anatomi dan fisiologi mata 2

2

3

4

5

6

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

14

Anatomi dan Faal Otot Ekstra Okuli

16

17

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

20

Anatomi Palpebra

21

Anatomi Palpebra

22

Anatomi Palpebra

23

Fungsi :– Melindungi bola mata

– Pembilasan dan pelicinan• Air mata

• Sekresi kelenjar

– Jalan masuk sinar ( fissura palpebra )

– Berkedip – menyingkirkan debu / kotoran yang masuk

KELOPAK MATA

24

Menutup mata :

- Otot orbikularis okuli – N. VII ( N. Facialis )

Membuka mata :

- Otot levator palp – N. III ( N. Okulomotor )

Otot tarsalis memegang tarsus

25

26

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

27

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

28

29

2. Khalasion

Radang steril granulomatus kelenjar meibom

Biasanya pembengkakan mengarah ke sisi konj.

Khalazion yang besar menekan kornea astigmatism

Tanda radang (-)

R/. drainage

30

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

35

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.

36

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