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PENYAKIT ORBITA
FKK UMJ
SRI FULINA
Orbital Diseases
Preseptal cellulitis
Orbital cellulitis
ANATOMI ORBITA Orbita : btk spt buah Pir dengan
n.optikus sebagai tangkainya. Volume orbita :± 30 cc Bolamata hanya 1/5 bgn ruangannya. Lemak dan otot menempati bagian
terbesar. Batas anterior rongga orbita adalah
septum orbita yg berfungsi sebagai pemisah antara palpebra dan orbita.
Orbita berhubungan dengan :- Bgn atas : sinus frontalis- Bgn bawah : sinus maksilaris- Bgn medial : sinus etmoidal dan sinus spenoidal.- Bgn dasar : tipis mudah rusak oleh
trauma langsung terhadap bolamata- fraktur”blow out” dgn herniasi isi orbita kedalam antrum maksilaris
Vaskularisasi : - A.Oftalmika cabang pertama dari a,karotis interna
(intra kranial ) - Cabang intra orbita - a.retina sentralis yang
memasuki n.optikus sekitar 8-15 mm dibelakang bolamata.
Cabang a.oftalmika-a.lakrimalis memperdarahi gld.lakrimalis dan palpebra superior.
Cabang-cabang muskularis ke berbagai otot orbita : - a.siliaris post longus/brevis
- a.palpebralis medialis untuk palpebra. - a.supraorbitalis - a.supratroklearis
A.siliaris posterior brevis memperdarahi koroid dan bagian-bagian n.optikus.
Kedua a.siliaris post longa memperdarahi korpus siliaris dan saling beranastomosis satu sama lain dan dgn a.siliaris ant membentuk sirkulus arterialis mayor iris.
Cabang-cabang muskular a.siliaris ant menuju muskuli rekti dan memasok darah ke sklera,episklera,limbus dan konyungtiva
serta turut membentuk sirkulus arterialis mayor iris.
Aliran vena orbita tu mel v.oftalmika sup dan inf juga menampung darah dari v.vorteks,v.siliaris ant dan v.retina sentralis.
V.Oftalmika berhubungan dgn sinus kavernosus mel fissura orbitalis sup dan dgn pleksus venous pterigoideus mel fissura orbitalis inf.
V.Oftalmika sup mula-mula di bentuk dariv.Supraorbitalis dan v.supratroklearis dan
dari satu cabang v.angularis yg semuanya mengalirkan darah dari kulit di daerah periorbital.
Vena ini membentuk hubungan langsung antara kulit wajah dgn sinus kavernosus , sehingga dapat menimbulkan trombosis sinus kavernosus yg potensial fatal akibat infeksi superfisial di kulit periorbital.
Differentiation between preseptal and orbital cellulitis is important because treatment, prognosis, and complications are different
Preseptal Cellulitis
Infection of the eyelids and soft tissue structures anterior to the orbital septum
May be due to skin infection, trauma, upper respiratory illness or sinus infection
Preseptal Cellulitis - Symptoms
Mild to very severe eyelid edema Eyelid erythema Normal ocular motility Normal pupil exam Mild systemic signs (fever, preauricular
and submandibular adenopathy)
Preseptal Cellulitis - Evaluation
Swab drainage if present for gram stain and culture
Blood cultures in more severe cases CT scan of orbit to assess the paranasal
sinuses, posterior extention into the orbit, and presence of subperiosteal or orbital abcesses
Preseptal Cellulitis - treatment
Systemic antibiotics The younger the patient and the more
severe the disease the more likely to initiate inpatient treatment (IV antibiotics)
Preseptal selulitis
Orbital Cellulits
Infectious process posterior to the orbital septum that affects orbital contents
Medical emergency !!!! Requires combined efforts of pediatrician,
ophthalmologist and often otolaryngologist for management
Orbital Cellulitis - Causes
Bacterial infection of the adjacent paranasal sinuses, particularly the ethmoids
Infants may develop secondary to dacryocysitis (infection of the nasolacrimal system)
Orbital Cellulitis – Signs and Symptoms
Redness and swelling of lids Impaired motility often with pain on eye
movement Proptosis Decreased vision Afferent pupillary defect Optic disc edema
Orbital Cellulitis: Note the marked lid swelling and erythema
Orbital Cellulitis: Note the periorbital edema and erythema and the chemosis (conjunctival swelling)Picture from Section 6 of the Basic and Clinical Science Course published by the Foundation of the American Academy of Ophthalmology
Orbital selulitis
Orbital sellulitis associated with orbital absces
Orbital Cellulitis Management
Hospitilization Ophthalmology consult (urgent) Blood culture Orbital CT scan IV antibiotics
Orbital Cellulitis Complications
Optic nerve damage (permanent visual loss)
Meningitis in 1.9% of cases as infection may spread through the valveless orbital veins
Subperiosteal abcess Cavernous sinus thrombosis
Subperiosteal abcess of the left orbit. Note the dome shaped elevation of the periosteum along the left medial orbital wall. Picture from Section 6 of the Basic and Clinical Science Course published by the Foundation of the American Academy of Ophthalmology
RL
Cavernosis sinus thrombosis
CTS is obstruction cavernosis sinus
by thrombus.
The obstruction cause venous
stagnation sign in eye.
Main cause :
● Infection from other place such as ;
face,mid ear,head,mouth,paranasalis
sinus or orbita.
Pathogenesis :
Thrombus-material consists of blood
component in vessels or heart.
The process ---thrombus—cavernosis
sinus---infection.
Thrombus can occur by 4 factors:1. Infection by microorganisms
especially streptococcus.
2. Alteration of endothelial layer of the
blood vessels.
Irritation or toxin---endothelial rough
adhesion of thrombus.
3. Alteration of blood viscocity—fibrin
4. Alteration of blood circulation.
Clinical featurs : Systemic :
- Fever
- Head ache
- Nauseous / vomiting
- Consiousness - Dead
OcularSupraorbital pain
Lacrimation
Photofobia
Decreased of vision
Exopthalmos
Palpebral edema
Periorbital edema
Pupil reflex
Papil edema
Extraocular muscle paresis
Hazy cornea
One eye …. 24-46 hours the fellow eye
Severe illness
Diagnosis :
- Anamnesis---infection from the other
place.
- Systemic evaluation
- Funduscopy— papil edema
- Laboratorium – leucositosis
- Angiography --- filling defect
- CT Scan
Management :
- Total bed rest
- IVFD dextrose 5%
- IV Antibiotik
- Eye ointment
Differential diagnosis:1. Orbital cellulitis : - unilateral - no papil edema - normal pupil reflex2. A-V Aneurisma : - exophthalmos with noise3. Pseudotumor orbita : - limitation eye movement - exophthalmos - palpebra edema without inflam
Prognosis : Depend of the adequad of
management and therapy.
The patient could died ---
complication