6a.corneal Disorder - Dr Artati

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