DETEKSI DINI RESIKO

PENYAKIT MATA PADA

DOKTER KELUARGA
 DOKTER KELUARGA
• Penyelenggara pelayanan kesehatan personal,
tingkat pertama, menyeluruh,dan
berkesinambungan kepada pasien yang terkait
dengan keluarga, komunitas serta lingkungan
dimana tempat pasien itu berada (Singapore
College General Practitioners, 1987)
• Deteksi dini, mengenali lebih awal resiko penyakit
mata, sebelum menjadi keadaan bertambah
buruk, (preventif) sesuai kompetensi ( SKDI 2012)
• Inflammatory or infectious nodules that develop
in the eyelid
• Most frequently  inspissation or secondary
infection of sebaceous glands
• Those occuring in the anterior eyelid in the
gland of zeiss or lash follicles  external
hordeolum
• Those occuring in the posterior eyelid from
meibomian gland inspissation  internal
hordeolum
• Usually caused by Staphylococcus aureus
• Clinical presentation:
- Painful, tender, red nodular masses near the
eyelid margin
- They may rupture  purulent drainage
- Generally self limited, improving
spontaneously in 1-2 weeks
• Management:
- Warm compress with massage over the
lesion
- Topical & systemic AB  not really
necessary
- Incision and drainage  in persistent lesion
Hordeolum

9
• Localized lipogranulomatous inflammation
involving either meibomian or zeiss glands
• Develop slowly and are typically painless
• Management:
- Hot compress
- Attempted expression of the inflamed
meibomian gland
- Intralesion injection of steroid  in lesion
that fail to respond conservative therapy
- Incision drainage  persistent lesion
KALAZION

11
 Episcleritis
• Acute, benign, usually idiopathic, recurrent
and frequently bilateral condition.
• Usually self-limiting, attacks typically lasts a
few days
• Adult > children
• Classifications :
– Simple episcleritis
– Nodular episcleritis
 Simple Episcleritis
• ¾ cases, predominantly affects females
• Great tendency to recur
• Presentation :
– Redness, mild discomfort
• Signs :
– Redness maybe sectoral or diffuse
– The attack often reaches its peak within 12 hours and
then gradually fades the next few days
– Often flits from one eye to the other or may be
bilateral
Simple sectorial episcleritis Simple diffuse episcleritis
 Treatment
• Self-limiting benign disease, frequently
doesn’t need any treatment
• If severe or prolong enough : topical steroid 1-
2 weeks
– Benefit over topical NSAID and topical lubricants
• Systemic th/ :
– Oral NSAID such cyclo-oxygenase inhibitor,
fluribiprofen 100 mg for 10 days
– Less morbidity
• Less common cause in adult
conjunctivitis
• The source of infection is either direct
contact with an infected individual’s
secretion or the spread of infection from
the organism colonizing the patient’s
own nasal and sinus mucosa

• Clinical presentantion:
- Rapid onset
- Conjunctival inflammation & purulent
discharge
Clinical classification of bacterial conjunctivitis
• Management:
- Topical antibiotic  definitive
treatment should be based on culture
results
- Systemic antibiotic  gonococcal
conjunctivitis
Bacterial Conjunctivitis
• Clinical presentation :
- Bleeding spot
- Hyperlacrimation
- Secretion minimal
- Follicle in upper tarsal conjunctiva

• Management :
- Hygiene
- Artificial tears
- Antibiotic  secondary infection
Viral Conjunctivitis
• Age 5 – 25 yo
• Types: palpebral type and limbal type
• Symptoms :
- Itchy
- Usually recurrrent in summer
• Signs :
- Bilateral inflammation
- Follicles, papil, cobblestone in upper
tarsal conjunctiva
- Trantas dots in limbal cornea
• Management:
- Avoid outdoor activities, especially in
summer
- Cold compress
- Steroid topical in acute phase
- Topical antihistamine
- Topical mast cell stabilizer
- Injection steroid in tarsal conjunctiva
 severe case
Palpebral Type Vernal Keratoconjunctivitis
Limbal Type Vernal Keratoconjunctivitis
 Scleritis
• Characterized by oedema and cellular infiltration
of the entire thickness of the sclera
• Much less common than episcleritis
• Classifications :
– Anterior :
• Non-necrotizing : diffuse, nodular
• Necrotizing with inflammation : vaso-occlusive,
granulomatous, surgically induced
– Scleromalacia perforans
– Posterior scleritis
 Treatment
 First line treatment : Corticosteroid such prednisolone
 Administered in high doses either orally or intravenously to
achieve disease remission
 Oral corticosteroids started at high doses between 60-
80mg/day in adults then tapered to an acceptable
maintenance dose.
 Intravenous corticosteroids are used when rapid remission is
required for patients with necrotising scleritis with potential
globe perforation.
 Immunosuppressive agents are indicated for patients
with severe scleritis, in situations where corticosteroids
are inadequate to control disease or when the dose is
too high to be tolerated for long term treatment
Hyphema
• Results from injury to the vessels of
peripheral iris or anterior ciliary
body
• Anterior segment bleeding 
penlight examination  layering of
blood in the inferior anterior
chamber
• Sometimes, the bleeding is so subtle
 few circulating RBC in anterior
chamber  slitlamp examination 
microscopic hyphema
Total hyphema
• Hyphema grading:
- Grade 1: Layering of blood < 1/3 in
the anterior chamber
- Grade 2: Layering of blood 1/3-1/2
in the anterior chamber
- Grade 3: Layering of blood 1/2-2/3
in the anterior chamber
- Grade 4: layering of blood >2/3 in
the anterior chamber
• The major concern after traumatic
hyphema  rebleeding (secondary
hemorrhage)
• Rebleeding may complicate any
hyphema, regardless of size & occurs
most frequently between 2 & 5 days after
injury
• The timing of rebleeding  related to the
lysis & clot retraction that occur during
this period
• Complication associated with rebleeding:
- Glaucoma
- Optic atrophy
- Corneal blood staining (corneal
imbibisio)
Corneal blood staining
after traumatic hyphema
• Combination of elevated IOP,
endothelial dysfunction & anterior
chamber blood  corneal blood
staining

• Management:
- A protective shield of the injury eye
- Moderate restriction of physical
activity
- Elevation of the head of the bed
- Frequent observation
• Medical management :
- Topical cycloplegic agent
- Antifibrinolytic agent
- Topical corticosteroid
- Avoid aspirin and NSAID  increased
the risk of rebleeding

• Surgery management (to evacuate

blood)  to prevent irreversible
corneal blood staining & optic atrophy
from persistenly elevated IOP
Dry Eye Syndrome
Symptoms mSymptoms
• Discomfort
• Increased blinking
• Foreign body sensation (~punctate epithelial
keratopathy)
• Burning
• Dry sensation
• Photophobia
• Blurred vision
• Worse toward the end of day, with
prolonged use of eyes, with exposure to
environmental extremes
 Management
• Mild
– Artificial tears, preservative-free
– Change/discontinue topical and
systemic medications associated
– Smoking cessation
– Warm compress with eyelid massage
~bolster lipid layer
• Severe
– Punctal occlusion
– Lateral tarsorrhaphy
Anterior segment complications of blunt trauma

Hyphaema Sphincter tear Iridodialysis Vossius ring

Cataract Lens subluxation Angle recession Rupture of globe

• Hematom palpebra

• Subconjunctival bleeding
Dislokasi lensa
• Ruptur kornea dengan
prolaps iris

• Katarak traumatika
Ruptur Palpebra + Prolaps iris
 Corpus Alienum di
Kornea dan Konjungtiva

• Irigasi dengan larutan isotonis

Penatalaksanaan • Ekstraksi corpus alienum
• Erosi kornea

• Korpus alienum di kelopak

mata atas
• Korpus alienum
(plastik)
• EKSTRAKSI KORPUS ALIENUM
(menggunakan spatula)
 • trauma akibat benda
Trauma tajam/benda asing yg masuk
mekanik ke mata, seperti; serpihan
kaca, logam, percikan proses
;Tajam pengelasan dan peluru.
 • Penurunan tajam
penglihatan dari
ringan sampai buta
Tanda • Kerusakan organ
tergantung bagian
dan mata yg terlibat dan
beratnya trauma,
Gejala • Mengenai Orbita ,
fraktur
saluran lakrimal; ruptur  gangguan sistem eksresi alir mata

Konjungtiva ; perdarahan subkonjungtiva , robekan

konjungtiva, CA

Kornea , erosi – ruptur partial / full thicknes, CA

Jika trauma mekanik hebat  destroyed eye

Penatalaksanaan; Awal (dilokasi kejadian)

• Mata tidak boleh dibebat dan di lindungi tanpa kontak, (

dope mata)
• Hindari manipulasi yg berlebihan d penekanan bolamata
• Benda asing tidak boleh dikeluarkan
• Penderita dipuasakaantisipasi tindakan operasi

Penanganan di Rumah sakit ;

• Pemberian AB spektrum luas ( non steroid)

Penanganan di Rumah sakit ;
• Pemberian AB spektrum luas ( non steroid)
• Pemberian analgetik dan sedasi ( bila perlu)
• Pemberian toksoid tetanus
• Pengangkatan benda asing, tidak berhasil 
tind, pembedahan
Trauma kimia asam ; bahan
kimia pH < 7
• Mis; cuka, H2SO4,HCL,HNO3,
CH3COOH,

Trauma kimia basa/alkali

• Mis; sabun cuci, detergen, kapur,
bahan pembersih lantai, lem
perekat
 Tanda dan gejala :

Pada trauma kimia

• kekeruhan kornea akibat terjadi koagulasi
protein epitel kornea

Pada trauma kimia basa

• Terjadi proses penyabunan, ( proses terus
berlangsung dan penetrasi ke dalam bola mata)
Trauma kimia asam kuat berkonsentrasi tinggi (cuka para)
ODS
PENATALAKSANAAN
• Irigasi dengan cairan fisiologis / air bersih
2 Liter selama 15-30 menit, sampai pH
netral  untuk mengeliminasi bahan
kimia
• Penilaian gradasi ( Huges)
 Grading of severity of chemical injuries
Grade I (excellent prognosis)
• Clear cornea
• Limbal ischaemia - nil

Grade II (good prognosis) Grade III (guarded Grade IV (very poor

prognosis) prognosis)

• Cornea hazy but visible • No iris details • Opaque cornea

iris details
• • Limbal ischaemia > 1/2
Limbal ischaemia - 1/3 to 1/2
• Limbal ischaemia < 1/3
• Pemberian obat topikal;
– Antibiotik
– Sikloplegik
– Anti glaukoma ( mencegah glaukoma sekeunder)
– Steroid ( 7 hari pertama)- anti inflamasi
– EDTA
– Artifisial Tear
• Oral vitamin C
• Pemasangan bandage contact lens
• Tindakan operatif – kumbah BMD sp keratoplasti jika terjadi kekeruhan
kornea yg permanen
 TRAUMA FISIS

• Trauma thermal
– mis: panas api, listrik, sinar Las, sinar matahari
• Trauma bahan radio aktif,
– mis: sinar radiasi ( radio logi )
Glaukoma Akut
• Kondisi mata dengan peningkatan
tek bolamata yang mendadak
disertai mata merah dan nyeri
serta adanya penurunan visus
• Penderita disertai keluhan sakit
sekitar mata dan terkadang kepala
disertai mual bahkan muntah
• Penderita dirawat
• Tekanan Bolamata (TIO) di turunkan dg obat obatan dan evaluasi TIO
/jam:
• Medikamentosa:
– Karbonik anhidrasi ( diamox) oral 250 ( 3-4) ;
– KCL tab 2x 500 mg
– Pilocarpin ( kornea sdh jernih)
– Timolol 0,5 % / betaksolol 0,5 % 2x 1 tetes
– Steroid topikal
• Cairan hiperosmotik
• Tindakan operatif ;Iridektomi atau iridotomi perifer (NdYag laser)
CRAO ( central retinal arteri oclusion)
• Salah satu sisebabkan penyakit vaskuler ,
berupa oklusi V.Retina central, ditandai dengan
penurunan tajam penglihatan yg berat,dan
mendadak,dan defek lap pandang, tidak nyeri
• Dekompresi bola mata
• Oklusi segera di hilangkan
• Obat Antiagregasi trombosit
• Injeksi intravitreal steroid &/ Anti VEGF
• Penyakit yang mendasari diobati juga
Traumatik optik neuropati ( TON)
• Penurunan tajam penglihatan yg mendadak paska
trauma pada kepala atau pada mata
• Gejala : Tajam penglihatan turun mendadak pasca
trauma, Gangguan lapang pandang, diplopia
• Terkadang mengalami perbaikan sendiri
• Pemberian steroid high dose
• Tindakan op; dekompresi orbital (orbital canal
decompresi)
TOKSIS NEUROPATI
• Penurunan tajam penglihatan pasca terpapar
bahan kimia, obatan tertentu
• Gejala; Penurunan tajam pengilhatan ,
terkadang disertai gangguan defek glaukoma
 Penatalaksanaan

• Eliminasi penyebab
• Steroid (high dose)
• Vitamin neurotropik