BAHAN PEMICU 5

PENGINDERAAN
Ivan Buntara
405120049
Blefaritis
Definition
• Chronic blepharitis (chronic marginal blepharitis) is a
very common cause of ocular discomfort and irritation.
• Blepharitis may be subdivided into anterior and
posterior, although there is considerable overlap and
both types are often present (mixed blepharitis).
• Anterior blepharitis affects the area surrounding the bases of
the eyelashes and may be staphylococcal or seborrhoeic.
• Posterior blepharitis is caused by meibomian gland
dysfunction and alterations in meibomian gland secretions.
• A reaction to the extremely common hair follicle and
sebaceous gland-dwelling mite Demodex
Blefaritis anterior Blefaritis posterior

Demodex
Treatment
• Lid hygiene
• Antibiotics
• Topical sodium fusidic acid, erythromycin, bacitracin,
azithromycin or chloramphenicol
• Oral antibiotic regimens include doxycycline (50–100 mg
twice daily for 1 week and then daily for 6–24 weeks), other
tetracyclines, or azithromycin (500 mg daily for 3 days for
three cycles at 1-week intervals)
• Plant and fish oil supplements
• Topical steroid
• Tear substitutes
• Tea tree oil
• Topical ciclosporin
Trikiasis
Trichiasis
• Misdirection of growth from individual follicles
• It is commonly due to inflammation such as chronic
blepharitis or herpes zoster ophthalmicus, but can
also be caused by trauma, including surgery such as
incision and curettage of a chalazion
Treatment
• Epilation
• Electrolysis
• Laser ablation
• Cryotherapy
• Surgery
Hipopion
 Definition
• Hypopyon refers to a whitish purulent exudate composed of
myriad inflammatory cells in the inferior part of the anterior
chamber (AC), forming a horizontal level under the influence of
gravity.
• Hypopyon is common in HLA-
B27-associated AAU, when a
high fibrin content makes it
immobile and slow to absorb.
In patients with Behçet
disease the hypopyon
contains minimal fibrin and so
characteristically shifts
according to the patient’s
head position.
Endoftalmitis
Definition
• Endophthalmitis is an inflammatory condition of
the intraocular cavities usually caused by infection.
• The 2 types of endophthalmitis are endogenous
and exogenous.
• Endogenous results from the hematogenous spread of
organisms from a distant source of infection (eg:
endocarditis)
• Exogenous results from direct inoculation of an
organism from the outside as a complication of ocular
surgery, foreign bodies, and/or blunt or penetrating
ocular trauma.
Symptoms
• Visual symptoms in any hospitalized patient or
patient taking immunosuppressive therapy
• Visual loss
• Eye pain and irritation
• Headache
• Photophobia
• Ocular discharge
• Intense ocular and periocular inflammation
• Injected eye
Causes
• Gram positive organisms are the most common
causative: Staphylococcus epidermidis,
Staphylococcus aureus, and Streptococcus species.
• Gram negative organisms: Pseudomonas,
Escherichia coli, Enterococcus.
• When endogenous endophthalmitis is considered
alone, the precentage of bacterial organism drops
markedly because of a greater proportion of fungal
infections.
• Traumatic endophthalmitis
PP
• Laboratory studies: gram stain, culture of the
aqueous and vitreous
• RT-PCR
• Imaging studies
 conjuctivitis
-bacterial: acute bacterial , giant fornix syndr., adult chlamydial , trachoma, neonatal
-viral
-allergic

Acute bacterial conjuctivitis

e.c: strep. Pneumoniae, staph. Aureus, H. influenza, M.catarhalis, N.gonorrheae,

Meningococcal conjuctivitis

Symptom: acute inset of redness , grittiness, burning, discharge

Sign : eyelid oedema &eritema, conjuctival injection , discharge ( watery

mucopurulent)(hyperacute purulent  GO/ meningococcal), superficial corneal punctate
epithelial erosion, peripheral corneal ulceration , lymphadenopathy
PP: binocular conjuctival swabs & scrapping, culture, PCR
Th/ :
-topical antibiotic (4x/d)(1 wk) : chloramphenicol, aminoglikosida, kuinolon , macrolide,
polmisin B, fusidic acid, bacitrasin
Gonococcal & meningococcal : kuinolon, gentamisin, chloramphenicol, bacitrasin (1-2
hourly a.w.a systemic tt/)

-systemic antibiotic :
GO sefalosporin gen III, kuinolon , alternatif:macrolide
Infx H.influenza: amoksisilin +asam clavulanat
Mengingococcal: benzyl penisilin, ceftriaxone, cefotaximeIM; ciprofloksasin PO
-irigasi

-contact lens min 48 jam sth resolusi gejala scr komplet

Giant fornix syndr .

Chronic relapsing pseudomembarane purulent conjuctivitis

e.c: retained debris in upper fornix

SS: large prot. Aggregation MbB see in the upper fornix , secondary corneal
vascularization , lacrimal obstruction

Th/:
- repeated sweeping of the fornix w/ cotton tipped applicator
- Tpical & systemic antibiotic
- Steroid topical intensive
- Surgical forniceal construction
Adult chlamydia conjuctivitis

e.c: C. trachomatis

SS:
- Subacute onset of unilateral/ bilateral redness, watering, dischare
- Large fllicles,mild conjuctival scarring and superior pannus , discharge : watery
/mucopurulent , superficial punctate keratitis, perilimbal subepithelial corneal
infiltrates , tender preauricular lymphadenopathy

Urogenital infection  lk: asymptomatic , pr: disuria, discharge

PP: tarsal conjuctival scrapping, PCR, giemsa staining , direst imunofluoresecence,

enzyme immunoassay , McCOY cell culture , swabs

Th/:
- systemic( azitromicin 1g diulang sth 1 mgg, doksisiklin, 100mg 2dd 10d, alternatif:
amioksisilin, ciprofloksasin)
- Topical antibiotic: eriromisin , tetrasiklin ointment
- Abtinence from sexual contact until completon of th/ ( 1 wk after azitromisin)
Trachoma

SS:
1. Active trachoma:
1. Mixed follicular / papillary conjuctivitis
2. Discharge: mucopurulent
2. Cicatrical trachoma:
1. Linier / stelate conjuctiva scar in mild cases,broad confluent scar in severe dz
2. Herbers pits
3. Severe corneal opacification
4. Dry eye

PP: jrg  Dipstick enzyme immunoassay

e.c:
- c.trachomatis serovars A, B, Ba, C
Th/: SAFE - Chlamydophila psittaci
Antibiotics: - Chlamydophila pneumoniae
- azitromisin 20 mg /kgBB up to 1g)(single)
- Eritromisin 500 mg ( 2dd 14d)
- Doksisiklin 100 mg( 2 dd )(10d)
- Topical 1%tetraciclin
Neonatal conjuctivitis
e.c:
- during vaginal deliv:
C.trachomatis, HSV-2, N.gonorrheae
-staph, strep, gram –
-topical prep used for prophylaxis
-Congenital nasolacrimal abstruction
diag
Th/
Viral conjuctivitis
e.c: adeno virus

Transmisi:
contact w/ respiratory / occular secretion
Fomites

SS:
Nonspecific acute follicular conjuctivitis watering, redness, irritation, itching , mild
photophobia
Epidemic keratoconjunctivitise.c: Adeno V serovars 8,19, 37 the most severe
ocular adenoviral infx keratitis , photophobia
Acute haemorrhagic conjuctivitis  us/tropical area  ec: entero V, coxsackie V 
rapid onset resolve within 1-2 wk  conjunctival haemoeehage generally marked
Definisi: Gejala: menghilang dalam 24 jam Tatalaksana:
Peradangan lokal -Mata merah, rasa tidak nyaman, -mildno treatment
jaringan ikat vaskular rasa pasir  sering, -kompres dingin/refigerated
penutup sklera photophobiabisa terjadi artificial tears maybe
helpful
Tanda: -steroid topikal potensi
Epid: -> 50% kasus bilateral sedang (4X!)  1-2 minggu
-sering dijumpai -visus  biasa selalu normal usually sufficient
-PR>LK -Kemerahan pada mata  sectoral -Oral NSAID
-anak-anak jarang (2/3), atau diffuse terkadangibuprofen
200 mg (3x1)
Etiologi: idiopatik

Simple episcleritis 75 %
Klasifikasi
Nodular episcleritis

EPISKLERITIS

Sumber : kanski hal 254-255, vaughan&asbury hal. 165-166

 Simple episcleritis 75 % Gejala:
Klasifikasi -mata merah  terlihat pertama kali saat
bangun tidur2-3 haribertambah luas
Nodular episcleritis dan menjafdi tidak nyaman
Tanda:
-tender red vascular nodules  di
intrapalpebral fissura
-intraocular pressure  sangat jarang
meningkat
-stelah beberapa kali terjadi inflamasi 
dialatasi pd permanen dapat terjadi

Tatalaksana:
-sama dengan simple episcleritis
 Nodular episcleritis

Sumber : kanski hal 254-255, vaughan&asbury hal. 165-166

Definisi:
Peradangan sklera,
ditandai dengan
infiltrasi selular,
destruksi kolagen, dan
remodelling vaskular SKLERITIS

Epid:
-jarang
-PR>LK
-khasnya timbul pada dekade
kelima/keenam
Diffuse
Non-necrotizing Nodular
Klasifikasi Immune-mediated Anterior scleritis Necrotizing
Posterior scleritis
Infectious

Sumber : kanski hal 255-267, vaughan&asbury hal. 16-167

IMMUNE-MEDIATED SCLERITIStipe paling sering,
sering berhubungan dengan penyakit sistemik

Anterior non-necrotizing  diffuse

Gejala:
-Mata merahprogressing menjad nyeri yang menjalar ke muka dan temporal
-rasa tidak nyamanmembangunkan psien pada pagi hari
-respon terhadap anlagesik poor
Tanda:
-vascular congestion and dilatasi  berhubungan dengan oedema
-dapat terjadi kemosis (eodem konjungtiva), eyelid swelling, anterior uveitis dan peningkatan
TIO
-setelah oedem menghilangmuncul grey/blue appearance  karena peningkatan scleral
translucency (gambar 8.4 B)
Anterior non-necrotizing  nodular sering riwyat herpes zoster ophthalmicus sebelumnya
Gejala:
-Nyeri yang muncul tiba-tiba diikuti dengan mkemerahan yang bertambah dan muncul
scleral nodules

Tanda:
-scleral nodules
 single/multipel
 Warna : deeper blue-red than episcleral nodules and immobile
-muliple nodules  menyatu jika tidak di obati
Anterior nocrotizing scleritis with inflammation
aggressive form of scleritis Komplikasi anterior scleritis:
-age of onset  later than that of non-necrotizing -acute infiltrative stromal keratitis
scleritis (average 60 years) -sclerosing keratitis
-60 % bilateral -peripheral ulcerative keratitis
-tidak di terapi  severe visual morbidity and even -uveitis
loss of the eye -glaucoma
-hypotony
Gejala: -perforation of the sclera
-Gradual onset of pain becomes severe and
persistent  menjalar ke temporal,
alis/rahangsering mengganggu tidur dan respon
terhadap analgesik jelek

Posterior scleritis:
Bermanifestasi sebagai nyeri yang disertai penurunan penglihatan,
dengan sedikit atau tanpa kemerahan
Diagnosis:
didasarkan pada deteksi penebalan sklera posterior dan koroid
dengan USG atau CT scan
Treatment of immune-mediated scleritis:
-Topical steroid relieve symtomps and oedema in non-necrotizing disease
-Systemic NSAIDhanya untuk yang non-necrotizing disease
-Periocular steroid injections
-Systemic steroids
-Immunsuppresives

Infectious scleritisjarang
Penyebab :
-Herpes zooster
-Tuberkulosis
-Leprosy
-Syphilis
-Lyme disease
-Penyebab lain ( jamur,pseudomonas seruginosa dan nocardia)

Tatalaksana:
-Spesific antimicrobial treatment
-Topical and systemic steroid  untuk mengurangi inflamasi
Pterigium

Jar. Fibrovaskular, berbtk triangular

dgn apeks di kornea, “thick & flesh
wing”

Etiologi :
•Debu, angin, mata kering, & iritasi
•Proses degenerasi akibat paparan
sinar UV ber>an pd mata

SS :
•Mata merah
•Tajam penglihatan N
•Jar. Fibrovaskular konjungtiva
tumbuh scra abnormal berbtk spti
sayap
•Ggg penglihatan

Terapi :
•Lubrikan topikal  pembedahan
Pinguecula

Tampak spti nodul kuning pd kedua sisi kornea (>

byk di nasal) di daerah apertura palpebrae

>> org dewasa

Nodul : jar hialin & jar elastik kuning,

jrg bertumbuh besar, tpi sering
meradang

Terapi :
•X perlu
•Steroid lemah topikal :
prednisolone 0,12%
•NSAID
 Perdarahan •Patch merah yg terdpt pd konjungtiva
subkonjungtiva •Mata merah yg tjd akibat pecahnya P.D yg terdpt di bwh lap.
konjungtiva

Etiologi : SS :
•Spontan •Bercak merah
•Trauma ringan •Terasa mengganjal
•Aktivitas yg terlalu berat •Perdarahan tanpa nyeri
•HT/ kelainan PD

Diagnosis :
•Anamnesis
•Pem. Tekanan darah
•Funduskopi
•Eksplorasi bola mata

Tatalaksana :
Kompres hangat
Endoftalmitis Peradangan supuratif intraokular yg melibatkan
segmen anterior & posterior mata

Etiologi : FR :
•Pasca-operasi •E. pasca-operasi
•E. Akut pasca0operasi : •Pra-operasi
Staphylococcus aureus koagulase (-), •Intra-operasi
Streptococcus sp., & Gram (-) •E. Endogen : DM, imunokompremais, keganasn
•E. Kronis : Porpionibacterium acne,
Staph. Koagulase (-), & jamur Pem. Mata :
•Endogen Segmen anterior :
•Gram (+) •Pembengkakan & spasme kelopak mata
•Gram (-) •Konjungtiva hiperemis, khemosis &
MK : edema kornea
Diagnosis :
•↓ tajam penglihatan •Bilik mata depan : sel (+), flare (+), fibrin
•Anamnesis
•Mata merah & hipopion
•PF
•Floaters Segmen posterior :
•PP : Biakan
•Fotofobia •Kekeruhan vitreus
kuman
•Nyeri •Nekrosis retina

Talak :
•Pasca operasi / pasca trauma : injeksi antimikroba (AB & antifungal) intravitreal & virektomi
•Endogen : antimikroba sistemik, virektomi & antimikroba intravitreal
 Inf. Kelenjar di
Hordeolum •H. Interna : pembengkakan besar cth: kel. Meibom
palpebra
•H. Eksterna : > kecil & > superfisial cth : kel. Zeis .
Etiologi : Moll
•Staph. aureus
Talak :
Gejala : •Kompres hangat 3-4x/hari slma 10-15 mnt
•Nyeri •Insisi & drainase bahan purulen
•Merah •Salep AB pd saccus conjungtivalis stiap 3 jam
•Bengkak

Hordeolum eksterna
 Kalazion

Radang granulomatosa kronik yg

steril & idiopatik pd kel. Meibom

Pembengkakan setempat yg terasa

sakit & berkembang dlm bbrpa
minggu

Awal : Radang ringan, nyeri tekan yg

mirip hordeolum

Pem. Histo :
Proliferasi endotel asinus & respons
radang granulomatosa yg melibatkan
sel2 kel. jenis Langerhans

Talak :
•Eksisi bedah  kuretase materi
gelatinosa & epitel kelenjarnya
•Penyuntikan steroid intralesi  lesi
kecil
 Blefaritis Radang bilateral kronik yg umum di
Anterior tepi palpebra

2 jenis :
•Stafilokok (ulseratif) : Staph. aureus/ Staph. epidimidis
•Seboroik (non ulseratif) : Pityrosporum ovale

Gejala : Campuran 
•Iritasi kronik slg bbrpa
•Rasa terbakar blan/ thun klo tdk
•Gatal diobati
•Mata yg terkena “bertepi merah”
•Byk sisik mggantung di bulu mata
•Tipe stafilokok : sisiknya kering, palpebra merah,
ulkus2 kecil di spjg tepi palpebra & bulu mata rontok
•Tipe seboroik : sisik berminyak, tdk tjd ulserasi, &
tepian palpebra tdk bgtu merah
•Tipe campuran : kedua sisik ada, tepian palpebra
merah & mgkn berulkus

Talak :
•Harus dibersihkan
•Stafilokok : AB/ salep mata sulfonamide 1x/hari
 Blefaritis
Peradangan palpebra akibat disfungsi kel. Meibom
Posterior

Kronik & bilateral

•Perubahan kel. Meibom :

•Meibomianitis
•Sumbatan muara kel. olh sekret yg
kental, pelebaran kel. Meibom dlm
lempeng tarsus
•Keluarnya sekret abnormal lunak
mirip keju bila kel. Dipencet
•Tepi palpebra : hiperemis & telangiektasia
•Palpebra membulat & menggulung ke dlm
•Air mata mgkn berbusa/ sgt berlemak
•Kornea  vaskularisasi perifer & mjd tipis
trtma di inferior

Talak :
•AB sistemik : doxycycline 100mg 2x/hari
•Steroid topikal lemah : prednison 0,125%
2x/hari
Dakrioadenitis Radang akut kel. lakrimal

•>> anak2 : komplikasi parotitis, infeksi

virus Epstein Barr, campak, / influenza
•Dewasa : gonore

Kronik :
•Infiltrasi limfositik jinak, limfoma,
leukemia, / tuberkulosis

MK :
•Nyeri hebat
•Pembengkakan
•Pelebaran PD tjd di aspek temporal
palpebra superior

Talak :
•AB sistemik
Dakriosistitis Infeksi saccus lacrimalis

•Bayi •Unilateral
•Wanita menopause •Sllu sekunder

•Akut : Stap. aureus/ Strep. β hemolyticus

•Kronis : Strep. Pneumoniae / Candida
albicans

Gejala :
•Berair mata
•Belekan
Akut :
•Gjla rdang, sakit, bengkak & nyeri tekan
Kronik : berair mata

Terapi :
•Akut : AB sistemik
•Kronik : AB tetes
•Dakriosistorinostomi

Kronis : ↑ risiko tjd endoftalmitis

pascaoperasi katarak
 Peny mata yg disebabkan oleh
Xeropthalmia
kekurangan asupan vit. A yg mrpkn
manif. akhir dri defisiensi yg parah
Gejala :
•Blindness (nyctalopia)
•Discomfort
•Loss of vision
Konjungtiva :
•Xerosis  keringnya konjungtiva di interpalpebral
•Bitot spots  triangular patches of foamy
keratinized epithelium
Kornea :
•Lustreless appearance due to socondary xerosis
•Bilateral punctate corneal epithelial erosions in the
inter palpebral  defects
Keratinization :
•Sterile corneal melting by liquefactive necrosis
(keratomalacia)  perforasi
Terapi :
Sistemik : Oral/ IM vit A, Suplemen multivit. & mknn
vit. A
Lokal : Lumbrikasi, Asam retinoid topikal,
Manajemen perforasi
 Peradangan lokal jar ikat vaskular penutup sklera yg
Episkleritis
relatif srg dijumpai
•Org muda : dekade ke3/4 Jinak & smbuh sendiri
•P : L = 3 : 1 dlm 1-2 mggu
•2/3  unilateral

Gejala :
•Kemerahan
•Iritasi ringan
•Rasa tdk nyaman

Pem. Mata :
•Injeksi episklera : nodular,
sektoral / difus
•Tdk ada peradangan /
edema pd sklera di bwhnya

Talak :
•Airmata buatan penyejuk
stiap 4-6 jam
•+ kelainan : doxycycline
100 mg 2x/hari dll
 Ditandai dgn infiltrasi selular, destruksi
Skleritis
kolagen & remodelling vaskular

•Perubahan  diperantai proses imun / infeksi

•Trauma lokal  proses peradangan

•>> bilateral
•P >> L
•Dekade ke5/6

MK :
•Nyeri : berat, konstan & tumpul 
terbangun malam hari Skleritis posterior :
•Ketajaman penglihatan sdkt ber(-) •Nyeri
•TIO sdkt ↑ •↓penglihatan
•Sdkt / tanpa
Tanda : kemerahan
Bola mata warna ungu gelap

Talak :
•NSAID sistemik : indometasin 75mg/hari /
ibuprofen 600mg/hari  X  prednisone oral
0,5-1,5 mg/kg/hari
•Cyclophospamide
•AB
 Glaukoma
Akut Etiologi :
Blokade aliran aqueous  ↑
TIO scra mendadak

Klasifikasi : DD :
•Tersangka sudut tertutup •Iritis akut
•Sudut tertutup primer •Konjungtivitis akut
•Glaukoma sudut tertutup primer

MK : Talak :
•↓ tajam penglihatan mendadak •Asetazolamid 500 mg IV
•Mata merah, berair & fotofobia •Apraclonidine 1% timolol
•Tampak halo apabila pasien mlhat 0,5%, prednisolon 1% /
sumber cahaya deksametason 0,1%
•Nyeri yg luar biasa, mual, & muntah •Pilokarpin 2-4%
•↑ TIO •Analgesik & antipiretik
•Injeksi silier & konjungtiva hiperemis
•Edema epitel kornea & kornea keruh
•Pupil terdilatasi, oval vertikal, tdk
reaktif
•Mata kontralateral  sudut bilik mata
depan dangkal
 LASERASI KELOPAK
• Trauma tajam atau tumpul yang keras dapat merusak kelopak
secara luas sehingga terjadi kelainan berupa laserasi kelopak.
• Laserasi dapat disertai dengan kerusakan kanalikuli lakrimal
yang merupakan saluran ekskresi sistem lakrimal mata.
• Adalah penting diperhatikan bahaya dari hilangnya
bagian kelopak yang dapat mengakibatkan
hilangnya lindungan bola mata terhadap dunia luar.
• Pada keadaan ini diperlukan penutupan segera bola
mata yang tidak terlindung oleh kelopak.
 DAFTAR PUSTAKA
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ophthalmology. 18th ed. New York: The McGraw-Hill Companies,
Inc.; 2011.
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Medical Series.
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pathologic basis of disease. 9th ed. Philadelphia: Saunders
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