria, hipotensi 0.5%, dll
Simpatomimetik First choice utk POAG yg pny Adrenalin 0.5% 1% 2%,
(Agonis alfa dan kontraindikasi beta-blocker. Pny efek Dipivefrin 0.1%
beta adrenergik) MIDRIATIL shg tdk blh utk yg glaukoma
sudut sempit!
Miotikum Pd POAG bs memperlancar aliran aquos Pilokarpin 1% 2% 3% 4%
(Cholinergic krn trabekula lbh terekspos saat miosis. Carbachol 3%
Agonis) Pd PACG bs membuka sudut krn pupil
konstriksi
Carbonic aquos dgn menginhibisi Asetazolamid tab 250 mg
anhydrase langsung enzim CA
inhibitor (CAI)
Agen Manitol 20%, gliserol
hiperosmotik darah shg darah di vasa menarik air dr
vitreous. Bagus utk penurunan TIO
temporer (mau operasi)
Sikloplegik Kerja m.siliaris diblok, efek Atropin Sulfat
parasimpatolitik. Hasilnya akan midriasis
Pada Glaukoma Sudut Tertutup Akut Sudut

Iridokorneal tertutup/sempit (Muskulus siliaris tidak
berkontraksi)
Kondisi pupil dilatasi/mid-dilatasi
- Berikan agen yang dapat menyebabkan pupil miosis sehingga

sudut iridokorneal terbuka (m. siliaris kontraksi)
(c/o : Agonis kolinergik (Pilokarpin))
- Jangan berikan agen yang dapat menyebabkan pupil midriasis,
kerja m. siliaris diblok, sehingga sudut iridokorneal tertutup
(c/o : Agonis alfa (brimonidine, epinefrin);
Sikloplegik (Atropin Sulfat)
Glaukoma Kongenital
Terjadi karena saluran pembuangan tidak terbentuk dgn baik atau

bahkan tidak terbentuk sm skali.
Klasifikasi
-
-
3. Sekunder: fibrolasia retrolental, tumor (retinoblastoma, juv
xantogranuloma), inflamasi, penggunaan steroid.
Tx: bedah ©Bimbel UKDI MANTAP
MATATowww.foxitsoftware.com/shopping
MERAH
remove this notice, visit:
VISUS TURUN
Endoftalmitis
Inflamasi bola mata yg melibatkan vitreous dan segmen depan. Tp
kenyataannya bs jg melibatkan koroid dan retina
hiperemis, kemosis, edem palpebra dan kornea

Post OP paling sering OP katarak, kertoplasti tembus, vitrektomi
Tx: topikal antibiotik, steroid, antibiotik sistemik.
Post OP akut <2 mggu
Post OP kronik >4 mggu

Eksogen
Post trauma
Infeksi
Filtration belb-related
Endogen
endoftalmitis
Sisa lensa,
Non-infeksi
trauma

Endoftalmitis vs Panoftalmitis
Enukleasi melibatkan Eviserasi adalah pengangkatan isi

pengangkatan bola mata dan bola mata tapi dengan menyisakan
sebagian nervus optikus anterior, sklera dan, pada beberapa kasus,
dengan usaha untuk juga menyisakan kornea.
mempertahankan konjungtiva,
kapsula Tenon, serta otot
ekstraokular.
TRAUMA TUMPUL PADA MATA To remove this notice, visit:

Kelainan Definisi Manifestasi
Khemosis The swelling (or edema) of the The conjunctiva becomes swollen and gelatinous in
conjunctiva. Due to exudation from appearance. Often, the eye area swells so much that the
abnormally permeable capillaries. A eyes become difficult or impossible to close fully.
nonspecific sign of eye irritation. Caused
by allergies or viral infections, as well as
eye rubbing
Iridodialisis known as a coredialysis, is a localized may be asymptomatic and require no treatment, but those
separation or tearing away of the iris from with larger dialyses may have corectopia (displacement of
its attachment to the ciliary body; usually the pupil from its normal, central position) or polycoria (a
caused by blunt trauma to the eye pathological condition of the eye characterized by more
than one pupillary opening in the iris) and experience
monocular diplopia, glare, or photophobia
Hifema Darah pada COA yg berasal dr pendarahan Tx: bed rest kepala elevasi 60 derajat, asam traneksamat,
vasa pd korpus siliari, a.koroidalis, vasa SA utk midriasis, steroid sistemik atau topikal,
irirs. Hifema primer: segera stlh trauma, asetazolamid bl TIO naik. Cegah glaukoma. Bila TiO ttp
hifema sekunder: 3-5 hari stlh trauma tinggi atau bl sinekia anterior perifer lakukan OP
(parasentesis COA).
Hemoftalmos Pendarahan pd vitrous body krn robekan Perlu evaluasi dgn USG. Bila ringan biarkan resorpsi
pd retina, siklodialisis, iridodialisis, ruptur spontan. Bila berat OP vitrektomi
koroid.
Blow out Fraktur dasar orbitae Ekimosis, edem palpebra, diplopia vertikal, keterbatasan
fracture gerak vertikal,nyeri


http://samoke2012.files.wordpress.com/2012/10/trauma-kimia-pada-mata.pdf
TRAUMA KIMIA MATA

Klasifikasi :
Merupakan trauma yang mengenai bola
mata akibat terpaparnya bahan kimia baik Derajat 1: kornea jernih dan tidak
yang bersifat asam atau basa yang dapat ada iskemik limbus (prognosis
merusak struktur bola mata tersebut sangat baik)
Keadaan kedaruratan oftalmologi karena Derajat 2: kornea berkabut
dapat menyebabkan cedera pada mata, dengan gambaran iris yang masih
baik ringan, berat bahkan sampai terlihat dan terdapat kurang dari
kehilangan penglihatan 1/3 iskemik limbus (prognosis
Etiologi : 2 macam bahan yaitu yang baik)
bersifat asam (pH < 7) dan yang bersifat Derajat 3: epitel kornea hilang
basa (pH > 7,6) total, stroma berkabut dengan
Pemeriksaan Penunjang : gambaran iris tidak jelas dan
Kertas Lakmus : cek pH berkala sudah terdapat 1/2 iskemik
Slit lamp : cek bag. Anterior mata dan lokasi luka limbus (prognosis kurang)
Tonometri
Derajat 4: kornea opak dan
Funduskopi direk dan indirek
sudah terdapat iskemik lebih dari
1/2 limbus (prognosis sangat
©Bimbel UKDI MANTAP buruk)
http://samoke2012.files.wordpress.com/2012/10/trauma-kimia-pada-mata.pdf
Trauma Kimia www.foxitsoftware.com/shopping
Trauma Asam : Trauma Basa :

Bahan asam mengenai mata maka Bahan kimia basa bersifat koagulasi sel
akan segera terjadi koagulasi protein dan terjadi proses safonifikasi, disertai
epitel kornea yang mengakibatkan dengan dehidrasi
kekeruhan pada kornea, sehingga bila Basa akan menembus kornea, kamera
konsentrasi tidak tinggi maka tidak okuli anterior sampai retina dengan
akan bersifat destruktif cepat, sehingga berakhir dengan
Biasanya kerusakan hanya pada kebutaan.
bagian superfisial saja Pada trauma basa akan terjadi
Bahan kimia bersifat asam : asam penghancuran jaringan kolagen kornea.
sulfat, air accu, asam sulfit, asam Bahan kimia bersifat basa: NaOH, CaOH,
hidrklorida, zat pemutih, asam amoniak, Freon/bahan pendingin lemari
asetat, asam nitrat, asam kromat, es, sabun, shampo, kapur gamping,
asam hidroflorida semen, tiner, lem, cairan pembersih
dalam rumah tangga, soda kuat.

Trauma Kimia
Tatalaksana Emergensi : Tatalaksana Medikamentosa :
Irigasi : utk meminimalkan Steroid : mengurangi
durasi kontak mata dengan inflamasi dan infiltrasi
bahan kimia dan neutrofil
menormalkan pH mata; dgn Siklopegik : mengistirahatkan
larutan normal saline (atau iris, mencegah iritis (atropine
setara) atau scopolamin) dilatasi
Double eversi kelopak mata : pupil
utk memindahkan material Antibiotik : mencegah infeksi
Debridemen : pada epitel oleh kuman oportunis
kornea yang nekrotik

http://samoke2012.files.wordpress.com/2012/10/trauma-kimia-pada-mata.pdf; Ilmu Penyakit Mata, Sidarta Ilyas
TRAUMA TUMPUL PADA LENSA

Dislokasi Lensa : putusnya zonula Zinn kedudukan
lensa terganggu
Subluksasi Lensa : putusnya sebagian zonula Zinn
lensa berpindah tempat.
Luksasi lensa anterior : seluruh zonula Zinn di sekitar
ekuator putus lensa masuk ke dalam bilik mata depan
Luksasi lensa posterior : putusnya zonula Zinn di seluruh
lingkaran ekuator lensa lensa jatuh ke dalam badan
kaca dan tenggelam di dataran bawah polus posterior
fundus okuli
Trauma Lensa-Subluksasi Lensa

Dapat karena trauma atau spontan (pada
penderita sindrom Marphan zonula Zinn
rapuh)
Gejala : visus menurun, iridodenesis, lensa
menjadi lbh cembung miopik.
Penyulit : Glaukoma, uveitis
Tatalaksana : kacamata koreksi yang sesuai,
bila timbul penyulit operasi (pengeluaran
lensa)
Ilmu Penyakit Mata, Sidarta Ilyas, 2005
MATA TENANG
Pendarahan Vitreous VISUS TURUN

MENDADAK
bintik2 hitam, berkabut

Tanda: refleks fundus
hilang, tampak darah pd
vitreous, mild RAPD
Etiologi: proliferative
diabetic retinopathy,
posterior vitreous
detachment, ablasio retina,
BRVO, AMD eksudatif,
sickle cell disease, trauma,
tumor intraokular, SAH,
SDH, Eales disease
Tx: sesuai etiologi,
vitrectomy ©Bimbel UKDI MANTAP
MATA TENANG
Ablasio Retina VISUS TURUN

MENDADAK
Lapisan sel kerucut dan

sel batang terpisah dari
lapisan sel epitel pigmen
(RPE).
Di antaranya memang
tidak terdapat
perlengketan (asal
embriologi beda) tp ada
celah potensial.
3 macam:
1. Ablasio retina eksudatif
2. Ablasio retina traksional
3. Ablasio retina
rhegmatogen ©Bimbel UKDI MANTAP
MATA TENANG
Ablasio Retina Rhegmatogen VISUS TURUN

MENDADAK
Robekan pada retina menyebabkan

cairan subretinal yg berasal dari
synchitic vitreous masuk ke celah
potensial dan menyebabkan ablasio
dr dalam.
Retinal breaks (defek retina sensoris)
bertanggung jwb, dsebabkan oleh
adanya traksi vitreoretinal dan
kelemahan pd retina perifer (RF).
Faktor risiko: miopia,
afakia,degenerasi anyaman, trauma
okular.
SS: flashing lights, benda apung,
defek lapang pandang tepi lalu jadi
sentral, gjala awal adlh bayangan
ringan
Ablasio Retina Rhegmatogen

MATA TENANG
Ablasio Retina Traksional VISUS TURUN

MENDADAK
Disebabkan tarikan retina
ke dalam vitrous body.
pandang, bs
asimptomatik, retina yg
detached terlihat konkaf
Etiologi: jaringan
fibroselular pd vitreous
(kr PDR), sickle cell
retinopathy, ROP, trauma
Tx: vitrektomi, scleral
buckle

MATA TENANG
Ablasio Retina Eksudatif VISUS TURUN

MENDADAK
Karena timbunan
cairan di celah
potensial krn ada
kelainan RPE dan
koroid misal koroiditis,
tanpa didahului
robekan.
lapang pandang, area

yg detached berubah
sesuai posisi
(gravitasi)
OKLUSI VASKULAR RETINA

MATA TENANG
VISUS TURUN
(Arteri) MENDADAK
NAMA GEJALA TANDA ETIOLOGI TERAPI
Central Retinal Unilateral, tdk Opasitas Embolus, Kontroversial:

Artery superfisial pd trombosis, GCA, masase okular,
Occlusion mendadak polus posterior SLE, parasentesis
(CRAO) (counting retina, cherry- hiperkoagulasi COA,
finger-LP), riw red spot di asetazolamid
amaurosis fugax sentral makula, 500 mg iv/po,
RAPD hiperventilasi
pd paper bag
spy asidosis
Branch Retinal Unilateral, tdk Opasitas Idem idem
Artery nyeri, superfisial pd
Occlusion distribusi
(BRAO) lapang cabang arteri yg
pandang, riw defek, edema
amaurosis fugax lokal

(Arteri)
CRAO BRAO


MATA TENANG
VISUS TURUN
(Vena) MENDADAK
NAMA GEJALA TANDA ETIOLOGI TERAPI
Central Retinal Unilateral, tdk Pendarahan retina difus Atherosclerosis Obati penyakit
Vein Occlusion di seluruh kuadran, vena , HT, glaukoma, dasar, laser bl
(CRvO) mendadak dilatasi dan tortuous, hiperkoagulasi, ada
cotton wool, edema vaskulitis, obat neovaskularis
diskus dan makula, (kontrasepsi asi, aspirin 81-
neovaskularisasi oral, diuretik) 325 mg po qd,
anti VEGF
Branch Retinal Unilateral, tdk Pendarahan superfisial Peny dinding Laser bl ada
Vein Occlusion visus pd distribusi cabang arteri menekan neovaskularis
(BRVO) atau sebagian vena yg defek, tdk vena pd titik asi, tx
lapang melintas midline, cotton crossing penyakit
pandang dgn wool, edemavena dasar
blind spot dilatasi dan tortuous


(Vena)
CRVO BRVO

Optic Neuritis Foxit Advanced PDF Editor

Major symptoms
Sudden loss of vision (partial or complete)

Sudden blurred or "foggy" vision
Pain on movement of the affected eye
The vision might also be described as "disturbed/blackened" rather than blurry, as
when feeling dizzy
Many patients with optic neuritis may lose some of their color vision in the
affected eye (especially red), with colors appearing subtly washed out compared
to the other eye
Remarkable differences between the presentation of adult optic neuritis as compared

to pediatric cases include more often unilateral optic neuritis in adults, while children
much predominantly present with bilateral involvement
Symptoms peak several days to weeks after onset, while symptoms failing to
improve after 8 weeks should suggest a diagnosis other than optic neuritis.
Medical examination
The head of the optic nerve can easily be visualised by a slit lamp with high plus or
by using direct ophthalmoscopy
However, frequently there is no abnormal appearance of the nerve head in optic
neuritis (in cases of retrobulbar optic neuritis), though it may be swollen in some
patients (anterior papillitis or more extensive
©Bimbel optic neuritis).
UKDI MANTAP
MATA TENANG
Neuritis Optik Toksik VISUS TURUN

MENDADAK
SS: tanda alkoholisme, Tx: eliminasi kausa, B1 100

rokok, nutrisi kurang (B1, mg po bid, folat 1 mg po
B12), riwayat penggunaan bid, in B12 1000 mg im/bln
obat2an tertentu utk anemia pernisiosa.
(kloramfenikol, etambutol,
isoniazid, digitalis,
streptomisin,
klorpropamid, disulfiram,
lead, etilklorfinol)

MATA TENANG
VISUS TURUN
PERLAHAN
Gangguan Refraksi (Ametropia)
Anomali Titik Sebab Manifestasi Komplik Koreksi
fokus asi
Miopia Di depan -AKSIAL: aksis AP >> -Penglihatan dekat baik Ablasio Lensa sferis
retina (makroftalmos, membaca -Penglihatan jauh jelek retina, negatif terkecil
terlalu dekat, wajah lebar) -Miop tinggi: bola mata lbh katarak yang memberikan
-KURVATURA: mnnonjol, COA lbh dalam, visus 6/6. miop
keratokonus/globus, pupil lebar, fundus trigroid tinggi diberikan
keratektasia, lensa tll pengurangan 2/3
cembung, katarak imatur koreksi penuh
-INDEKS BIAS: DM
-POSISI: lensa tll ke depan
Hipermetropia Di -AKSIAL: aksis AP << - Glaukom Lensa sferis positif

(Hyperopia) belakang (mikroftalmos, edem makula, baik) hrs berakomodasi a sudut terbesar yg
retina ablatio retina) supaya jatuh di retina sempit memberi visus
-KURVATURA: kornea plana, -Melihat dekat, akomodasi terbaik.
sklerosis lensa, afakia >> shrg astenopia
-INDEKS BIAS: kadar gula -Hipertrofi otot siliaris, COA
dangkal, miosis, papil
-POSISI: lensa tll ke belakang hiperemis
MATA TENANG
VISUS TURUN
Gangguan Refraksi PERLAHAN
Anomali Titik fokus Sebab Manifestasi Komplik Koreksi

asi
Astigmatisme Berbagai Kelainan kornea (90%): - Mata kabur saat melihat Risiko Menyatukan
derajat refraksi perubahan lengkung jauh dan dekat, obyek ambliopi kedua fokus
pada berbagai kornea; kelainan lensa, membayang, astenopia. a utama (dengan
meridian shg kekeruhan lensa lensa silinder),
fokus jg (ex.katarak insipien, kemudian kedua
bermacam2 imatur) fokus yang sudah
bersatu tsb
diletakkan tepat
di retina (dengan
lensa sferis).
Presbiopia PP jauh shg ensa - Penglihatan dekat kurang, - Sferis positif
pekerjaan mengeras, tdk kenyal, astenopia, mata sakit, sesuai umur (40
dekat sulit daya kontraksi otot siliar lakrimasi tahun adisi S+1D,
berkurang 45 tahun adisi
S+1,5D, 50 tahun
adisi S+2D, 55
tahun adisi S+2D,
60 tahun adisi
S+3D)



Miopia simpleks Foxit Advanced PDF Editor
Jenis paling umum www.foxitsoftware.com/shopping
Diameter AP >> atau Indeks Bias >>

Umumnya < 6D
Miopia Nokturnal
Hanya terjadi di cahaya redup/malam
Disebabkan karena kurangnya kontras cahaya untuk menstimulus akomodasi yang
sesuai, mata tidak bisa melihat dengan jelas untuk benda dengan jarak tak hingga
(Akomodasi berlebihan)
Psedomyopia
Hasil dari bertambahnya kekuatan refraksi okular o/k overstimulasi akomodasi
mata atau spasme m.siliaris. Umumnya pada orang dengan near-work secara
reguler, belajar terus menerus menjelang ujian
Miopi degeneratif
Miopi patologis
Miopi derajat tinggi dengan perubahan degeneratif pada segmen posterior
Dapat menyebabkan perubahan visus/ lapang pandang. Sekuele seperti retinal
detachment dan glaukoma umum terjadi
Miopia induksi
Miopia yang didapat (Acquired)
Akibat paparan bermacam-macam agen farmasetik, variasi level kadar gula darah,
nuclear sclerosis pada kristalin lensa, dll.
Miopi ini bersifat temporer atau©Bimbel
reversibel
UKDI MANTAP

KOMPONEN To remove this notice, visit:

HIPERMETROPIA Tanpa Dengan

sikloplegik sikloplegik
Total hypermetropia is
the total amount of
refractive error, which is
estimated after complete
cycloplegia with atropine



Macam-macam astigmatisma

Contoh soal astigmatisma no.1

Contoh soal astigmatisma no.2

Koreksi lensa
OD S -0.75 C-
OS S -1.00 C-


Contoh soal presbiopia

Soal Jawaban
1. Wanita 45 thn, sulit 1. OD S+2.00 OS S+1.00
membaca (buku hrs S+3.50 S+2.50
dijauhkan). Riw kacamata -. or OD S+2.00 OS S+1.00 adisi
VOD 6/15 dikoreksi S+2.00 S+1.50 ODS
jadi 6/6, VOS 6/9 dikoreksi
S+1 jadi 6/6. resep?
2. Pria 45 thn, OD dikoreksi S- 2. OD S-1.00 OS S-0.50
1D jd 6/6, OS dgn S-0.5D jd S+0.50 S+1.00
6/6. or OD S-1.00 OS S-0.50 adisi
S+1.50 ODS

Amblyopia
In general, amblyopia is believed to result
Definition from disuse from inadequate foveal or
peripheral retinal stimulation and/or
a decrease of vision, either abnormal binocular interaction that
unilaterally or bilaterally, for causes different visual input from the
foveae.[6]
which no cause can be Three critical periods of human visual
found by physical acuity development have been
determined.[7, 8] During these time
examination of the eye. The periods, vision can be affected by the
various mechanisms to cause or reverse
term functional amblyopia amblyopia. These periods are as follows:
often is used to describe - The development of visual acuity from the
20/200 range to 20/20, which occurs from
amblyopia, which is birth to age 3-5 years.
potentially reversible by - The period of the highest risk of deprivation
amblyopia, from a few months to 7 or 8
occlusion therapy. Organic years.
amblyopia refers to - The period during which recovery from
amblyopia can be obtained, from the time
irreversible amblyopia. of deprivation up to the teenage years or
even sometimes the adult years.
Amblyopia Foxit Advanced PDF Editor

Etiologi
Ax
Anisometropia
Elicit any previous Inhibition of the fovea occurs to eliminate the abnormal
binocular interaction caused by one defocused image and one
history of patching or focused image.
eye drops as well as This type of amblyopia is more common in patients with
anisohypermetropia than anisomyopia. Small amounts of
past compliance with hyperopic anisometropia, such as 1-2 diopters, can induce
these therapies. amblyopia. In myopia, mild myopic anisometropia up to -3.00
diopters usually does not cause amblyopia.
Document previous Hypermetropic anisometropia of 1.50 diopters or greater is a
long-term risk factor for deterioration of visual acuity after
ocular surgery or occlusion therapy.
disease. Strabismus
The patient favors fixation strongly with one eye and does not
In addition to the alternate fixation. This leads to inhibition of visual input to the
retinocortical pathways.
routine information, Incidence of amblyopia is greater in esotropic patients than in
obtaining a family exotropic patients.
Strabismic anisometropia
history of strabismus
These patients have strabismus associated with anisometropia.
or other ocular Visual deprivation
problems is important Amblyopia results from disuse or understimulation of the retina.
This condition may be unilateral or bilateral. Examples
because the presence include cataract, corneal opacities,ptosis, and surgical lid
of these ocular closure.[10]
Organic
problems may Structural abnormalities of the retina or the optic nerve may be
predispose a child to present. Functional amblyopia may be superimposed on the
©Bimbel UKDI
organic MANTAP
visual loss.
amblyopia.
Physical Foxit Advanced PDF Editor
Visual acuity To remove this notice, visit:
Diagnosis of amblyopia usually requires a 2-line difference of visual acuity between the eyes; however, this definition is somewhat arbitrary
and a smaller difference is common.
Crowding phenomenon
A common characteristic of amblyopic eyes is difficulty in distinguishing optotypes that are close together. Visual acuity often is better
when the patient is presented with single letters rather than a line of letters.
Diagnosis is not an issue in children old enough to read or with use of the tumbling E.
Testing in preverbal children
If the child protests with covering of the sound eye, amblyopia can be diagnosed if it is dense.
Fixation preference may be assessed, especially when strabismus is present.
Induced tropia test may be performed by holding a 10-prism diopter before one eye in cases of an orthophoria or a microtropia.
In infants who cross-fixate, pay attention to when the fixation switch occurs; if it occurs near primary position, then visual acuity is equal in
both eyes.
Caution should be used when obtaining Teller acuity in children, as grating acuity may be less reduced than Snellen acuity, especially in
strabismic amblyopia.
Contrast sensitivity
Strabismic and anisometropic amblyopic eyes have marked losses of threshold contrast sensitivity, especially at higher spatial frequencies;
this loss increases with the severity of amblyopia.
Neutral density filters
Patients with strabismic amblyopia may have better visual acuity or less of a decline of visual acuity when tested with neutral density filters
compared to the normal eye. This was not found to be true in patients with anisometropic amblyopia or organic disease.
Binocular function
Amblyopia usually is associated with changes in binocular function or stereopsis.
Eccentric fixation
Some patients with amblyopia may consistently fixate with a nonfoveal area of the retina under monocular use of the amblyopic eye, the
mechanism of which is unknown. This can be diagnosed by holding a fixation light in the midline in front of the patient and asking them to
fixate on it while the normal eye is covered. The reflection of the light will not be centered.
Refraction
Cycloplegic refraction must be performed on all patients, using retinoscopy to obtain an objective refraction. In most cases, the more
hyperopic eye or the eye with more astigmatism will be the amblyopic eye. If this is not true, one needs to investigate further for ocular
pathology. ©Bimbel UKDI MANTAP


MATATo remove
TENANG this notice, visit:
VISUS TURUN
Katarak (kekeruhan lensa) PERLAHAN
Nuclear
Age-related Cortical
Subcapsular
Kausa: infeksi intrauterin. Bila

Congenital sentral, tebal, unilateral, >2mm
hrs segera OP dlm 2 bln pertama
Katarak Childhood Acquired
Traumatic Korpal, thermal, radiasi ion
Intraocular Uveitis kronis, glaukoma, retinal

disease detachment, retinitis pigmentosa
Secondary Systemic DM, hipokalsemia, myotonic
disease dystrophy, dermatitis atopik, dll
Drug-
induced
Klorpromazin, miotikum long act,
amiodaron, busulfan
KATARAK-SENILIS

Ilmu Penyakit Mata Ed 3. Jakarta: Balai Penerbit FKUI; 2006 Foxit Advanced PDF Editor
KATARAK-SENILIS
Katarak senilis adalah kekeruhan lensa yang terdapat pada usia lanjut, yaitu usia di atas 50
tahun
Epidemiologi : 90% dari semua jenis katarak
Etiologi :belum diketahui secara pasti multifaktorial:
Faktor biologi, yaitu karena usia tua dan pengaruh genetik
Faktor fungsional, yaitu akibat akomodasi yang sangat kuat mempunyai efek buruk
terhadap serabu-serabut lensa.
Faktor imunologik
Gangguan yang bersifat lokal pada lensa, seperti gangguan nutrisi, gangguan
permeabilitas kapsul lensa, efek radiasi cahaya matahari.
Gangguan metabolisme umum
4 stadium: insipien, imatur, matur, hipermatur
Gejala : distorsi penglihatan, penglihatan kabur/seperti berkabut/berasap, mata tenang
Penyulit : Glaukoma, uveitis
Tatalaksana : operasi (ICCE/ECCE)

NUCLEAR: progresif perlahan, www.foxitsoftware.com/shopping
miopisasi (krn indeks refraksi
second sight (mampu melihat

dekat tanpa kacamata),
umumnya bilateral
SUBCAPSULAR: bisa
anterior/posterior, anterior:
metaplasia fibrosa dr epitel
anterior lensa; posterior:
migrasi sel epitel ke posterior,
visus jauh
CORTICAL: bilateral, silau saat

melihat sumber cahaya

kejadian Lensa Opasitas Korteks Kapsul

bengkak krn tersebar seluruhnya mengecil dan
termasuki air dipisahkan opak mengkerut
olh area krn air keluar
bersih dr lensa
visus > 6/60 5/60 -1/60 1/60 -0

Protein struktural larut dalam air yang disebut

disintesis pada serabut lensa dan menjadi 90 persen dari
keseluruhan protein lensa5,6. Kristalin- -subunit
yang saling berhubungan dan terpisahkan secara konstan6.
Kemampuan kristalin-
lensa yang didenaturasi oleh beberapa faktor termasuk oksidasi dan
panas, bergantung pada sifat dinamis strukturnya. Kristalin-
memiliki struktur dan fungsi yang serupa dalam membantu
mengurangi hamburan cahaya pada lensa7.
Glikasi kristalin- yang disebabkan oleh diabetes yang tak
terkontrol dapat menekan efisiensi kemampuannya karena
terbentuknya cross-linkages di antara subunit-subunit protein. Hal
tersebut kemudian menyebabkan agregat dari protein yang
terdenaturasi meningkatkan hamburan cahaya dan dan
menurunkan transparansi lensa8.


TES BAYANGAN (SHADOW TEST)

Tujuan tes bayangan adalah untuk mengetahui derajat kekeruhan lensa.
Dasarpemeriksaan adalah makin sedikit lensa keruh pada bagian posterior maka makin
besarbayangan iris pada lensa yang keruh tersebut, sedang makin tebal kekeruhan lensa
makinkecil bayangan iris pada lensa.
Alat yang digunakan adalah lampu sentolop dan loup. Tehniknya adalah sentolopdisinarkan
pada pupil dengan membuat sudut 45º dengan dataran iris, dengan loup dilihatbayangan iris
pada; lensa yang keruh.Penilaiannya :
a. Bila bayangan iris pada lensa terlihat besar dan letaknya jauh terhadap pupil
berartilensa belum keruh seluruhnya (belum sampai ke depan); ini terjadi pada katarak imm
atur, keadaan ini disebut shadow test (+).
b. Apabila bayangan iris pada lensa kecil dan dekat terdapat pupil berarti lensa
sudahkeruh seluruhnya (sampai pada kapsul anterior) terdapat pada katarak matur,keadaan
ini disebut shadow tes(-).
c. Bila katarak hipermatur, lensa sudah keruh seluruhnya, mengecil serta terletak jauhdi
belakang pupil, sehingga bayangan iris pada lensa besar dan keadaan ini
disebutpseudopositif
Tatalaksana Katarak
Non bedah: memperbaiki fungsi visual sementara, memperlambat
Bedah:
METODE CARA Keterangan
EKIK (ekstraksi katarak Membuang lensa dan kapsul scr Ind: Katarak tak stabil,
intrakapsular) keseluruhan menggembung, hipermatur,
terluksasi
KI: Absolut: anak, ruptur kapsul
krn trauma.
Relatif: miop tinggi, marfan,
morgagni, vitrous ke COA
EKEK (ekstraksi katarak Membuang nukleus dan korteks Irisan kecil, risiko astigmat rendah.
ekstrakapsular) mel kapsul anterior lalu menanam Tdk bs utk zonula lemah
IOL
SICS (small incision cataract Irisan sangat kecil, hampir tdk Baik utk sklerosis nukleus derajat
surgery) butuh jahitan 2 dan 3, subkapsular posterior,
awal kortikalis
EKEK + fakoemulsifikasi Menggunakan ultrasonik utk
memecah nukleus
©Bimbel UKDIdan
MANTAP
mengaspirasi lensa
Pirenoxine
Pirenoxine (abbreviated PRX, trade
name Catalin) is a medication used in
the possible treatment and
prevention of cataracts. A report in
the journal of Inorganic
Chemistry showed that in liquid Systematic (IUPAC) name
solutions pirenoxine could cause 1,5-Dioxo-4H-pyrido[3,2-a]phenoxazine-3-carboxylic acid
decreased cloudiness of a crystallin Clinical data
solution produced to mimic the Trade names Catalin
environment of the eye. Pirenoxine Pregnancy cat. ?
interacts with selenite or calcium Legal status ?
ions that have been proven as factors Identifiers
leading to the formation of lens CAS number 1043-21-6
cataract.[1] ATCvet code QS01XA91
Pirenoxine reduces the cloudiness of PubChem CID 4846
the lens solution containing calcium ChemSpider 4846
by 38% and reduced the cloudiness UNII 27L0EP6IZK
of the selenite solution by 11% Chemical data
Formula C16H8N2O5
Mol. mass
©Bimbel UKDI MANTAP 308.24512 g/mol

MATA TENANG
RETINOPATI DIABETIKA VISUS TURUN

PERLAHAN
Hiperglikemia TINGKAT KEPARAHAN GAMBARAN FUNDUSKOPI
Retinopati (-) Gambar lapisan

Fundus normal
hilangnya pericyte
endotel, retina
penebalan Mild NPDR Beberapa mikroanurisma
membrana basalis. Moderate NPDR Lbh berat dr mild tp lbh ringan
SS: melihat titik2 dr severe
dan benda Severe NPDR 1 dari: >20 pendarahan intraretina
mengapung, pd 4 kuadran, venous beading pd
2 kuadran, intraretinal
pandangan kabur, microvascular abnormality pd 1
sulit melihat saat kuadran, proliferasi (-)
malam. PDR Neovaskularisasi (NVD or
NVE), pendarahan vitreous,
Tx: fotokoagulasi pendarahn retina
laser, anti-VEGF
MATA TENANG
VISUS TURUN
RETINOPATI DIABETIKA PERLAHAN
Kelainan2:
1. Edema retina: krn
kebocoran kapiler esp
di makula (macular
edema).
2. Hard exudate: krn
transudasi plasma
kronis
3. Pendarahan retina: krn
gangguan
permeabilitas
mikroaneurisma
4. Cotton wool spots:
nerve fiber layer retina
iskemik

MATA TENANG
VISUS TURUN
RETINOPATI DIABETIKA PERLAHAN
Kelainan2:
1. Edema retina: krn
kebocoran kapiler esp
di makula (macular
edema).
2. Hard exudate: krn
transudasi plasma
kronis
3. Pendarahan retina: krn
gangguan
permeabilitas
mikroaneurisma
4. Cotton wool spots:
nerve fiber layer retina
iskemik


Hemorrhages
Preretinal Hemorrhages
Berlokasi di antara retina dan dinding posterior vitreous (subhyaloid) / dibawah lapisan
Bentuknya bisa tidak beraturan, atau boat shape,
dengan batas atas mendatar, dan batas bawah melengkung, yang akan menghalangi
retina dan vasa2 retina
Penyebab : trauma, neovaskularisasi retina (diabetic retinopathy, radiation retinopathy,
oklusi vasa), perdarahan dari CNV, hypertensive retinopathy, Valsava retinopathy,
posterior vitreous detachment, shaken-baby syndrome, dan retinopathy o/k gangguan
darah
Intraretinal Hemorrhages
Beberapa tipe : pola flamed-shaped, dot/blot, Roth spot. Apabila terjadi bilateral,
biasanya berkaitan dengan gangguan sistemik (DM/HT)
Flame shaped : batasnya feathery, lokasinya di retina superfisial, dimana disana terletak
lapisan serabut saraf. Biasanya terjadi pada retinopati hipertensi dan okusi vena
Dot/blot : tampak seperti titik, lingkaran kecil (dot) atau bahkan lebih besar (blot) dan
berlokasi di lapisan outer plexiform. Biasanya tampak di retinopati diabetik
Subretinal Hemorrhages
Berlokasi di bawah retina neurosensorik (spasium di antara lapisan retina neurosensorik
dan RPE (retinal pigment epithelium))
Tampak sebagai warna yang gelap dengan vasa retina jelas di atasnya
Bentuknya tidak beraturan (amorphous) o/k tidak ada ikatan yang kuat antara retina
neurosensorik dengan RPE. Biasanya terjadi pada ablasio retina khususnya di polus
posterior
Essential of Ophtalmology, 2007

MATA TENANG
VISUS TURUN
RETINOPATI HIPERTENSI PERLAHAN
S: biasanya asimptomatis,
Px: penyempitan arteri2

retina, bilateral.
Kronis: AV nicking, sklerosis
arteri (cooper/silver wiring),
cotton wool, flame-shaped
hemorrhages,
makroaneurisma, oklusi
vasa retina
Akut/maligna: hard exudates,
edema retina, cotton wool,
flame-shaped hemorrhages,
papiledem.
Tx: kontrol HT
Hypertensive retinopathyEdited with the trial version of
Foxitfeatures
Advanced PDF Editor :
Mild to moderate hypertension:
Variable degrees of arteriolar
narrowing
Hemorrhages in the retinal nerve
-shaped
Exudates, including some that fan

out around the center of the
Cotton wool spots

Microaneurysms
Moderate to severe hypertension:

In cases of severe hypertension ,
the retinal arterioles are much
narrower than normal, and there is
edema of the optic nerve head .
Arteriolosclerosis accompanies long
standing hypertension and
commonly affects the retinal and
choroidal vessels.
The thickened retinal arterioles
become attenuated, increasingly
tortuous, and of irregular caliber.

At sites where the arterioles cross The abnormal retinal arterioles appear
veins, the veins may appear kinked clinically as parallel white lines at sites of
(arteriovenous nicking) , but the vascular crossings (arterial sheathing).
venous diameter is not narrower The narrowed lumen of the retinal
distal to the compression, an vessels decreases the visibility of the
appearance which indicates that the blood column and makes them first
kinked appearance of veins is not appear orange on opthalmoscopic
due to compression by a taut
sclerotic artery. Instead it reflects Eventually as the blood column
sclerosis within the venous walls, becomes completely obscured, light
because retinal arteries and veins reflected from the sclerotic vessels
share a common adventitia at sites appear as threads of silver wire
of arteriovenous crossings.

Hypertensive Retinopathy
Modified Scheie Classification
Grade 0 - No changes
Grade 1 - mild generalized retinal
arteriolar narrowing
Grade 2 - more severe generalized
narrowing, focal areas of
arteriolar narrowing and
arteriovenous (AV) nicking
Grade 3 - grade 1 and 2 signs plus the
presence of microaneurysms, retinal
hemorrhages, hard exudates and
cotton-wool spots
Grade 4, - accelerated (malignant)
hypertensive retinopathy, consists of
signs in the preceding three
grades plus optic disc swelling and
macular edema

MATA TENANG
Age-Related Macular Degeneration VISUS TURUN

PERLAHAN
lipofusin+, radikal bebas), deposit laminar basal,

perubahan kapiler koroid.
Tipe Gejala Tanda Terapi
AMD non- Vit C, vit E, beta

eksudatif (dry pucat, macular karoten, zinc, cupric
ARMD) parasentral, DRUSEN keras dan oxide, sayur hijau. TX
lunak, atrofi EPR RF (HT, dislipidemia,
rokok).
EMD eksudatif Gangguan penglihatan dan Anti-VEGF
(wet ARMD) cairan subretinal atau
makropsia, skotoma sentral detach EPR yg
berhubungan dgn
CNV (choroidal
neovascularization)
ARMD Dry ARMD

with fine
drusen
Dry ARMD
with soft
drusen
Wet ARMD

Retinitis Pigmentosa
Definisi: Retinitis pigmentosa is the most common of a group of hereditary
progressive retinal degenerations or dystrophies. There is considerable variation
and overlap among the various forms of retinitis pigmentosa. Common to all of
them is progressive degeneration of the retina, specifically of the light receptors,
known as the rods and cones. The rods of the retina are involved earlier in the
course of the disease, and cone deterioration occurs later. In this progressive
degeneration of the retina, the peripheral vision slowly constricts and central vision
is usually retained until late in the disease.
Etiologi: Retinitis pigmentosa is an inherited condition which involves both eyes. If
it starts in one eye, the other eye usually develops the same condition in a
number of years. Most cases are familial, inherited in a variety of ways, including
dominant, recessive, and sex-linked recessive. Some cases are sporadic and lack a
family history of the disease. A thorough genetic pedigree, often with the aid of a
genetic counselor, is essential in determining risk of future generations acquiring
the disease.
SS: Since retinitis pigmentosa begins as rod degeneration, the patient first notices
increasing difficulty in night vision, followed by difficulty seeing in the periphery.
Slowly progressive constriction of the visual field leads to tunnel vision. A small
area of central vision in both eyes usually persists for years. Generally
night blindness precedes tunnel vision by years or even decades. Total blindness
eventually ensues in most cases. The age of appearance of legal blindness ranges
from as early as childhood to as late as the 40s.
Retinitis Pigmentosa

6 otot ekstraokular Foxit Advanced PDF Editor

Inervasi= LR6(SO4)3

M. Rectus Lateral et Medial

M. Rectus superior et inferior

M. Rectus Superior M. Rectus Inferior
Aksi primer : depresi
Aksi sekunder : extorsi
Aksi tersier : adduksi
Seperti SR...aksi primer

meningkat saat abduksi dan
menurun saat adduksi
SR dan IR sm2 adduksi pd aksi

M. Obliquus superior et inferior

M. Obliquus Superior M. Obliquus Inferior

Isolated third nerve palsy

Defek n.III kanan dgn

ptosis
SS: diplopia binokular,
ptosis, dg/tanpa nyeri.
Bila pupil terkena: fixed,
dilated, tdk reaktif. Posisi anatomis:
eksotropia OD dan
Etiologi dilatasi pupil
1. Pupil terkena:
aneurisma (esp. arteri
comunicans post.); Lirik ke kiri: OD tdk bs
tumor, trauma. adduksi
2. Pupil sehat: iskemik
Tx: tergantung etiologi
Lirik ke kanan: OD bisa
abduksi normal
Isolated fourth nerve palsy

SS: diplopia binokular

vertikal/oblik, sulit
membaca, bs asimptomatik.
Defisiensi gerakan ke inferior,
mata yg terkena tampak
hipertropik pd posisi
Defek n.IV kiri: pd posisi anatomis
anatomis. Pasien biasanya
hipertropia OS
mendongakkan kepala ke
bahu kontralateral utk
menghilangkan diplopia.
Etiologi: trauma, infark
(DM/HT), kongenital,
idiopatik, demyelinisasi.
Tx: tx penyebab, patch,
operasi Lirik ke kanan: overaksi m.obliqus
inferior OS
Isolated sixth nerve palsy

SS: diplopia binokular

horizontal, memburuk
saat melihat jauh.
Defisiensi gerakan ke
lateral. Proptosis(-). Defek n.VI kanan: OD bisa adduksi penuh
Etiologi: vaskulopati
(DM, HT, aterosklerotik),
massa pd sinus
cavernosus, dll.
Tx: tx penyebab, patch,
operasi. Lirik ke kanan: abduksi OD terbatas
Strabismus
Misalignment of one or both eyes so as the
eye (eyes) is not looking straight at the object
of regard.
Significance
In children In adult
Children need normally Frequent sign of
aligned eyes to develop neurological disease
vision. Frequent presentation of
Strabismus in childhood is systemic disease ( Thyroid
the second most common disease & Myasthenia)
presentation of Cosmetology
retinoblastoma.
Strabismus is a common
presentation for refractive
errors.
Anatomy & Physiology
Muscle Nerve Function Testing

MR 3 rd Nasal Look to nose
LR 6th Temporal Look away
SR 3rd Elevate, intorts, Up & Out

adducts
IR 3 rd Depress, extrorts, Down & Out
adduct
Anatomy & Physiology
Muscle Nerve Function Testing

Superior 4th Intorts, depress, Look Down
Oblique abducts & In
Inferior 3rd Extrorts, elevates, Look Up & In

Oblique abducts
ESOTROPIA
EXOTROPIA
HIPERTROPIA
HIPOTROPIA
ORTO tengah pupil
15 * ET tepi pupil
30* ET tepi limbus
45 *ET luar limbus

ADDITIONAL CLASSIFICATIONS
constant or intermittent the frequency it occurs
bilateral both eyes converge or diverge at the same time
unilateral if it always involves the same eye
alternating when the turning is sometimes the right and other

times the left eye
Latent or manifest (phoria or tropia)
from: American Optometric Association

Causes of Strabismus
Congenital: imbalance between innervations
and contraction
Refractive errors
Loss of vision
Paralysis or Neuromuscular
Restrictive: thyroid eye disease
Tumors
Presenting symptoms of Strabismus
Deviation of the eye (cosmesis)

Double vision
Torticollis (abnormal head posture)
Unexplained visual loss in a normal looking
eye (Microtropia)
Defek Lapang Pandang

Gangguan sistem lakrimal

Lapisan air mata NORMAL
DEFISIENSI air mata
Sebab-sebab:
Kerusakan gld lakrimal olh inflamasi,
neoplasma
Gld lakrimal bs kongenital atau
akuisita
Sumbatan duktus sekretorius (mis pd
SJS)
Lesi neurogenik
Disfungsi gld Meibom (banyak pd org
tua)
Dari dalam ke luar:
1. Musin: melapisi kornea dan konjungtiva,
dihasilkan sel goblet konjungtiva DEFISIENSI musin
2. Air: dihasilkan oleh gld lacrimalis, Krause, Karena kerusakan sel goblet yg
dan Wolfering
3. Lemak: berhub dg udara, mencegah disebabkan defisiensi vitamin
penguapan, dihasilkan olh Meibom dan Zeis
A atau sikatrik konjungtiva shg
xerois

EPIPHORA
Overflow of tears onto the face.
A clinical sign that constitutes insufficient tear film drainage
from the eyes tears will drain down the face rather than
through the nasolacrimal system
Etiology :
Occular irritation and inflammation (including trichiasis and entropion)
Obstructed tear outflow tract which is divided according to its
anatomical location (i.e. ectropion, punctal, canalicular or nasolacrimal
duct obstruction) due to aging (a spontaneous process),
conjunctivochalasis, infection (i.e. dacryocystitis), rhinitis, and in
neonates or infants, failure of the nasolacrimal duct to open

http://en.wikipedia.org/wiki/Epiphora_(medicine)

EPIPHORA
Diagnosis :
by history presentation and observation of the lids
Fluorescein dye to examine for punctal reflux by pressing on the
canaliculi in which the clinician should note resistance of reflux as it
irrigates through the punctum into the nose
Management :
If epiphora is caused by ectropion or entropion, lid repair is indicated.
A surgical procedure called a dacryocystorhinostomy is done to join
the lacrimal sac to the nasal mucosa in order to restore lacrimal
drainage

http://en.wikipedia.org/wiki/Epiphora_(medicine)

Dakriodenitis Dakriosistis
Radang pd gld lakrimalis. Radang pd sakus lakrimalis krn
Sering pd anak sbg sumbatan duktus nasolakrimalis,
biasanya unilateral.
komplikasi peny sistemik ex.
SS: epifora, eksudat, uji
morbili, dewasa ec trauma. regurgitasi+, sakit, merah, NT pd
SS: nyeri dan bengkak di daerah nasal.
orbita bag temporal Etio: S.aureus, S.pneumoniae,
Candida albicans, H.influenza





Lid Malposition
Entropion Ectropion
Inversion of lower lid, most Outward turning of lower
commonly due to age- eyelid from globe, usually in
related tissue laxity. elderly patients. Frequently
Causes discomfort due to associated with epiphora
lashes, rubbing on the (watery eye) and chronic
inferior cornea, especially conjunctivitis.
on downgaze, e.g. reading.

Lash Disorders
Trichiasis Distichiasis
Inward misdirection of Abnormal accessory lashes
lashes, causing irritation. arising near meibomian gland
Refer for a more definitive orifices. May be congenital, but
procedure: surgery, is more frequently acquired
cryotherapy or laser secondary to scarring, e.g. ocular
therapy. cicatricial pemphigoid.

Eye Corpus Alienum Foxit Advanced PDF Editor

Dapat berupa:
Metalik: Fe, Pb, Al, Cu, dll.

Non metalik: Kayu, kaca, kapur, dll
Dapat ditemukan:
Diluar bola mata: kornea, konjungtiva, atau palpebra

Didalam bola mata
Sering korpus alienum logam di kornea: Serbuk besi ketika memakai gerinda mesin atau percikan dari las
dengan kecepatan yang cukup tinggi dan secara mendadak tertananam dan melukai kornea.
Anamnesis dan gejala klinis
Subyektif: Penderita mengeluh dengan adanya benda asing yang masuk ke mata
Obyektif: Pelebaran pembuluh darah perikornea, corpus alienum, visus menurun atau normal.
Cara pemeriksaan:
Anestesi local dengan pantocain tetes 2%

Pemeriksaan dengan lampu senter dan loupe atau dengan slitlamp.
Penatalaksanaan
Anestesi local dengan pantocain tetes 2%

Pasang speculum mata
Pengeluaran corpus alienum dengan:
Kapas lidi steril
Ujung jarum suntik No. 25 steril ©Bimbel UKDI MANTAP
Pemberian AB salep mata
Pemeriksaan Visus
PRINSIP PENGUKURAN VISUS
Membedakan 2 titik
terpisah
Besar 1 menit busur
Besar tiap huruf 5 menit

Pemeriksaan Visus
KARTU SNELLEN TES PINHOLE
PECAHAN =
jarak pemeriksan
-----------------------------------
Jarak huruf terkecil yang
masih dapat terbaca (kode/skore)
TIDAK ADA SATUAN
PENCATATAN :
Pecahan 6/50 - 6/6
Decimal
Cincin landolt c eye chart Uji sheridan/gardiner To remove this notice, visit:

Pemeriksaan Visus
Visus 1/60 (Hitung jari = Counting Finger)

Visus 1/300 (Hand Movement)
Proyeksi (Superior, Inferior, Nasal, Temporal)
Visus 1/~ (light Perception)
Visus nol (No Light Perception)
Pemeriksaan Bola Mata

Pemeriksaan segmen anterior :

Supersilia, palpebra, konjungtiva tarsal,
konjungtiva bulbi, kornea, kamera okuli anterior,
iris, pupil, dan lensa.
Pemeriksaan segmen posterior:

Badan kaca, retina, papil saraf optik


Visual Pathway and

Pupillary Light Reflex

Relative Afferent Pupillary Defect

(RAPD) / Marcus Gunn Pupil




Berhadapan jarak 1 m
Pemeriksa dianggap normal

tes definisi Foxit Advanced PDF Editor
Anel Test Uji patensi saluran lakrimalis dengan cara memasukkan jarum tumpul ke punctum lakrimal
Macam-macam Pemeriksaan
ke dalam sakus lakrimal, kemudian larutan garam fisiologis disemprotkan. Tes Anel + bila
ada rasa asin di tenggorokan dan Tes Anel bila tidak ada asing (ada gangguan patensi).
Uji Fluoresin untuk melihat adanya defek pada epitel kornea. Kertas fluoresin dibasahi terlebih dahulu
dengan garam fisiologis kemudian diletakkan pada saccus konjungtiva inferior setelah
terlebih dahulu penderita diberi anestesi lokal. Penderita diminta menutup matanya
selama 20 detik, kemudian kertas diangkat. Defek kornea akan terlihat berwarna hijau dan
disebut sebagai uji fluoresin positif.
Amsler Grid Untuk mengetahui fungsi penglihatan sentral makula. Untuk melihat adanya skotoma pada
lapang pandang dan dokumentasi metamorfopsia.
Shadow Test Utk mengetahui stadium katarak. Apabila lensa belum keruh seluruhnya, ketika disinari
menggunakan senter dari depan bola mata dengan sudut ± 45o, sinar akan dipantulkan dan
mengenai iris sehingga terbentuk bayangan iris pada pupil yang terlihat seperti bulan sabit.
shadow test (+).
Hirschberg a screening test that can be used to assess whether a person has strabismus (ocular
Test misalignment). Performed by shining a light in the person's eyes and observing where the
light reflects off the corneas. When doing the test, the light reflexes of both eyes are
compared, and will be symmetrical in an individual with normal fixation.
Schirmer Test Untuk memeriksa produksi air mata, dengan cara menyisipkan kertas saring di fornix
inferior kemudian tunggu 5 menit. Normalnya produksi air mata minimal 10 mm dari
pangkal kertas saring basah oleh air mata.
Seidel Test Untuk mengetahui adanya perforasi kornea, dengan cara setelah fluoresin menempel pada
kornea dilakukan sedikit penekanan kornea.
©Bimbel UKDI Apabila ada lubang kornea maka fluoresin
MANTAP
terencerkan oleh akuos yg keluar shg tampak sebagai suatu aliran
Anel test
Amsler grid
Schirmer test Seidel test

Hirschberg test

Vitamin A deficiency : Xerophtalmiawww.foxitsoftware.com/shopping

Color Blindness

Cause

Gejala

Test For Color Blindness


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Eye Lid Disorder Foxit Advanced PDF Editor

KLASIFIKASI BLEFARITIS ANTERIOR To remove this notice, visit:

KLASIFIKASI BLEFARITIS ANTERIOR

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Hot compresses followed by gentle massage evacuate stagnant secretions. This

Intralesional injection of steroid. Since the chalazion is encapsulated by connective

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Pterygium To remove this notice, visit:

Tanda dan gejala

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Pulau-pulau Pulau-pulau fusch pada kornea di

Riwayat Riwayat kerusakan permukaan

Pembuluh Pembuluh darah lebih menonjol

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Evaluasi REAKSI- REAKSI INFLAMASI KONJUNGTIVAL

PAPILAR: hiperplasi epitel konjungtiva, bentuk poligonal,

Konjungtivitis akut To remove this notice, visit:

lnn preaurikular lnn preaurikular

tanda herpetik + toxic,

Pathology Etiology Feature Treatment

non S.epidermidis, discar mukopurulen/purulen, trimetoprim/polimiksin B

Klamidial Chlamydia riwayat vaginitis, servisitis, atau Azitromisin 1 gr p.o single

©Bimbel UKDI MANTAP

dapat asimetrik, discar tebal, Topical antihistamine

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Konjungtivitis Viral www.foxitsoftware.com/shopping

Pharyngoconjunctival fever (PCF): tipe 3 dan

Enterovirus 70 (Acute hemorrhagic

Tx: steroid topikal short term, MCS, 5. Konjungtivitis Giant-Papilar

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mukoid: vernal; mukopurulen: Hiperemia Generalisat Generalisat Generalisat Generalisat

Subconjunctival Hemorrhage To remove this notice, visit:

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Subconjunctival hemorrhage (cont.)

The most common cause for spontaneous subconjunctival hemorrhage is

The condition is painless, clearing itself within 7 to 14 days

Warm compresses may be useful in symptomatic relief. Treatment involves

©Bimbel UKDI MANTAP

©Bimbel UKDI MANTAP

episkleritis skleritis To remove this notice, visit:

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nyeri, injeksi perikornea, sekret sedikit/-, kekeruhan kornea

Normal corneal layers

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AAO, 2014 ©Bimbel UKDI MANTAP

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How to Diagnose Corneal Ulcers?

The use of fluorescein stain, which is taken up by exposed corneal

Other tests that may be necessary include a Schirmer's test for