Anamnesis & Pemeriksaan Oftalmologi

Muhammad Asroruddin asroruddin@gmail.com

Departemen Ilmu Kesehatan Mata

Fakultas Kedokteran Universitas Tanjungpura

Brief Overview of Ocular Anatomy, Physiology and Terminology

Retinal Anatomy

Eye Movements

HISTORY

1. History of Present Illness

(HPI)

2. Past Medical History

(PMH)

3. Past Ocular History(POH)

4. Family History

5. Allergies

6. Medications

Chief Complaint Characteristics:

Duration

Frequency

Intermittency

Rapidity of onset

Location

Severity

Associated symtoms

Principal systemic illnesses

History of Present Illness (HPI)

• Red, painful eyes

• Floaters and Flashing

Lights

• Transient vision loss

• Blurry vision

• Chronic itching and

tearing

• Headaches and scalp

tenderness

Chief Complaint

Vision? Irritated

Eyes?

Flashes or

Floaters? Headaches

Blurry ?

Glare

Problem ?

Near/far

vision ?

Worse

when

reading/wat

ching TV?

Red ?

Stinging or

Aching Pain ?

Watering ?

Discharge?

Worsening

when

Reading/Wat

ching TV?

Ask every

patient?

New or old ?

Camera

flash?

Temporal

arteritis

symptoms?

Migraine

Symptoms?

Chief Complaint Characteristics:

Duration

Frequency

Intermittency

Rapidity of onset

Location

Severity

Associated symtoms

Principal systemic illnesses

Past Medical History (PMH)

Diabetes?

Hypertension?

Coronary artery disease?

Thyroid problems ?

Asthma ?

Past clinic visits

Past surgeries

Cataract surgeries,

Eye trauma

Glaucoma

History by examining their eyedrops.

Past Ocular History (POH)

Family History:

History of glaucoma

History of blindness

Allergies:

List basic allergies and their reaction

Sulfa drugs ?

Medications:

Eyedrops?

Betha blockers?

Blood Thinners ?

Anamnesis

1. Keluhan utama • Mata merah, visus menurun

• Mata merah, visus baik

• Mata tenang, visus menurun mendadak

• Mata tenang, visus menurun perlahan

2. Riwayat penyakit sekarang

3. Riwayat keluarga dan Penyakit sistemik

Mata Merah Visus Menurun

• Kelainan berada di media refraksi

• Media refraksi: kornea, bilik mata depan,

lensa, badan kaca, retina

• Kornea: keratitis, ulkus kornea

• Bilik mata depan: uveitis anterior

• Retina: glaukoma akut, uveitis

posterior

Mata Merah Visus Menurun

Mata Merah Visus Baik

• Kelainan bukan berada di media refraksi

• Kelainan: di konjungtiva

• Kelainan berupa konjungtivitis

Mata Tenang Visus Menurun

• Mata tenang visus menurun

akut: Ablasio retina

Neuritis optika

Oklusi arteri / vena retina

• Mata tenang visus menurun

perlahan • Katarak

• Kelainan refraksi

Retina sensorik terpisah dari lapisan pigmen akibat masuknya cairan sub retinal

ABLASI RETINA

Rhegmatogenous

Akibat robekan retina

Non-rhegmatogenous

Akibat traksi atau eksudatif

OKLUSI VENA RETINA

CABANG SENTRAL

•

NEURITIS OPTIKA

Mata tenang

visus menurun perlahan

KATARAK

Immatur Matur

Morgagnian Hipermatur

Status Ophthalmologicus

• Membedakan 2 titik terpisah

• Besar 1 menit busur

• Besar tiap huruf 5 menit

PRINSIP PENGUKURAN VISUS

Pemeriksaan refraksi

Pemeriksan Refraksi Tes Baca

Kartu pemeriksaan penglihatan anak

PENGUKURAN VISUS

PECAHAN =

jarak pemeriksan

-----------------------------------

Jarak huruf terkecil yang

masih dapat terbaca (kode/skore)

TIDAK ADA SATUAN

PENCATATAN :

Pecahan 6/50 - 6/6

Decimal

KARTU SNELLEN TES PINHOLE

C r i t e r i a S n e l l e n

Normal 6/6 to 6/18

Visual impairment <6/18 to 6/60

Severe visual impairment/

low vision

<6/60 to 3/60

Blind < 3/60

0.1 - 6/60 0.2 - 6/30 0.3 - 6/20 0.4 - 6/15 0.5 - 6/12 0.6 - 6/10 0.7 - 6/8.5 0.8 - 6/7.5 0.9 - 6/6.6 1.0 - 6/6

The Notation, Criteria of Visual Acuity

Near or Far Vision?

Pinhole test

Pinhole can actually improve vision by several diopters.

Pinhole Occluder blocks most of the misaligned rays that

cause visual blur, and allows the central rays to focus on the

retina

If patient shows no improvement with pinholing, start thinking

about other visual impediments like cataracts or retinal

problems

KEDUDUKAN BOLA MATA

ESOTROPIA

EXOTROPIA

HIPERTROPIA

HIPOTROPIA

DERAJAT HETEROTROPIA

ORTO tengah pupil

15 * ET tepi pupil

30* ET tepi limbus

45 *ET luar limbus

PERGERAKAN BOLA MATA

• CARDINAL GAZE

FIELD: Menilai kerja ke-6

otot ekstraokuler

• Konvergensi

• Diplopia

• Nystagmus

CARDINAL GAZE FIELD

Pemeriksaan Bola Mata

1. Pemeriksaan segmen anterior :

• Supersilia, palpebra, konjungtiva tarsal, konjungtiva

bulbi, kornea, kamera okuli anterior, iris, pupil, dan

lensa.

2. Pemeriksaan segmen posterior:

• Badan kaca, retina, papil syaraf optik

Injeksi Siliar

Injeksi Konjungtiva

INJEKSI KONJUNGTIVA BULBI

Injeksi Sklera

TES SENSITIVITAS KORNEA

TES FLUORESCEIN

BILIK MATA DEPAN

HIPOPION

Kedalaman BMD

IRIS

• Perlekatan = Synechia

• Operasi : iridektomi perifer

• Iridodialisis

• Crypti

• Warna

Pupil

• Refleks Cahaya Langsung

• Refleks Cahaya Tak Langsung (Consensual refleks)

• Relative Afferent Pupillary Defect (RAPD) Grade I - IV

• Katarak

• Shadow test

LENSA

PEMERIKSAAN FUNDUSKOPI

SISTEMATIKA PENILAIAN FUNDUS

PEMERIKSAAN FUNDUS

• Refleks : Rata - bercak hitam

• Papil NII: Batas warna ekskavasi

• Gambaran Arteri & Vena

• Makula: Reflek & Warna

• Retina: Eksudat perdarahan, pigmen, tear

Optic Disc !!

(a) Normal disc: note the distribution of the neuroretinal rim around the disc. (b) A swollen disc: the margin is not clearly demarcated; the patient had papilloedema. (c) The cup is enlarged, the neuroretinal rim thinned and the ISNT pattern lost. The patient has glaucoma. (d) New vessels are growing at the disc: this patient had diabetes.

Retina !!

(a) Exudates in a circular (circinate) pattern with a retinal haemorrhage in the centre. (b) Drusen at the macula; note the margins are less distinct than those of the exudates (c) The retinal haemorrhage here follows the pattern of the nerve fibre layer. The white lesion on the left

is a cottonwool spot, a sign of retinal ischaemia. Note how it differs from the exudates and drusen. The retinal vein appears tortuous and swollen. This patient had a branch retinal vein occlusion.

(d) A preretinal haemorrhage.

PAPIL N. OPTIKUS

• CUPPING KECIL

(fisiologis)

• CUPPING BESAR

(fisiologis)

• CUPPING GLAUKOMA

(total)

PEMERIKSAAN TAMBAHAN

• KAMPIMETRI

• TONOMETRI

• EXOFTALMOMETRI

• ANEL

• TES SCHIRMER

TES KONFRONTASI

Berhadapan jarak 1 m

Pemeriksa dianggap normal

KAMPIMETER GOLDMAN

PEMERIKSAAN TIO PALPASI

2 Tangan

1 Tangan

TONOMETER SCHIOTZ

1

TERA

MACAM TONOMETER

TES ANEL

TES HERTEL

TES SCHIRMER

Iris (I): Flat ? pupil

round?

Lens (L): clear, or hazy ?

phakic (they have

their own lens),

pseudophakic (prosthetic lens),

or aphakic (no

lens at all)?

Vitreous (V): blood cells

floating ?

Example of Notation (west)

Wnl = with normal limit, ou = both

eyes, NVI = Neovascularization of

Iris, PCIOL= Posterior Chamber

lens, NSC= Necrosclerotic

Cataract, PVD=