Post on 21-Sep-2014
Blok Organ Indera
Dr. Artati Sri Redjeki Sp.MDr. Artati Sri Redjeki Sp.M
KELAINAN KORNEA
Kornea Jaringan transparan Dinding depan bola mata Jernih, tembus pandang Media refrakta Struktur teratur, deturgesen/dehidrasi
relatif, pompa bikarbonat pada endotel Kerusakan endotel > epitel Epitel sawar terhadap mikroorganisme
Anatomi
Kornea:1. Epithel2. Membran Bowman3. Stroma4. Membran Decemet5. endotel
Kelainan kornea kongenital Peradangan
Infeksi Allergi Neuro paralitik lagoftalmos
degeneratif Pigmentasi Kekeruhan
Kelainan Kongenital Mikro kornea Megalo kornea Sklero kornea Kornea plana keratektasia
Microcornea• Very rare, hereditary, unilateral or bilateral• Corneal diameter is 10 mm or less• Shallow anterior chamber but other dimensions are normal
Associated systemic syndromesTurner, Ehlers-Danlos, Weill-Marchesani andWaardenburg
Ocular associationsGlaucoma, cataract, cornea plana, leukoma and iris abnormalities
Megalocornea
• Renal carcinoma and mental handicap
Systemic associations• Marfan, Apert, Ehlers-Danlos and Down syndromes• Osteogenesis imperfecta
• Very rare, hereditary, bilateral• Corneal diameter 13 mm or more• Very deep anterior chamber
• High myopia and astigmatism • Occasionally lens subluxation
Sclerocornea• Very rare, usually bilateral• Peripheral opacification and vascularization of cornea• ‘Scleralization’ makes cornea appear smaller
Kornea Plana Sangat jarang Bilateral Kelengkungan minim Hipermetrop Kamera ant’or dangkal Sering terjadi glaukoma
Keratoconus
Keratectasia• Very rare, usually unilateral• Severe corneal opacification and protruberance• Probably caused by intrauterine keratitis
Degenerasi kornea Keratokonus Arkus senilis Penyakit Terrien Keratopati pita <berkapur> Degenerasi Noduler Salzman Distrofi kornea
Epitel kornea Stroma kornea Membran posterior kornea
Arcus senilis• Innocuous and extremely common in elderly• Occasionally associated with hyperlipoproteinaemia
• Bilateral, circumferential bands of lipid deposits• Diffuse central and sharp peripheral border
• Peripheral border separated from limbus by clear zone
• Clear zone may be thinned ( senile furrow)
Fuchs’s Endothelial Dystrophy
Corneal Dystrophy Herediter
Band keratopathy
• Interpalpebral limbal opacification
• Common, unilateral or bilateral depending on cause• Subepithelial calcification
• Central spread of calcification• Small holes within calcified area• Separated by clear zone
Progression
Peradangan Keratitis
Superfisial Ulserosa / epitelial Non ulserosa /sub epitelial
Profunda / stroma Ulserosa
Sentral perifer
Non ulserosa
Endotelial
Infeksi kornea Bakteri
Ulkus kornea pnemokokus Ulkus kornea pseudomonas
Jamur Candida, fusarium, aspergillus
Virus Herpes Simpleks
Epitelial disciformis
Herpes Zoster / varicella zoster Acanthamoeba
Gejala umum Keratitis Keluhan
Visus turun Fotopobi, nyeri, rasa kelilipan
Klinis Mata merah – inj. Perikorneal Hiper / hipoesthesi Kornea edem Infiltrat Ulkus hipopion
Keratitis Bakterialis Onset 24 – 48 jam post inokulasi Ulkus berbatas tegas Warna kelabu, hipopion
Keratitis bakterial Predisposisi
Penggunaan lensa kontak Penyakit kronis mata luar Hipoesthesi
Gambaran klinis Ulkus berbatas tegas Menyebar tak teratur Dari tepi ke sentral
Terapi Antibiotika lokal & sistemis
Keratitis Fungi Klinis
trauma bahan organik Ulkus putih ke abu2 an Infiltrat bentuk bulu Sering ada lesi satelit Hipopion
terapi Anti jamur lokal & sistemik keratoplasti
Keratitis epitelial herpes simpleks •Ulkus dendritik denganterminal bulbs• tes fluorescein
•Meluas berbentuk geografik
•Salep mataAciclovir 3% x 5 daily•Trifluorothymidine 1% tetes setiap 2 jam
•Debridemen bila tidak ada perbaikan
Terapi
Keratitis disciformis herpes simpleks
• edem sentralentral epithelial and stromal
• lipatan membrana Descemet
• keratik precipitat halus
- Steroid topikal dengan anti viral
• sering disertai dengan cincin Wessely
Terapi
tanda Gejala tambahan.
Herpes zoster keratitis
• Develops in about 50% within 2 days of rash• Small, fine, dendritic or stellate epithelial lesions• Tapered ends without bulbs• Resolves within a few days
• Develops in about 30% within 10 days of rash• Multiple, fine, granular deposits just beneath Bowman membrane• Halo of stromal haze
Nummular keratitisAcute epithelial keratitis
• May become chronic
Treatment - topical steroids, if appropriate
Keratitis Parasit
Microfilaria
Keratoplasty Lekoma Cornea
Protozoal Disease Predisposisi
Pemakai lensa kontak cairannya
sakit tidak sesuai gejala Ulkus
indolen Cincin stroma Infiltrat perineural
Terapi Chlorhexidine, paromomycin
Leukoma Kornea dengan Neovaskularisasi
Abses Kornea dengan Hipopion
Komplikasi – Penyembuhan Sikatriks Nebula Makula lekoma Panus Stafiloma kornea Desmetocel Pseudo pterigium