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FARMAKOTERAPI PADA GANGGUAN
MATA
GENERAL PRINCIPLES OF TREATMENT
Drug treatment in ophthalmology is largely directed to one of the following approaches:
1. Reduction of inflammation by prompt and intensive treatment of microbial infection
2. Reduction of raised intraocular pressure3. Removal of an opacified corneal epitelium4. Physiological replacement of tear5. Intraocular fluid replacement
ANATOMI MATA
Lacrimal Apparatus
Normal aqueous flow
CATARACTS
• Is defined as any opacity in the crystalline lens of the eye
• Blindness
Causa:• Diabetes mellitus• Ultraviolet light• Trauma• Drugs• Age • Congenital • Ocular Surgery
Drugs
Chlorpromazine
• Long-acting mioticsOther drugs
• Amiodarone• Busulphan
- initially posterior subcapsularSystemic or topical steroids
- central, anterior capsular granules
Symptoms• blurred vision,which is usually worse
when viewing distant objects• cannot see so well in bright light and
might even be wearing a pair of dark glasses
• look double• the vision is much worse in bright
sunlight
Classification
Classification according to maturity
Immature Mature
Hypermature Morgagnian
Anterior polar cataract May be dominant inheritance
Capsular Pyramid
With persistent pupillary membrane
With Peters anomaly
Nuclear cataract
• Exaggeration of normal nuclear ageing change• Causes increasing myopia
• Increasing nuclear opacification
• Initially yellow then brown
Progression
Cortical cataract
Initially vacuoles and clefts Progressive radial spoke-like opacities
Progression
Subcapsular cataract
Anterior Posterior
Treatment:
1. To delaying the progression cataract.- Bendazac lysine 1 % ( eye drops )- Bendazac lysine 500 mg 3 times daily ( orally )2. Cataract surgery- Preoperative: To prevent constriction of the pupil
diclofenac ( topically )- Intraoperative: gentamicin ( inj. Subconjunctiva)- Post operative: corticosteroid ( topically ) + / - antibiotic ( topically),
: NSAID 1-4 weeks
Treatment:
3. Local anaesthetics:
- Bupivacaine 0.25 % - 0.75 %
- Lignocaine 1 %
- Mepivacaine 1 % - 2 %
- Etidocaine 1 %
GLAUCOMA• Associated with elevated intraocular
pressure (IOP )• Intra cranial pressure is set to the retinal
pressure• Optic disk cupping• Patient with IOP greater than 21 mm Hg
should be suspected of having glaucoma• the pressure of elevated IOP is not
synonymus with glaucoma,for example: tumor inside the brain.
IOP and Optic disc
GLAUCOMA
• Is characterized by:- The optic nerve damage is usually with elevated Intra Ocular Pressure ( IOP ) greater than 21 mm Hg- Visual field changes - Can cause blindness
• SignsThe three cardinal signs are:1. Raised intraocular pressure.2. Cupping of the optic disc.3. Visual field loss.
Etiology
Causa :
Age
Miopi
Heredity
Diabetes
Drugs
Classification of glaucoma
• Primary glaucoma:
1. Open angle
2. Closed angle
• Secondary glaucoma:
1. Open angle
2. Closed angle
• Congenital glaucoma
GLAUCOMA
OPEN ANGLE GLAUCOMA :
1.Pathological changes in the trabecular meshwork decrease the outflow of aqueous humour
2.The primary defect is reduced drainage of the aqueous humour into canal of Schlemm
GLAUCOMA
CLOSED ANGLE GLAUCOMA :
• Cause:1. The result from forward ballooning of the peripheral iris, it touches the back of cornea
2. The flow of aqueous humor between the cornea and the iris is reduced
Chronic open angle glaucoma (primer)
Symptoms:
No symptom
No visual acuity complaint
Peripheral visual field loss
- difficulty in walking
- can not see anything surround
Totally blind (end state)
Signs:
• Quiet eye
• Gonioscopy: normal
• Glaucomatous optic atrophy (CD > 0,6,disc hemorrhage)
• Glaucomatous visual field defects
• IOP > 21 mmHg
ACUTE ANGLE CLOSURE GLAUCOMA
(primer)
Symptoms :
Severe pain
Redness
Blurred vision
Nausea
Vomiting
Acute angle closure glaucoma(primer)
• Palpebral spasm• Conjungtival hyperemia• Corneal edema• Shallow anterior chamber• Pigment dispersion• Gonioscopy: closed angle• Optic nerve: hyperemic, edematous• Visual field: nonspecific constriction• High IOP (>21 mmHg)
Open angle sec.glaucoma (secunder)
• Uveitis
• Hipermatur lens
• Steroid
• Trauma
Symptom Acute or chronic
Closed angle secunder glaucoma
• Uveitis
• Subluxation/dislocation of lens
• Intraocular neoplasm
• Neovascularization of the angle
Symptom: acute glaucoma
Congenital glaucoma
• First year of life
• Photophobia
• Buphthalmos/enlarge eye globe
• Corneal clouding
• High IOP
Saluran pembuangan tidak sempurna
Glaucoma examination
Ophthalmoscopy (Optic nerve)
Tonometry (Intraocular pressure/IOP)
Gonioscopy (Anterior chamber angle)
Perimetry (Visual field)
Visual field loss in glaucoma
OphthalmoscopyOphthalmoscopy
Tonometry
TonometryPerimetry
Glaukoma
normal
GLAUCOMA THERAPY
Medical therapySurgery
• By decreasing aqueous prod / inflow
• By increasing outflow
• By destructing the ciliary body
• Filtration surgery
GLAUCOMA SURGERY
• Trabeculectomy to connect the anterior chamber with subconjuctival space
• Laser trabeculoplasty (Photocoagulator) making scar in trabeculum
• Gonioplasty/iridoplasty making scar in iris to open the iridocorneal angle
Management of open angle glaucoma
Management of angle closure glaucoma
INFECTION AND INFLAMMATION
OCULARACUTE CONJUNCTIVITIS
Conjunctivitis or inflammation on mucosa which covers the back part of the eye.
• Cause:Bacteria:
- Staphylococcus - Streptococcus pneumonia- Haemophhilus aegyptus
TREATMENT:
Sulfonamides - the first effective chemotherapeutic agent,- the prevention and cure of bacterial infection.
Side effects:- Patients with acid urine of the older sulfonamide are insoluble and may precipitate causing crystalling deposits can cause urinary obstructive.
Tetracycline - Active against bacteria and some micro organisms that
are resistant to cell-wall-active anti microbial agent
Side effects:- Gastrointestinal iritation,- Hepatic toxicity,- Renal toxicity,- Brown discoloration of the teeth.
DACRYOCYSTITIS
Begins with the closings of ductus nasolacrimal.
• Cause: Bacteria Streptococcus pneumonia
• Treatment:- Antibiotic ( orally and parenterally )- Decongestant nose drops
BACTERIAL CORNEAL ULCERS
• Cause:Viruses (Herpes simplex), fungi (Aspergillus, Candida spp), bacteria (Streptococcus pneumoniae)
• Treatment:- Antibiotics (topical)
BACTERIAL CORNEAL ULCERS
Mata normal
FUNGAL KERATITIS
The symptoms of fungal corneal ulcers are redness andsevere pain.
• Cause:- Candida sp- Aspergillus sp
• Treatment:- Amphotericin B 0.15 % ( drops ) every hour- Nystatin 100.00 U/ml( topically ) every two hour- Clotrimazole 1 % ( drops )
Treatment
- AMPHOTHERICIN B. 0,15% (drops), is one of a family of some 200 polyene macrolide antibiotics.
Side effects (rare):- Fever,- Chill.
- Nystatin 100.00 U/ml (topically), has the same mechanisms of action with amphothericin B.
Side effects (rare):
- Fever,
- Chill.
OPHTHALMIA NEONATORUM
It refers to acute conjunctivitis in the first 4 weeks in the life of a child.
• Cause:- Chlamydia- Bacteria:Neisseria gonorrhoeae (potentially leading to
blindness), S.aureus, S.pneumoniae, S.pyogenes, H. influenzae, Herpes simplex virus.
• Treatment:- Neonatus born to mother with active gonococcal: penicillin
G (i.m)- Chlamydia : Erythromycin 10 mg /kg BB. 3 x daily ( orally )
+ tetracycline (topically)
OPHTHALMIA NEONATORUM
TRACHOMA
Is an infection on conjuctiva or cornea caused by chlamydia trachoma
• Treatment:- Tetracycline (topical or systemic) 3 to 6 weeks- Erythromycin ( i.m ) once a week for three weeks
TRACHOMA
Treatment
Tetracycline - Active against bacteria and some micro organisms that are resistant to cell-wall-active anti microbial agent.
• Side effects:- Gastrointestinal iritation,- Hepatic toxicity,- Renal toxicity,- Brown discoloration of the teeth.
Erythromycin (taken orally), is usually bacteriostatics but can be bacteriocidal in high concentration.
Side effects:
- fever,
- eosinophilia,
- skin eruption.
VIRUS INFECTION
Viral lesion of the lids, conjunctiva and cornea can be caused by a number of different viruses: varicelal- zoster, herpes simplex vaccina
• Treatment- Iodoxuridine (topical), - Ganciclovir (systemic)
Treatment
- Iodoxuridine (topical), is an iodinated thymidine
analogue.
• Mechanisms of action: Inhibits replication of various DNA viruses,
including herpes viruses.
• Side effects:- Pain, - Pruritis, - Inflammation in the eye or eyelids
Ganciclovir (systemic), is an acyclic guanine nucleotide analogue. The agent has inhibitory activity against all herpes viruses especially CMV (Cito Megalo Virus)
• Mechanisms of action: Inhibits viral DNA synthesis.
• Side effects:- Pain, - Pruritis, - Inflammation in the eye or eyelids
Thank you