FARMAKOTERAPI PADA GANGGUAN

MATA

GENERAL PRINCIPLES OF TREATMENT

Drug treatment in ophthalmology is largely directed to one of the following approaches:

1. Reduction of inflammation by prompt and intensive treatment of microbial infection

2. Reduction of raised intraocular pressure3. Removal of an opacified corneal epitelium4. Physiological replacement of tear5. Intraocular fluid replacement

ANATOMI MATA

Lacrimal Apparatus

Normal aqueous flow

CATARACTS

• Is defined as any opacity in the crystalline lens of the eye

• Blindness

Causa:• Diabetes mellitus• Ultraviolet light• Trauma• Drugs• Age • Congenital • Ocular Surgery

Drugs

Chlorpromazine

• Long-acting mioticsOther drugs

• Amiodarone• Busulphan

- initially posterior subcapsularSystemic or topical steroids

- central, anterior capsular granules

Symptoms• blurred vision,which is usually worse

when viewing distant objects• cannot see so well in bright light and

might even be wearing a pair of dark glasses

• look double• the vision is much worse in bright

sunlight

Classification

Classification according to maturity

Immature Mature

Hypermature Morgagnian

Anterior polar cataract May be dominant inheritance

Capsular Pyramid

With persistent pupillary membrane

With Peters anomaly

Nuclear cataract

• Exaggeration of normal nuclear ageing change• Causes increasing myopia

• Increasing nuclear opacification

• Initially yellow then brown

Progression

Cortical cataract

Initially vacuoles and clefts Progressive radial spoke-like opacities

Progression

Subcapsular cataract

Anterior Posterior

Treatment:

1. To delaying the progression cataract.- Bendazac lysine 1 % ( eye drops )- Bendazac lysine 500 mg 3 times daily ( orally )2. Cataract surgery- Preoperative: To prevent constriction of the pupil

diclofenac ( topically )- Intraoperative: gentamicin ( inj. Subconjunctiva)- Post operative: corticosteroid ( topically ) + / - antibiotic ( topically),

: NSAID 1-4 weeks

Treatment:

3. Local anaesthetics:

- Bupivacaine 0.25 % - 0.75 %

- Lignocaine 1 %

- Mepivacaine 1 % - 2 %

- Etidocaine 1 %

GLAUCOMA• Associated with elevated intraocular

pressure (IOP )• Intra cranial pressure is set to the retinal

pressure• Optic disk cupping• Patient with IOP greater than 21 mm Hg

should be suspected of having glaucoma• the pressure of elevated IOP is not

synonymus with glaucoma,for example: tumor inside the brain.

IOP and Optic disc

GLAUCOMA

• Is characterized by:- The optic nerve damage is usually with elevated Intra Ocular Pressure ( IOP ) greater than 21 mm Hg- Visual field changes - Can cause blindness

• SignsThe three cardinal signs are:1. Raised intraocular pressure.2. Cupping of the optic disc.3. Visual field loss.

Etiology

Causa :

Age

Miopi

Heredity

Diabetes

Drugs

Classification of glaucoma

• Primary glaucoma:

1. Open angle

2. Closed angle

• Secondary glaucoma:

1. Open angle

2. Closed angle

• Congenital glaucoma

GLAUCOMA

OPEN ANGLE GLAUCOMA :

1.Pathological changes in the trabecular meshwork decrease the outflow of aqueous humour

2.The primary defect is reduced drainage of the aqueous humour into canal of Schlemm

GLAUCOMA

CLOSED ANGLE GLAUCOMA :

• Cause:1. The result from forward ballooning of the peripheral iris, it touches the back of cornea

2. The flow of aqueous humor between the cornea and the iris is reduced

Chronic open angle glaucoma (primer)

Symptoms:

No symptom

No visual acuity complaint

Peripheral visual field loss

- difficulty in walking

- can not see anything surround

Totally blind (end state)

Signs:

• Quiet eye

• Gonioscopy: normal

• Glaucomatous optic atrophy (CD > 0,6,disc hemorrhage)

• Glaucomatous visual field defects

• IOP > 21 mmHg

ACUTE ANGLE CLOSURE GLAUCOMA

(primer)

Symptoms :

Severe pain

Redness

Blurred vision

Nausea

Vomiting

Acute angle closure glaucoma(primer)

• Palpebral spasm• Conjungtival hyperemia• Corneal edema• Shallow anterior chamber• Pigment dispersion• Gonioscopy: closed angle• Optic nerve: hyperemic, edematous• Visual field: nonspecific constriction• High IOP (>21 mmHg)

Open angle sec.glaucoma (secunder)

• Uveitis

• Hipermatur lens

• Steroid

• Trauma

Symptom Acute or chronic

Closed angle secunder glaucoma

• Uveitis

• Subluxation/dislocation of lens

• Intraocular neoplasm

• Neovascularization of the angle

Symptom: acute glaucoma

Congenital glaucoma

• First year of life

• Photophobia

• Buphthalmos/enlarge eye globe

• Corneal clouding

• High IOP

Saluran pembuangan tidak sempurna

Glaucoma examination

Ophthalmoscopy (Optic nerve)

Tonometry (Intraocular pressure/IOP)

Gonioscopy (Anterior chamber angle)

Perimetry (Visual field)

Visual field loss in glaucoma

OphthalmoscopyOphthalmoscopy

Tonometry

TonometryPerimetry

Glaukoma

normal

GLAUCOMA THERAPY

Medical therapySurgery

• By decreasing aqueous prod / inflow

• By increasing outflow

• By destructing the ciliary body

• Filtration surgery

GLAUCOMA SURGERY

• Trabeculectomy to connect the anterior chamber with subconjuctival space

• Laser trabeculoplasty (Photocoagulator) making scar in trabeculum

• Gonioplasty/iridoplasty making scar in iris to open the iridocorneal angle

Management of open angle glaucoma

Management of angle closure glaucoma

INFECTION AND INFLAMMATION

OCULARACUTE CONJUNCTIVITIS

Conjunctivitis or inflammation on mucosa which covers the back part of the eye.

• Cause:Bacteria:

- Staphylococcus - Streptococcus pneumonia- Haemophhilus aegyptus

TREATMENT:

Sulfonamides - the first effective chemotherapeutic agent,- the prevention and cure of bacterial infection.

Side effects:- Patients with acid urine of the older sulfonamide are insoluble and may precipitate causing crystalling deposits can cause urinary obstructive.

Tetracycline - Active against bacteria and some micro organisms that

are resistant to cell-wall-active anti microbial agent

Side effects:- Gastrointestinal iritation,- Hepatic toxicity,- Renal toxicity,- Brown discoloration of the teeth.

DACRYOCYSTITIS

Begins with the closings of ductus nasolacrimal.

• Cause: Bacteria Streptococcus pneumonia

• Treatment:- Antibiotic ( orally and parenterally )- Decongestant nose drops

BACTERIAL CORNEAL ULCERS

• Cause:Viruses (Herpes simplex), fungi (Aspergillus, Candida spp), bacteria (Streptococcus pneumoniae)

• Treatment:- Antibiotics (topical)

BACTERIAL CORNEAL ULCERS

Mata normal

FUNGAL KERATITIS

The symptoms of fungal corneal ulcers are redness andsevere pain.

• Cause:- Candida sp- Aspergillus sp

• Treatment:- Amphotericin B 0.15 % ( drops ) every hour- Nystatin 100.00 U/ml( topically ) every two hour- Clotrimazole 1 % ( drops )

Treatment

- AMPHOTHERICIN B. 0,15% (drops), is one of a family of some 200 polyene macrolide antibiotics.

Side effects (rare):- Fever,- Chill.

- Nystatin 100.00 U/ml (topically), has the same mechanisms of action with amphothericin B.

Side effects (rare):

- Fever,

- Chill.

OPHTHALMIA NEONATORUM

It refers to acute conjunctivitis in the first 4 weeks in the life of a child.

• Cause:- Chlamydia- Bacteria:Neisseria gonorrhoeae (potentially leading to

blindness), S.aureus, S.pneumoniae, S.pyogenes, H. influenzae, Herpes simplex virus.

• Treatment:- Neonatus born to mother with active gonococcal: penicillin

G (i.m)- Chlamydia : Erythromycin 10 mg /kg BB. 3 x daily ( orally )

+ tetracycline (topically)

OPHTHALMIA NEONATORUM

TRACHOMA

Is an infection on conjuctiva or cornea caused by chlamydia trachoma

• Treatment:- Tetracycline (topical or systemic) 3 to 6 weeks- Erythromycin ( i.m ) once a week for three weeks

TRACHOMA

Treatment

Tetracycline - Active against bacteria and some micro organisms that are resistant to cell-wall-active anti microbial agent.

• Side effects:- Gastrointestinal iritation,- Hepatic toxicity,- Renal toxicity,- Brown discoloration of the teeth.

Erythromycin (taken orally), is usually bacteriostatics but can be bacteriocidal in high concentration.

Side effects:

- fever,

- eosinophilia,

- skin eruption.

VIRUS INFECTION

Viral lesion of the lids, conjunctiva and cornea can be caused by a number of different viruses: varicelal- zoster, herpes simplex vaccina

• Treatment- Iodoxuridine (topical), - Ganciclovir (systemic)

Treatment

- Iodoxuridine (topical), is an iodinated thymidine

analogue.

• Mechanisms of action: Inhibits replication of various DNA viruses,

including herpes viruses.

• Side effects:- Pain, - Pruritis, - Inflammation in the eye or eyelids

Ganciclovir (systemic), is an acyclic guanine nucleotide analogue. The agent has inhibitory activity against all herpes viruses especially CMV (Cito Megalo Virus)

• Mechanisms of action: Inhibits viral DNA synthesis.

• Side effects:- Pain, - Pruritis, - Inflammation in the eye or eyelids

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