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MATA MERAH VISUS NORMAL

Perdarahan subkonjungtiva

Definisi
sinonim
• bleeding in the eye
• eye injury
• ruptured blood vessels
• blood in the eye
• bleeding under the conjunctiva
• bloodshot eye
• pinkeye
Manifestasi Klinis
• Asimptomatik, jarang mengalami
nyeri
• Tampak adanya perdarahan di
sklera dengan warna merah terang
(tipis) atau merah tua (tebal).
• Peradangan (-) atau peradangan
ringan.
• Perdarahan akan meluas dalam 24
jam pertama berkurang perlahan
ukurannya karena diabsorpsi
patofisiologi
Pembuluh
Konjungtiva
Lapisan
Lapisan
Konjungtiva
ETIOLOGI
• Idiopatik
• Manuver Valsalva (seperti batuk, tegang, muntah – muntah, bersin)
• Traumatik
• Hipertensi
• Gangguan perdarahan, termasuk penyakit hati atau hematologik,
diabetes, SLE, parasit dan defisisensi vitamin C.
• Berbagai antibiotik, obat NSAID, steroid, kontrasepsi, penggunaan
warfarin.
• Sequele normal pada operasi mata
• Beberapa infeksi sistemik febril
• Penggunaan lensa kontak
Diagnosis dan pemeriksaan
penatalaksanaan
EPISKLERITIS
Adalah reaksi radang jaringan ikat vaskular yang terletak antara
konjungtiba dan permukaan sklera
EPISCLERITIS • Benign
• Self-limiting condition
• Simple or nodular
• Not a mild version of scleritis
• Adult (men=women)
• Children (men>women) (1.6:1)
• Acute onset in general
• Nodular episcleritis is more insidious
• Not much pain at all
• May present as hot,prickly
EPISCLERITIS Physical examination
• VA is usually not affected
• Lid edema
• Chemosis
• Brick red injection, not violaceous
• Normal vessels architecture
• Topical phenylephrine blanch only
conjunctival vasculature and
superficial episcleral capillary plexus
Pathogenesis and risk factors
Scleritis Episcleritis
• Disordered immune
•Idiopathic, jypersensitivity,
response
• Immune complex sistemic disease (TB, RA,
deposition (type III SLE, syphilis), toxic.
hypersensitivity)
• Post surgery scleritis has •Self-limited benign
96% chance of presented inflammation without
necrotizing scleritis
(cataract,pterygium Sx) destructive (not
• Possibly from sight- threatening)
infection,trauma,endogenous
substance
Clinical
Episcleritis
•Abrupt Scleritis
- Days to • Insidious – over
weeks several days
•Redness
• Pain, tenderness
without irritation
•Mild ocular
to palpation,
discomfort radiate
-Burning • Worse
sensation, at
irritation night+awak
•Localized e
Vessel
EPISCLERITIS engorgement
Chemosi
s
injection

Mata terasa kering, sakit ringan, mengganjal,


konjungtiva kemotik
EPISCLERITIS Nodular
Displacing of reflected
light
Injectio
Faint brick red
color
n

Benjolan setempat, batas tegas dan warna


merah ungu di bawah konjungtiva. Ditekan
nyeri menjalar ke mata
SKLERITIS
• Sensory innervation
from the ciliary
nerves
– short posterior
ciliary nerves  the
posterior portions
– two long posterior ciliary
nerves  the
anterior region.

• Extraocular muscles
are inserted into the
sclera

• Dull ache of scleral


inflammation is made
Clinical finding
• Watson and Hayreh
SCLERITIS
classification

Penyakit sistemik : peny jaringan ikat, pasca


herpes, sifilis, gout,TB, sifilis, pseudomonas,
sarkoidosis, hipertensi, benda asing dan
pasca bedah
Skleritis Anterior
 Diffuse Anterior Scleritis
 Peradangan yang meluas pada seluruh permukaan
sclera
 Skleranya edema dan kemerahan
 Merupakan skleritis yang paling umum terjadi

 Nodular Anterior Scleritis


 Adanya satu atau lebih nodul radang yang eritem,
tidak dapat digerakkan
 Nyeri pada sclera anterior
 20% kasus berkembang menjadi skleritis nekrosis.
Diffuse
Anterior Scleritis

a) Nodular Anterior Scleritis


b) Penipisan dari sclera setelah resolusi
dari nodul
SCLERITIS
• Nodular anterior scleritis
presents with a nodule
that is firm, immobile
and tender to palpation
• Yellow or deep red
 Necrotizing Anterior Scleritis with Inflammation
 Nyeri sangat berat
 Kerusakan pada sclera terlihat jelas
 Apabila disertai dengan inflamasi kornea, dikenal sebagai
sklerokeratitis.

 Necrotizing Anterior Scleritis without Inflammation


 Biasa terjadi pada pasien yang sudah lama menderita
rheumatoid arthritis
 Diakibatkan oleh pembentukan nodul rhematoid
 Dikenal sebagai skleromalasia perforans.
SCLERITIS Necrotizing scleritis

surrounding scleral edema and


congestion
Markedly injected surrouding
area
• Necrotizing scleritis without inflammation, also termed
scleromalacia perforans, is almost total lack
of symptoms
• Patient may present with blurred vision because of
astigmatism or may notice a discoloration of the sclera
SCLERITIS

• In necrotizing scleritis , only conjunctiva may cover


prolapsed uvea, but perforation is uncommon
without trauma
SCLERITIS

Necrotizing scleritis without inflammation


is most common in elderly women with
long-standing RA
Posterior scleritis
• may be difficult to diagnose unless accompanied by anterior
scleritis
• The condition is under-diagnosed and frequently leads to sight-
SCLERITIS

threatening complications
• About 20% of all cases of scleritis
• About 30% of patients have systemic disease
• Patients may complain of loss of vision, pain, or
diplopia and findings may include hyperopia,
conjunctival chemosis, proptosis, lid edema or
retraction, and ophthalmoplegia
SCLERITIS

• Posterior segments=optic nerve edema, optic neuritis,


serous and exudative RD, ME, annular ciliochoroidal
detachment and choroidal thickening, mass and folds,
all commonly associated with visual loss