 Penyelenggara pelayanan kesehatan

personal, tingkat pertama, menyeluruh,dan

berkesinambungan kepada pasien yang
terkait dengan keluarga, komunitas serta
lingkungan dimana tempat pasien itu berada
(Singapore College General Practitioners,
1987)
 Deteksi dini, mengenali lebih awal resiko
penyakit mata, sebelum menjadi keadaan
bertambah buruk, (preventif) sesuai
kompetensi ( SKDI 2012)
• Inflammatory or infectious nodules that develop
in the eyelid
• Most frequently  inspissation or secondary
infection of sebaceous glands
• Those occuring in the anterior eyelid in the
gland of zeiss or lash follicles  external
hordeolum
• Those occuring in the posterior eyelid from
meibomian gland inspissation  internal
hordeolum
 Usually caused by Staphylococcus aureus
 Clinical presentation:
- Painful, tender, red nodular masses near the
eyelid margin
- They may rupture  purulent drainage
- Generally self limited, improving
spontaneously in 1-2 weeks
 Management:
- Warm compress with massage over the
lesion
- Topical & systemic AB  not really
necessary
- Incision and drainage  in persistent lesion
Hordeolum

9
• Localized lipogranulomatous inflammation
involving either meibomian or zeiss glands
• Develop slowly and are typically painless
• Management:
- Hot compress
- Attempted expression of the inflamed
meibomian gland
- Intralesion injection of steroid  in lesion
that fail to respond conservative therapy
- Incision drainage  persistent lesion
KALAZION

11
 Acute, benign, usually idiopathic, recurrent
and frequently bilateral condition.
 Usually self-limiting, attacks typically lasts a
few days
 Adult > children
 Classifications :
◦ Simple episcleritis
◦ Nodular episcleritis
 ¾ cases, predominantly affects females
 Great tendency to recur
 Presentation :
◦ Redness, mild discomfort
 Signs :
◦ Redness maybe sectoral or diffuse
◦ The attack often reaches its peak within 12 hours
and then gradually fades the next few days
◦ Often flits from one eye to the other or may be
bilateral
Simple sectorial episcleritis Simple diffuse episcleritis
 Self-limiting benign disease, frequently
doesn’t need any treatment
 If severe or prolong enough : topical steroid
1-2 weeks
◦ Benefit over topical NSAID and topical lubricants
 Systemic th/ :
◦ Oral NSAID such cyclo-oxygenase inhibitor,
fluribiprofen 100 mg for 10 days
◦ Less morbidity
 Less common cause in adult conjunctivitis
 The source of infection is either direct
contact with an infected individual’s
secretion or the spread of infection from
the organism colonizing the patient’s own
nasal and sinus mucosa

 Clinical presentantion:
- Rapid onset
- Conjunctival inflammation & purulent
discharge
Clinical classification of bacterial conjunctivitis
 Management:
- Topical antibiotic  definitive
treatment should be based on culture
results
- Systemic antibiotic  gonococcal
conjunctivitis
Bacterial Conjunctivitis
• Clinical presentation :
- Bleeding spot
- Hyperlacrimation
- Secretion minimal
- Follicle in upper tarsal conjunctiva

• Management :
- Hygiene
- Artificial tears
- Antibiotic  secondary infection
Viral Conjunctivitis
• Age 5 – 25 yo
• Types: palpebral type and limbal type
• Symptoms :
- Itchy
- Usually recurrrent in summer
• Signs :
- Bilateral inflammation
- Follicles, papil, cobblestone in upper
tarsal conjunctiva
- Trantas dots in limbal cornea
 Management:
- Avoid outdoor activities, especially in
summer
- Cold compress
- Steroid topical in acute phase
- Topical antihistamine
- Topical mast cell stabilizer
- Injection steroid in tarsal conjunctiva
 severe case
Palpebral Type Vernal Keratoconjunctivitis
Limbal Type Vernal Keratoconjunctivitis
 Characterized by oedema and cellular
infiltration of the entire thickness of the
sclera
 Much less common than episcleritis
 Classifications :
◦ Anterior :
 Non-necrotizing : diffuse, nodular
 Necrotizing with inflammation : vaso-occlusive,
granulomatous, surgically induced
◦ Scleromalacia perforans
◦ Posterior scleritis
 First line treatment : Corticosteroid such
prednisolone
 Administered in high doses either orally or
intravenously to achieve disease remission
 Oral corticosteroids started at high doses between
60-80mg/day in adults then tapered to an acceptable
maintenance dose.
 Intravenous corticosteroids are used when rapid
remission is required for patients with necrotising
scleritis with potential globe perforation.
 Immunosuppressive agents are indicated for
patients with severe scleritis, in situations
where corticosteroids are inadequate to
control disease or when the dose is too high to
be tolerated for long term treatment
 Results from injury to the vessels of
peripheral iris or anterior ciliary body
 Anterior segment bleeding  penlight
examination  layering of blood in the
inferior anterior chamber
 Sometimes, the bleeding is so subtle 
few circulating RBC in anterior chamber
 slitlamp examination  microscopic
hyphema
Total hyphema
 Hyphema grading:
- Grade 1: Layering of blood < 1/3 in the
anterior chamber
- Grade 2: Layering of blood 1/3-1/2 in
the anterior chamber
- Grade 3: Layering of blood 1/2-2/3 in
the anterior chamber
- Grade 4: layering of blood >2/3 in the
anterior chamber
 The major concern after traumatic hyphema
 rebleeding (secondary hemorrhage)
 Rebleeding may complicate any hyphema,
regardless of size & occurs most frequently
between 2 & 5 days after injury
 The timing of rebleeding  related to the
lysis & clot retraction that occur during this
period
 Complication associated with rebleeding:
- Glaucoma
- Optic atrophy
- Corneal blood staining (corneal imbibisio)
Corneal blood staining
after traumatic hyphema
 Combination of elevated IOP,
endothelial dysfunction & anterior
chamber blood  corneal blood
staining

 Management:
- A protective shield of the injury eye
- Moderate restriction of physical
activity
- Elevation of the head of the bed
- Frequent observation
 Medical management :
- Topical cycloplegic agent
- Antifibrinolytic agent
- Topical corticosteroid
- Avoid aspirin and NSAID  increased
the risk of rebleeding

 Surgery management (to evacuate

blood)  to prevent irreversible
corneal blood staining & optic atrophy
from persistenly elevated IOP
Symptoms mSymptoms
• Discomfort
• Increased blinking
• Foreign body sensation (~punctate epithelial
keratopathy)
• Burning
• Dry sensation
• Photophobia
• Blurred vision
• Worse toward the end of day, with
prolonged use of eyes, with exposure to
environmental extremes
 Mild
◦ Artificial tears, preservative-free
◦ Change/discontinue topical and systemic
medications associated
◦ Smoking cessation
◦ Warm compress with eyelid massage ~bolster
lipid layer
 Severe
◦ Punctal occlusion
◦ Lateral tarsorrhaphy
Anterior segment complications of blunt trauma

Hyphaema Sphincter tear Iridodialysis Vossius ring

Cataract Lens subluxation Angle recession Rupture of globe

 Hematom palpebra

 Subconjunctival bleeding
 Ruptur kornea
dengan prolaps iris

 Katarak traumatika
Ruptur Palpebra + Prolaps iris
 Corpus Alienum di
Kornea dan
Konjungtiva

• Irigasi dengan larutan isotonis

Penatalaksanaan
• Ekstraksi corpus alienum
 Erosi kornea

 Korpus alienum di
kelopak mata atas
 Korpus alienum
(plastik)
 EKSTRAKSI KORPUS ALIENUM
(menggunakan spatula)
 • trauma akibat benda
Trauma tajam/benda asing yg
masuk ke mata, seperti;
mekanik serpihan kaca, logam,
;Tajam percikan proses
pengelasan dan peluru.
 • Penurunan tajam
penglihatan dari ringan

Tanda sampai buta

• Kerusakan organ

dan
tergantung bagian mata
yg terlibat dan beratnya
trauma,

Gejala • Mengenai Orbita , fraktur

saluran lakrimal; ruptur  gangguan sistem eksresi alir mata

Konjungtiva ; perdarahan subkonjungtiva , robekan

konjungtiva, CA

Kornea , erosi – ruptur partial / full thicknes, CA

Jika trauma mekanik hebat  destroyed eye

Penatalaksanaan; Awal (dilokasi kejadian)

• Mata tidak boleh dibebat dan di lindungi tanpa kontak, (

dope mata)
• Hindari manipulasi yg berlebihan d penekanan bolamata
• Benda asing tidak boleh dikeluarkan
• Penderita dipuasakaantisipasi tindakan operasi

Penanganan di Rumah sakit ;

• Pemberian AB spektrum luas ( non steroid)

Penanganan di Rumah sakit ;
• Pemberian AB spektrum luas ( non steroid)
• Pemberian analgetik dan sedasi ( bila perlu)
• Pemberian toksoid tetanus
• Pengangkatan benda asing, tidak berhasil
 tind, pembedahan
Trauma kimia asam ; bahan
kimia pH < 7
•Mis; cuka, H2SO4,HCL,HNO3,
CH3COOH,

Trauma kimia basa/alkali

•Mis; sabun cuci, detergen, kapur,
bahan pembersih lantai, lem
perekat
Pada trauma kimia
• kekeruhan kornea akibat terjadi koagulasi
protein epitel kornea

Pada trauma kimia basa

• Terjadi proses penyabunan, ( proses terus
berlangsung dan penetrasi ke dalam bola mata)
PENATALAKSANAAN
•Irigasi dengan cairan fisiologis / air
bersih 2 Liter selama 15-30 menit,
sampai pH netral  untuk
mengeliminasi bahan kimia
•Penilaian gradasi ( Huges)
 Grading of severity of chemical injuries
Grade I (excellent prognosis)
• Clear cornea
• Limbal ischaemia - nil

Grade II (good prognosis) Grade III (guarded Grade IV (very poor

prognosis) prognosis)

• Cornea hazy but visible • No iris details • Opaque cornea

iris details
• • Limbal ischaemia > 1/2
Limbal ischaemia - 1/3 to 1/2
• Limbal ischaemia < 1/3
 Pemberian obat topikal;
◦ Antibiotik
◦ Sikloplegik
◦ Anti glaukoma ( mencegah glaukoma sekeunder)
◦ Steroid ( 7 hari pertama)- anti inflamasi
◦ EDTA
◦ Artifisial Tear
 Oral vitamin C
 Pemasangan bandage contact lens
 Tindakan operatif – kumbah BMD sp keratoplasti jika
terjadi kekeruhan kornea yg permanen
 Trauma thermal
◦ mis: panas api, listrik, sinar Las, sinar matahari
 Trauma bahan radio aktif,
◦ mis: sinar radiasi ( radio logi )
Glaukoma Akut
• Kondisi mata dengan peningkatan
tek bolamata yang mendadak
disertai mata merah dan nyeri
serta adanya penurunan visus
• Penderita disertai keluhan sakit
sekitar mata dan terkadang kepala
disertai mual bahkan muntah
 Penderita dirawat
 Tekanan Bolamata (TIO) di turunkan dg obat obatan dan
evaluasi TIO /jam:
 Medikamentosa:
◦ Karbonik anhidrasi ( diamox) oral 250 ( 3-4) ;
◦ KCL tab 2x 500 mg
◦ Pilocarpin ( kornea sdh jernih)
◦ Timolol 0,5 % / betaksolol 0,5 % 2x 1 tetes
◦ Steroid topikal
 Cairan hiperosmotik
 Tindakan operatif ;Iridektomi atau iridotomi perifer
(NdYag laser)
CRAO ( central retinal arteri
oclusion)
•Salah satu sisebabkan penyakit
vaskuler , berupa oklusi V.Retina
central, ditandai dengan penurunan
tajam penglihatan yg berat,dan
mendadak,dan defek lap pandang,
tidak nyeri
• Dekompresi bola mata
• Oklusi segera di hilangkan
• Obat Antiagregasi trombosit
• Injeksi intravitreal steroid &/ Anti VEGF
• Penyakit yang mendasari diobati juga
Traumatik optik neuropati ( TON)
•Penurunan tajam penglihatan yg mendadak paska
trauma pada kepala atau pada mata
•Gejala : Tajam penglihatan turun mendadak pasca
trauma, Gangguan lapang pandang, diplopia
 Terkadang mengalami perbaikan sendiri
 Pemberian steroid high dose
 Tindakan op; dekompresi orbital (orbital canal
decompresi)
TOKSIS NEUROPATI
•Penurunan tajam penglihatan pasca
terpapar bahan kimia, obatan
tertentu
•Gejala; Penurunan tajam pengilhatan
, terkadang disertai gangguan defek
glaukoma
 Eliminasi penyebab
 Steroid (high dose)
 Vitamin neurotropik