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ORBITA
ORBITA Piramid Bola mata Saraf Otot Jaringan lemak
40 mm35 mm
40 mm
30 cc
Dinding Orbita :
Atap orbita Os frontale Os Sphenoid ala parva Berhubungan : Fossa kranii ant Sinus frontalis Dinding lateral Os Zygoma Os frontale Os Sphenoid ala magna Berhubungan : Fossa kranii media Fossa pterygopalatina
Dinding medial Os Ethmoid Os Frontale Os Lakrimal Os Maksila bgn frontal Berhubungan : Sinus Ethmoid &
Sphenoid Kavum nasi
Dasar orbita Os Maksila Os Palatina Os Zygoma Berhubungan : Sinus maksila Rongga tulang
palatina
Jaringan Lunak Rongga Orbita
Peri orbita Periost Kanal Optik Duramater Anterior Septum orbita
N.Optika Diselubungi Selubung otak
Otot ekstra okuler Diselubungi Fascia, Ligamen dan jar ikat.
Jar lemak Kel lakrimal Pemb.darah ( art & vena ) + saraf
Bulbus Okuli Jar orbita
Art/vena ophthalmika ( + Cabang )
Saraf : optik,III,IV,VI dan perifer
Dinding orbita keras/kaku
Perub isi orbita
Proptosis / Eksophthalmos
Kelainan orbit
• Orbit dangkal• Orbit dalam• Fraktur orbit• Tumor orbit• Radang/infeksi orbit (cellulitis orbita)• Enophthalmos• Exophthalmos• Graves’ ophthalmology
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Anatomi dan Faal Otot Ekstra Okuli
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Pergerakan bola mata dilakukan oleh 6 pasang otot ekstra okuli yaitu :
OtotCara Kerja
NervusPrimer Sekunder Tertier
Rektus medial adduksi - - IIIRektus lateral abduksi - - VIRektus superior elevasi intorsi adduksi IIIRektus inferior depresi ekstorsi adduksi IIIOblikus superior intorsi depresi abduksi IVOblikus inferior ekstorsi elevasi abduksi III
Duksi (monocular movement) mata kanan. Tanda panah
menunjukkan arah gerakan mata dari posisi primer
Anatomi Palpebra
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Anatomi Palpebra
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Anatomi Palpebra
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Anatomi Palpebra
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Fungsi :– Melindungi bola mata
– Pembilasan dan pelicinan• Air mata
• Sekresi kelenjar
– Jalan masuk sinar ( fissura palpebra )
– Berkedip – menyingkirkan debu / kotoran yang masuk
KELOPAK MATA
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Menutup mata :
- Otot orbikularis okuli – N. VII ( N. Facialis )
Membuka mata :
- Otot levator palp – N. III ( N. Okulomotor )
Otot tarsalis memegang tarsus
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Otot – otot orbikularis preseptal dan pretarsal
origo diatas fascia kantong/sakus lakrimalis
bila kontraksi ekskresi lakrimalis ke d.n.l
Otot levator palpebra n.III- Aponeurosisnya insersi kepermukaan ant. tarsus & kulit
- Fungsi : mengangkat kelopak mata
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Infeksi dan Radang ke Kelopak Mata
1. Hordeolum Infeksi stafilokokus
Tanda – tanda infeksi +
Interna : kelenjar meibom Relatif besar
Eksterna : Kelenjar Zeiss dan moll. Kompres hangat, drainage, salep antibiotika
Kx. Sellulitis
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2. Khalasion
Radang steril granulomatus kelenjar meibom
Biasanya pembengkakan mengarah ke sisi konj.
Khalazion yang besar menekan kornea astigmatism
Tanda radang (-)
R/. drainage
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LENSA
BiconvexAvascularTransparanTebal 4mm, diameter 9 mmAnt : humor akuosPost : vitreousPosisi : lig suspensorium (zonula) zinn
ANATOMI MATA & LENSA
ISI LENSA
65% air35% Protein, mineral, glutation, Potasium, Ascorbid acid, dllTidak ada syaraf nyeri, pembuluh darahNutrisi : cairan intraokuler
KATARAK
1. Developmental : Katarak Kongenital Katarak Juvenil
2. Degeneratif : Katarak Senil3. Komplikata : Katarak karena :
Uveitis, DM4. Trauma : Katarak Traumatika
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ANATOMI FISIOLOGI LENSA?
• Clouding of the normally clear lens of the eye.
Healthy lens Lens with a cataract
• Can be compared to a window that is frosted or yellowed.
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What is a Cataract ?
• A clear lens refracts light onto the retina and fine-tunes our focusing ability.
• A cloudy lens prevents light from focusing sharply on the retina.
• VITREOUS– Transparent gel structure that fills the posterior cavity of the
globe
• OPTIC NERVE HEAD (N II) – Round, ǿ 1.5 mm, C/D ratio
• NEUROSENSORY RETINA– Transparent– Why orange ?? pigment from melanocytes of the choroidal
stroma and retinal pigmented epithelium (RPE)
• RETINAL VESSEL– Artery: Straight,white reflex– Vein : Darker, turtous– A/V ratio : 2/3
• FOVEA – Central retinal depression, ǿ 1.5 mm ( 1 DD)– Ophthalmoscopically : light reflex– Darker than surroundings
(FAZ,melanin,xantophyl)– Fovea avascular zone (ǿ 0.5 mm)
Basic Anatomy
The Vitreous
• Vitreous contains water (99%), collagen, hyaluronic acid
• Vitreous base : straddles the ora serrata
• Vitreous body : central & cortex vitreous
• Outermost part of the vitreous (hyaloid) : Vitreous cortex, divided into anterior cortex & posterior cortex
The Vitreoretinal Interface
• Posterior vitreous cortex attached to the retina at internal limiting membrane (ILM)
• Young individual : strong adhesion
Diseases of the vitreous
• Vitreous hemorrhage– Traumatic– Non traumatic :
• Diabetic retinopathy• Retinal break• Posterior vitreous
detachment• Retinal
neovascularization– Tx :
• Bed rest• Vitrectomy
Vitrectomy
Diseases of the vitreous
• Posterior Vitreous Detachment (PVD) Age ↑ vitreous
liquefies, loss of hyaluronic acid loss of gel volume contractile force
Detachment
Diseases of the vitreous
• Asteroid hyalosis – Minute white
opacities– Calcium-containing
phospolipids– Relationship :
Diabetes & hypertension (+)
• Tx :– Vitrectomy
The Retina
• Thin membranous structure that lines the posterior aspect of the eye
• Divided : central zone & peripheral zone• Retinal base : anterior ora serrata posterior N II• Retinal cells are stratisfied in 10 layers
Ten Layers of The Retina
1. Internal limiting membrane2. Nerve fiber layer3. Ganglion cell layer4. Inner plexiform layer5. Inner nuclear layer6. Outer plexiform layer7. Outer nuclear layer8. Photoreceptor cell (rod &
cone)9. Retinal pigment epithelium
(RPE)10. Bruch membrane
Photoreceptor Cells
• ROD– 92 million– Perifer >>– Scotopic vision
(vision in dim light)
• CONE– 5 million– Central >>– Photopic vision
( vision in bright, color)
Rod & Cone Cortex 17,18,19
Bipolar cells Lateral corpus geniculatum
Ganglion cells Optic tract
Optic nerve Chiasma
Retinal Pigment Epithelium
• Single layer of hexagonally shaped cuboidal cells, lying between Bruch’s membrane & retina
• Contributes to retinal function :– Absorbs light– Maintain subretinal (RPE-fotoreceptor)
space– Phagocytosizes rod & cone outer segment– Forms the outer blood-ocular barrier– Retinol (vit A) metabolisme
• BRUCH’S MEMBRANE– Basal portion of the RPE– Throughout life, lipids & oxidatively damaged
materials build up between Bruch’s membrane
• CHOROID– Richly vascularized– Enveloping the retina & RPE
Blood Suply to the Retina
• Two sources :– Central retinal artery
• 2/3 inner retina
– Choroidal blood vessels (65-85%)
• 1/3 Outer retina (particularly photoreceptor)
• Fovea avascular zone– Choroidal blood
vessels
The Macula
SYNONIM : • Posterior pole• Macula lutea• Central retina• Area centralis
The Macula• Histologic Definition
– Contains two / more ganglion cell layers
– It contains xantophyll pigment
• (Clinical observation size)– Round area at posterior
pole, ǿ 5.5 mm (3.5 DD)– 4 mm temporal, 0.8 mm
inferior to the center of the optic disc
MakulaFovea
The Fovea• Synonim : Fovea centralis• Histologic definition :
– Depression in the inner retinal surface
– Photoreceptor layer which is entirely cones
– RPE : taller, melanosome ↑
• Clinical observation :– Concave central
retinal depression – ǿ 1.5 mm (1 DD)
Cross-section of Fovea
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