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Mendadak
Dr.Michael Indra Lesmana, Sp.M
FK UKRIDA-RS.FMC Sentul
Don’t forget Basic eye examinations!!
• Visual Acuity
• Pupillary test
• Funduscopy
• EOM
• Confrontation test
• Amsler grid test
Visual Pathway
• Retina
• Optic Nerve
• Chiasm
• Optic Tract
• LGB
• Optic Radiations
• Occipital Cortex
Visual Pathway
Retina
Retina
• Thin, semitransparent, multilayer sheet of neural tissue
• Ends at the Ora Serrata
– Located 6.5 mm behind Schwalbe’s line temporally and 5.7mm nasally
– 0.1 mm thick at the Ora and 0.23 mm thick at the posterior pole
• Closely attached to the RPE, and thus related to Bruch’s Membrane,
the choroid nd the Sclera
– This attachement may be easily separated (as in retinal detachment) to form the
Subretinal Space
– However, at the optic disc and at the ora serrata, the retina and the RPE are firmly
attached
• Macula
– Characteristics:
• Located in the area of the temporal vascular arcade
• Region where more than one layer of ganglion cell nuclei can be found
– Fovea:
• Thinner outer nuclear layer
• 1.5 mm in diameter
• Xanthophyll pigment
– Foveola:
• Central depression within the fovea
• Photoreceptor cells (made up mainly of Cones), glial cells, Mueller cells
• Responsible for the most acute vision
– Foveal Avascular Zone:
• Capillary-free zone
• Important landmark for treatment of subretinal neovascular membrane
Retina
• Layers of the Retina:
– Internal limiting membrane
• Abuts the vitreous
– Nerve fiber layer
• axons of the ganglion cells
– Ganglion cell layer
– Inner plexiform layer
• Axons of the bipolar and amacrine cells and dendrites of the ganglion cells and their
synapses
– Inner nuclear layer
• Nuclei of bipolar, horizontal, Mueller and amacrine cells
– Outer plexiform layer
• Made up of the connections b/w photoreceptor synaptic bodies and the horizontal and
bipolar cells
• Thicker at the macula (layer of Henle)
– Outer nuclear layer of photoreceptor nuclei
• Rods and cones
– Extenal limiting membrane
– Layer of rods and cones
– Retinal pigment epithelium
• Functions:
– Vitamin A metabolism, maintenance of the outer blood-retinal barrier, phagocytosis of the
photoreceptor outer segments, absorption of light, heat exchange, formation of the basal
lamina,production of mucopolysaccharides, active transport
• Adjacent RPE cells are attached to each other by junctional complexes which provide
both structural and metabolic stability (outer blood-retinal barrier)
– Zonula occludentes and Zonula adherentes
• Thickest at the Papillomacular Bundle and thinnest at the Fovea
Optic Nerve
• not really a peripheral nerve, it is actually a direct
extension of the CNS
• 1.88mm V, 1.77mm H
• Corresponds to the “blind spot” in perimetry
• 1.2 M axons
• 50 mm long
• Blood supply:
– Circle of zinn-haller
• Short PCA
• Choroidal circulation
• Pial vasculature
Optic Nerve
• 4 parts:
– intra-ocular (optic nerve head)
• 1 mm long; 1.5 mm H; 1.8 mm V
• optic disc (visible by fundoscopy)
• non-myelinated axons)
– intra-orbital
• 25 mm in length; 3 to 4.5 mm in diam
• lined by dura, arachnoid and pia mater
• fuses at the apex of the orbit with periosteum and annulus of zinn
– intra-osseous/intra-canalicular
• 9 mm in length
• bordered by the paranasal sinuses
• Firmly anchored to the bone
– Significance: a small mass lesion in the canal can cause compressive optic
neuropathy even before it becomes readiologically visible
– intra-cranial
• 10 mm long, may vary from 3 to 16 mm
• region where the carotid artery bifurcates into ACA and MCA
VISUAL FIELDS
Visual Field Defects
• location of lesion:
– optic nerve monocular loss of
– vision
– optic chiasm bitemporal
– hemianopsia
– optic tract (incongrous)
homonymous
– hemianopsia
– temporal lobe “pie in sky”
– parietal lobe “pie in the floor”
– occipital lobe (congrous)
– homonymous
hemianopsia
Objectives
• Diabetic Retinopathy
(Vitreous Haemorrhage, DME, NAAION,
Tractional retinal detachment)
• CSR (Central Serous Retinopathy)
• CRVO-BRVO
• CRAO-BRAO
• Optic Neuritis-papilitis, Methanol-toxic optic
neuropathy
Vitreous Haemorrhage Pre-retinal Hge USG/ B-scan
In Diabetic patient
Rhegmatogenous Retinal Detachment
Occurs in High myopic eye, aging process and post traumatic eye
USG
Tractional Retina Detachment Rhegmatogenous RD
CSR (Central Serous Retinopathy)
CSR/CSCR
• Is an eye disease which causes visual impairment,
often temporary, usually in one eye. When the
disorder is active it is characterized by leakage of
fluid under the retina that has a propensity to
accumulate under the central macula.
• This results in blurred or distorted
vision (metamorphopsia).
• The disease is considered idiopathic but mostly
affects white males in the age group 20 to 50.
• The condition is believed to be exacerbated
by stress or corticosteroid use.
CRVO-BRVO
– papilledema
• strictly refers to edema of the disc secondary to an
increase in intra-cranial pressure
– optic disc edema
• may be secondary to an ischemic, inflammatory, or
infiltrative process
– pseudoedema
• conditions that may present clinically with an
appearance of a swollen disc or blurred disc margin
Optic Atrophy
• The end result of diseases or
injuries to the optic nerve.
• Funduscopy will show a very pale
optic disc
• Common causes
– Long standing papilledema
– Inflammation (optic neuritis)
– Ischemia
– Glaucoma