ANATOMY OF EYE LAYERS OF RETINA

VISUAL PATHWAY

Photoreceptor akan converts light energy into a

neuronal signal  dikirim ke bipolar cell dan amacrine
cell lalu ke ganglion cell  axons of ganglion cells exit
retina via optic nerve trs nanti nyilang crossing optic
chiasm  optic tract carries fibrers from chiasm to LGN
 fibers leave LGN as optic radiations yang akan
berakhir pada visual cortex of occipital lobe.
MEDIA REFRAKSI

REFRAKSI: Pembiasan cahaya/sinar pada mata yang

LAYERS OF CORNEA ditentukan oleh media penglihatan

YANG TERMASUK MEDIA REFRAKSI:

 Kornea
 Aqueous humour
 Lensa
 Vitrous body

RED EYE

CAUSE:

 ↑blood vessels supply

 ↓outflow (due to occlusion)
 Vessel damage
LOKASI - Discharge: watery, mucoid,
purulent/mucopurulent
1. Posterior conjungtiva - Nonspecific: watery eyes, irritation, stinging,
2. Cilliary anterior/episklera foreign body sensation, photophobia/gatal
CLASSIFICATION - Conjunctival injection
- Eyelid swelling
↓ vision Acute IOP N  Keratitis - Tarsal conjunctiva:
 Acute uveitis papillae/follicles/membrane
 Sinus - Cornea & pupils normal
cavernosus
 Trombosis ETIOLOGY OF CONJUNCTIVITIS
Not IOP N+ Glaucoma
Acute
Normal Pain  Episcleritis
vision  Scleritis
 Hordeolum
 Conjungtivitis
 Pingueculitis
w/o Gradual  Chronic
Pain conjungtivitis
 Blepharitis
 Pterigyum
Sudden Subconjungtiva
bleeding

CONGESTION OF CONJUNCTIVAL BLOOD VESSELS

TIPE2 INJEKSI

CONJUNCTIVITIS

CLINICAL PRESENTATION:
BLEPHARITIS
DEFINISI:
- Inflamasi eyelid  red, gatal, swollen, scales
kyk ketombe gitu formed di eyelash
- Bisa affect all ages
- Not contagious, not cause damage to eyesight
RISK FACTOR
- Dandruff
- Dry skin
- Acne
- Poor hygiene
- Diabetes
KLASIFIKASI
- Anterior blepharitis
o Occurs di bagian luar eyelid ujung
deket eyelashes
o Etiologi: bacteria (staphylococcal
blepharitis) atau dandruff of the
scalp and eyebrows (seborrheic
blepharitis), allergies, mites
- Posterior blepharitis
o Occurs di bagian dalem eyelid yg
touches the eyeball
o Etiologi: occur when the glands of
the eyelid irregularly produce oil
(meibomian blepharitis)
SUBTYPES OF BLEPHARITIS
- Staphylococcal blepharitis
o Mildly sticking eyelids
o Lid margins menebal
o Missing & misdirected eyelash
- Seborrheic blepharitis
o Scales yg berminyak dkt di base of
eyelashes
o Mild redness di eyelid
- Ulcerative blepharitis
o Hard crust dkt eyelash
o Kalo di remove  bleed
o Eyelash loss
o Distorsi front edges of eyelid
o Chronic tearing
o Cornea inflamed – severe
- Meibomian blepharitis
o Pasien biasa ada blockage of oil
glands in eyelid
o Poor quality of tears
o Redness di lining of eyelid
SIGN & SYMPTOMS
- Burning sensation
- Gatal
- Merah dan swollen eyelid
- Dry eyes/crusting of eyelid
- Blurred vision, missing/misdirected eyelash,
inflamasi eye tissue – more severe
TREATMENT
- Good hygiene of eyelid
- Kompres air hangat/bersihin pake baby
shampoo
- Massage utk clean oil accumulated di eyelid
- Jgn pake makeup utk smntara
KERATITIS
DEFINISI: peradangan kornea
ETIOLOGI
- Bakteri
- Virus (Herpes simplex/zoster, chlamydia)
- Jamur
- Reaksi hipersensitivitas
- Trauma
SIGN & SYMPTOMS:
- Mata merah, sakit
- Berair/sekret berlebih
- Sulit buka mata krn sakit
- Penglihatan kabur/buram
- Silau & sensitive thd cahaya
- Rasa mengganjal
RISK FACTOR
- Dry eyes, trauma, drug toxicity, UV exposure,
contact lens irritation, allergy, chronic
conjunctivitis  may lead to cornea ulcer
KOMPLIKASI
- Peradangan kornea kronik
- Infeksi virus berulang
- Ulkus kornea
- Corneal scars
- Penurunan ketajaman penglihatan
- Kebutaan
PEMERIKSAAN PENUNJANG
- Kultur bakteri
- Tes sensivitas resistensi obat
TREATMENT
- Bakteri: Ab spektrum luas eye drops
- Jamur: Ab spektrum luas eye drops + anti jamur
Zalf mata
- Virus: Ab spektrum luas ed + anti virus Zalf mata
- Hipersensitivitas: Ab spectrum luas + steroid ed
KERATITIS-CORNEAL ULCER
SIGN & SYMPTOMS:
- Photophobia
 - Periocular pain - Eksoftalmus
- Foreign body sensation
- Ciliary flush 7. Toksoplasmosis okuler
- Corneal opacity

DIAGNOSIS
CATARACT
- ↓corneal sensibility
- Fluorescen test CONGENITAL CATARACT
- Assessment of corneal regularity SENILE CATARACT
MANAGEMENT DEFINISI: age-related, vision impairing dz, characterised by gradual
- Refer ke dr ophthalmologist progressive clouding & thickening of the lens of the eye.
- Medication depend on etiology nya, e.g viral: antiviral SIGN & SYMPTOMS:

- ↓visual acuity (ketajaman)

DD VISUS TURUN MATA TENANG - Glare (silau)
1. Glaukoma - Myopic shift: mild to moderate degree of increased myopia –
- Mual muntah makin minus
- Sakit kepala - Monocular diplopia: double vision only in 1 eye, ttp ada
walaupun 1 mata lainnya ditutup/eyes look into different
2. Katarak location
- Penglihatan seperti tertutup asap DIAGNOSIS
- Buram
- Diplopia/polypia monokuler - Complete ocular exam: visual acuity
- Gangguan penglihatan warna - Refleks cahaya langsun tdk langsung (utk liat kelainan pupil)
- Black spots - Slit lamp exam
- Exam of nuclear size and bunescence
3. Kelainan refraksi - Direct and indirect ophthalmoscope
A. Miopi - Other: USG/CT/MRI
o Penglihatan jauh kabur, deket: normal
o Astenopia (mata lelah) STAGING
o Gambaran spot floating krn degenerasi - Hypermature
vitrous o Dense white opacity, contain milky fluid within the
o Menekan kelopak mata bersamaan spy capsule (degenerated lens cortex)
mendapat penglihatan yang lbh baik o Obscure red reflex
B. Hipermiopi o Visual acuity (VA): worse than finger count/hand
o Penglihatan dekat kabur motion
o Astigmatisme - Mature
C. Presbiopi o Opaque (buram)
o Usia ≥ 40 tahun o Totally obscure red reflex
o VA: ga bs better read than 20/200 VA chart
4. Ambliopia - Immature
- Berkurang penglihatan 1 mata o Variable amount of opacification
- ↓ketajaman penglihatan terutama pada o May include high and low-density areas with some
fenomena crowding
clear lens fibers
- Hilangnya sensitivitas kontras
o VA: better than 20/200
- Mata mudah mengalami fiksasi eksentrik
- Incipient
- Anisokoria
o Seen on slit lamp exam, tp little clinical significance
- Tdk mempengaruhi penglihatan warna
o Ada gangguan penglihatan tp msh bs baca 20/20
5. Retinopati MANAGEMENT
- Penglihatan menurun perlahan
Medication: sorbitol-lowering agents, aspirin, gluthione-raising agents,
6. Retinoblastoma antioxidant vitamin C dan E.
- Leukokoria (cat’s eye)
Surgical:
- Strabismus
- Visus ↓ - Intracapsular cataract extraction (ICCE)
- Mata merah, sakit o Extraction entire lens
 o Udh jrg dipake krn byk timbul komplikasi
- Extracapsular cataract extraction (ECCE)
o Removal of lens nucleus, retention of integrity
posterior capsule
o Lebih bagus drpd ICCE
- Phacoemulsification (scleral inscision)
o Extraction of lens nucleus, lens substrate aspirated
through needle
- All above + Intraocular lens (IOL) implantation

TIPE2 GANGGUAN REFRAKSI

1. Miopia: rabun jauh

2. Presbiopia: rabun dekat usia lanjut
3. Hipermetropi: rabun dekat
4. Astigmatism: silinder (distorsi penglihatan
akibat kelengkungan kornea dan lensa yang
tidak sama di berbagai meridien

TRIAS LASERASI KORNEA

Triage 1 – immidiate life threatening condition

Triage 2: treat within 10 minutes

- Chemical burns (acid/alkali) – alkali burn (mata

jadi putih, conjunctiva merah)
- Penetrating eye injury (PEI) – iris prolapse,
- Sudden vision loss
- Severe eye pain (acute glaucoma) – red eye,
cloudy cornea, painful

Triage 3: treat within 30 minutes

- Painless loss of vision – central retinal vein

occlusion
- History PEI
- Hypopyon – pus in front chamber of eye
- Hyphaema (total) – blood in front chamber of
eye

Triage 4: treat within 60 minutes

- Foreign body – non penetrating

- Painful red eye
- Flash burn
- Sudden increase in numbers of floaters
- Flashes
- Small hyphaema

Triage 5: treat within 2 hours, less urgent, condition

chronic/minor

- Conjunctivitis
- Blepharitis
- Chalazion
- Dry eyes
- Long term history of floaters
- Subtarsal foreign bodies – no eye redness