2

ORBITA

ORBITA
Piramid

40 mm

Bola mata
Saraf
Otot
Jaringan lemak

30 cc

35 mm

40 mm

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

Berhubungan :

Os Maksila
Os Palatina
Os Zygoma
Sinus maksila
Rongga tulang
palatina

Jaringan Lunak Rongga

Orbita
Peri orbita

Periost
Kanal Optik
Anterior

Duramater
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 :
Otot

Cara Kerja

Nervus

Primer

Sekunder

Tertier

Rektus medial

adduksi

III

Rektus lateral

abduksi

VI

Rektus superior

elevasi

intorsi

adduksi

III

Rektus inferior

depresi

ekstorsi

adduksi

III

Oblikus superior

intorsi

depresi

abduksi

IV

Oblikus 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

KELOPAK MATA
Fungsi :
Melindungi bola mata
Pembilasan dan pelicinan
Air mata
Sekresi kelenjar

Jalan masuk sinar ( fissura palpebra )

Berkedip menyingkirkan debu / kotoran
yang masuk
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

ANATOMI MATA & LENSA

Biconvex
Avascular
Transparan
Tebal 4mm, diameter 9 mm
Ant : humor akuos
Post : vitreous
Posisi : lig suspensorium
(zonula) zinn

ISI LENSA

65% air
35% Protein, mineral, glutation,
Potasium, Ascorbid acid, dll
Tidak ada syaraf nyeri, pembuluh darah
Nutrisi : cairan intraokuler

KATARAK
1. Developmental : Katarak Kongenital
Katarak Juvenil
2. Degeneratif : Katarak Senil
3. Komplikata : Katarak karena : Uveitis,
DM
4. Trauma
: Katarak Traumatika

ANATOMI FISIOLOGI LENSA?

Healthy lens

Lens with a cataract

Clouding of the normally

clear lens of the eye.
35

Can be compared to a window

that is frosted or yellowed.

What is a
Cataract ?

A clear lens refracts light

onto the retina and finetunes our focusing
ability.
36

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, 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, 1.5 mm ( 1 DD)
Ophthalmoscopically : light reflex
Darker than surroundings
(FAZ,melanin,xantophyl)
Fovea avascular zone ( 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.
2.
3.
4.
5.
6.
7.
8.

Internal limiting membrane

Nerve fiber layer
Ganglion cell layer
Inner plexiform layer
Inner nuclear layer
Outer plexiform layer
Outer nuclear layer
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 Bruchs
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

 BRUCHS MEMBRANE
Basal portion of the RPE
Throughout life, lipids & oxidatively damaged
materials build up between Bruchs
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

 Histologic Definition
Contains two / more
ganglion cell layers
It contains xantophyll
pigment
(Clinical observation size)
Round area at posterior
pole, 5.5 mm (3.5 DD)
4 mm temporal, 0.8 mm
inferior to the center of
the optic disc

The Macula

Makula

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
1.5 mm (1 DD)

The Fovea

Cross-section of Fovea