KELAINAN KORNEA

Blok Organ Indera

Dr. Artati Sri Redjeki Sp.M

Kornea
Jaringan transparan Dinding depan bola mata Jernih, tembus pandang Media refrakta Struktur teratur, deturgesen/dehidrasi relatif, pompa bikarbonat pada endotel Kerusakan endotel > epitel Epitel sawar terhadap mikroorganisme

Anatomi
Kornea: 1. Epithel 2. Membran Bowman 3. Stroma 4. Membran Decemet 5. endotel

Kelainan kornea
kongenital Peradangan

Infeksi Allergi Neuro paralitik lagoftalmos

degeneratif Pigmentasi Kekeruhan

Kelainan Kongenital
Mikro kornea Megalo kornea Sklero kornea Kornea plana keratektasia

Microcornea

Very rare, hereditary, unilateral or bilateral Corneal diameter is 10 mm or less Shallow anterior chamber but other dimensions are normal

Ocular associations
Glaucoma, cataract, cornea plana, leukoma and iris abnormalities

Associated systemic syndromes

Turner, Ehlers-Danlos, Weill-Marchesani and Waardenburg

Megalocornea

Very rare, hereditary, bilateral Corneal diameter 13 mm or more Very deep anterior chamber High myopia and astigmatism Occasionally lens subluxation

Systemic associations
Marfan, Apert, Ehlers-Danlos and Down syndromes Osteogenesis imperfecta Renal carcinoma and mental handicap

Sclerocornea

Very rare, usually bilateral Peripheral opacification and vascularization of cornea Scleralization makes cornea appear smaller

Kornea Plana
Sangat jarang Bilateral Kelengkungan minim Hipermetrop Kamera antor dangkal Sering terjadi glaukoma

Keratoconus

Keratectasia

Very rare, usually unilateral Severe corneal opacification and protruberance Probably caused by intrauterine keratitis

Degenerasi kornea
Keratokonus Arkus senilis Penyakit Terrien Keratopati pita <berkapur> Degenerasi Noduler Salzman Distrofi kornea

Epitel kornea Stroma kornea Membran posterior kornea

Arcus senilis
Innocuous and extremely common in elderly Occasionally associated with hyperlipoproteinaemia

Bilateral, circumferential bands of lipid deposits Diffuse central and sharp peripheral border

Peripheral border separated from limbus by clear zone Clear zone may be thinned ( senile furrow)

Fuchss Endothelial Dystrophy

Corneal Dystrophy Herediter

Band keratopathy
Common, unilateral or bilateral depending on cause Subepithelial calcification Progression

Interpalpebral limbal opacification Separated by clear zone

Central spread of calcification Small holes within calcified area

Peradangan

Keratitis

Superfisial

Ulserosa / epitelial Non ulserosa /sub epitelial

Profunda / stroma

Ulserosa Sentral perifer Non ulserosa

Endotelial

Infeksi kornea

Bakteri

Ulkus kornea pnemokokus Ulkus kornea pseudomonas Candida, fusarium, aspergillus

Jamur

Virus

Herpes Simpleks

Epitelial disciformis

Herpes Zoster / varicella zoster

Acanthamoeba

Gejala umum Keratitis

Keluhan

Visus turun Fotopobi, nyeri, rasa kelilipan Mata merah inj. Perikorneal Hiper / hipoesthesi Kornea edem Infiltrat Ulkus hipopion

Klinis

Keratitis Bakterialis
Onset 24 48 jam post inokulasi Ulkus berbatas tegas Warna kelabu, hipopion

Keratitis bakterial

Predisposisi

Penggunaan lensa kontak Penyakit kronis mata luar Hipoesthesi

Ulkus berbatas tegas Menyebar tak teratur Dari tepi ke sentral Antibiotika lokal & sistemis

Gambaran klinis

Terapi

Keratitis Fungi

Klinis

trauma bahan organik Ulkus putih ke abu2 an Infiltrat bentuk bulu Sering ada lesi satelit Hipopion

terapi

Anti jamur lokal & sistemik keratoplasti

Keratitis epitelial herpes simpleks

Ulkus

dendritik denganterminal bulbs tes fluorescein

Meluas

berbentuk geografik

Terapi
Salep mataAciclovir 3% x 5 daily Trifluorothymidine 1% tetes setiap 2 jam Debridemen bila tidak ada perbaikan

Keratitis disciformis herpes simpleks

tanda

Gejala tambahan.

edem sentralentral epithelial and stromal lipatan membrana Descemet keratik precipitat halus

sering disertai dengan cincin Wessely

Terapi

- Steroid topikal dengan anti viral

Herpes zoster keratitis

Acute epithelial keratitis Nummular keratitis

Develops in about 50% within 2 days of rash Small, fine, dendritic or stellate epithelial lesions Tapered ends without bulbs Resolves within a few days

Develops in about 30% within 10 days of rash Multiple, fine, granular deposits just beneath Bowman membrane Halo of stromal haze May become chronic

Treatment - topical steroids, if appropriate

Keratitis Parasit

Microfilaria

Keratoplasty

Lekoma Cornea

Protozoal Disease

Predisposisi

Pemakai lensa kontak cairannya

sakit tidak sesuai gejala Ulkus

indolen Cincin stroma Infiltrat perineural Chlorhexidine, paromomycin

Terapi

Leukoma Kornea dengan Neovaskularisasi

Abses Kornea dengan Hipopion

Komplikasi Penyembuhan
Sikatriks Nebula Makula lekoma Panus Stafiloma kornea Desmetocel Pseudo pterigium