Download - Ektropion Dan Entropion
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EYELIDS & ADNEXADr. Halimah Pagarra, Sp.M(K)
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ANATOMY of the EYELIDS
7 Structural layers:1. Skin & subcutaneous tissue2. Muscle of protraction (Orbicularis Oculi)3. Orbital septum4. Orbital fat5. Muscle of retraction (levator)6. Tarsus7. Conjunctiva
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Upper eyelid anatomy
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Lower eyelid anatomy
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Eyelid Margin Anatomy
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Fig. A. The upper and lower tarsal plates and their attachments to the levator aponeurosis and to Whitnall’s ligament
Fig B. The three-dimensional organization of the upper eyelid
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Orbicularis Muscle & related musculature
Deeper eyelid & anterior orbital structure
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Periorbital and eyelid arteries
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Major features of the normal eyelid. a. Eyelid margin with cilia; b. upper eyelid crease; c. medial canthus; d. lateral canthus; e. caruncle; f. plica; g. brow.
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ENTROPION
Berputarnya margo palpebra ke dalam → bulu mata bersentuhan dengan bola mata (kornea atau konjungtiva)
Klasifikasi : E. kongenital (primer dan
sekunder) E. dapatan ( spastik, senil,
mekanik & sikatriks)
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Etiologi : En. Kongenital
E. Kongenital Primer : perkembangan yg berlebihan dr serabut M. orbikularis marginal
E. Kongenital Sekunder : ok anoftalmus (bola mata -) , enoftalmus (bola mata masuk kedalam), mikroftalmus (bola mata mengecil)
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Entropion Dapatan
1. E. Spastik : - peradangan okuler akut
- bebat mata yg lama2. E. Mekanik (semua umur, pdu palp.
Inferior) ok : enoftalmus (kurangnya lemak orbita), anoftalmus, mikroftalmus, kalazion, hiperplasi konjungtiva, atrofi bulbi.
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Entropion Dapatan3. E. Senil ( usia 70-75 th) ok :
- kurangnya lemak orbita, elastisitas kulit ↓ konjungtiva berkerut
4. E. Sikatriks :- radang kronik konjungtiva & tarsus (trakoma, Sx SJ)- trauma thermis/kimia- energi radiasi- trauma operasi
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GEJALA KLINIK : Iritasi Lakrimasi Fotofobi Nyeri Ulkus kornea Kekeruhan kornea Vaskularisasi kornea( DD : Trikiasis)
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TERAPI
Non operasi → u/ Entropion Spastik :1. Pemakaian protesa ( atrofi bulbi / post enukleasi)2. Eversi palpebra dgn plester adhesive di permukaan luar palpebra3. Epilasi : mencabut cilia yg menyentuh bola mata
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TERAPI TERAPI OPERATIF UNTUK :1. E. Spastik yg gagal dg terapi non op.:
a. entropion suture (Gaillard –arlt tehnik)b. Jahitan diatas kancing plastik (1 mgg dibuka)c. Jahitan Snellend. Tehnik authore. Modifikasi Author (Wheeler orbicularis strip technique)
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TERAPI
2. ENTROPION SENILa. Kauterisasi Ziegler membentuk jar parutb. Modifikasi Zieglerc. Reseksi Kulit
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TERAPI3. Entropion Sikatriks
a. Palpebra superior : - Streatfield-Snellen- Horizontal tarsal section- Tarsal resection with mucosal
graft- Von Milliagen tarsochilloplasty
b. Palpebra inferior :- Eksisi kulit & otot (Panas)- Eksisi kulit & otot (graft)- Tarsal section
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Pre operasi Post operasi
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EKTROPION
Palpebra berputar keluar permukaan konjungtiva tampak dari luar
Klasifikasi : Ek. Kongenital (jarang) Ek. Dapatan : Spastik, mekanik,
sikatriks, paralitik, senil.
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Etiologi Ek.Spastik spasme m.orbikularis
(anak-anak/remaja), iritasi, edema konjungtiva
Ek. Mekanik akibat gaya berat (tumor/inflamasi)
Ek. Sikatriks setelah trauma Ek. Paralitik ok parese N.VII (morbus
hansen,lues, radang) Ek. Senil hilangnya tonus &
bertambahnya relaksasi MOO pinggir kelopak terkulai kedepan.
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Gejala Klinik
SubyektifMata merah, epifora, kekeruhan kornea
ObyektifInspeksi : margo terbalik kedepanMata tidak tertutup sempurnaEpifora ok pungtum eversi.
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TERAPI
NON OPERATIF : Untuk kasus ringan, sementara Ek.Spastik (bebat mata, menyeka air
mata dr bawah ke atas) Ek. Atonik (Senil & Paralitik)
Jahitan (suture) Snellen, Argyl Robertson, Verhoeff,Wiener.
Elektrocauter (Galvanocauter Ziegler)
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Terapi Operatif Ek. Senil : = Ek Paralisis
Full Ziegler Cautery Blaskovics ( E. Medial) Modifikasi Author Yuhut Helmholtz Author (E. Lateral) Argyll Robertson IMRE (1/3 tengah) Kuhnt-Szymanowsky
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Pre operasi Post operasi
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TERIMA KASIH