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LABORATORY
ANATOMY MEDICAL
FACULTY
MUHAMMADIYAH UNIVERSITY OF
PURWOKERTO 2016
Tim Editor:
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ORBITA
In general, the orbita is divided into two parts, namely eye assesorius organ and
eyeball ( occuli ) .
1. Organ Assesorius
a. Palpebra (eyelid)
Palpebra Superior
Palpebra Inferior
Separated by canthus medial and lateral canthus
Fissurapalpebra : hole between the superior and inferior palpebral place
enter into saccus conjunctivae
b. Conjunctiva (epithelial)
Conjunctiva Fornix
Conjunctiva Palpebra (indicators of anemia)
Conjunctiva Bulby (identification of red eyes)
Apparatus Lacrimalis
Glandula lacrimalis
Ductus lacrimalis:
Lacus lacrimalis
Punctum lacrimalis
Canaliculi lacrimalis
Caruncula lacrimalis
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Sacus lacrimalis
Ductus nasolacrimalis
c. Musculus occuli externus (musculus Mover eyeball)
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M.Rectus Superior
M.Rectus Inferior
M.Rectus Media
M.Rectus lateral
M.Obliquus superior
M.Obliquus inferior
d. Cilia (eyelashes)
e. Glandulatarsalia
f. Supercilia(eyebrows)
g.
h.
2. Bulbus Occuli (Eyeball)
a. Divided into two rooms by a lens clan corpus ciliaris
b. Cavitas anterior
Contains aquosus humor ( the clear liquid )
Divided 2 slices den room by pupi
o Camera anterior bulbi
o Camera posterior bulbi
c. Cavitas posterior
d. Contains corpus vitreous ( transparent gel )
e.
f.
3. Tunica bulbi (Layer of the eyeball)
a. Tunica Fibrosa
Cornea
Sclera
Limbus
b. Tunica vaskulosa
Iris
Corpus cilliaris
Choroidea
Pupil
M. Cilliaris
c. Tunica nervosa/ Retina
Stratum pigmentosa
Stratum nervosa
4. Lens cristalina/lens
Hanged pads corpus ciliaris by the suspensory ligament lentis( ZonulaZinn )
5. Flow of humor aquosus
Processes ciliaris camera bulbi posterior pupil camera bulbi anterior
canalis schlemm vena.
Clinical applications : the intraocular pressure , serves to maintain the balance
Ductus nasolacrimalis
Figure : Stye of the upper eyelid. B: Hordeolum pointing on the inner
aspect of the lid and at the meibomian gland opening at the lid margin.
(Ilyas,2005)
2. Kalazion
Eyelid has a thin layer of skin , while at the rear there is a mucous
membrane called tarsal conjunctiva . In the petals there are parts in the form of the
glands and muscles. Glands that found on the eyelids are Moll glands or sweat
glands , Zeis glands at the base of the hair , and the Meibomian glands on the
tarsus which leads to the border of the eyelid . (Vaughan,2000)
Sebaceous glands
G
lan Moll gland or sweat glands
ds Zeis glands at the base of the hair, associated with hair follicles
:
and produce sebum
Meibomian gland ( glandtarsalis ) contained in the tarsus . These
glands produce sebum ( oil ) .
Chalazion is a mass in the eyelid resulting from chronic non-infectious
3. Ptosis
Ptosis is drooping eyelid. Ptosis is a condition where the upper eyelid cannot
open or cannot lifted to the top so the gap of eyelid becomes smaller than normal.
The grade of ptosis are:
a. Mild : about 2 mm
b. Moderate : about 3 mm
c. Severe : more than 3 mm
The classification of ptosis are:
a. Unilateral ptosis
b. Bilateral ptosis
c. Complete bilateral ptosis
Signs and symptomps ptosis requires a careful history to determine the
age of onset, familial insidence, rate of progression, variability/fatigability, and
association with other occular findings. The treatment of ptosis is surgical. The
preferred method of repair is an external lid crease incision with
reattachment or advancement of the levatoraponeurosis to the tarsal plate.
(Mansjoer,2005)
4. Cataract
Causes Cataract
The eye functions much like a camera. Light rays enter the
eye, passing through the cornea, the aqueous humor -- transparent fluid
in the front of the eye -- and then the pupil and into the lens. The lens
bends the light rays to focus objects onto the retina lining the back of
the eye. From there, the image passes through the retinal cells, into the
optic nerve, and finally to the back of the brainwhich process the
images.
Cataractsoccur when there is a buildup of protein in the lens that
makes it cloudy. This prevents light from passing clearly through the lens, causing
some loss of vision. Since new lens cells form on the outside of the lens, all the
older cells are compacted into the center of the lens resulting in the cataract.
Types of cataractsinclude:
Symptoms of Cataracts
Cataracts usually form slowly and cause few symptoms until they
noticeably block light. When symptoms are present, they can include:
Nearsightedness (myopia) occurs when the eyeball is too long for
the refractive power of the cornea and lens. Because of the relatively long size,
light is focused in front of (rather than directly on) the retina, and the person has
trouble clearly seeing distant objects. In children, nearsightedness frequently
increases until children stop growing.
Farsightedness (hyperopia) occurs in some people when the eyeball
is too short for the refractive power of the cornea and lens. Because of the
relatively short size, light is focused behind the retina. Children and young adults
who are mildly farsighted may be able to see clearly if their lens is flexible enough
to properly refocus light on the retina. However, with aging, the lens stiffens.
Thus, as
farsighted adults age, seeing near objects clearly becomes more
difficult and seeing distant objects also becomes more difficult. Blurring of nearby
objects is worse in dim light.
Astigmatism is an imperfectly shaped cornea or lens (not perfectly
round or spherical), which may cause objects to appear blurred at any distance.
Presbyopia occurs as people age. As people reach their early or mid
40s, the lens becomes increasingly stiff. The lens does not change shape easily, so
it cannot focus on nearby objects. As adults age, they often notice difficulty seeing
nearby objects. This difficulty occurs because the lens loses its ability to change
shape.
Aphakia is the absence of a lens resulting from a birth defect, eye
injury, or eye surgery for removal of a cataract. If a person has had a lens removed
to treat cataracts but has not had a lens implant, objects look blurred at any
distance.
Symptoms
A person who has a refractive error may notice that vision is blurred
for distant objects, near objects, or both. For example, a child who becomes
nearsighted may have difficulty seeing the chalkboard in school. People may
sometimes have headaches caused by squinting or frowning. In children, frowning
when reading and excessive blinking or rubbing of the eyes may indicate the child
has a refractive error. Occasionally, when a person stares for a long time trying to
read something, the eyes can dry out and become itchy, red, and irritated.
(Vander,2015)
6. Synechia
Iris synechia is an abnormal attachment between the iris surface and another
structures. In a posterior synechia, the posterior iris surface is adherent to the
anterior lens surface. In an anterior synechia, the anterior iris surface is adherent to
the corneal endothelium or the trabecular meshwork. Synechia can occur as a result
of a sharp blow to the head or a whiplash-type movement that brings the two
structures forcefully together. Alternatively, cells and debris from a uveal infection
that are circulating in the aqueous humor can make the surface sticky
and so cause synechia (Remington, 2012).
If a posterior synechia involves a large portion of the pupillary margin,
aqueous will accumulate in the posterior chamber. Continual production of
aqueous causes the pressure in the posterior chamber to increase, which in turn
causes the iris to bow forward in a configuration called iris bomb. This can push
the peripheral iris against the trabecular meshwork, setting the stage for a dramatic
increase of intraocular pressure (IOP). A drug-induced dilation usually will break a
posterior synechia. The break usually occurs between the epithelial layers, leaving
remnants of the posterior epithelium on the anterior surface of the lens
(Remington, 2012).
An anterior synechia usually occurs at the iris periphery and involves the
meshwork. It is called a peripheral anterior synechia (PAS). Aqueous outflow is
impeded by a PAS, causing an increase in IOP if the adhesion occupies a
considerable amount of the trabecular meshwork (Remington, 2012).
Picture 1.Anterior synechia (left); posterior synechia (right) (Slatter, 2002).
7. Glaucoma
Most of the time in glaucoma, damage occurs when the optic nerve, or
certain parts of the retina, get compressed as a result of high pressure inside the
eye. If the optic nerve is damaged, it cannot send electrical impulses to the brain to
produce a proper image (CNIB, 2008).
Classification of Glaucoma
A. Open-angle glaucoma
Open-angle glaucoma is by far the most common form of the
disease. It occurs when fluid in the eye passes too slowly through a spongy
meshwork connecting the cornea and the iris. This causes a buildup of
pressure that damages the optic nerve (CNIB, 2008).
C. Closed-angle glaucoma
Picture.Normal vision and vision with glaucoma (CNIB, 2008).
Over time this can expand to tunnel vision or even
complete vision loss. Acute closed-angle glaucoma is a medical
emergency and has a sudden onset of symptoms (CNIB, 2008):
Severe eye pain
Headaches (especially in dim light)
Blurred vision
Nausea
Redness in the eye
Haloes around lights
8. Retinophaty
A. Retinophaty Hypertension
Hypertensive retinopathy is damage to the retina from high blood
pressure. The retina is the layer of tissue at the back part of the eye. It changes
light and images that enter the eye into nerve signals that are sent to the
brain. Causes
High blood pressure can damage blood vessels in the retina. The
higher the blood pressure and the longer it has been high, the more severe the
damage is likely to be. You have a higher risk of damage and vision loss when
you have diabetes, high cholesterol level, or you smoke. Rarely, blood
pressure readings suddenly become very high, but when they do, it can cause
severe changes in the eye. Other problems with the retina are also more likely,
such as:
Symptoms
Treatment :
B. Retinophaty Diabeticum
Diabetic eye disease can affect many parts of the eye, including the
retina, macula, lens and the optic nerve.
Cataract is a clouding of the eyes lens. Adults with diabetes are 2-5
times more likely than those without diabetes to develop cataract.
Cataract also tends to develop at an earlier age in people with diabetes.
Glaucoma is a group of diseases that damage the eyes optic nervethe
bundle of nerve fibers that connects the eye to the brain. Some types of
glaucoma are associated with elevated pressure inside the eye. In adults,
diabetes nearly doubles the risk of glaucoma
All forms of diabetic eye disease have the potential to cause severe
vision loss and blindness.
Diabetic Retinopathy
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21.
22. (Khurana,2007)
23.
24.
9. Ablatio Retina / Retinal Detachment
25. A retinal detachment is a separation of the sensory retina from
theunderlying retinal pigment epithelium (RPE). There are numerous variations in
the basic pathogenesis of a retinal detachment. They include developmental factors
(e.g., myopia and Marfan syndrome) that affect the overall size and shape of the
globe vitreoretinal disorders (e.g., coloboma and retinal dysplasia), metabolic
disease (e.g., diabetic retinopathy), vascular disease (e.g., sickle cell disease),
trauma, inflammation, degenerative conditions, and neoplasms. Retinal
detachments can be classified as rhegmatogenous or nonrhegmatogenous.
a. Rhegmatogenous Retinal Detachment
26. The most common type of retinal detachment,
rhegmatogenous, results from a break in the sensory retina. The break is
most often caused by vitreous traction on the surface of the retina. This
traction physically pulls a small section of the sensory retina away from
the pigment epithelium, resulting in what is called a "retinal tear." Traction
at the site of a tear can initiate retinal detachment surrounding the tear by
pulling on the surface of the adjacent retina. The break in the retina may
also allow fluid from the vitreous cavity to percolate into the potential
subretinal space. Thus, a rhegmatogenous retinal detachment caused by a
retinal tear is the result of
27. both vitreous traction and fluid ingress between the sensory
retina and the pigment epithelium.
b. Nonrhegmatogenous Retinal Detachment
28. The second type of retinal detachment, nonrhegmatogenous,
usually results from the accumulation of exudate or transudate in the
potential subretinal space, rather than from a retinal break. Sometimes a
nonrhegmatogenous retinal detachment is caused by sheer traction, without
the production of a retinal tear. Other etiologies of this type of detachment
include chorioretinitis, metastatic choroidal tumor, choroidal effusion,
retinal angioma, Harada's disease, pars planitis, sympathetic ophthalmia,
eclampsia, and trauma. (William,2004)
29.
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