Lisa RT.

Nama
Umur
Status
No MR

OD OS

Visual Acuity

Correction

Addition

Spectacles

Pergerakan Bola Mata

Alignment

Palpebra Massa ( ) Nyeri tekan ( ) Krusta ( ) Lithiasis ( ) Massa ( ) Nyeri tekan ( ) Krusta ( ) Lithiasis ( )
Distichiasis ( ) Trichiasis ( ) Distichiasis ( ) Trichiasis ( )
Ptosis ( ) Lagopthalmos ( ) Hordeolum ( ) Ptosis ( ) Lagopthalmos ( ) Hordeolum ( )

Konjungtiva bulbi Injeksi ( ) Pinguecula ( ) Pterygium ( ) Injeksi ( ) Pinguecula ( ) Pterygium ( )

Konjungtiva Tarsal Folikel ( ) Papil ( ) Folikel ( ) Papil ( )

Kornea Infiltrat ( ) Sikatriks ( ) Neovaskularisasi ( ) Infiltrat ( ) Sikatriks ( ) Neovaskularisasi ( )

COA Dalam/Dangkal Dalam/Dangkal

Pupil RCL ( ) RCTL ( ) RAPD ( ) Glass Reflex ( ) RCL ( ) RCTL ( ) RAPD ( ) Glass Reflex ( )

Iris

Lense Keruh ( ) Shadow Test ( )

Vitreous

Fundus

TIO
Applanation Tonometry

Palpasi

Campus

Lapang
Pandang

Anamnesis
Keluhan Utama

Rw Penyakit
Lisa RT.