BAB I PENDAHULUAN 1.1 Latar Belakang Mata merupakan salah satu organ penting bagi manusia. Organ mata merupakan salah satu alat komunikasi manusia terhadap dunia luar. Fungsi mata sebagai salah satu panca indera menerima rangsang sensoris cahaya yang kemudian akan divisualisasikan oleh otak kita sehingga kita dapat memahami keadaan di sekitar kita. Mata merupakan panca indera yang halus yang memerlukan perlindungan terhadap faktor – faktor luar yang berbahaya. (Sidarta Ilyas, masalah kesehatan mata anda) Sebagai sebuah organ, mata mempunyai kaitan yang sangat erat antara satu bagian dengan bagian lainnya. Seperti sebuah rangkain listrik yang akan menyala sebuah lampu bolham, diperlukan beberapa komponen mulai dari sumber energi (listrik/batere), kabel penghubung dan lampu. Apabila salah satu komponen tersebut rusak maka lampu bolham tidak akan menyala. Begitu pula dengan organ mata kita, tidak cukup dengan adanya mata yang sehat namun jaras nervus optikus serta fungsi otak yang baik akan menghasilkan satu kerja yang baik. Begitu banyak kelainan pada mata, hal yang paling sering dilihat adalah mata merah. Mulai dari iritasi ringan sampai perdarahan karena trauma akan memberikan tampilan klinis mata merah. Terkadang mata merah yang terjadi secara tiba – tiba akan memberikan kekhawatiran bagi pasien. Seperti pada perdarahan subkonjungtiva misalnya. Perdarahan subkonjungtiva secara klinis memberikan penampakan mata Perdarahan Subkonjungtiva 1
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BAB I PENDAHULUAN
1.1 Latar Belakang
Mata merupakan salah satu organ penting bagi manusia. Organ mata merupakan salah
satu alat komunikasi manusia terhadap dunia luar. Fungsi mata sebagai salah satu panca
indera menerima rangsang sensoris cahaya yang kemudian akan divisualisasikan oleh
otak kita sehingga kita dapat memahami keadaan di sekitar kita. Mata merupakan panca
indera yang halus yang memerlukan perlindungan terhadap faktor – faktor luar yang
berbahaya. (Sidarta Ilyas, masalah kesehatan mata anda)
Sebagai sebuah organ, mata mempunyai kaitan yang sangat erat antara satu bagian
dengan bagian lainnya. Seperti sebuah rangkain listrik yang akan menyala sebuah lampu
bolham, diperlukan beberapa komponen mulai dari sumber energi (listrik/batere), kabel
penghubung dan lampu. Apabila salah satu komponen tersebut rusak maka lampu
bolham tidak akan menyala. Begitu pula dengan organ mata kita, tidak cukup dengan
adanya mata yang sehat namun jaras nervus optikus serta fungsi otak yang baik akan
menghasilkan satu kerja yang baik.
Begitu banyak kelainan pada mata, hal yang paling sering dilihat adalah mata merah.
Mulai dari iritasi ringan sampai perdarahan karena trauma akan memberikan tampilan
klinis mata merah. Terkadang mata merah yang terjadi secara tiba – tiba akan
memberikan kekhawatiran bagi pasien. Seperti pada perdarahan subkonjungtiva
misalnya. Perdarahan subkonjungtiva secara klinis memberikan penampakan mata merah
terang hingga gelap pada mata. Secara umum bekuan darah akibat perdarahan
subkonjungtiva dapat hilang dengan sendirinya dikarenakan diabsorpsi oleh tubuh.
Namun begitu mata merah juga tidak boleh dianggap sebagai hal yang biasa karena
teriritasi oleh debu atau benda tertentu. Pasien dengan hipertensi diyakini sebagia faktor
resiko tersendiri terjadinya perdarahan pada subkonjungtiva. Pada keadaan tertentu
seperti perdarahan subkonjungtiva yang disertai adanya gangguan visus, sering kambuh
atau bahkan menetap maka harus segera dikonsultasikan ke dokter spesialis mata. Untuk
itu, diperlukan pengetahuan yang cukup untuk mengetahui bagaimana perdarahan
subkonjungtiva beserta faktor resiko dan penanganannya.
1.2 Keyword
Mata merah
Perdarahan subkonjungtiva
Perdarahan Subkonjungtiva 1
Hipertensi
Faktor resiko
BAB II ISI
2.1 Anatomi Mata dan Konjungtiva
Mata sebuah organ yang kompleks yang memiliki lebih dari satu sistem anatomi yang
mendukung fungsi mata itu sendiri. Secara umum ada beberapa sistem anatomi yang
mendukung fungsi organ mata, yaitu :
1. Anatomi kelopak mata
Kelopak mata memiliki peranan proteksi terhadap bola mata dari benda asing yang
menbahayakan mata. Kelopak atau palpebra mempunyai fungsi melindungi bola
mata, serta mengeluarkan sekresi kelenjarnya yang membentuk film air mata di depan
kornea. Pada kelopak terdapat bagian – bagian seperti kelanjar sebasea, kelenjar Moll,
kelenjar Zeis dan kelenjar Meibom. Sementara pergerakan kelopak mata dilakukan
oleh M. Levator palpebra yang dipersarafi oleh N. Fasialis.
2. Anatomi sistem lakrimal
Sistem lakrimal terdiri atas 2 bagian, yaitu :
Sistem produksi ata glandula lakrimal. Sistem sekresi air mata atau lakrimal
terletak di daerah temporal bola mata.
Sistem ekskresi mulai pada pungtum lakrimal, kanalikuli lakrimal, sakus lakrimal,
duktus nasolakrimal, meatus inferior.
3. Anatomi konjungtiva
Konjungtiva merupakan membran yang menutupi sklera dan kelopak bagian
belakang. Bermacam – macam obat mata dapat diserap melalui konjungtiva ini.
Konjungtiva mengandung kelenjar musin yang dihasilkan oleh sel Goblet. Musin
[Recurrent subconjunctival hemorrhages leading to the discovery of ocular adnexal lymphoma]
Hicks D, Mick A.
Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA. [email protected]
AbstractBACKGROUND: Subconjunctival hemorrhages commonly occur idiopathically or from causes including ocular surgery, trauma, anticoagulation medications, or a Valsalva maneuver. When a hemorrhage persists or recurs, a more extensive list of differential diagnoses must be considered. This report details a case in which persistent subconjunctival hemorrhages led to the discovery of ocular adnexal lymphoma.
CASE REPORT: A 68-year-old white man presented with a 7- to 8-month history of a recurrent red left eye. There was no associated pain, discharge, or change in vision over that time. The right eye was never involved. An ocular examination of the left eye found a mild nasal subconjunctival hemorrhage and a salmon-pink-colored lesion involving the superior conjunctiva. Clinical findings, photos, magnetic resonance images, and histopathology results are presented and reviewed. The signs, symptoms, incidence, pathophysiology, treatment, and prognosis of ocular adnexal lymphoma are also discussed.
CONCLUSION: Lymphomas can occur in a variety of sites in the body. It is well documented that primary tumors can originate in the ocular adnexa. Although not typical, the first sign in this case was a recurrent subconjunctival hemorrhage. The importance of a thorough ocular examination is paramount for a patient's ocular health and possibly the patient's life.
PMID: 20705524 [PubMed - in process]
[Epidemiology of traumatic and spontaneous subconjunctival haemorrhages in Congo]
Kaimbo Wa Kaimbo D.
Department of Ophthalmology, University of Kinshasa, DR Congo. [email protected]
AbstractPURPOSE: To determine frequency and associated conditions of subconjunctival haemorrhage
METHODS: A descriptive and cross-sectional study of all consecutive patients with traumatic and spontaneous subconjunctival haemorrhage (SCH) examined between 1999 and 2004 in a general practice of ophthalmology.
RESULTS: There were 58 (0.8%) patients with SCH (61 eyes) among 6843 consulting patients. They consisted of 34 (58.6%) women and 24 (41.4%) men, with a mean age (SD) of 30.7 years (16). Among the 58 patients with SCH, 30 (51.7%) had traumatic SCH and 28 (48.3%) had spontaneous SCH. In both populations of patients, females outnumbered males. The mean age was 35.5 and 26.4 years for patients with spontaneous and traumatic SCH, respectively (P = 0.04). Patients with spontaneous SCH presented earlier (< or = 3 days, P = 0.006) and complained of a red eye at a greater extent than patients with traumatic SCH (P = 0.02). There were no statistically significant differences between the patients with spontaneous and traumatic SCH with respect to gender (P = 0.75), eye involvement (P = 0.69), location of SCH (P = 0.23) and occupation of patients (P = 0.50). The condition was unilateral in 90% of eyes. Location of SCH was most found to be temporal (36.1%) or nasal (26.2%). In spontaneous SCH, no apparent associated condition was found in 64.3%. Hypertension (14.3%) was the most frequent associated condition. Other associated conditions were rare and included vomiting, sneezing, malaria, hypoglycaemia, sickle cell disease and delivery. In traumatic SCH, 67% injuries occurred at home.
CONCLUSION: SCHs were seen in 0.8% of patients and occurred more frequently in women than in men in this study.
[Traumatic subconjuntival hemorrhage. Presentation and associated injuries]
Lima-Gómez V, Morales-Ortiz N.
Servicio de Oftalmología, Hospital Juárez de México. [email protected]
AbstractBACKGROUND: Subconjunctival hemorrhage is frequent in ocular trauma and is traditionally left untreated, awaiting spontaneous resolution unless associated with open globe injury. A study was performed to identify characteristics of eyes with subconjunctival hemorrhage, rate of coexisting additional injuries, and whether visual acuity might allow detection of the latter.
MATERIAL AND METHODS: Patients evaluated for ocular trauma at our service between 1996 and 2000 with subconjunctival hemorrhage were included; eyes without visual acuity record were eliminated. Each eye was re-qualified according to standardized classification of ocular trauma. Presence of additional ocular injuries in eyes with different grade (visual acuity) was recorded. Rate of additional injuries by grade was compared with chi-square and odds ratio (OR).
RESULTS: A total of 178 eyes of 168 patients aged 1 to 84 years (average 27.63 years, standard deviation (SD) 17.3) were evaluated; grade (visual acuity) was 1 in 107 eyes (60.1%), 2 in 35 (19.7%), 3 in 22 (12.3%), 4 in 11 (6.2%) and 5 in three (1.7%) eyes. Seventy six eyes had additional injuries (42.7%, 95% confidence interval [CI 95%] 35.5-49.9%). A higher proportion of additional injuries was found in patients with grade < 1 (66.2%) than in those with grade 1 (27.1%, p < 0.001 OR 5.27, 95% CI 2.72-10.68).
DISCUSSION: A high rate of patients with subconjunctival hemorrhage presented additional injuries. Visual acuity < 1 increased probability of having additional damage. It is suggested that visual acuity be evaluated in every injured eye, even when diagnosis of subconjunctival hemorrhage is evident and data of open globe absent, to help detect eyes that require specialized evaluation.
PMID: 19764134 [PubMed - indexed for MEDLINE]
[Contact Lens-Induced Subconjunctival Hemorrhage]
Mimura T, Yamagami S, Mori M, Funatsu H, Usui T, Noma H, Amano S.
Department of Ophthalmology, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan; Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
AbstractPURPOSE: To present the first detailed assessment of the clinical features of CL-induced subconjunctival hemorrhage and associated risk factors.
DESIGN: Cross-sectional and case-control study of age-matched randomized groups.
METHODS: A total of 45 CL wearers with subconjunctival hemorrhage aged 18 to 45 years (CL-Hemorrhage group), 200 age-matched healthy control subjects (non-CL group), and 200 age-matched CL wearers (CL group) were enrolled. The conjunctiva was divided into the following 8 equal areas: superior, superior/nasal, nasal, inferior/nasal, inferior, inferior/temporal, temporal, and superior/temporal. The site of hemorrhage, the grade, and other parameters of conjunctivochalasis at 3 locations (nasal, middle, and temporal), and the grade of pinguecula on the nasal or temporal conjunctiva were determined in all subjects.
RESULTS: Typically, subconjunctival hemorrhage affected 1 or 2 regions of the temporal conjunctiva. The grade of conjunctivochalasis and pinguecula was higher in both the affected and unaffected eyes of the CL-Hemorrhage group than the non-CL and CL groups (all P < .00001). The effect of downward gaze or digital pressure on the extent of conjunctivochalasis was more marked in the CL-Hemorrhage group and superficial punctate keratitis was more common (all P < .00001). Multivariate logistic regression analysis of variables revealed that the presence of conjunctivochalasis and pinguecula were associated with an increased risk of CL-induced subconjunctival hemorrhage (all P < .05).
CONCLUSIONS: These results suggest that the major risk factors for CL-induced subconjunctival hemorrhage are conjunctivochalasis and pinguecula.
[Subconjunctival hemorrhage and conjunctivochalasis]
Mimura T, Usui T, Yamagami S, Funatsu H, Noma H, Honda N, Fukuoka S, Shirakawa R, Hotta H, Amano S.
Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
AbstractOBJECTIVE: Subconjunctival hemorrhage (SCH) is a relatively common disease, but there have been no reports concerning the relationship between SCH and conjunctivochalasis (CCh). We compared the grade of CCh between patients with SCH and control patients.
DESIGN: Prospective, nonrandomized study.
PARTICIPANTS: A total of 104 patients with SCH aged 41 to 94 years and 120 age- and gender-matched controls aged 41 to 94 years were enrolled.
METHODS: The conjunctiva was divided into the following 8 equal areas: superior, superior/nasal, nasal, inferior/nasal, inferior, inferior/temporal, temporal, and superior/temporal. The age, gender, medical history, ocular history, site of hemorrhage, grade of CCh at 3 locations (nasal, middle, and temporal), and other parameters of CCh were determined in all subjects.
MAIN OUTCOME MEASURES: Grade of each CCh parameter and location of SCH.
RESULTS: The mean grade of CCh was higher in patients with SCH than in control patients at the nasal (P<0.00001), middle (P<0.00001), and temporal areas (P<0.00001). The downward gaze- or digital pressure-dependent changes of CCh and the frequency of superficial punctate keratitis were all increased in SCH patients compared with control patients (P<0.00001, P<0.00001, and P = 0.00106, respectively). The number of areas involved by SCH and the presence of SCH in each area were positively correlated with the grade of each CCh-related parameter (P<0.05).
CONCLUSIONS: This was the first assessment of the grade of CCh in a large series of consecutive patients with SCH. Our results strongly suggest that CCh may have an important role in the pathogenesis of SCH.
PMID: 19596440 [PubMed - indexed for MEDLINE]
[Location and extent of subconjunctival hemorrhage]
Mimura T, Yamagami S, Usui T, Funatsu H, Noma H, Honda N, Fukuoka S, Hotta H, Amano S.
Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan. [email protected]
AbstractPURPOSE: Subconjunctival hemorrhage (SCH) is a relatively frequent disease; however, there have been no reports about its location and extent. We examined its location and extent.
METHODS: A total of 151 patients with SCH aged 2-94 years were studied. The conjunctiva was divided into 8 equal areas. The age, gender, medical history, ocular history and site of hemorrhage were determined for all subjects.
RESULTS: The number of areas involved by SCH showed an age-related increase. Traumatic SCH had a smaller extent compared with SCH related to hypertension, diabetes
and hyperlipidemia, or idiopathic SCH. Overall, SCH was significantly more common in the inferior areas than the superior areas (55.3% vs. 25.0%, p < 0.000001). In patients with SCH secondary to trauma or diabetes, however, the temporal areas were affected more often than the nasal areas (61.5% vs. 30.8% and 73.3% vs. 20.0%, respectively).
CONCLUSION: SCH showed an age-related increase in extent and was predominant in the inferior areas. However, traumatic SCH was usually detected as localized hemorrhage in the temporal areas.
[Risk factors and complications of subconjunctival hemorrhages in patients taking warfarin]
Leiker LL, Mehta BH, Pruchnicki MC, Rodis JL.
Colmery-O'Neil Veterans Affairs Medical Center, Topeka, Kansas, USA.
AbstractOBJECTIVES: The aim of this study was to identify patients with subconjunctival hemorrhage (SCH) on warfarin therapy, to describe risk factors that may contribute to SCH development, and to identify complications related to SCH.
METHODS: A retrospective chart review was conducted including patients treated at a university anticoagulation clinic over 2 years (4,334 patient visits). Data collection included patient demographics; international normalized ratios (INRs) before, at time of, and after SCH; risk factors for increased risk of bleeding; patient-reported complications related to SCH; recent changes in medication use; and warfarin dosage adjustments made in response to the event. The data were summarized using descriptive statistics and frequencies described as percentages.
RESULTS: Fifteen SCH events were identified at an event rate of 0.35%. Two were excluded because of related surgeries near the time of SCH events. The average patient age was 67.3 years (range, 51 to 82). A total of 76.9% (n = 10) of patients had INRs within the goal range at the appointment before reporting the SCH. A total of 46.2% (n = 6) of patients reported alterations in medication regimens during the month preceding SCH. Various patient conditions were documented that may increase the risk of SCH development. No ophthalmic complications were associated with SCHs.
CONCLUSIONS: An SCH event rate of 0.35% was identified. Many factors may have precipitated SCH; however, ophthalmic complications were uncommon.
PMID: 19410227 [PubMed - indexed for MEDLINE]
[Prevalence of factor XIII Val34Leu polymorphism in patients affected by spontaneous subconjunctival hemorrhage]
AbstractPURPOSE: To verify the prevalence of Val34Leu polymorphism in factor XIII A-chain gene (FXIII Val34Leu) in patients with spontaneous subconjunctival hemorrhage (SCH).
DESIGN: Nonrandomized case-control study.
METHODS: One hundred seven white patients suffering from one or more episodes of idiopathic SCH and 107 healthy subjects were matched for age and gender, and genotyped for FXIII Val34Leu. Anamnestic, ophthalmologic, cardiovascular, and serologic examinations were performed.
RESULTS: Frequency of FXIII mutated allele (Leu34) was significantly higher in SCH patients than in controls. Computing together heterozygotes (Val/Leu) and homozygotes (Leu/Leu), genotype distribution was statistically different. In a conditional logistic regression model, the comparison of the three separated genotypes, performed among 25 patients with recurrent idiopathic SCHs and controls, gave significant differences for both Val/Leu and Leu/Leu variables.
CONCLUSION: Both homozygosity and heterozygosity for FXIII Val34Leu predispose to idiopathic SCH, emphasizing the role of Leu34 allele as inherited risk factor for spontaneous, especially recurrent, SCHs.
PMID: 15364237 [PubMed - indexed for MEDLINE]
[Recurrent episodes of spontaneous subconjunctival hemorrhage in patients with factor XIII Val34Leu mutation]
Department of Ophthalmology, University of Ferrara, Ferrara, Italy. [email protected]
AbstractPURPOSE: To report on the occurrence of frequent episodes of spontaneous subconjunctival hemorrhage (SCH) in patients with the Leu 34 allele of the coagulation factor XIII (FXIII), known to be associated with high hemorrhagic risk.
DESIGN: Observational case series.
METHODS: Five young adults who had suffered from recurrent idiopathic SCH not associated with any recognized ocular and systemic hemorrhagic risk factor were investigated. Accurate anamnestic, ophthalmologic, hematologic, and serologic examinations were performed, together with blood pressure measurements, electrocardiogram (ECG), and 24-hour Holter ECG recordings. FXIII Val34Leu polymorphism was studied by DNA chain polymerase reaction.
RESULTS: DNA analyses showed that the hemorrhagic mutated Leu34 allele was present in four of our selected patients: two mutated homozygotes (Leu/Leu) and two heterozygotes (Val/Leu). In the last subject this polymorphism was not detected. All the other clinical evaluations did not disclose any significant abnormality.
CONCLUSIONS: The FXIII Val34Leu mutation may be associated with an increased risk for spontaneous episodes of SCH.
[Spontaneous subconjunctival haemorrhage--a sign of hypertension?]
Pitts JF, Jardine AG, Murray SB, Barker NH.
Tennent Institute of Ophthalmology, Western Infirmary, Glasgow.
AbstractThe relationship between the condition of spontaneous subconjunctival haemorrhage (SCH) and hypertension was investigated. Seventy eight patients with SCH and 78 controls with unrelated ophthalmic conditions were compared. Blood pressure (BP) was significantly higher at presentation in the group with SCH at 149 (SD 27)/89 (SD 15) versus 142 (SD 25)/81 (SD 12). The proportion of hypertensives by WHO criteria (systolic blood pressure > 160 and/or diastolic blood pressure >95) was 46% on presentation compared with 23% of the control group. The morphology of the lesion did not influence the association with hypertension although there was a suggestion that the group with raised haemorrhages had a tendency to higher systolic blood pressure. It is recommended that all patients with SCH have their BP checked; this will result in the diagnosis of a significant number of new hypertensives.
[Eye diseases and control of labor. Studies of changes in the eye in labor exemplified by subconjunctival hemorrhage (hyposphagmas)]
Stolp W, Kamin W, Liedtke M, Borgmann H. (Gyn.-Geburtsh, Abteilung, Johanniter-Krankenhauses Bonn)
AbstractThe possible significance of subconjunctival bleedings (hyposphagmas) as a symptom for other pathological changes of the eye was studied in a group of 354 postpartum patients. They were found in 10.5% of the cases. A relatively higher frequency occurred in primiparas. No other maternal factors than parity were detected as of statistically significant influence. A slightly higher percentage in mothers with large newborn (above average cranial circumference) indicates a relationship to the necessary bearing-down effort. In a second study, 49 postpartum women with subconjunctival bleeding were examined by an ophthalmologist. Neither any intraocular or retrobulbar bleeding nor any other grievous damage to the eye were found. In accordance with the literature we recommend, that highly myopic pregnant women (even with a previous history of retinal detachment, but ophthalmologically sufficiently treated) should undergo induced delivery. However, the approach to pregnant women with retinal detachment occurring and treated during pregnancy, or to glaucoma-patients with risk to a small remaining visual field, should be more careful. In those cases, a vaginal operative delivery procedure (forceps, vacuum-extraction) is recommended. Nevertheless, one should consider individual wishes of the mother, when striving to diminish the risk to the foetus. The same applies to irrational fears related to previously damaged (and possibly only functional) eye.