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Felecia Christy
405140077
Anatomi Mata
• otot
• Saraf
• Pendarahan
• Organ
• Rongga antara
• lacrimation
Anatomy
Layers of the eye
Extraocular Muscle

There are seven skeletal extraocular


(extrinsic) muscles associated with the
eye. Levator palpebrae superioris is an
elevator of the upper eyelid, and the other
six, i.e. four recti (superior, inferior,
medial and lateral), and two obliques
(superior and inferior), are capable of
moving the eye in almost any direction.
http://images.medicinenet.com/images/image
_collection/anatomy/eye-anatomy.jpg
HISTOLOGI MATA
The eye is formed by three layers, or tunics:
• fibrous tunic
which forms a capsule enclosing and protecting the other
components of the eye. It is subdivided into the sclera, with
primarily structural functions, and the cornea.
• vascular tunic, which forms the choroid, ciliary body
and iris. The choroid has primarily nutritive functions.
The ciliary body generates the aqueous humor of the
eye. The iris is part of the optic apparatus in which it
functions a contractile diaphragm.
• neural tunic consists of the retina. The retina proper
forms the photoreceptive layer of the eye.
http://www.lab.anhb.uwa.edu.au/mb140/Core
Pages/eye/eye.htm
Lapisan Mata
Cornea
• The anterior surface of the cornea is lined by a stratified
squamous epithelium.
• The corneal stroma consists of 200 - 250 layers of
regularly organized collagen fibrils (mainly tropcollagen
type I). Flattened fibrocytes, referred to as keratocytes,
are located between the layers of collagen fibres. The
regular arrangement of the collagen fibres and their small
diameter (20 - 60 nm) acount for the transparency of the
cornea.
• The posterior surface of the cornea is lined by an
endothelium, the posterior endothelium. The posterior
endothelium and the corneal stroma are separated from
each other by the posterior limiting lamina or Descemet's
membrane
CHOROID
• The choroid consists of loose connective tissue, which
houses a dense network of blood vessels.
• melanocytes are numerous  give the choroid its dark
colour.
• Small blood vessels are especially frequent in the inner
part of the choroid, which is called the choriocapillary
layer. This layer supplies the retina with nutrients.
• Bruch's membrane is located between the choroid and
the retina. It consists of two layers of collagen fibres
and a network of elastic fibres between them.
Ciliary body
• The ciliary body is an inward extension of the
choroidea at the level of the lens. Ciliary processes are
short extensions of the ciliary body towards the lens.
• The ciliary processes contain a dense network of
capillaries.
• The cells of the inner layer of the ciliary epithelium
generate the aqueous humor of the eye.
• Fibers, which consist of fibrillin, extend from the ciliary
processes towards the lens and form the suspensory
ligament of the lens  accomodation
IRIS
•Myoepithelial cells in the outer (or anterior) layer of the retina, i.e. the
layer adjacent to the stroma of the iris, have radially oriented muscular
extensions, the dilator pupillae muscle. Embedded in the central portion of
the iridial stroma  annular sphincter pupillae muscle. The two muscles
regulate the size of the pupil.
•Pupillary constriction, which is mediated by the sphincter pupillae muscle,
is clinically refered to as miosis - dilation, mediated by the dilator pupillae
muscle, as mydriasis.
•The pigmentation of cells in the stroma and anterior border layer of the iris
determines to color of the eyes. If cells are heavily pigmented the eyes
appear brown. If pigmentation is low the eyes appear blue. Intermediate
levels create shades of green and grey.
LENS
• The lens consists of a
lens capsule, the
subcapsular epithelium
and lens fibres. It does
not contain blood
vessels or nerves.
• The mature lens fibres,
i.e. very long (up to 12
mm), hexagonal cells,
form the body of the
lens. http://www.lab.anhb.uwa.edu.au/mb140/Core
Pages/eye/eye.htm
RETINA
Bruch’s membrane
Faal Penglihatan
• Gelombang cahaya pertama kali masuk ke mata
melewati kornea.
• Jumlah cahaya yg masuk mata diatur oleh iris. Di
tengah iris terdapat pupil, tempat di mana cahaya
masuk ke dalam mata. Ukuran bukaan pupil
dapat disesuaikan oleh kontraksi dari otot iris
untuk memasukan bnyak atau sedikitnya cahaya
sesuai kebutuhan
• Daya akomodasi: penyesuaian lensa mata
terhadap macam-macam jarak
Faal Penglihatan
• Sel batang dan kerucut terdiri dari lempeng
membranosa pipih yg banyak mengandung molekul2
fotopigmen
• Fotopigmen terdiri dari protein enzimatik disebut opsin
yg berikatan dgn retinen, suatu turunan vit A
• Ada 4 jenis fotopigmen.
– Di sel batang rodopsin(hanya memberi gambaran
bayangan abu2)
– Sel kerucut merah, hijau, biru berspon scr selektif thdp
berbagai panjang gel, shg penglihatan warna dapat terjadi
fototransduksi
• Scan
Aqueous Humor
• Secara terus menerus dibentuk dan direabsorpsi.
Keseimbangan antara pembentukan dan
reabsorpsi diatur oleh volume total dan tekanan
cairan intraokular
• Berfungsi sebagai pembawa nutrisi untuk kornea
dan lensa, keduanya kekurangan suplai darah
karena pembuluh darah dapat menghalangi
jalannya cahaya ke fotoreseptor
• Diproduksi dengan kecapatan 5 ml/hari oleh
jaringan kapiler dalam ciliary body
• Setelah terbentuk aqueous humor mengalir dintara
ligamen2 lensamelalui pupil ruang anterior mata
mengalir dalam susut antara kornea dan iris melalui
trabekula2 dan akhirnya masuk dalam kanalis schlemm
Susunan Optik Mata
STRUKTUR LETAK FUNGSI

Aqueous humor Rongga anterior antar kornea dan lensa dan Cairan encer jernih yang terus menerus dibentuk
mengandung zat gizi untuk kornea dan lensa

Badan (korpus) Turunan khusus lapisan koroid di sebelah Membentuk aqueous humor dan mengandung
siliaris anterior; membentuk suatu cincin yang otot siliaris
mengelilingi tepi luar lensa

Bintik buta Titik yang sedikit di luar pusat di retina dan tidak Rute untuk berjalannya saraf optikus dan
mengandung fotoreseptor (juga dikenal sebagai pembuluh darah
diskus optikus)

Fovea Tepat dibagian tengah retina Daerah dengan ketajaman paling tinggi

Iris Cincin otot yang berpigmen dan tampak di Mengubah-ubah ukuran pupil dengan
dalam aqueous humor berkontraksi; menentukan warna mata
Susunan Optik Mata
STRUKTUR LETAK FUNGSI
Kornea Lapisan paling luar mata yang jernih di anterior Berperan sangat penting dalam kemampuan
refraktif mata

Koroid Lapisan tengah mata Berpigmen untuk mencegah


berhamburannya berkas cahaya di mata;
mengandung penbuluh darah yang memberi
makan retina; di bagian anterior membentuk
badan siliaris dan iris

Lensa Antara aqueous humor dan vitreous humor; Menghasilkan kemampuan refraktif yang
melekat ke oto-otot siliaris melalui ligamentum bervariasi selama akomodasi
suspensorium

Ligamentum Tergantung diantara otot siliaris dan lensa Penting dalam akomodasi
suspensorium

Makula lutea Daerah tepat di sekitar fovea Memiliki ketajaman yang tinggi karena
banyak mengandung sel kerucut
Susunan Optik Mata
STRUKTUR LETAK FUNGSI

Neuron bipolar Lapisan tengah sel-sel saraf di retina oleh retina Penting dalam pengolahan rangsanagn
cahaya

Oto siliaris Komponen otot sirkuler dari badan siliaris; Penting untuk akomodasi
melekat ke lensa melalui ligamentum
suspensorium

Pupil Lubang bundar anterior di bagian tengah iris Memungkinan jumlah cahaya yang masuk
mata bervariasi

Retina Lapisan mata yang paling dalam Mengandung fotoreseptor (sel batang dan
sel kerucut)

Saraf optikus Keluar dari setiap mata di diskus optikus (bintik Bagian pertama jalur penglihatan ke otak
buta)

Sel batang Fotoreseptor di bagian paling luar retina Bertanggung jawab untuk penglihatan
dengan sensitivitas tinggi, hitam-putih,
dan penglihatan malam
Susunan Optik Mata
STRUKTUR LETAK FUNGSI

Sel ganglion Lapisan bagian dalam retina Penting dalam pengolahan rangsangan cahaya oleh
retina; membentuk saraf optikus

Sel kerucut Fotoreseptor di bagian paling luar retina Bertanggung jawab untuk ketajaman penglihatan,
penglihatan warna, dan penglihatan siang hari

Sklera Lapisan luar mata yang kuat Lapisan jaringan ikat protektif; membentuk bagian
putih mata yang tampak; di bagian anterior
membentuk kornea

Vitreous humor Antara lensa dan retina Zat semi cair mirip gel yang membantu
mempertahankan bentuk mata yang bulat
Daya Akomodasi
• Kemampuan mata mengubah kecembungan
lensa mata  bayangan dapat tepat jatuh pada
retina disebut daya akomodasi.
• Mata melihat benda yang jauh, otot mata dalam
keadaan rileks, dan lensa mata manjadi lebih
pipih(menipis)keadaan tanpa akomodasi.
• Mata melihat benda yang dekat, otot mata dalam
keadaan mengencang dan lensa mata menjadi
lebih cembung(tebal), disebut keadaan
akomodasi, jika keadaan lensanya cembung
maksimal disebut keadaan akomodasi maksimal.
Mekanisme Akomodasi
• Akomodasi → kemampuan mencembungkan lensa → akibat
kontraksi m. siliaris → relaksasi ligamen sunpensorius yang
memegang lensa, dan sebaliknya jika m. siliaris berelaksasi →
kekuatan dioptri lensa paling lemah.
• Makin bertambah usia, lensa kehilangan elastisitasnya dan menjadi
suatu massa yang relatif keras, mungkin karena denaturasi protein
secara progresif, sehingga daya akomodasi menurun dari 14 dioptri
setelah lahir menjadi 2 dioptri pada usia 45 – 50 tahun
• Sesudah itu lensa mata dianggap hampir sama sekali tidak dapat
berakomodasi yang disebut : presbiopia
Akomodasi
• Proses dimana
kecembungan lensa
mata diperbesar krn
proses aktif otot mata

• Melihat jauh/ istirahat :


lensa pipih
Melihat dekat
: lensa cembung
Kelainan pada Mata Tenang
(Mendadak)
• Ablasio Retina
• Oklusi Vena dan Arteri
• Amaurosis Fugaks
• Neuritis Optik
• Pendarahan Retina dan Vitreus
• Glaukoma akut
• Ambliopia toksik
• Papil edema
• uveitis posterior
Retinal detachment
Definition
• the separation of the sensory retina, ie,
the photoreceptors and inner tissue
layers, from the underlying retinal
pigment epithelium

• 3 types
– Rhegmatogenous
– Traction
– Hemorrhagic
Rhegmatogenous Retinal
Detachment
• most common type of retinal detachment
• usually preceded or accompanied by
posterior vitreous detachment and is
associated with
– myopia, aphakia, lattice degeneration, and ocular
trauma

• Characteristics
– full-thickness break in the sensory retina
– variable degrees of vitreous traction
– passage of liquefied vitreous through the break
into the subretinal space
• Binocular indirect ophthalmoscopy
with scleral depression
–elevation of the translucent detached
sensory retina with one or more full-
thickness sensory retinal breaks
• such as a horseshoe tear,
– most common in the superotemporal quadrant
• round atrophic hole,
– temporal quadrants
• anterior circumferential tear (retinal
dialysis)
– inferotemporal quadrant
• Treatment
– Principal aim  treat all the retinal breaks
• cryotherapy or laser being applied to
– create an adhesion between the pigment epithelium and
the sensory retina,
– preventing any further influx of fluid into the subretinal
space,
– to drain subretinal fluid, internally or externally,
– relieve vitreo-retinal traction
– Surgery techniques:
• pneumatic retinopexy
– air or expandable gas is injected into the vitreous to
maintain the retina in position, while the chorioretinal
adhesion induced
• Scleral buckling
– maintains the retina in position, while the chorioretinal
adhesion forms, by indenting the sclera with a sutured
explant in the region of the retinal break
• Pars plana vitrectomy
– relief of vitreo-retinal traction, internal drainage of
subretinal fluid,
Traction Retinal Detachment
• most commonly due to proliferative diabetic
retinopathy
• can also be associated with proliferative
vitreoretinopathy, retinopathy of prematurity,
or ocular trauma
• Characteristics
– has a more concave surface and is likely to be more
localized, usually not extending to the ora serrata
– tractional forces actively pull the sensory retina away
from the underlying pigment epithelium toward the
vitreous base
• Traction is due to formation of vitreal, epiretinal, or subretinal
membranes consisting of fibroblasts and glial and retinal
pigment epithelial cells
• Treatment
–Pars plana vitrectomy allows removal of
the tractional elements followed by
removal of the fibrotic membranes
–Retinotomy and/or injection of
perfluorocarbons or heavy liquids may
be required to flatten the retina
–Gas tamponade, silicone oil, or scleral
buckling may be used
Serous & Hemorrhagic Retinal
Detachment
• occurs in the absence of either retinal
break or vitreoretinal traction
• form as a result of accumulation of fluid
beneath the sensory retina and are
caused primarily by diseases of the
retinal pigment epithelium and choroid
– Degenerative, inflammatory, and infectious
diseases  subretinal neovascularization 
serous retinal detachment
• may also be associated with systemic
vascular and inflammatory disease
Retinal Haemorrhage
• Retinal haemorrhage = disorder of the eye in
which bleeding occurs into the light sensitive
tissue on the back wall of the eye.
• Caused by:
– hypertension
– Diabetes mellitus
– Retinal vein occlusion
– Shaking (particularly in young infants)
– Severe blows to the head
– any condition that alters the integrity of the endothelial
cells  abnormality of the retinal vascular system and
systemic factors (vessel wall disease, blood disorder,
reduce perfusion)
• Result from diapedeses from veins or capillaries,
and the morphologic appearances depend on the
size, site, and extent of damage to the vessel
a. Preretinal hemorrhages  damage to the superficial disk
or retinal vessels
b. Linear hemorrhages  small hemorrhages lie in the
superficial nerve fibres and characteristic linear appearance
 flame shaped
c. Punctate hemorrhages  retina are punctate and derived
from capillaries and small venules
d. Subretinal hemorrhages  less common because no blood
vessels between the retina and the choroid 
hemorrhages are large and red, well-defined margin and no
fluid level
e. Hemorrhages under the retinal pigment epithelium 
usually dark and large
f. White centered hemorrhages (roth’s spots)  pale or
white centers in a variety : cotton-wool spot with
surrounding hemorrhage, retinal hemorrhage in
combination with extravasation of white corpuscles, and
retinal hemorrhage with central resolution
• Retinal haemorrhages that take place outside
of the macula  can go undetected foe
many years
–Only picked up in eye exam
(opthalmoscopy, fundus photography,
dilated fundus exam
• Posterior vitreous detachment or retinal
detachment  severe impairment of vision
Diagnosis
• Opthalmoscopy A fluorescent dye is often
injected into the patient's
bloodstream beforehand
• Fundus camera more detailed view of the
blood vessels in the retina.

Treatment
• Mild hemmorhage without
involvement of chronic disease
 resorb without treatment
• Laser surgery
• VEGF drugs : avastin, lucenti
Optic Neuritis
Classification According to According to
ophthalmoscopic appearance aetiology
• Retrobulbar neuritis
– Optic disc appears normal • Demyelinati
– Most common type in adult ng
– Frequently associated with multiple
sclerosis
• Papillitis • Parainfectio
– Optic disc appears hyperaemia and us
oedema
– May be associated with peripapillary • Infectious
flame-shaped haemorrhages
– Most common type in children • Non-
• Neuroretinitis infectious
– Papillitis in association w/ inflammation
of the retinal nerve fiber layer and
macular star figure
– Least common type
Demyelinating optic neuritis
Symptoms
• Subacute monocular visual impairment
• Age range 20–50 years (mean around 30)
• Some patients  tiny white or coloured
flashes or sparkles (phosphenes)
• Discomfort or pain in or around the eye
(>90%)  by ocular movement; it may
precede or accompany the visual loss and
usually lasts a few days
• Frontal headache and tenderness of the
globe
Signs
• Visual acuity  usually 6/18–6/60
(may rarely be worse)
• Other signs of optic nerve
dysfunction, particularly impaired
colour vision and a relative afferent
pupillary defect.
• Optic disc  normal in the majority
of cases (retrobulbar neuritis); the
remainder show papillitis
• Temporal disc pallor may be seen in
the fellow eye, indicative of previous
optic neuritis.
Visual field defects
• Diffuse depression of
sensitivity in the entire
central 30°  most
common.
• Altitudinal/arcuate
defects and focal
central/centrocaecal
scotomas are also
frequent.
• Focal defects 
frequently accompanied
by an element of
superimposed
generalized depression
Course
• Vision worsens  several days to 3
weeks  begins to improve
• Initial recovery is fairly rapid and then
slower over 6–12 months
Prognosis
• Recover visual acuity to 6/9 or better
(>90%)
• Subtle parameters of visual function,
such as colour vision  may remain
abnormal.
• Mild relative afferent pupillary defect
may persist.
• Temporal optic disc pallor or more
marked optic atrophy may ensue.
• Develop chronic optic neuritis with
slowly progressive or stepwise visual
loss (10%)
Treatment
• Indications for steroid treatment
– When visual acuity within the first week of onset is
worse than 6/12  treatment may speed up
recovery by 2–3 weeks and may delay the onset of
clinical MS over the short term
• Steroid regimen
– Methylprednisolone sodium succinate 1 g i.v daily 
3 days, followed by
– Oral prednisolone (1 mg/kg daily)  11 days,
subsequently tapered over 3 days.
• Oral prednisolone may ↑↑ the risk of recurrence of optic
neuritis if used without prior intravenous steroid.
• Immunomodulatory treatment (IMT)
– reduces the risk of progression to clinical MS in some
patients, but the risk versus benefit ratio has not yet
been fully defined
Parainfectious Optic Neuritis
• May be associated with viral infections (measles,
mumps, chickenpox, rubella, whooping cough and
glandular fever)
• May also occur following immunization
• Children  more frequently
• Usually 1–3 weeks after a viral infection, with acute
severe visual loss, generally involving both eyes
• Bilateral papillitis is the rule; occasionally there
may be a neuroretinitis or the discs may be normal
• Prognosis for spontaneous visual recovery 
very good
• Treatment  not required in the majority of
patients
• Visual loss is severe  consider i.v steroids, with
antiviral cover where appropriate
Infectious Optic Neuritis
• Sinus-related
– uncommon
– Sometimes  recurrent attacks of unilateral
visual loss associated with severe headache and
spheno-ethmoidal sinusitis
– Treatment  systemic antibiotics; surgical
drainage (if appropriate)

• Cat-scratch fever (benign lymphoreticulosis)


– by Bartonella henselae inoculated by cat scratch or
bite
• Syphilis
– may cause acute papillitis or neuroretinitis  during
primary or secondary stages

• Lyme disease (borreliosis)


– a spirochaetal infection caused by Borrelia burgdorferi
transmitted by a tick bite
– may cause neuroretinitis and occasionally acute retrobulbar
neuritis, which may be associated with other neurological
manifestations and can mimic multiple sclerosis
• Cryptococcal meningitis
– in patients with AIDS may be associated with acute optic
neuritis, which may be bilateral

• Varicella zoster virus


– may cause papillitis  spread from contiguous retinitis (i.e.
acute retinal necrosis, progressive retinal necrosis) or
associated with herpes zoster ophthalmicus.
Non-infectious Optic Neuritis
Sarcoidosis
• 1–5% of patients with neurosarcoid
• May occasionally be the presenting feature of
sarcoidosis but usually develops during the course
of established systemic disease
• The optic nerve head may exhibit a lumpy
appearance suggestive of granulomatous
infiltration
• Steroid therapy  response often rapid
• Methotrexate  used as an adjunct to steroids or
as monotherapy in steroid-intolerant patients.
Autoimmune
• Autoimmune optic nerve involvement may
take the form of retrobulbar neuritis or
anterior ischaemic optic neuropathy
• may also experience slowly progressive
visual loss suggestive of compression
• Treatment  systemic steroids and other
immunosuppressants.
Kelainan pada Mata Tenang
(Perlahan)
• Miopia Ringan • diplopia binokuler
• hipermetropia • rabun senja
• presbiopi • ambliopia
• astigmatisma • AMD Strabismus
• katarak • Keratokonus
• glaukoma • anisometropia pada dewasa dan
anak
• retinopati • optic disc cupping
• retinitis pigmentosa • atrofi optik
GLAUKOMA
Optic neuropathy characterized by optic disc cupping and visual field loss associated with
elevated IOP
ETIOLOGI • gangguan aliran aqueous humor yang disebabkan oleh
-gangguan pada sistem drainage di anterior chamber angle/open-angle
-gangguan pada akses menuju sistem drainage / angle-closure glaucoma

GEJALA KLINIS •Sudut terbuka : IOP biasanya tidak > 30 mmHg, tidak bergejala,
penglihatan turun dalam waktu yang perlahan
•Sudut tertutup : IOP bisa mencapai 60-80 mmHg, mata merah, mual,
penglihatan turun tiba-tiba, rasa sakit yang berat karena IOP tinggi

PEMERIKSAAN •Pemeriksaan lapang pandang


• Tonometri untuk mengukur IOP ( yg paling banyak dipakai Goldmann
applanation) normal IOP : 11-21 mmHg
•Gonioscopy untuk melihat keadaan sudut di anterior chamber
•Ophtalmoscopy (optic disc assessment)cup-disk ratio, pada glaukoma >
0,5 (optic cup enlargement)

http://www.glaucoma.org.au/what.htm, Vaughan & Asbury’s


General Ophtalmology 8th Ed, 2011
GLAUKOMA

TATALAKSANA •Beta adrenergic blocking agents


-Timolol maleate 0,1%, 0,25%, 0,5% gel 1x di pagi hari
-Betaxolol topikal beta-1 selective

•Alpha-2 adrenergic agonist


-Apraclonidine (0,5% solution 3x/hari + 1% solution sebelum dan sesudah laser
treatment)

•Alpha adrenergic agonist


-Brimonidine (0,2% 2x/hari)ada efek meningkatkan outflow, efek samping yang
umum: reaksi alergi. Sering dikombinbasi dengan timolol.
•Carbonic anhydrase inhibitor  bisa utk glaukoma akut
-Oral Axetazolamide 125-250 mg 4x/hari, IV (500 mg)

•Untuk meningkatkan outflow:


-prostaglandin analogs
•Surgery
• Optic disk assessment
RESEP GLAUKOMA
dr.X Jakarta,
26 Aug 2015
Jalan S Parman
SIP

R/ Timolol Maleate 0,25% drops No.I


S 2 dd gtt II o.d.
Pro: Tn. X
Usia: 42 tahun
Christmas tree cataract:
• Uncommon
• Characteristic:
polychromatic needle-
like formations in the
deep cortex and
nucleus
Cataract
maturity
• Immature cataract is one in
which the lens is partially
opaque.
• Mature cataract is one in
which the lens is completely
opaque.
• Hypermature cataract has a
shrunken and wrinkled
anterior capsule due to
leakage of water out of the
lens.
• Morgagnian cataract is a
hypermature cataract in
which liquefaction of the
cortex has allowed the
nucleus to sink inferiorly
Cataract in systemic disease
Diabetes mellitus: snowflake cortical
opacities
• Hyperglycaemia  high level of glucose in
the aqueous humour  diffuses into the
lens  glucose is metabolized into
sorbitol  accumulates within the lens 
secondary osmotic overhydration 
affect the refractive index (mild) or later
evolve into frank opacities
Myotonic dystrophy
Atopic dermatitis
Neurofibromatosis type 2
Treatment
Operative
• Indications for surgery
– Visual improvement: indicated when
the opacity develops to a degree
sufficient to cause difficulty in
performing essential daily activities.
Clear lens exchange (replacement of the
healthy lens with an artificial implant) is
an option for the management of
refractive error.
– Medical: indications are those in which
a cataract is adversely affecting the
health of the eye, for example
phacolytic or phacomorphic glaucoma;
clear lens exchange usually definitively
addresses primary angle closure.
Refraction disorder
Presbyopia
• The loss of accommodation that comes with
aging to all people
• inability to read small print or discriminate
fine close objects
• About age 44-46 increase until about age 55,
when they stabilize but persist
• worse in dim light and usually worse early in
the morning or when the subject is fatigued.
• Therapy
– corrected by  a plus lens  make up for the
lost automatic focusing power of the lens
– Fine for reading but blurred for distant objects 
leaving the top open and uncorrected for distance
vision
Myopia
• When the image of distant objects focuses in front of the
retina in the unaccommodated eye or nearsighted
• If the eye is longer than average, the error is called axial
myopia
• If the refractive elements are more refractive than
average, the error is called curvature myopia or refractive
myopia
• Prognosis  high degree of myopia  susceptibility
to degenerative retinal changes, including retinal
detachment
• Concave spherical (minus) lenses are used to correct the
image in myopia
Hyperopia
• the state in which the unaccommodated eye would
focus the image behind the retina
• A young person may obtain a sharp distant image by
accommodating, as a normal eye would to read
• The young hyperopic person may also make a sharp
near image by accommodating more
• Classification
– reduced axial length (axial hyperopia) in certain congenital
disorders
– reduced refractive error (refractive hyperopia), as
exemplified by aphakia
• Prognosis  esotropia , monocular amblyopia
Astigmatism
• The eye produces an image with multiple focal
points or lines
• regular astigmatism  two principal meridians,
with constant power and orientation across the
pupillary aperture, resulting in two focal lines
– astigmatism with the rule  greater
refractive power is in the vertical meridian
– astigmatism against the rule  the greater
refractive power is in the horizontal meridian
– Oblique astigmatism  regular astigmatism
in which the principal meridians do not lie
within 20 degrees of the horizontal and vertical
• irregular astigmatism  the power or
orientation of the principal meridians
changes across the pupillary aperture
• Etiology  abnormality of corneal shape
• corrected with cylindrical lenses, frequently
in combination with spherical lenses
ANISOMETROPIA
DEFINISI Perbedaan kemampuan refraksi pada kedua mata
terdapat fokus yang tidak sama dari kedua mata
•Dapat mengakibatkan ambliopia (“lazy eye”) karena salau satu mata
memliki penglihatan yang lebih blurry. Otak cenderung mengambil
hasil penglihatan dari mata yang lebih jelas penglihatannya, maka
mata yang satu lagi bisa diabaikan/malas digunakan dan tidak
berkembang penglihatannya.

•Screening anisometropia:
-Kondisi strabismus
-Usia 3-4 tahun atau lebih muda

•Tatalaksana :
-Mengkoreksi kelainan refraksi di kedua mata dengan kacamata yang
sesuai (kacamata harus selalu digunakan).
-Untuk memacu penggunaan mata yang lebih berat kelainan
refraksinya, mata yang lebih ringan kelainannya boleh ditutup.

http://www.aapos.org/terms/conditions/153
Diplopia
• Strabismus -> fovea menerima bayangan yg
berbeda
• Objek yg terlihat oleh salah satu fovea
dicitrakan pada daerah retina perifer di mata
yg lain
• Bayangan fovea terlokalisasi tepat di depan;
tapi bayangan retina perifer dr objek yg sama
di mata yg lain dilokalisasi di arah yg lain ->
diplopia (objek yg sama terlihat di 2 tempat)
•Paul Riordan-Eva, John PW. Vaughan & Asbu
general ophtalmology. 17th ed. USA: McGraw
Hill, 2008
Diplopia Binokular
• Diplopia subjective complaint of
seeing 2 images instead of one and is
often referred to as double-vision in
lay parlance.
• with both eyes binocular
• corrected by covering either eye
• Pathophysiology: Binocular diplopia
(or true diplopia)  breakdown in
the fusional capacity of the binocular
system.
• The normal neuromuscular
coordination cannot maintain
correspondence of the visual objects
on the retinas of the 2 eyes.
• Rarely, fusion cannot occur because
of dissimilar image size, which can
occur after changes in the optical
function of the eye
following refractive surgery (eg,
LASIK) or after a cataract is replaced
by an intraocular lens.

http://emedicine.medscape.com/
Diabetic Retinopathy
Risk factor & epidemiology
• Chronic hyperglycemia, hypertension,
hypercholesterolemia, and smoking
• Young people with type I (insulin-dependent)
diabetes do not develop retinopathy for at
least 3–5 years after the onset of the systemic
disease
• Type II (non–insulin-dependent) diabetics may
have retinopathy at the time of diagnosis
Screening
• should be performed within 3 years from
diagnosis in type I diabetes, on diagnosis
in type II diabetes  annually
thereafter in both types
• Digital fundal photography has been
proven to be an effective and sensitive
method for screening
• Seven-field photography is the gold
standard
• Mydriasis is necessary for best quality
photographs, especially if there is cataract
• Diabetic retinopathy can progress rapidly
during pregnancy
– pregnant diabetic woman should be examined
by an ophthalmologist or digital fundal
photography in the first trimester and at least
every 3 months until delivery
Classification

• Nonproliferative Retinopathy
small-vessel damage and occlusion
• thickening of the capillary endothelial basement membrane and
reduction of the number of pericytes  microaneurysm

– Mild nonproliferative retinopathy  1 microaneurysm


– moderate nonproliferative retinopathy  extensive
microaneurysms, intraretinal hemorrhages, venous
beading, and/or cotton wool spots
– Severe nonproliferative retinopathy  cotton-wool
spots, venous beading, and intraretinal microvascular
abnormalities (IRMA)
• Diagnose  intraretinal hemorrhages in four quadrants, venous
beading in two quadrants, or severe intraretinal microvascular
abnormalities in one quadrant
• Maculopathy
– breakdown of the inner
blood–retinal barrier at
the level of the retinal
capillary endothelium 
leakage of fluid and
plasma constituents into
the surrounding retina 
focal or diffuse retinal
thickening or edema
– common in type II
diabetes and requires
treatment once it
becomes clinically
significant
• Proliferative Retinopathy
– most severe ocular complications of diabetes mellitus
– Progressive retinal ischemia  formation of
delicate new vessels that leak serum proteins (and
fluorescein) profusely
– Early  presence of any new vessels on the optic
disk or elsewhere in the retina
– High risk characteristic
• new vessels on the optic disc extending more than one-
third disk diameter,
• any new vessels on the optic disk with associated vitreous
hemorrhage,
• new vessels elsewhere in the retina extending more than
one-half disk diameter with associated vitreous
hemorrhage
Treatment
• good control of hyperglycemia, systemic
hypertension, and hypercholesterolemia
• Intravitreal injections of triamcinolone or anti-
VEGF agents
• pan-retinal laser photocoagulation (PRP)
–inducing regression of new vessels
• Vitrectomy is able to clear vitreous
hemorrhage and relieve vitreoretinal traction
PAPILEDEMA

http://medicastore.com/penyakit/3430/Papiledema.html
Definisi
• Suatu keadaan dimana terjadi
pembengkakan saraf optik pada
tempat masuknya ke mata akibat
peningkatan tekanan dalam darah
atau daerah sekitar otak
Etiologi
• Tumor, pseudotumor, atau abses
otak.
• Cedera kepala
• Perdarahan otak
• Infeksi atau peradangan otak atau
selaput otak
• Trombosis sinus kavernosus
• Hipertensi
• Penyakit paru-paru berat
http://medicastore.com/penyakit/3430/Papiledema.html
Gejala
• Awal dapat terjadi tanpa adanya
gangguan penglihatan. Kemudian
terjadi gangguan penglihatan
seketika, seperti penglihatan jadi
kabur, penglihatan ganda,
penglihatan berkelip-kelip atau
hilangnya penglihatan total.
• Sakit kepala, mual, atau muntah
juga dapat terjadi.
Diagnosa
• Oftamoskop, terkadang butuh
MRI atau CT scan.
• Kadang ultrasonografi mata perlu
untuk membedakan papiledema
dgn gangguan lain yang juga
menyebabkan pembengkakan
saraf optik.
http://medicastore.com/penyakit/3430/Papiledema.html
Pengobatan
• Kelainan yang menyebabkan
perlu diatasi sesegera mungkin.
Peningkatan tekanan
serebrospinal akibat tumor otak
bisa diatasi dengan
pembedahan untuk
mengangkat tumor atau terapi
radiasi
• Papiledema karena peningkatan
tekanan intrakranial yang tidak
diketahui penyebabnya dapat
diberi pengobatan untuk
membantu menurunkan TIK

http://medicastore.com/penyakit/3430/Papiledema.html
Optic atrophy
• Primary optic atrophy
– Occurs without antecedent swelling of the optic nerve head
– May be caused by lesions affecting the visual pathways from
the retrolaminar portion of the optic nerve to the lateral
geniculate body
– Sign :
• White, flat disc with clearly delineated margins
• Reduction in the number of small blood vessels on the disc surface
• Attenuation of peripapillary blood vessels and thinning of the retinal
nerve fibre layer
• The atrophy may be diffuse or sectoral depending on the cause and
level of the lesion
• Temporal pallor may indicate atrophy of fibres from the
papillomacular bundle, which enters the optic nerve head on the
temporal side
• Band atrophy caused by involvement of the fibres entering the optic
disc nasally and temporally with sparing of the superior and inferior
portions occurs in lesions of the optic chiasm or tract
– Cause :
• Optic neuritis
• Compression by tumours and aneurysms
• Hereditary optic neuropathies
• Toxic and nutritional optic neuropathies
• Trauma
• Secondary optic atrophy
– Preceded by long-standing swelling of the optic nerve
head
– Sign : according to the cause
• White or dirty grey, slightly raised disc with poorly delineated
margins due to gliosis
• Reduction in the number of small blood vessels on the disc
surface
• Surrounding ‘water marks’
– Causes include chronic papilloedema, anterior ischaemic
optic neuropathy and papillitis
• Consecutive optic atrophy
– Caused by disease of the inner retina or its blood supply
– The cause is usually obvious on fundus examination such
as retinitis pigmentosa, old vasculitis, retinal necrosis and
excessive retinal photocoagulation
Strabismus
• Vergences are binocular, simultaneous,
disjugate movements
• Convergence is simultaneous adduction
(inward turning); divergence is outward
movement from a convergent position
• Reflex convergence has four components:
– Tonic convergence
– Proximal convergence
– Fusional convergence
– Accommodative convergence
Strabismus (positions of gaze)
• Six cardinal positions of gaze are identified in
which one muscle in each eye is principally
responsible for moving the eye into that position as
follows:
– Dextroversion (right lateral rectus and left medial rectus).
– Laevoversion (left lateral rectus and right medial rectus).
– Dextroelevation (right superior rectus and left inferior
oblique).
– Laevoelevation (left superior rectus and right inferior
oblique).
– Dextrodepression (right inferior rectus and left superior
oblique).
– Laevodepression (left inferior rectus and right superior
oblique).
• Nine diagnostic positions of gaze are those
in which deviations are measured. They
consist of the six cardinal positions, the
primary position, elevation and depression
Laws of ocular motility
• Agonist–antagonist
• Synergists
• Yoke muscles
• The Sherrington law
• The Hering law
Kegawatdaruratan yang harus
dirujuk
Resep