kuliah 3 sistim lakrimal
TRANSCRIPT
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SISTIM LAKRIMAL & SISTIM LAKRIMAL & AIR MATA (TEARS)AIR MATA (TEARS)
ARMANTO SIDOHUTOMOARMANTO SIDOHUTOMO
FAKULTAS KEDOKTERANFAKULTAS KEDOKTERAN
UNIVERSITAS WIJAYA KUSUMAUNIVERSITAS WIJAYA KUSUMA
SURABAYA SURABAYA
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APPARATUS LAKRIMALISAPPARATUS LAKRIMALIS
KELENJAR LAKRIMALIS MAYOR, MINOR KELENJAR LAKRIMALIS MAYOR, MINOR DAN ACCESORIUSDAN ACCESORIUS
PUNGTUM LAKRIMALIS SUP. & INF.PUNGTUM LAKRIMALIS SUP. & INF.
CANALICULI LACRIMALISCANALICULI LACRIMALIS
SACCUS LACRIMALISSACCUS LACRIMALIS
DUCTUS NASOLACRIMALISDUCTUS NASOLACRIMALIS
MEATUS NASI INFERIORMEATUS NASI INFERIOR
SELURUH SAL. AIR MATA DILAPISI EPITELSELURUH SAL. AIR MATA DILAPISI EPITEL
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GAMBAR APPARATUS LAKR.GAMBAR APPARATUS LAKR.
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ANATOMI LAKRIMALANATOMI LAKRIMAL
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PENGALIRAN AIR MATA :PENGALIRAN AIR MATA :
1.1. DAYA KAPILER KANALIKULIDAYA KAPILER KANALIKULI
2.2. GAYA BERAT/GRAVITASIGAYA BERAT/GRAVITASI
3.3. KEDIPAN KLP. MATA AKB KONTR. M. KEDIPAN KLP. MATA AKB KONTR. M. ORBIKULARIS OKULI, MEKN. POMPA ORBIKULARIS OKULI, MEKN. POMPA SACCUS LACRIMALIS KE MEATUS SACCUS LACRIMALIS KE MEATUS NASI INFERIORNASI INFERIOR
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MEKANISME POMPA KEDIPMEKANISME POMPA KEDIP
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PENYAKIT APP. LAKR.PENYAKIT APP. LAKR.
1.1. EPIFORA (TEARING=HIPERSEKRESI) EPIFORA (TEARING=HIPERSEKRESI) KARENA : KARENA :
a.a. KELN. PENGALIRAN O/K PEMBUNTUAN KELN. PENGALIRAN O/K PEMBUNTUAN ATAU PARADOXIC LAKRIMALATAU PARADOXIC LAKRIMAL
b.b. PENYAKIT MATA SPT. KONJUNGTIVITIS, PENYAKIT MATA SPT. KONJUNGTIVITIS, KERATITIS, IRITIS, BENDA ASING MATAKERATITIS, IRITIS, BENDA ASING MATA
c.c. DAKRIOSISTITIS=INFEKSI SAKUS LAKR. DAKRIOSISTITIS=INFEKSI SAKUS LAKR.
2.2. MATA KERING (DRY EYES)MATA KERING (DRY EYES)
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DAKRIOSISTITISDAKRIOSISTITIS
BISA AKUT ATAU KRONIKBISA AKUT ATAU KRONIK
90% PX USIA BAYI, ANAK & PX 90% PX USIA BAYI, ANAK & PX MENOPAUSE>40 THMENOPAUSE>40 TH
E/C JAMUR SERING TERBENTUK E/C JAMUR SERING TERBENTUK DACRIOLITH DAN MEMBUNTU DNLDACRIOLITH DAN MEMBUNTU DNL
TEARING, SEKRET/DISCHARGETEARING, SEKRET/DISCHARGE
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AKUT : TANDA RADANG AKUT, AKUT : TANDA RADANG AKUT, PALPASI TDP TENDERNESS PALPASI TDP TENDERNESS (PERLUNAKAN) & SEKRET PURULEN(PERLUNAKAN) & SEKRET PURULEN
TX : TX :
– ANTIBIOTIKA LOKAL & SISTEMIKANTIBIOTIKA LOKAL & SISTEMIK
– KOMPRES HANGAT SESERING KOMPRES HANGAT SESERING MUNGKINMUNGKIN
– BERSIHKAN SEKRETBERSIHKAN SEKRET
– FASE ABSES, INSISIFASE ABSES, INSISI
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DAKRIOSISTITIS AKUT DAKRIOSISTITIS AKUT
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DAKRIOSISTITIS AKUT & ABSESDAKRIOSISTITIS AKUT & ABSES
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KRONIS, TANDA RADANG AKUT KRONIS, TANDA RADANG AKUT MEREDA, SEKRET MUKOID & TEARINGMEREDA, SEKRET MUKOID & TEARING
SERING DISERTAI ULKUS KORNEASERING DISERTAI ULKUS KORNEA
PERFORASI KULIT SAKUS, TERJADI PERFORASI KULIT SAKUS, TERJADI FISTULAFISTULA
TX :TX :– PROBINGPROBING– DACRYOSISTORHINOSTOMIDACRYOSISTORHINOSTOMI
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KISTA KLJ. LAKRIMALISKISTA KLJ. LAKRIMALIS
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DAKRIOSISTITIS PADA BAYIDAKRIOSISTITIS PADA BAYINORMAL, DNL AKAN TERBUKA NORMAL, DNL AKAN TERBUKA SPONTAN SBL BAYI LAHIR, KDG2 SPONTAN SBL BAYI LAHIR, KDG2 BUNTU SALAH SATU, TEARINGBUNTU SALAH SATU, TEARING
TX :TX :– ANTIBIOTIKA TETES MATAANTIBIOTIKA TETES MATA– MASSASE DAERAH DNL & SAKUSMASSASE DAERAH DNL & SAKUS– GAGAL, IRIGASIGAGAL, IRIGASI– GAGAL, PROBINGGAGAL, PROBING– RESPON BIASANYA BAIK, GAGAL BILA RESPON BIASANYA BAIK, GAGAL BILA
TERJADI OBSTRUKSITERJADI OBSTRUKSI
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IRIGASIIRIGASI
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PROBINGPROBING
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CANALICULITISCANALICULITISKRONIK, UNILATERALKRONIK, UNILATERALBIASANYA E/C JAMUR ACTINOMYCES, BIASANYA E/C JAMUR ACTINOMYCES, CANDIDA ASPERGILUSCANDIDA ASPERGILUSGX : MIRIP KONJUNGTIVITIS DGN GX : MIRIP KONJUNGTIVITIS DGN SEKRET PURULENSEKRET PURULENTX : TX : – KURET JAR. NEKROTIKKURET JAR. NEKROTIK– IRIGASIIRIGASI– ANTIJAMUR, ANTIBIOTIKAANTIJAMUR, ANTIBIOTIKA– GAGAL, CANALICULECTOMIGAGAL, CANALICULECTOMI
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CANALICULITISCANALICULITIS
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DACRYOADENITISDACRYOADENITIS
RADANG AKUT KLJ. LAKRIMALRADANG AKUT KLJ. LAKRIMALANAK2 :PAROTITIS EPIDEMIKA/MUMPS, ANAK2 :PAROTITIS EPIDEMIKA/MUMPS, INFLUENZA DAN MORBILIINFLUENZA DAN MORBILIDEWASA : NEISSERIA GONORHOICADEWASA : NEISSERIA GONORHOICAAKUT : TANDA RDG AKUT KLJ LAKR.AKUT : TANDA RDG AKUT KLJ LAKR.TX : ANTIBIOTIKA, K/P INSISITX : ANTIBIOTIKA, K/P INSISIKRONIS : MANIFESTASI SARCOIDOSIS, KRONIS : MANIFESTASI SARCOIDOSIS, MICULICZ SINDROM, TUBERCULOSE, MICULICZ SINDROM, TUBERCULOSE, LYMPHOCYTIC LEUKEMIA, LYMPHOCYTIC LEUKEMIA, LYMPHOSARCOMA LYMPHOSARCOMA
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DACRYOADENITISDACRYOADENITIS
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AIR MATA/TEARSAIR MATA/TEARS
KOMPOSISI SEKRESI KLJ. LAKR. KOMPOSISI SEKRESI KLJ. LAKR. MAYOR DAN MINOR, SEL GOBLET & MAYOR DAN MINOR, SEL GOBLET & MEIBOOMMEIBOOM
LAPISAN TIPIS 7-10 um, MELAPISI LAPISAN TIPIS 7-10 um, MELAPISI KORNEA & KONJUNGTIVAKORNEA & KONJUNGTIVA
VOLUME = 6 ulVOLUME = 6 ul
PERGANTIAN RERATA = 1,2 ulPERGANTIAN RERATA = 1,2 ul
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FUNGSI AIR MATAFUNGSI AIR MATA
1.1. MEMBASAHI EPITEL KORNEA & MEMBASAHI EPITEL KORNEA & KONJUNGTIVAKONJUNGTIVA
2.2. MERATAKAN PERMUKAAN KORNEAMERATAKAN PERMUKAAN KORNEA
3.3. MENCEGAH KERUSAKAN SEL EPITELMENCEGAH KERUSAKAN SEL EPITEL
4.4. MENGHAMBAT PERTUMBUHAN MENGHAMBAT PERTUMBUHAN MIKROORGANISMEMIKROORGANISME
5.5. MEMPERMUDAH PENETRASI OBATMEMPERMUDAH PENETRASI OBAT
6.6. MENCEGAH EVAPORASI TEARSMENCEGAH EVAPORASI TEARS
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KOMPOSISI AIR MATAKOMPOSISI AIR MATA
GAMA GLOBULIN, IgA, IgD, IgG, IgE, IgMGAMA GLOBULIN, IgA, IgD, IgG, IgE, IgM
LYSOZYMLYSOZYM
GLUCOSA 2,5mg/dlGLUCOSA 2,5mg/dl
UREA 0,04mg/dlUREA 0,04mg/dl
K+, Na+, Cl-K+, Na+, Cl-
Ph = 7,35Ph = 7,35
Osmolaritas = 295-309 mosmol/LOsmolaritas = 295-309 mosmol/L
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LAPISAN AIR MATALAPISAN AIR MATA
1.1. SUPERFICIAL LIPID LAYER SUPERFICIAL LIPID LAYER (MONOMOLEKULER)(MONOMOLEKULER)
2.2. MIDDLE LAYER (AQUOS LAYER)MIDDLE LAYER (AQUOS LAYER)3.3. DEEP MUCINUS LAYER, TDD DEEP MUCINUS LAYER, TDD
GLICOPROTEIN & MUCINGLICOPROTEIN & MUCINMUCIN (GLICOPROTEIN) MELAPISI MUCIN (GLICOPROTEIN) MELAPISI
EPITEL KORNEA & KONJUNGTIVAEPITEL KORNEA & KONJUNGTIVAEPITEL TERDIRI DARI LIPOPROTEIN EPITEL TERDIRI DARI LIPOPROTEIN
(HIDROFOBIK) (HIDROFOBIK)
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GAMBAR LAPISAN AIR MATAGAMBAR LAPISAN AIR MATA
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MUCIN LAYERMUCIN LAYER
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SECARA PERIODIK TERJADI SECARA PERIODIK TERJADI PERGANTIAN LAPISAN AIR MATAPERGANTIAN LAPISAN AIR MATA
MRPK USAHA MENCEGAH MRPK USAHA MENCEGAH KEKERINGAN SETEMPATKEKERINGAN SETEMPAT
CARANYA ?CARANYA ?
......................KEDIP DONGKEDIP DONG
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1. DRY EYE SYNDROME1. DRY EYE SYNDROME
SINDROMA MATA KERINGSINDROMA MATA KERING
DEFISIENSI SALAH SATU KOMPOSISI DEFISIENSI SALAH SATU KOMPOSISI TEARS FILMTEARS FILM
KELUHAN KELUHAN – MATA PEDIH, NGERES SPT BERPASIRMATA PEDIH, NGERES SPT BERPASIR– GATAL, SEKRET MUKUS BERLEBIHAN, GATAL, SEKRET MUKUS BERLEBIHAN,
PANAS, TAKUT SINARPANAS, TAKUT SINAR– MATA MERAH & NYERIMATA MERAH & NYERI
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PEMX : KLJ. LAKR. MEMBENGKAKPEMX : KLJ. LAKR. MEMBENGKAK
KORNEA : KORNEA : – PUNCTAT KERATITIS (AKUT)PUNCTAT KERATITIS (AKUT)– FILAMEN (KRONIS)FILAMEN (KRONIS)
SCHIRMER TEST, NORMAL 15mmSCHIRMER TEST, NORMAL 15mm
KX : KERATOCONJ. SICCA, MENURUNNYA KX : KERATOCONJ. SICCA, MENURUNNYA VISUS, ULSERASI KORNEA SAMPAI VISUS, ULSERASI KORNEA SAMPAI PERFORASI KORNEAPERFORASI KORNEA
TX : TX : – AQUOS DEF. : ARTIFICIAL TEARSAQUOS DEF. : ARTIFICIAL TEARS– MUCIN DEF. : SERUM PENDERITA, TETES MATA MUCIN DEF. : SERUM PENDERITA, TETES MATA
ATAU WATER SOLUBLE POLYMERSATAU WATER SOLUBLE POLYMERS
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2. HIPERSEKRESI LAKRIMAL2. HIPERSEKRESI LAKRIMAL
CX : CX : 1.1. RANGSANGAN/STIMULASI KLJ. LAKR, RANGSANGAN/STIMULASI KLJ. LAKR,
EMOSI, NYERI, NEUROGENIK, MATA EMOSI, NYERI, NEUROGENIK, MATA LELAH, EROSI KORNEA, BENDA ASING LELAH, EROSI KORNEA, BENDA ASING MATA, IRITASI N. FASIALIS O/K MUNTAH, MATA, IRITASI N. FASIALIS O/K MUNTAH, TERTAWA, SINAR YG KUATTERTAWA, SINAR YG KUAT
2.2. KEBUNTUAN APARATUS LAKRIMALIS O/K KEBUNTUAN APARATUS LAKRIMALIS O/K OKLUSI ATAU EVERSI PUNGTUM LAKR., OKLUSI ATAU EVERSI PUNGTUM LAKR., OBSTR. KANALIKULI & DUKTUS OBSTR. KANALIKULI & DUKTUS NASOLAKRIMALISNASOLAKRIMALIS
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3. CROCODILE TEARS3. CROCODILE TEARS
PARADOXIC LAKRIMASIPARADOXIC LAKRIMASI
UNILATERALUNILATERAL
EXCESSIVE TEARING SAAT EXCESSIVE TEARING SAAT MENGUNYAHMENGUNYAH
CX : CX : – SEQUELLE BELL`S PALSYSEQUELLE BELL`S PALSY– REGENERASI N. FASIALISREGENERASI N. FASIALIS
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4. BLOODY TEARS4. BLOODY TEARS
SELALU BERHUBUNGAN MENSTRUASI SELALU BERHUBUNGAN MENSTRUASI (PRIMER)(PRIMER)
SEKUNDER O/K RUDAPAKSA, BLOOD SEKUNDER O/K RUDAPAKSA, BLOOD DYSCRASIA, TUMOR SAKUS DYSCRASIA, TUMOR SAKUS LAKRIMALISLAKRIMALIS
HIPERTENSI, TJD. EPISTAXIS-REFLUX-HIPERTENSI, TJD. EPISTAXIS-REFLUX-BLOODY TEARSBLOODY TEARS
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