Palp Ebra Jan 14
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Jannes fritz tan
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Trichiasis Sign
Bulu mata mengarah keposterior gbr. 1Etiologi
IdiopathikSekunder
Blefaritis anterior kronis Herpes zoster oftalmikus Trachoma
Therapy EpilasitemporerElektrolisis gbr 2Kryotherapy>> depigmentasi gbr.3Lamellar lid division dan kryotherapyAblasi Argon laser gbr.4
DDDistychiasis: kongenital; didapat (metaplastik bulu mata)Pseudotrichiasis: entropion; epiblefaron; ptosis bulu
mata
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Trichiasis
Gbr. 1 Gbr.2
Gbr. 3 Gbr.4
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Distichiasis kongenital
Genetik:autosomal dominan
Sign: baris kedua bulu mata mengarah posterior gbr.5
Therapy Lamellar lid division dan
kryotherapy lamella posterior gbr.6
Asosiasi sistemikLymphoedema-trichiasis
syndr. (Miege disease)
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Acquired distichiasis(metaplastic lashes)Pathogenesis
Metaplasia dan dedifferensiasi gl. Meibom kedalam folikel rambut
SignBulu mata berasal dari muara gl.
Meibom gbr.7 Etiologi
Sikatrisasi konjungtivitis pada penyakit mukokutaneus
Trauma khemisTherapy
Epilasi temporer Lamellar lid division dan
kryotherapy lamella posterior
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Ptosis bulu mataSign
Bulu mata atas turun
EtiologiPrimer (idiopatik)Sekunder
Floppy eye syndrome Dermatochalasis dengan
anterior lamellar slip Facial parese lama
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Madarosis
Sign Bulu mata berkurang/tidak ada gbr.9
Etiologi Lokal: blefaritis anterior kronik; infiltrating tumor; trauma
thermis; trichotilomania Iatrogenik: radiasi tumor; kryotherapy tumor; pengangkatan
trichiasis Penyakit kulit: herpes zoster oftalmikus; alopecia areata;
atopik dermatitis; psoriasis; ichtyosis Penyakit sistemik: hypothyroidism; hypopituitarism; acquired
syphilis; SLE; leprosy; ehlers-danlos syndr. Drug-induced: agen sitotoksik; obat antithyroid;
antikoagulans; thallium; gold Kongenital: atrichia; lid coloboma; cryptophthalmus; hereditary
ectodermal dysplasia syndrome
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Poliosis Sign
Rambut memutih prematur termasuk silia
Etiologi Lokal: blefaritis anterior kronis;
simfatetik oftalmiaSistemik: Vogt-Koyanagi-Harada
syn.; Waardenburg syn.; albinism; Hermansky-Pudiak syn.; Chediak- Higashi syn.; Tuberous sclerosis; atrofi hemifasial progresif
Anti malaria
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Hypertrichosis
Sign gbr. 11jumlah >>
(polytrichosis), panjang dan kecemerlang an bulu mata abnormal
Etiologi KongenitalDrug-induced
Prostaglandin lokal, Siklo sporin, Phenitoin, Cortison, minoxidil
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Blefaritis Marginalis KronisKlasifikasi
Anterior Stafilokokkus Seborhoik mixed
PosteriorMixed anterior & posteriorAngularParasitik
Phthiriasis palpebrarum Demodex follicorum
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Blefaritis Stafilokokal
Sign gbr.12; 13Hiperemis dan teleangiektasi
margo anterior, collarettesNotching, sikatriks, madarosis
pada kasus lama dan beratTherapy
Lid hygiene dengan shampo bayi yang diencerkan
Antibiotik topikal salep pada kasus berat
Komplikasi Instabilitas tearfilm;
konjungtivitis papiller kronis; erosi pungtata kornea epithel inferior; keratitis marginalis (fluorometholon)
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Blefaritis SeborhoikPathogenesis
Infeksi pityrosporum ovale, iritasi lipase bakteri
Sign gbr.14Hiperemis margo
anterior, oily debris, krusta melekat ke bulu mata
Therapy Sama blefaritis
stafilokokal
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Blefaritis PosteriorPathogenesis
Obstruksi gl.Meibom oleh meibom acne rosaceaSign
Hiperemis posterior lid dan penyumbatan mulut gl.meibom gbr. 15
Penekanan mekanis meibom seperti odol gbr. 16Therapy
Sistemik: Tetrasiklin qid/1 mggbd/6-12mgg Doxisiklin 100mg.bd/1
mggdaily/ 6-12mgg Minosiklin 100mg daily/6-12mgg Azithromisin 500 mg daily/1 mgg
Lokal: kompres panas; sodium fusidat gel topikal (acne rosasea);
ekspresi mekanik gl.Meibom
Komplikasi Chalazion rekurrens; keratokonjungtivits sicca
evaporatif; konjungtivitis papiller; erosi epithel kornea inferior
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Blefaritis posterior
Gbr.15Gbr.16
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Blefaritis AngularisPathogenesis
Infeksi Moraxella Lacunata, Staph. Aureus
Sign gbr.17Kulit hiperemis,
maserasi, krusta pada kanthus medialis
Therapy Krim Eritromisin,
Basitrasin
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Phthiriasis PalpebrarumPathogenesis
Infestasi Phthirus Pubis (kutu rambut kelamin)
SignKutu dan telor menempel
di bulu mata
Therapy Gunting bulu mataMerkuri oxida kuning1
%,anti kholinesterasi, laser atau kryotherapy
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Demodex FolliculorumPathogenesis
Infestasi demodex follicularum (mite)
SignKrusta bentuk tube,
tipis, transparans pada margo palpebralis dan bulu mata
Therapy Lid hygieneAntibiotik salep
(eritromisin; basitrasin)
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Allergi Acute allergic oedema gbr.20
Sign: edema. sakit (-), transientEtiologi: gigitan serangga, angioedema, urtikaria, obat
sistemikContact dermatitis
Etiologi: hipersensitivitas obat topikal (obat, preservatif)Sign: eritema,penebalan, krusta gbr.21Therapy:menyingkirkan penyebab, hidrokortison 1%
Atopic dermatitis (eczema)Sign: penebalan, krusta, fissura vertikal gbr.22Therapy: emolient, hidrokortison 1% krem, th/ infeksiAsosiasi okular:
umum (blefaritis stafilokokus, blefaritis angularis, penyakit vernal anak, keratokonjungtivitis kronis);
tidak umum(keratokonus, katarak presenilis); jarang (ablasi retina)
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Allergi
Gbr. 20Gbr. 21
Gbr. 22
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Infeksi viralHerpes zoster oftalmikusHerpes simplex primerMolluskum kontagiosum
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Herpes Zoster Oftalmikus
Sign gbr.23Krusta, ulserasi kulit yang diinervasi cabang I N.Trigeminus
TherapyValasiklovir sistemik 1gr.tid, Famsiklovir 250mg tid( atau 750 mg
daily)selama 7 hariKomplikasi
Kelopak mata: trichiasis, madarosis, sikatrik kulit, ptosisSegment anterior: konjungtivitis, episkleritis, skleritis, keratitis,
uveitisNeurologik: optik neuritis, paralisis n. cranial okulomotor,
hemiplegia kontralateral, ensefalitis
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Herpes Simplex PrimerSign gbr. 24
Kumpulan vesikel
TherapyAsiklovir atau pensiklovir
krim
Komplikasi Konjungtivitis folikulerKeratitis epithelial
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Molluscum ContagiosumPathogenesis
Infeksi sel epithel dengan virus M. Contagiosum dari kontak langsung atau fomites
Sign gbr. 25Nodul umbilikasi, pucat, waxy
TherapyEksisidestruksi dengan kauter,
kryoth/, laserKomplikasi
Konjungtivitis folikulerKeratitis epithelial
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Infeksi bakteri diffusImpetigoErysipelasNecrotizing fasciitis
KistaKista Moll (apocrine hidrocystoma)Eccrine hidrocystomaKista ZeissKista sebaceousKista epidermal inclusionmilia
NodulChalazion (kista meibom)Internal hordeolum (chalazion akut)Hordeolum externa (stye)
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Impetigo Pathogenesis
Infeksi kulit menular o/ Staph. aureus a/ Strep. pyogenes
Sign gbr.26Vesikel, bulla ruptur
krusta kuning keemasanTherapy
Eritromisin, basitrasin salep
Flucloxacillin, eritromisin sistemik
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Erysipelas (St Anthony`s fire)Pathogenesis
Infeksi superfisial sekunder dari trauma kulit minor Strep. pyogenes
Sign gbr.27erithema, batas jelas, plak
subkutan
Therapy Penisilin, pristinamisin
sistemik
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Necrotizing FasciitisPathogenesis
Infeksi berat jaringan lunak subkutan o/ Strep. Pyogenes, Staph. Aureus trombosis, nekrosis
Sign gbr.28Palpebra nekrotis, hitam
Therapy Benzil penisillin ivDebridement jaringan
nekrotis
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Kista
Gbr. 29 Kista Moll:kecil,bulattranslusen, lesi di margo
Gbr.30 Eccrine hidrocystoma: samaKista Moll tapi tidak di margo
Gbr. 31 kista Zeiss: bulat kecil,tidak translusen, di margo,sekret sebaseus
Gbr.32 kista sebaseus: mirip zeisstapi di kanthus medialis
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Kista (sambungan)
Gbr. 33 kista epidermal inklusion: lesisubkutan, mobil. sering palpebra sup.,
didahului trauma/operasi
Gbr. 34 Milia: kumpulan kista kecil,berasal dari folikel rambut, gl.sebaseus
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Chalazion (Kista Meibom)Pathogenesis
Reaksi radang lipogranulomatos k/ rembesan sekresi gl. Meibom yang tersumbat, bukan kista
PredisposisiBlefaritis posterior kronisAcne rosaceaDermatitis seborhoik
Sign gbr. 35Nodul, sakit (-), dalam tarsus
Therapy Observasi lesi kecil resolusi
spontanInsisi & kuretaseInjeksi steroid dalam lesi
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Hordeolum Interna (Chalazion akut)Pathogenesis
Infeksi Staphilokokus akut dari gl. Meibom
Sign gbr.36Nodul, nyeri tekan, dalam
tarsus, bisa cellulitis
Therapy Kompres panasInsisi, kuretase kalau
infeksi (-)
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Hordeolum Externa (Stye)
PathogenesisInfeksi akut staphylokokus,
abses folikel rambut dari gl. Zeiss/Moll
Sign gbr. 37Nodul, nyeri,margo palp.,
bisa cellulitis ringan
TherapyKompres panasEpilasi silia yang terkena
infeksi folikel
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Tumor Tumor benigna
Viral wart (papilloma squamous sel)Keratosis seborhoik (papilloma sel basal)Granuloma pyogenikKeratoacanthomaNevus melanositikNevus strawberry (hemangioma kapiler)Port-wine stain (nevus flammeus)
Tumor premalignanActinic (solar) keratosisLentigo maligna (Hutchinson frecle, precancerous
melanosis of Dubreuilh)Tumor malignan
Karsinoma sel basalKarsinoma sel squamouskarsinoma gl. SebaceusMelanomaKaposi sarcomaKarsinoma sel Merkel
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Tumor benigna
Gbr. 38 Papilloma sel squamous: lesi sesil,pedunculated, permukaan sep. raspberry Gbr.39 Keratosis seborhoik (papiloma
sel basal): lesi datar, coklat, berminyak,permukaan verrucous, sep. menempel
Gbr. 40 Granuloma pyogenik: lesi merah jambu, tumbuh cepat, mudah berdarah, di
dahului operasi, trauma atau infeksi
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Tumor benigna (sambungan)
Kerato Acanthoma Sign: nodul, tumbuh
cepat, krater berisi keratin, involusi spontan bbrp. mgg
DD: karsinoma sel basal nodululseratif (ulkus rodent)
Nevus MelanositikSign: lesi papilomatos,
datar, pigmentasi bervariasi, rambut dapat tumbuh
Klasifikasi histologis: 1. intradermal 2. junctional 3.compound
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Nevus Strawberry (hemangioma kapiler)Sign
Lesi merah, pucat dengan penekanan, tumbuh setelah lahir
Therapy Koagulasi laser pada lesi awal Injeksi steroid terseringSteroid sistemik pada lesi luas Inj. SC interferon alpha 2b
pada steroid resistenOperasi reseksi pada kasus
tertentu
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Port-Wine Stain (Nevus Flammeus)Sign
Bercak, warna pink, batas jelas, tidakmemucat pada penekanan
Therapy:Erbium laser dini
Asosiasi Ipsilateral mata: glaukom;
hemangiom khoroid diffusSistemik:Sturge-Weber synd.;
Klippel-Trenaunay-Weber synd.
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Premalignant tumorActinic (solar) Keratosis
Sign: lesi datar, krusta, hiperkeratosis, predisposisi karsinoma sel squamous
Therapy: biopsi eksisi, kryoth/
Lentigo MalignaSign: pigmentasi, makula,
tumbuh lambat, predisposisi melanoma
Therapy: observasi pada penebalan transformasi malignan
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Karsinoma sel basal
Gbr. 47 tumor nodul,lesi keras, bercahayap.d. permukaan dilatasi
Gbr. 48 tumor nodul ulseratif (ulkusRodent),menonjol dengan tepi menggulung
Gbr. 49 tumor sklerosis, indurated plaque;batas tidak jelas
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Karsinoma sel squamous
Gbr.50 tumor sep. plak, bersisik, eritematos, hiperkeratosis
Gbr. 51 Tumor nodular, lesi hiperkeratosis
Gbr.52. tumor ulserasi, dasar merahbatas jelas, indurated, tepi menggaung
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Karsinoma gl. SebaseusSign
Karsinoma gl. Meibom nodular gbr 53Penyebaran Ca gl. Meibom khas penebalan margo
palpebra dan madarosis lokal gbr.54Penyebaran pagetoid khas ekstensi tumor dalam
epithel konjungtiva gbr. 55Ca gl. Zeiss, lesi nodul/ulserasi, tumbuh lambat pada
margo palpebra gbr 56DD
Tumor nodul chalazion rekurrensTumor meluas blefaritis kronis unilateralPenyebaran pagetoidkonjungtivitis kronis unilateral
atau superior limbic konjungtivitis
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Gbr. Karsinoma gl. Sebaseus
Gbr.53
Gbr. 55
Gbr. 54
Gbr. 56
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Melanoma Sign
Penyebaran superfisial khas plak, batas ireguler, pigmentasi bervariasi gbr.57
Nodul lesi biru-hitam gbr.58
DDKarsinoma sel basal
berpigmentNevus berpigment
Gbr.57
Gbr.58
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Kaposi SarcomaNodul merah-violet,
vaskuler, khas pada AIDS
Karsinoma sel MerkelNodul tumbuh
cepat, sangat berbahaya, kulit diatasnya intak, biasanya palpebra sup.
Gbr. 60Gbr.59
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Penanganan Eksisi
Hampir semua karsinoma sel basal sembuh dengan eksisi batas 4 mm
Eksisi radikal pada karsinoma sel basal besar dan tumor agresif seperti Ca gl.Meibom dan Melanoma
RadiotherapyKarsinoma sel basal kecil yang tidak mengenai
kanthus medialis, kalau operasi tidak bisaKaposi sarcoma
Cryotherapy Karsinoma sel basal kecil dan superfisial
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Ektropion
Ektropion involusiEktropion sikatriksEktropion paralitik
EntropionEntropion involusiEntropion sikatriksEntropion
kongenital
Ptosis Neurogenik
Parese N. III Horner syndrome Marcus Gunn jaw-
winking syndrome Regenerasi aberans
N.IIIMyopathik
Ocular myopathy Kongenital sederhana Blepharophimosis
synd. Neuromyopathy
myasthenia gravis Aponeurotik levator Mekanik gravitasi
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Ektropion InvolusiPathogenesis
Kelopak kendor horizontal ok/ tendon kanthus lateralis dan medialis kendor
Sign gbr. 61Ektropion dengan kelopak mata bawah kendor
Therapy Prosedur Lazy T kalau predominan ektropion
medial gbr. 62Pemendekan kelopak horizontal untuk
ektropion umum gbr.63Prosedur Kuhnt-Szymanowsky untuk ektropion
umum dengan kulit berlebih gbr.64
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Gbr. 61
Gbr.63
Gbr.62
Gbr.64
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Ektropion Sikatriks
Sign gbr.65Ektropion,berhubungan
dengan sikatriks dan kontraktur
Therapy gbr.66Memanjangkan/
mengendorkan palpebra vertikal( Z-plasty)
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Ektropion Paralitik
SignEktropion palpebra
inferior,berhubungan dengan lagophthalmus k/parese fasialis
Therapy LubrikasiMenutup mata
dengan plester waktu tidur
Tarsorrhapi lateral
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Entropion InvolusionalPathogenesis gbr.69
Perobahan ok/umur dengan kekendoran horizontal palpebra, instabilitas vertikal dan overriding pretarsal o/ pretarsal orbikularis waktu tutup mata
Sign gbr.70Entropion dengan
palpebra inferior kendorTherapy
Transverse everting sutures sementaragbr.71
Prosedur Wies utk koreksi terakhir gbr.72
Prosedur Jones, sering utk rekurrens gbr.73
Gbr.69
Gbr.70
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Therapy Entropion Involusi
Gbr. 71
Gbr.72
Gbr.73
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Entropion SikatriksSign
Entropion ok/ sikatriks konjungtiva palpebralis biasanya ok/ TrachomTherapy
Tarsotomi transvers(fraktur) dengan rotasi anterior margo palpebra
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Entropion KongenitalPathogenesis
Disgenesis aponeurosis retraktor inferiorSign gbr.75
Entropion dengan lekukan palpebra inferior(-)Therapy
Eksisi strip dari kulit dan otot dan fiksasi kulit-tarsus (pros. Hotz)
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Marcus Gunn Jaw-Winking syndrome
PathogenesisMisdireksi N. V divisi
mandibular ke levator
SignRetraksi ptosis pada stimulasi
otot pterygoid ipsilateral dengan membuka mulut, mengunyah, mengisap atau gerakan rahang kontralateral
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Regenerasi Aberans N.IIIPathogenesis
Misdireksi regenerasi fiber setelah paralisisis N.III didapat
SignPtosis akibat
pergerakan aneh palpebra sup. Berhubungan dengan beberapa pergerakan mata
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Simple Kongenital PtosisSign: unilateral/bilateral
ptosis dengan fungsi levator buruk dan lekukan palpebra (-)
Blepharophimosis syndrome Inheritens: ADSign : ptosis simetris,
telekanthus, epikanthus inversus, ektropion lateral palp. Inf.,pertumbuhan nasal bridge tidak baik, hipoplasia margo supraorbital
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Ptosis AponeurotikPathogenesis
Dehisensi, disinsersi atau peregangan aponeurosis levator, sering disebabkan perobahan involusi
Sign Fungsi levator baik, lekukan palp.sup. tinggi, sulkus
dalam pada kasus berat
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Therapy Ptosispemeriksaan preoperatif
Gbr. 81 Margin-reflex distanceNormal 4-4,5 mm
Gbr.82 Tinggi fissura vertikal
Gbr. 83 fungsi levator: normal lebih 15mm, baik 12-14mm, sedang 5-11mmburuk 4mm atau kurang
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Operasi Ptosis
Gbr.84 Fasanella-Servat untuk ptosisringan dan fungsi levator >10 mm
Gbr. 85 reseksi Levator-semua ptosisdengan fungsi levator >5 mm
Gbr.86 suspensi frontalis untuk ptosisberat dengan fungsi levator sangat buruk
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Lid RetractionSign
Palpebra sup. Istirahat ca. 2mm dibawah limbus superior (a). Pada lid retraction, setinggi atau lebih tinggi dari limbus superior(b)
Etiologi Penyakit thyroid mataNeurogenik: ptosis unilateral
kontralateral; facial palsy; aberrant regeneration N.III; Marcus Gunn jaw-winking synd.; parinaud synd.; hidro sepalus; tetes simpatomimetik
Mekanis: overkoreksi ptosis; sikatriks kulit palp.sup.
Kongenital: isolated; Duane retraction syn.; Down synd.; transient `eye popping pada bayi normal
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Pembengkakan kelopak diffusSign gbr. 88Etiologi
Radang: konjungtivitis berat; dakriosistitis akut; peradang an orbita; sellulitis preseptal; allergi akut; postoperasi
Non inflamasi: hernia orbital fat; trauma tumpul; blepharo chalasis; emfisema subkutan
Sistemik: myxoedema; nefrotik synd.; obstruksi vena cava superior;CHF; Fabry disease; Melkersson-Rosenthal synd.; trichinosis
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Dermatochalasis Pathogenesis
Kulit palpebra berlebihan ok/umur dapat disertai hernia lemak pada septum orbita
SignKelopak mengantong
dengan lekuk mata tidak jelas dan menyebabkan ptosis mekanis
Therapy blefaroplasty
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Blepharochalasis Pathogenesis
Non-pitting edema palpebra sup. Bilateral rekurrens tanpa rasa sakit, hilang spontan dalam bbrp. hari
Sign Pada kasus rekurens berat, kulit berlebihan, kerut
seperti kertas rokok, dapat ptosis aponeurotik
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Floppy Eyelid SyndromePredisposisi
Orang gemuk, sering sleep-apnoe
SignPalpebra sup. kendor seperti
karet mudah ditarik gbr.91Trauma konjungtiva tarsal
menyebabkan konjungtivitis kronisgbr 92
TherapyPelindung mata nocturnal,
plester kelopak pd.kasus ringanPemendekan horizontal kelopak
utk. Kasus beratDD
Konjungtivitis kronis, etiologi tidak jelas
Superior limbic keratokonjungtivitis
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Epicanthic FoldSign
Lipatan bilateral kulit dari palpebra sup/inf ke kanthus medialis
Palpebralis: fold simetris di palpebra sup/inf, paling sering kaukasus gbr. 93
Tarsalis: fold berasal dari medial palpebra sup. berlanjut ke medial, orientalgbr.94
Inversus: fold dari palpebra inf. kearah kantus medialis, blefaro fimosis sindromgbr.95
Supersiliaris: fold dari alis kearah bawah ke bagian lateral hidung
Therapy Y-V plasty smallfoldMustard double Z-plasty large
fold
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Telecanthus Sign
Jarak antara kanthus medialis bertambah ok/ tendon kanthus medialis yang terlalu panjang
Associated syndromNon-eponymous: blefaro
fimosis; fetal valporate; CHARGE (pagon syn.)
Eponymous: Waardenburg; Moebius; Treacher-Collins; Rubinstein-Taybi; Turner; von Recklinghausen neurofibro matosis
DDhipertelorism: orbit
terpisah jauh
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Koloboma Sign
Koloboma palpebra sup. pada batas 3 medial dan tengah, tidak berhubungan kondisi sistemik
Koloboma palp.inf. pada 1/3 batas tengah dan lateral, berhubungan kondisi sistemik, sering Treacher-Collins
Therapy Penutupan langsung
defek kecilSkin graft dan rotasi flap
dari defek besar
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Epiblepharon
SignFold horizontal, terbentang melewati
margo palpebra anterior dan silia mengarah vertikal terutama medial
TherapySpontan sembuh tidak perlu th/Eksisi strip kulit & otot (prosedur Hotz
)DD
Entropion kongenital dapat dibedakan dari epiblepharon dengan menarik palp.inf kebawah. Pada epiblepharon silia mengarah keluar tetapi palpebra tetap aposisi bulbus. Pada kongenital entropion seluruh palpebra tertarik dari bulbus
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Euryblepharon
SignPalpebra inferior
bergeser kebawah dan kanthus lateralis kebawah dan luar
Therapy Penguatan kanthus
lateral atau tarrsorhapy
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Ablepharon Sign
Defisiensi lamella anterior palpebra
TherapyRekonstruksi Skin graft
Anomali sistemikAblepharon-
macrostomia syndr. mulut membesar sep.ikan, anomali kuping, anomali genital dan kulit berlebihan
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Cryptophthalmus
SignKriptoftalmus komplet khas
dengan penukaran palpebra dengan lapisan kulit yang bersatu dengan mikroftalmus
Kriptoftalmus inkomplet khas dengan mikroftalmus, kelopak rudimenter, sakkus konjungtiva kecil
Systemic associationFraser syndrome
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