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Anatomy
Is a vascular layer that consists of :
Iris Cilliary body Choroid
Function :
Nutrition supply
Iris
Is a diaphragm that dividing ocular chamber into two parts:
Anterior Posterior
Building a hole at the center called as pupil Anterior part ---> origins from corneal endothelia Posterior part --> origins from retinal endothelia
Muscles :
M. Spchiter pupil ---> circular, N III (parasympatic), myosis M. dilator pupil ---> radier, sympatic, midriatics
Pupil
As a aperture that can found in an ordinary photographic camera Normal : round, central, isokor If > 1 : Polikoria, if not central : korektopia Pupil reaction :
toward to the direct and indirect light toward to the close point toward to the drugs
retina
N II
Chiasma optic
Optical tract Parasymphatic fiber N III
Horner syndrome :
miosis, ptosis, enofthalmus, anhydrous, paralysis of M. dilatator pupil
Cilliary body :
triangle form, the basis is at the front which the iris attached spreads until the Choroid consist of :
M. ciliaris for accommodation (longitudinal, circular, radier) Ciliar processus :
inside part divided into: pars plana pars corona originating zonula zinii fibers : suspending the lens, for accommodation process
On severe inflammation --> damage of ciliary body ---> atrophy ---> secretion ---> ptisis bulbi
Iris coloboma
Two forms :
Congenital : anomalies of formation Acquired : after glaucoma operation, optical iridectomy
Iris heterochromia bilateral ; unilateral differences colors between different area of the iris Two forms : Congenital : glaucoma congenital Acquired : iris atrophy after iridocyclitis/glaucoma
Th/
Using of black eye glasses Do not read (can not accommodate) R/ pilocarpine ---> for myotics
Iridodialisis
E/ : injuries ---> tearing of iris root --> pupil excentric Th/
Midriatics banded diplopia (+) ---> iris reposition
Hifema
E/ : injury --> rupture of blood vessels --> blood in the anterior chamber (hifem) There is two types :
Primary : straight after injuries Secondary :
fifth days after injuries > severe if immediately reabsorption of the clot & regeneration not occurred
Complication :
IOP elevated Corneal hemosiderosis Uveitis Muddying of vitreous body
Th/
totally bed rest IOP observation & condition of hifema IOP high --> diamox, glycerin --> 24 hours still high ---> parasintesa --> if normal & hifema still >>> --> parasintesa
Iris Neoplasm
Iris Tumor
Nevus Pigmentosus Iridis --> benign melanoma
clear border brown spotted not progressive no disturbances
Malignant
deep brown spotted rough surface not clear border Metastasis to preaulicular glands
Therapy :
Metastasis (-) : Iridectomy Metastasis (+) : Enucleation
Secondary iridocyclitis around eye region Perforating trauma SO Idiopathic ----> Immune reaction
Clinical Finding
Subjective :
Spontaneous pain of the eye ball, headache reference to temporal regions Photophobia Decreasing visual acuity
Objective :
Palpebra CB C COA : edema : ciliar injection : muddying, KP in endothel : Flare (+), Hipopion +/-, mild ---> narrow if iris bombe is present : Irregular --> sinechia post. Pupil : seclusion & oclusion
Complication :
muddiness of vitreous cataract IOP low or high
Sequels :
pupil seclusion pupil occlusion posterior synechia Iris bombe glaucoma
Uveitis Granulomatous
Non acute Cellular reaction >>> vascular Blurred iris surface KP in thick endothel deep COA muddying vitreous E/ allergy ? Acute reaction >>> cellular Fine KP Vitreous not so muddy COA : Hipopion +/-
Th/ :
Midriatics :
SA 0,5 % ed/eo for lowering blood vessel congestion/inflammation resting the eye (relaxation of M. spinchter pupil & M ciliaris)
Contra Indication :
Pulmonary TBC, Hypertension, DM, Coronary disturbances, Physiological disease, peptic ulcer
Choroid
Consists of several layer :
Epithelium Bruch membrane Chorio capillaries Blood vessels (medium and large size) Suprachoroid
Artery : origins from A. ciliaris breves Vein : 4 V. Vortikalis from 4 posterior quadrant --> V. ophthalmic --> cavernous sinus
Blunt trauma
Macular tearing ---> white sclera Th/ : SA --> relaxation of the eye
Tumor
Benign : melanoma, white spotted below retinal blood vessel ---> visual disturbances malignant :
secondary glands melano sarcoma Th/ :
Metastasis (-) : Enucleation Metastasis (+): Excenteration
Exudative Choroiditis
Clinical manifestation depend on location of the lesion --> macula ---> visual acuity decreased, even the inflammation is not severe Divided into :
Disseminate Diffuse Sircumscripted :
Centralized/Macular Paracentralized/paramacular Juxta Papillary Periphery
Sircumsripted Choroiditis :
limited exudat area, solitaire : PD : TBC, Lues, toxoplasma, focal infection
Disseminated Choroiditis
small exudat in just one area or all around the fundus PD : miliary TBC
Diffuse Choroiditis
Exudat are spreading to healthy area
Supurative Choroiditis
E/ :
Pyogenic bacteria, which exogenous acquired ---> ocular bulb perforating Endogenous --> hematogen metastasis percontinuitatum
Supurative Endophthalmitis
Supurative Endophthalmitis
Looks like without clinical sign manifestation if observed outside the eye Signs :
subjective : fast loss of visual acuity objective : yellow vitreous, fundus is not clearly seen
Gambar endof
Septic Endophthalmitis
The inflammation reaching the ciliary body Clinical sign :
Cilar injection (+), hipopion, choroid abscess & ciliary body Loosing fast of visual acuity, not reversible
Th/ :
Antibiotics Corticosteroid Analgesic Roborantia
Panophthalmitis
All of eye tissue are infected including the adnexa Clinical signs :
bulb protorsio, difficulty to move the eye, palpebral edema, conjugtival chemosis, muddying of cornea, perforating, visus 0, headache
Th/ :
bulbar evisceration Local & systemic antibiotics
Periphery --> even severe inflammation occurred, visual acuity good --> scotoma occur
(+) : blind spot (-) : blind spot with perimeter examination
Clinical signs :
Objective with ophthalmoscopy :
yellow spotted, clear border with retinal blood vessel above Blood vessels (-) : if the inflammation reach the retina Vitreous are muddy if inflammation cells are present
Subjective :
Visual acuity disturbances : metamorphosis --> macropsi & micropsi If exudat + infiltrate pressing the retina --> visual cell stacking Hemeralopia/nyctalopia --> if chronic Scotoma Fotopsi Photophobia
Symphatic Ophthlamia
Unique granulomatous iridocyclitis bilateral leading from wound of one eye ---> iridocyclitis (exiting eye) followed by other eye ( sympathizing eye)
Etiology :
Wound :
Injury ---> wounding of ciliary body Operation --> ciliary body ; iris ; capsule lentis are trauma
Corpus Alineum in Intra Ocular space Perforating of Corneal ulcer Corneal ulcer
Incubation
3 - 8 weeks after the eye wounding can also happen after 20 years
Beware :
Wounding eye --> recurrent iridocyclitis for more than 3 weeks Observe the other eye if iritasio simpatica occur :
photophobia lacrimation blurred vision pain flare (+)
Stadium I (Iritation)
Enucleating wounding eye as soon as possible (within 2 weeks) If neglected/doubtfully ---> iritatio oftalmia --> symphatic ophthalmia
Therapy :
Same as iridocyclitis