The Eye

dr. Duti Sriwati Aziz, SpPA

Sub Dep PA RSAL Dr. Ramelan FK UHT

 Orbita
Eyelid
Conjunctiva
Sclera
Cornea
Uvea
Retina & vitreuous
Optic Nerve

ORBITA

Figure 29-1 Anatomy of the eye.

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 Kelainan :

Proptosis
Thyroid ophthalmopathy
Infeksi
Neoplasma

1. PROPTOSIS
Tekanan orbita bola mata
terdorong proptosis
kelopak mata tak tertutup air mata
tak merata kornea kering
Nyeri
Infeksi

 2 macam :
1. Axial ( directly forward )
2. Positional

 Positional Medial, inferior o.k tek

superotemporal
Infeksi kel.lacrimalis
Neoplasma
Lymphoma
Pleimorphic adenoma
Adenoid cystic carcinoma ( Silindroma )

 Axial
Thyroid ophthalmopathy
Tumor CNS ( bukan SSP )
Meningioma
Glioma

2. Thyroid ophthalmopathy
Axial proptosis
Graves disease
karena :
Akumulasi extracellular matrix protein
Fibrosis muskulus rectus

The extraocular muscles are greatly distended in this postmortem dissection of tissues
from a patient with thyroid (Graves) ophthalmopathy. Note that the tendons of the
muscles are spared involvement.
(Courtesy of Dr. Ralph C. Eagle Jr, Wills Eye Hospital, Philadelphia, PA.)
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3. INFEKSI
Uncontrolled Sinusitis
Immunosuppressed mucormycosis
Diabetes sclerosing
Wegener granulomatosis
Idiopathic orbital inflammation orbital
inflammatory pseudotumor

Orbital inflammatory
pseudotumor

Unilateral
Bilateral
Seluruh elemen orbita
Kel lacrimalis sclerosing dacryoadenitis
Orbital myositis
Posterior scleritis

 Mikroskopis :
Fibrosis
Radang khronis
sel plasma, lymphocyte ( germinal centre ),
eosinophil

Lokasi :
Terbatas di Orbita
Bersamaan dengan keradangan di
retroperitoneum, mediastinum, thyroid

In idiopathic orbital inflammation (orbital inflammatory pseudotumor), the

orbital fat is replaced by fibrosis.
Note the chronic inflammation, accompanied in this case by eosinophils.
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4. Neoplasma
Vascular :
Capillary Hemangioma
Lymphangioma
Kel. Lacrimal :
Pleomorfik adenoma
Dermoid cyst
Neurilemmoma ( Schwannoma )
Limphoma maligna
Metastasis ( prostat, neuroblastoma, wilms tumor )

EYELID

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 Radang
Granuloma chalazion
Neoplasma

CHALAZION
Ekstravasasi lipid kejaringan sekitar
Reaksi granulomatous Lipogranuloma
O.k obstruksi sebaceous gland :
Blepharitis
Neoplasma

Neoplasma
1.
2.
3.
4.

Basalioma ( Basal Cell Ca )

Sebaceous Carcinoma
Melanoma
Kaposi sarcoma

Ulcerasi kornea

 Basalioma
Palpebra inferior
Chanthus medius

Sebaceous carcinoma
chalazion
Metastase kelenjar parotis dan
submandibula
Mortalitas 22%

 Kaposi sarcoma
Eyelid Purple hue
Mucous membran conjuctiva Bright red
( subconjuctival haemorrhage )
Conjuctiva menebal

CONJUNCTIVA

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 Scarr
Pinguecula & Pterygium
Neoplasma

Conjunctival scarring
Chlamydia trachomatis
Caustis alkalis
Pemphigoid
Iatrogenic
Scarring goblet cairan
ulcerasi visi

3. Pinguecula & Pterygium

Fibrovascular submucosa
Pinguecula
actinic damage
invasi cornea
Precursor Squamous Cell Ca & Melanoma

Pterygium
not invasi cornea
pada submucosa limbus ( solar elastosis )
Infeksi sekunder actinic granuloma

4. Neoplasma
Dapat CIN ( Conjunctival Intraepithelial
Neoplasma )
CIN + squamous papilloma Human
papilloma virus 16, 18
Mucoepidermoid Ca
Conjunctival nevi melanoma insitu
Conjunctival melanoma

SCLERA

 Sedikit vascular & fibroblast coklat,

operasi sukar sembuh
Rheumatic arthritis Immune complex
deposit necrotizing scleritis
Biru
High intraocular pressure staphyloma
Osteogenesis imperfecta
Congenital nevus / nevus of ota

CORNEA

 Keratitis & ulcer

Degeneration & distrophy

Band keratopathies
Keratoconus
Fuchs endothelial dystrophy
Stromal dystrophy

Keratitis & Ulcers

Bakteri, fungal, protozoa, virus ( H.
simplex, H. Zoster )
Aktivasi collagenase epithel &
fibroblast
H. simplex chronis reaksi
granulomatous pada Descemet

Chronic herpes simplex keratitis.

The cornea is thin and scarred (note the increased number of
fibroblast nuclei). Granulomatous reaction to Descemet's
membrane (arrows).
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Corneal Degeneration & Dystrophies

Degeneration

- bilateral/unilateral
- non-familial

Dystrophies

- bilateral
- hereditary

a. Band keratopathies
Calcific band keratopathy
timbunan kalsium pada lapisan
Bowman
Actinic band keratopathy pada
ultraviolet pengaruh collagen (solar
elastosis)

b. Keratoconus
Penipisan & ectasia cornea
progressive tanpa inflamasi atau
vaskularisasi
Etiologi : unknown
Biasanya bilateral, ada hubungan dg
Down syndrome, Marfan syndrome

Keratoconus.

 The tissue section is stained by periodic acid-Schiff to highlight the

epithelial basement membrane (ebm), which is intact.
Bowman's layer (bl), situated between the epithelial basement
membrane and the stroma (s), is not a basement membrane.
By tracing Bowman's layer from the right side of the
photomicrograph toward the center, one notices a discontinuity in
this layer, diagnostic of keratoconus.

 Patogenesa :
Activasi colagenases, gelatinases, matrix
metalloproteinases

Morfologi :
Cornea menipis, Bowmans pecah-pecah

c. Fuchs Endothelial Dystrophies

Ada pada anak-anak / dewasa
muda, progressive, autosomal
recessive
Rasa nyeri karena erosi epitel

d. Stromal Dystrophies
Ada pada anak-anak / dewasa muda,
progressive, autosomal recessive
Rasa nyeri karena erosi epitel
Keratan sulfat, amyloid pada stroma
kornea
Bentuknya ada 3 :
Lattice dystrophy
Granular dystrophy
Avellino dystrophy

ANTERIOR SEGMENT

1. Anatomi Fungsional
Bag. depan dibatasi cornea, lateral
dibatasi trabecular messwork, posterior
dibatasi iris
Lens capsule, sbg basement membrane
dari epitel lensa
Anterior segment : cornea, anterior
chamber, posterior chamber, iris, lensa
Posterior segment : sisa dibelakangnya

Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured with crypts and folds. Upper right, The normal flow of aqueous humor. Aqueous
humor, produced in the posterior chamber, flows through the pupil into the anterior chamber. The major pathway for the egress of aqueous humor is through the
trabecular meshwork, into Schlemm's canal. Minor outflow pathways (uveoscleral and iris, not depicted) contribute to a limited extent to aqueous outflow. Lower left,
Primary angle closure glaucoma. In anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens blocks the passage of aqueous
humor from the posterior chamber to the anterior chamber. Pressure builds in the posterior chamber, bowing the iris forward (iris bombé) and occluding the
trabecular meshwork. Lower right, A neovascular membrane has grown over the surface of the iris, smoothing the iris folds and crypts. Myofibroblasts within the
neovascular membrane cause the membrane to contract and to become apposed to the trabecular meshwork (peripheral anterior synechiae). Outflow of aqueous humor
is blocked, and the intraocular pressure becomes elevated.
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Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured with crypts and folds. Upper right, The normal flow of aqueous humor. Aqueous
humor, produced in the posterior chamber, flows through the pupil into the anterior chamber. The major pathway for the egress of aqueous humor is through the
trabecular meshwork, into Schlemm's canal. Minor outflow pathways (uveoscleral and iris, not depicted) contribute to a limited extent to aqueous outflow. Lower left,
Primary angle closure glaucoma. In anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens blocks the passage of aqueous
humor from the posterior chamber to the anterior chamber. Pressure builds in the posterior chamber, bowing the iris forward (iris bombé) and occluding the
trabecular meshwork. Lower right, A neovascular membrane has grown over the surface of the iris, smoothing the iris folds and crypts. Myofibroblasts within the
neovascular membrane cause the membrane to contract and to become apposed to the trabecular meshwork (peripheral anterior synechiae). Outflow of aqueous humor
is blocked, and the intraocular pressure becomes elevated.
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2. Cataract
Cataract yaitu kekeruhan lentikular, dapat
acquired/kongenital
Penyakit-penyakit :

Systemic (galactosemia, DM, Wilson, Atopic)

Radiation
Trauma
Intra ocular

Cataract yg berhubungan usia

kekeruhan nukleus

 Pigmen urochrome warna coklat

Migrasi epitel ke bagian belakang
posterior subcapsular cataract
Cortex lensa mencair morgagnian
cataract
Protein berat molekul tinggi yang pecah
dari lensa phacolysis membendung
trabecular meshwork glaucoma
phacolytic

3. Segmen anterior dan Glaucoma

Yaitu kumpulan penyakit ditandai dengan
perubahan yang jelas dari gangguan
pandang & nerve opticum cup
Biasanya dg peningkatan tekanan intra
okular, tetapi dapat juga normal
(normal/low tension glaucoma)
Aqueous humor dibentuk oleh ciliary
bodies masuk ke trabecular meshwork

Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured with crypts and folds. Upper right, The normal flow of aqueous humor. Aqueous
humor, produced in the posterior chamber, flows through the pupil into the anterior chamber. The major pathway for the egress of aqueous humor is through the
trabecular meshwork, into Schlemm's canal. Minor outflow pathways (uveoscleral and iris, not depicted) contribute to a limited extent to aqueous outflow. Lower left,
Primary angle closure glaucoma. In anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens blocks the passage of aqueous
humor from the posterior chamber to the anterior chamber. Pressure builds in the posterior chamber, bowing the iris forward (iris bombé) and occluding the
trabecular meshwork. Lower right, A neovascular membrane has grown over the surface of the iris, smoothing the iris folds and crypts. Myofibroblasts within the
neovascular membrane cause the membrane to contract and to become apposed to the trabecular meshwork (peripheral anterior synechiae). Outflow of aqueous humor
is blocked, and the intraocular pressure becomes elevated.
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Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured with crypts and folds. Upper right, The normal flow of aqueous humor. Aqueous
humor, produced in the posterior chamber, flows through the pupil into the anterior chamber. The major pathway for the egress of aqueous humor is through the
trabecular meshwork, into Schlemm's canal. Minor outflow pathways (uveoscleral and iris, not depicted) contribute to a limited extent to aqueous outflow. Lower left,
Primary angle closure glaucoma. In anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens blocks the passage of aqueous
humor from the posterior chamber to the anterior chamber. Pressure builds in the posterior chamber, bowing the iris forward (iris bombé) and occluding the
trabecular meshwork. Lower right, A neovascular membrane has grown over the surface of the iris, smoothing the iris folds and crypts. Myofibroblasts within the
neovascular membrane cause the membrane to contract and to become apposed to the trabecular meshwork (peripheral anterior synechiae). Outflow of aqueous humor
is blocked, and the intraocular pressure becomes elevated.
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Jenis glaucoma :
Glaucoma sudut terbuka
Glaucoma sudut tertutup

primary
secondary

Primary glaucoma sudut terbuka :

Mutasi pada GLC1A, pada chromosome 1
myocilin
Jenis glaucoma yg terbanyak

Secondary glaucoma sudut terbuka :

Phacolysis pada chataract
Darah (ghost cell glaucoma)
Pigmen iris (pigmentary glaucoma)
Oxytalan fibers (exfoliation glaucoma)
Necrotic tumor (melanomalytic glaucoma)

Primary glaucoma sudut tertutup :

Banyak pada hyperopia
Terjadi papillary block terjadi iris
bomb
Epitel lensa dapat rusak

Secondary glaucoma sudut tertutup :

Kelebihan VEGF (Vascular Endothelial
Growth Factor)
Neovascular glaucoma karena nekrotik
tumor
Endothel cornea berlebihan menutup
meshwork

4. Endophthalmitis &
Panophthalmitis

Traumatic iridocyclitis
Infeksi cornea
Uveitis
Anterior synechiae iris & trabc. m. Melekat krn
Posterior synechiae iris & lensa
exudate
fibrous metaplasia
anterior subcapsular

Sequelae of anterior segment inflammation.

This eye was removed for complications of chronic corneal inflammation
(which cannot be discerned at this magnification). The exudate (e) present
in the anterior chamber would have been visualized at the slit lamp as an
optical "flare." The iris is adherent focally to the cornea, obstructing the
trabecular meshwork (anterior synechia, arrow), and adheres to the lens
(posterior synechiae, arrowheads). An anterior subcapsular cataract (asc)
has formed. The radial folds in the lens are artifacts.
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Exogenous panophthalmitis.
Note the suppurative inflammation behind the lens and drawn up to the right of
the lens to the cornea, the site of the wound. The central portion of the vitreous
humor was extracted surgically (by vitrectomy). Note the adhesions to the
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UVEA

Terdiri dari
Iris
Ciliary bodies
Choroid

1. Uveitis
Adalah proses keradangan khronik dari
salah satu atau keseluruhan Uvea
Misal : juvenile rheumatic arthritis,
segmen anterior/posterior
Biasanya disertai keradangan retina
Sebabnya :

Infeksi bakteri (pneumocystis carnii )

Idiopathic (sarcoidosis) : granulomatous uveitis
Autoimune (sympathetic ophthalmia)

 Granulomatous Uveitis
Anterior segment : exudate mutton-fat
Posterior segment : choroid dan retina

Toxoplasma infeksi choroid & retina

Cytomegalovirus retina
Mycobacterium avium uvea

 Sympathetic ophthalmia
Bilateral granulomatous inflammation :
seluruh uvea
Pertama didapatkan pada : Louis Braille
sel-sel eosinophil
Terdapat Ag retina 2 minggu beberapa
tahun hypersensitivity delayed

Sympathetic ophthalmia. The granulomatous inflammation depicted here

was identified diffusely throughout the uvea. The uveal granulomas may
contain melanin pigmentand may be accompanied by eosinophils.

2. Neoplasma
Terbanyak metastase ke uvea (choroid)
Uveal nevi & Melanoma
Melanoma uveal adalah tumor intra
ocular tersering pada dewasa
Usia terutama dekade 7
Nevus choroid sering terjadi, 10% pd Ca
Penyebaran melanoma hematogenous, ke
liver, 5 YSR 80%

Figure 29-15 Uveal melanoma. A, Fundus photograph from a patient with a relatively flat pigmented lesion of the choroid near the optic
disc. B, Fundus photograph of the same patient several years later; the tumor has grown and has ruptured through Bruch's membrane.
C, Gross photograph of a choroidal melanoma that has ruptured Bruch's membrane. The overlying retina is detached. D, Epithelioid
melanoma cells are associated with an adverse outcome. E, Patterns rich in laminin (that are periodic acid-Schiff positive) surround
aggregates of melanoma cells; these patterns form a "fluid-conducting meshwork" in uveal melanoma and are associated with an
adverse outcome. (A to C from Folberg R: Pathology of the eye-an interactive CD-ROM program. Philadelphia, Mosby, 1996; E from
Maniotis AJ, Chen X, Garcia C, et al: Control of melanoma morphogenesis, endothelial survival, and perfusion by extracellular matrix.
Lab Invest 82(8):1031-1043, 2002.)

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Uveal melanoma. C, Gross photograph of a choroidal melanoma

that has ruptured Bruch's membrane. The overlying retina is
detached. D, Epithelioid melanoma cells are associated with an
adverse outcome.

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 Morfologi ada 2 jenis yaitu :

Spindle sel fusiform, sedikit atypic
Epitheloid sel spherical, sangat atypic
prognosa buruk

Dapat timbul :
Retinal detachment
Glaucoma

RETINA & VITREOUS

1. Anatomi Fungsional
Tidak ada aliran limphetic
Pigmen epitel retinal asal dari optic vesicle
Retinal detachment lepasnya neurosensory
retina dg pigmen epitel retina
persistent hyperplastic primary vitreous regresi
fetal vascular tdk sempurna
Asteroid hyalosis calcium soap dari debris
vitreus humor
Posterior vitreous detachment posterior face
humor lepas dari retina

Figure 29-16 Clinicopathologic correlations of retinal hemorrhages and exudates. The location of the hemorrhage within the retina
determines its appearance by ophthalmoscopy. The retinal nerve fiber layer is oriented parallel to the internal limiting membrane, and
hemorrhages of this layer appear to be flame-shaped ophthalmoscopically. The deeper retinal layers are oriented perpendicular to the
internal limiting membrane and hemorrhages in this location appear as cross-sections of a cylinder or "dot" hemorrhages. Exudates that
originate from leaky retinal vessels accumulate in the outer plexiform layer.
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2. Retinal Detachment
Lepasnya neurosensory retina dari pigmen
epithelium
Phlegmatogenous retinal detachment
seluruhnya lepas
proliferatif vitreoretinopathy
Surgical procedure retina pecah
Non-rhegmatogenous retinal detachment
tanpa pecahnya retina
- tumor
- hipertensi

Figure 29-17 Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. Retinal detachments are classified broadly
into non-rhegmatogenous (without a retinal break) and rhegmatogenous (with a retinal break) types. Top, In non-rhegmatogenous retinal detachment, the subretinal
space is filled with protein-rich exudate. Note in this sketch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can be seen in both non-rhegmatogenous and rhegmatogenous detachments. Middle, Posterior vitreous detachment involves the separation of the posterior
hyaloid from the internal limiting membrane of the retina and is a normal occurrence in the aging eye. Bottom, If, during a posterior vitreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting membrane of the retina, the vitreous humor will exert traction on the retina which will be torn at this point.
Liquefied vitreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this sketch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is being illustrated.
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Figure 29-17 Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. Retinal detachments are classified broadly
into non-rhegmatogenous (without a retinal break) and rhegmatogenous (with a retinal break) types. Top, In non-rhegmatogenous retinal detachment, the subretinal
space is filled with protein-rich exudate. Note in this sketch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can be seen in both non-rhegmatogenous and rhegmatogenous detachments. Middle, Posterior vitreous detachment involves the separation of the posterior
hyaloid from the internal limiting membrane of the retina and is a normal occurrence in the aging eye. Bottom, If, during a posterior vitreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting membrane of the retina, the vitreous humor will exert traction on the retina which will be torn at this point.
Liquefied vitreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this sketch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is being illustrated.
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Figure 29-17 Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. Retinal detachments are classified broadly
into non-rhegmatogenous (without a retinal break) and rhegmatogenous (with a retinal break) types. Top, In non-rhegmatogenous retinal detachment, the subretinal
space is filled with protein-rich exudate. Note in this sketch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can be seen in both non-rhegmatogenous and rhegmatogenous detachments. Middle, Posterior vitreous detachment involves the separation of the posterior
hyaloid from the internal limiting membrane of the retina and is a normal occurrence in the aging eye. Bottom, If, during a posterior vitreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting membrane of the retina, the vitreous humor will exert traction on the retina which will be torn at this point.
Liquefied vitreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this sketch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is being illustrated.
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3. Retinal Vascular Disease

Hypertension
Arteriolosclerosis
arteriole & vena berjalan bersama, pd tempat
tertentu terdapat cross, pada arteriolosclerosis
oclusi vena
Hipertensi maligna saluran rusak
Elschnig's spots
Occlusion retinal arteriole cytoid bodies
cotton wool spots

The retina in hypertension. A,

The wall of the retinal arteriole
(arrow) is thick. Note the
exudate (e) in the retinal outer
plexiform layer.

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Nerve fiber layer infarct.

The histology of a cottonwool spot-an infarct of the
nerve fiber layer of the
retina-is illustrated in the
photomicrograph. A focal
swelling of the nerve fiber
layer is occupied by
numerous red to pink
cytoid bodies
(arrowheads), bulbous
ends of severed axons.
Hemorrhage (arrows)
surrounding the nerve fiber
layer infarct as illustrated
here is a variable and
inconsistent finding.

 Diabetes Mellitus
Penebalan basement membrane epitel pars
plicata
Microangiopathy retinal : a. Preproliferatif
b. Proliferatif
a. Preproliferatif
- basement membrane menebal
- pericyte berkurang

The ciliary body in chronic

diabetes mellitus, periodic acidSchiff stain. Note the massive
thickening of the basement
membrane of the ciliary body
epithelia, reminiscent of
changes in the mesangium of
the renal glomerulus.

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 Microaneurisma microhemorrhages
macular edema gangguan visual
VEGF, angiogenesis microangiopathy
neovascularization of the disc
Traction retinal detachment rhegmatogenous
detachment
Neovascular iris neovascular membrane
kontraksi adhesi iris dg trabecular
meshwork glaucoma

The retina in diabetes mellitus. A, Note the tangle of abnormal vessels just beneath
the internal limiting membrane of the retina on the right half of the photomicrograph
(between arrows). This is an example of intraretinal angiogenesis known as
intraretinal microangiopathy (IRMA). Note the retinal hemorrhage in the outer
plexiform layer in the left half of this photomicrograph. Ophthalmoscopically, this
outer retinal layer hemorrhage would appear as a "dot" hemorrhage
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 Retinopathy of prematurity
Genetik susceptible
Bayi prematur
VEGF retinal angiogenesis
detachment

 Sickle Retinopathy, Retinal Vasculitis,

Radiation Retinopathy
a. Non proliferatif (intraretinal angiopathic
changes)
b. Proliferatif (retinal neovascularization)
Vascular occlusion : karena
- VEGF
- bFGF

 Retinal Artery and Vein Occlusions

Atherosclerosis pd retina trombosis

Emboli pd retinal karena trombi jantung
infark retina

cherry red spot

Cherry red spot juga ada pada Tay-Sachs and
Niemann-Pick
Dapat menyebabkan glaucoma sudut tertutup

Figure 29-22 The cherry-red spot in Tay-Sachs disease. A, Fundus photograph of the cherry-red spot in Tay-Sachs disease. B, Photomicrograph of the
macula in a patient with Tay-Sachs disease, stained with periodic acid-Schiff to highlight the accumulation of ganglioside material in the retinal
ganglion cells. The presence of ganglion cells filled with gangliosides outside the fovea blocks the transmission of the normal orange-red color of the
choroid, but absence of ganglion cells within the fovea (to the right of the vertical bar) permits the normal orange-red color to be visualized, accounting
for the so-called cherry-red spot. (A courtesy of Dr. Thomas A. Weingeist, Department of Ophthalmology & Visual Science, University of Iowa, Iowa
City, IA; B originates from the teaching collection of the Armed Forces Institute of Pathology.)
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4. Age Related Macular Degeneration

(ARMD)
Faktor penting yaitu usia
- rokok
Faktor penentu
- nutrisi
- vascular
Bruch's membrane
visual loss
Choriocapillaris
Ada 2 jenis :
a. Atropic ARMD :

b. Exudative ARMD

- branch, membrane
- retinal pigmen epithel

Figure 29-23 Age-related macular degeneration. A neovascular membrane is positioned between the retinal pigment epithelium (RPE)
and Bruch's membrane (BM). Note the blue discoloration of Bruch's membrane to the right of the label, indicating focal calcification.

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5. Other retinal degeneration

Retinitis pigmentosa :
Inherited retinal dissorder x linked
recessive, autosomal recessive / dominant
Mutasi photoreceptor cell, epitel pigmen
retina might blindness

6. Retinitis
Candida
Cytomegalovirus

7. Neoplasma
Retinoblastoma
Dari retinal cell ( neuronal )
Prognosis tergantung penyebaran o. nerve
choroidal
40% diturunkan lewat germ line RB allele

Morfologi :
Sel bulat, kecil, hyperchromatic
Flexner-Wintersteiner rosettes, fleurettes
Tingkat deferensiasi tak sesuai prognosis
Therapy chemotherapy
laser / cryopexy
Mutasi ke otak, bone marrow, paru
Ada yang jinak retinocytoma

Figure 29-24 Retinoblastoma. A, Gross photograph of retinoblastoma. B,

Tumor cells appear viable when in proximity to blood vessels, but necrosis
is seen as the distance from the vessel increases. Dystrophic calcification
(dark arrow) is present in the zones of tumor necrosis. FlexnerWintersteiner rosettes-arrangements of a single layer of tumor cells around
an apparent "lumen"-are seen throughout the tumor, and one such rosette
is indicated by the white arrow.
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 Lymphoma
Systemic lymphoma ke uvea (iris, cilliary,
choroid)
Retinal lymphoma
sel2 besar lymphoma spt pada otak
pd neurosensory retina dan retinal
pigmen epitel

OPTIC NERVE

1. Anterior Ischemic Optic

Neuropathy (AION)
Gangguan vascular
ischemia gangguan penglihatan
optic infarct
Infeksi arteritis AION
Emboli/trombosis nonarteritis AION

2. Papilledema
Tekanan yg tekanan pd syaraf mata
tekanan pd cerebrospinal
Tekanan intracranial
Bilateral papilledema tak ada
hubungan dengan visual loss

C, Normally, the termination of Bruch's membrane (arrowhead) is aligned with

the beginning of the neurosensory retina, as indicated by the presence of
stratified nuclei (arrow), but in papilledema, the optic nerve is swollen, and the
retina is displaced laterally. This is the histologic explanation for the blurred
margins of the optic nerve head seen clinically in this condition.
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3. Glaucomatous optic nerve

damage
Normal tension glaucoma ada mutasi pada
gene optineurin
Morfologi
Ganglion sel berkurang, lapisan serat syaraf tipis
N. opticus menjadi cupped & atrofi
Glaucoma timbul bila ada atrofi disertai cupping
Pada anak, intraocular pressure buphthlalmos,
megalocornea
Sclera tipis, staphyloma (elastic sclera)
Edematous cornea, degeneratif pannus

Figure 29-26 The retina and optic nerve in glaucoma. A, The normal retina is illustrated in the left panel, and the retina in long-standing glaucoma is in
the right panel. Both pictures were taken at the same magnification. Note that the full thickness of the glaucomatous retina is captured (right), whereas
only a portion of the normal retina (left) can be seen-a reflection of the thinning of the retina in glaucoma. In the glaucomatous retina, the areas
corresponding to the nerve fiber layer (NFL) and ganglion cell layer (GC) are atrophic; the inner plexiform layer (IPL) is labeled for a point of reference.
B, Glaucomatous optic nerve cupping results, in part, from loss of retinal ganglion cells, the axons of which populate the optic nerve. C, The arrows
point to the dura of the optic nerve. Notice the wide subdural space, a result of atrophy of the substance of the optic nerve. The degree of cupping on
the surface of the nerve is striking in this eye, which was removed because of complications of long-standing glaucoma.
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Figure 29-26 The retina and optic nerve in glaucoma. A, The normal retina is illustrated in the left panel, and the retina in long-standing glaucoma is in
the right panel. Both pictures were taken at the same magnification. Note that the full thickness of the glaucomatous retina is captured (right), whereas
only a portion of the normal retina (left) can be seen-a reflection of the thinning of the retina in glaucoma. In the glaucomatous retina, the areas
corresponding to the nerve fiber layer (NFL) and ganglion cell layer (GC) are atrophic; the inner plexiform layer (IPL) is labeled for a point of reference.
B, Glaucomatous optic nerve cupping results, in part, from loss of retinal ganglion cells, the axons of which populate the optic nerve. C, The arrows
point to the dura of the optic nerve. Notice the wide subdural space, a result of atrophy of the substance of the optic nerve. The degree of cupping on
the surface of the nerve is striking in this eye, which was removed because of complications of long-standing glaucoma.
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4. Optic Neuropathy lain

Inherited : Leber hereditary optic
neuropathy
Sekunder :
Defisiensi mutational : tobacco alcohol
amblyopia
Toxin : methanol

5. Optic Neuritis
Yaitu demyelinization nerve opticus
Sebab utama : multiple sclerosis
Dengan pengobatan bisa sembuh

Phthisis bulbi
Trauma
Radang intra ocular
Retinal detachment

atrophic phthisis
bulbi

Phthisis bulbi. The eye is small and internally disorganized. The

tension exerted on this hypotonic eye by the extraocular muscles
contributes to a square rather than round shape. Note the atrophic
optic nerve and the presence of intraocular bone posteriorly and
anteriorly.
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Morfologi :
- ciliochoroidal effusion
Exudate

- cyclitic membrane
Darah
- retinal detachment
- optic atrof
- intraocular bone metaplasia
osseous dari epitel pigmen
retina
- sclera tebal

TERIMA KASIH
SELAMAT BELAJAR
SEMOGA LULUS UJIAN