CASE REPORT PTERYGIUM

GANGGUAN KESEIMBANGANDISKUSI TOPIKHardy reinanda I 11108005ANATOMI SISTEM KESEIMBANGANFISIOLOGI SISTEM KESEIMBANGAN

SISTEM KESEIMBANGANAnatomy and histologyAlat vestibuler (alat keseimbangan) terletak di telinga dalam (Iabirin), terlindung oleh tulang yang paling keras yang dimiliki oleh tubuhLabirin terdiri atas labirin tulang dan labirin membran. Labirin membran terletak dalam labirin tulang dan bentuknya hampir menurut bentuk labirin tulang. Antara labirin membran dan labirin tulang terdapat perilimfa, sedang endolimfa terdapat di dalam labirin membran. Vaughan and Asburys, 2007VERTIGODefinisiEPIDEMIOLOGIKLASIFIKASIPATOFISIOLOGIDIAGNOSISTERAPIPROGNOSISDEFINISIVertigo adalah sebuah gejala yang mengacu pada adanya sensasi bergerak baik gerakan rotasional maupun gerakan linear yang sebenarnya tidak adaKelainan ini berhubungan dengan gangguan sistem keseimbangan tubuh.Ilyas, S. 2007EPIDEMIOLOGIBeberapa studi telah mencoba untuk menyelidiki epidemiologi dizzines, yang meliputi vertigo dan non-vestibular dizzines. Dizzines telah ditemukan menjadi keluhan yang paling sering diutarakan oleh pasien, yaitu sebesar 20-30% dari populasi umum. Dari keempat jenis dizzines, vertigo merupakan yang paling sering yaitu sekitar 54%. Pada sebuah studi mengemukakan vertigo lebih banyak ditemukan pada wanita dibanding pria (2:1), sekitar 88% pasien mengalami episode rekuren. KLASIFIKASIVertigo Vestibulera) Vertigo Periferb) Vertigo Sentral

Vertigo Non-vestibuler

PATOFISIOLOGIRasa pusing atau vertigo disebabkan oleh gangguan alat keseimbangan tubuh yang mengakibatkan ketidakcocokan antara posisi tubuh yang sebenarnya dengan apa yang dipersepsi oleh susunan saraf pusat.Ilyas, S. 2007Teori rangsang berlebihan (overstimulation) Teori Konflik SensorikTeori neural mismatchTeori OtonomikTeori Sinap

DIAGNOSISTERAPICLASSIFICATIONPATOPHYSIOLOGYSince the cornea is avascular, inflammatory process will not as effective and immediate as other well vascularized tissues. Wandering cell in corneal stroma will be the first immunologic cell which response to inflammatory process. It will become tissue macrophage. This process will then followed by vasodilatation of blood vessels in limbus (this will be seen as pericorneal injection). Infiltration of PMN, macrophages, and plasma cell will cause cornea looks cloudy. Ilyas, S. 2007PATOPHYSIOLOGYCorneal epithelium can be destroyed and form ulcer. Superficial ulcer will resolve perfectly, but the deeper one will leave scar. If the iris involved in this inflammatory response, Inflammatory cell will be accumulated in anterior chamber and can be seen as hypopion.

Ilyas, S. 2007Sign & SymptomsSymptomsRed EyesPhotphobiaPainBlurred visionForeign body sensation

SignCiliary injectionCornea abnormality (infiltrate, sikatriks, etc)Fluorescein test

Ilyas, S. 2007TreatmentPrinciple : according to the etiologyArtificial tearCyclopegicAnalgetic??Anti-inflammatoryPROGNOSISCan recover well if treated properly and appropriatelyNUMMULARIS KERATITISDEFINITIONETIOLOGYPATOPHYSIOLOGYCLINICAL FEATURESTREATMENT

DEFINITIONNummularis keratitis is a form of keratitis that characterized by groups of round infiltrates (nummus = coins) and demarcated edges. Nummularis keratitis usually chronic, often unilateral and were generally found at farmers who working in the rice fields The disease was first discovered by Dimmer in 1905.. Lesions, as shown below, large, round, and there are granular deposits just below bowman's membrane surrounded by haloPERDAMI, 2010 ; Kanski , 2007ETIOLOGYThe cause of keratitis nummularis is unknown exactly (Indonesian Ophthalmologist Association, 2010) Kanski (2010) and Yanoff (2009) says that the nummularis keratitis feature can be found on Herpes Zoster Ophthalmicus disease, Acanthamoeba infections, Onchocerca volvulus worm infection and Brucella infection.Lang (2002) and Reinhard (2006) says that the cause of keratitis are adenovirus nummularis.PATOPHYSIOLOGYHistopathological investigation of the biopsy revealed focal subepithelial infiltrates consisting of lymphocytes, histiocytes and fibroblasts is accompanied by disruption of the Bowman layer of collagen fibers. Pathogenesis of these infiltrates is most likely due to the constantly or continously viral replication in the keratosit which located at subepithelial layer that trigger the immunological reactions in the patient's bodyHillenkamp, et al. 2006CLINICAL FEATURESIn the beginning, there was ciliary injection, pain , and watery eyes; within 5-14 days will be followed by photophobia and round subepithelial infiltration It is usually chronic, unilateral. Multiple round infiltrates contained in the superficial layers of the cornea, usually does not cause ulceration Biswell, 2010 ; PERDAMI, 2010CLINICAL APPEARANCE

Kanski, 2010TREATMENTLocal corticosteroids on the keratitis nummularis give good results which is marked by the loss of inflammatory infiltrates and lacrimation, but absorption occurs in a long time, can be one to two years

Opthalmologist Association of Indonesia,2010REFERENCESBangun, CYY., 2009, Prevalensi Kebutaan Akibat Kelainan Kornea di Kabupaten Langkat, Universitas Sumatera Utara, Fakultas Kedokteran, Sumatera Utara, (Tesis).Biswell, R., 2010, Kornea. Di dalam: Whitcher, JP. dan Riordan-Eva, P. (eds), Oftalmologi Umum Vaughan dan Asbury, Edisi 17, Pendit, BU. (alih bahasa), EGC, Jakarta, hal. 125-149.Gartner LP, Hiatt JL. 2007. Color Textbook of Histology. New York: WB Saunders, Hillenkamp, J.; Sundmacher, R. and Reinhard, T., 2006, Treatment of Adenoviral Keratoconjunctivitis. In: Reinhard, T. and Larkin, DEP., Essentials in Ophthalmology: Cornea and External Eye Disease. Springer, Germany, pp.163-172.Ilyas S., 2000, Sari Ilmu Penyakit Mata., Balai Penerbit FKUI, Jakarta, hal. 41-62. REFERENCESIlyas S. 2007. Ilmu Penyakit Mata edisi ketiga. Jakarta: Balai Penerbit FKUI,Kanski, JJ., 2010, Signs in Ophthalmology: Causes and Differential Diagnosis, Mosby Elsevier, UK.Lang, GK., 2000, Ophthalmology: A Short Textbook, Thieme, New York, pp. 93-5.Perhimpunan Dokter Spesialis Mata Indonesia, 2010, Ilmu Penyakit Mata: Untuk Dokter Umum dan Mahasiswa Kedokteran, Edisi 2, Sagung Seto, Jakarta, hal 4-6; 113-120.Vaughan DG, et al. 2000. Oftalmologi umum edisi 14. Jakarta: Widya Medika.Vaughan and Asburys. 2007, General Ophthalmology ed.17. McGrawHillWhitcher, JP. and Srinivasan, M., 1997, Corneal Ulceration in Developing World A Silent Epidemic, Br J Ophthalmol, vol. 81, pp. 622-3 Yanoff, M. and Duker, JS., 2009. Yanoff and Dukers Ophthalmology. 3rd Edition, Mosby Elsevier, UK.

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