usia :
No.RM :
Hirschberg
Posisi : Posisi :
O.D O.S
Palp. sup :..................................................... Palp. sup :.....................................................
Palp. inf :..................................................... Palp. inf :.....................................................
Konj. tars. sup :..................................................... Konj. tars. sup :.....................................................
Konj. tars. Inf :..................................................... Konj. tars. Inf :.....................................................
Kornea :..................................................... Kornea :.....................................................
Bilik mata depan:.................................................... Bilik mata depan:....................................................
Pupil :..................................................... Pupil :.....................................................
Iris :..................................................... Iris :.....................................................
Lensa :..................................................... Lensa :.....................................................
Fundus okuli :..................................................... Fundus okuli :.....................................................
- Media :..................................................... - Media :.....................................................
- Papil :..................................................... - Papil :.....................................................
- Retina :..................................................... - Retina :.....................................................
- Makula :..................................................... - Makula :.....................................................
PEMERIKSAAN PENUNJANG
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DIAGNOSA
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TERAPI/TINDAKAN :
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