The Eye

dr. Duti Sriwati Aziz, SpPA

Sub Dep PA RSAL Dr. Ramelan – FK UHT

Orbita
Eyelid
Conjunctiva
Sclera
Cornea
Uvea
Retina & vitreuous
Optic Nerve
ORBITA
Figure 29-1 Anatomy of the eye.

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• Kelainan :
– Proptosis
– Thyroid ophthalmopathy
– Infeksi
– Neoplasma
 1. PROPTOSIS

• Tekanan orbita   bola mata terdorong

 proptosis

•  kelopak mata tak tertutup  air mata tak

merata  kornea kering 
– Nyeri
– Infeksi
• 2 macam :
1. Axial ( directly forward )
2. Positional
• Positional → Medial, inferior o.k tek
superotemporal
– Infeksi → kel.lacrimalis
– Neoplasma →
• Lymphoma
• Pleimorphic adenoma
• Adenoid cystic carcinoma ( Silindroma )
• Axial
– Thyroid ophthalmopathy
– Tumor CNS ( bukan SSP ) →
• Meningioma
• Glioma
 2. Thyroid ophthalmopathy

• Axial proptosis
• Grave’s disease
– karena :
• Akumulasi extracellular matrix protein
• Fibrosis muskulus rectus
 The extraocular muscles are greatly distended in this postmortem dissection of tissues from a
patient with thyroid (Graves) ophthalmopathy. Note that the tendons of the muscles are spared
involvement.
(Courtesy of Dr. Ralph C. Eagle Jr, Wills Eye Hospital, Philadelphia, PA.)
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 3. INFEKSI
• Uncontrolled Sinusitis
• Immunosuppressed → mucormycosis
• Diabetes sclerosing
• Wegener granulomatosis
• Idiopathic orbital inflammation → orbital
inflammatory pseudotumor
Orbital inflammatory pseudotumor
– Unilateral
– Bilateral
– Seluruh elemen orbita
– Kel lacrimalis → sclerosing dacryoadenitis
– Orbital myositis
– Posterior scleritis
• Mikroskopis :
– Fibrosis
– Radang khronis
• sel plasma, lymphocyte ( germinal centre ), eosinophil
• Lokasi :
– Terbatas di Orbita
– Bersamaan dengan keradangan di
retroperitoneum, mediastinum, thyroid
In idiopathic orbital inflammation (orbital inflammatory pseudotumor), the orbital fat
is replaced by fibrosis.
Note the chronic inflammation, accompanied in this case by eosinophils.
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 4. Neoplasma
• Vascular :
– Capillary Hemangioma
– Lymphangioma
• Kel. Lacrimal :
– Pleomorfik adenoma
• Dermoid cyst
• Neurilemmoma ( Schwannoma )
• Limphoma maligna
• Metastasis ( prostat, neuroblastoma, wilm’s tumor )
EYELID
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• Radang
• Granuloma → chalazion
• Neoplasma
 CHALAZION
• Ekstravasasi lipid kejaringan sekitar
– Reaksi granulomatous → Lipogranuloma
– O.k obstruksi sebaceous gland :
• Blepharitis
• Neoplasma
 Neoplasma
1. Basalioma ( Basal Cell Ca )
Ulcerasi kornea
2. Sebaceous Carcinoma
3. Melanoma
4. Kaposi sarcoma
• Basalioma
– Palpebra inferior
– Chanthus medius
• Sebaceous carcinoma
– ≈ chalazion
– Metastase → kelenjar parotis dan submandibula
– Mortalitas 22%
• Kaposi sarcoma
– Eyelid → Purple hue
– Mucous membran conjuctiva → Bright red
( ≈ subconjuctival haemorrhage )
– Conjuctiva menebal
CONJUNCTIVA
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• Scarr
• Pinguecula & Pterygium
• Neoplasma
 Conjunctival scarring
• Chlamydia trachomatis
• Caustis alkalis
• Pemphigoid
• Iatrogenic

Scarring  goblet   cairan  

ulcerasi  visi 
 3. Pinguecula & Pterygium
• Fibrovascular submucosa
• Pinguecula
– actinic damage
– invasi cornea
– Precursor Squamous Cell Ca & Melanoma
• Pterygium
– not invasi cornea
– pada submucosa limbus ( solar elastosis )
– Infeksi sekunder → actinic granuloma
 4. Neoplasma
• Dapat CIN ( Conjunctival Intraepithelial
Neoplasma )
• CIN + squamous papilloma  Human
papilloma virus 16, 18
• Mucoepidermoid Ca
• Conjunctival nevi  melanoma insitu
• Conjunctival melanoma
SCLERA
• Sedikit vascular & fibroblast → coklat, operasi
sukar sembuh
• Rheumatic arthritis  Immune complex deposit
 necrotizing scleritis
• Biru →
– High intraocular pressure  staphyloma
– Osteogenesis imperfecta
– Congenital nevus / nevus of ota
CORNEA
• Keratitis & ulcer
• Degeneration & distrophy
– Band keratopathies
– Keratoconus
– Fuchs endothelial dystrophy
– Stromal dystrophy
 Keratitis & Ulcers
• Bakteri, fungal, protozoa, virus ( H. simplex, H.
Zoster )
• Aktivasi collagenase  epithel & fibroblast
• H. simplex chronis  reaksi granulomatous
pada Descemet
 Chronic herpes simplex keratitis.
The cornea is thin and scarred (note the increased number of
fibroblast nuclei). Granulomatous reaction to Descemet's
membrane (arrows).
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 Corneal Degeneration & Dystrophies

• Degeneration - bilateral/unilateral
- non-familial

• Dystrophies - bilateral
- hereditary
a. Band keratopathies
• Calcific band keratopathy  timbunan
kalsium pada lapisan Bowman
• Actinic band keratopathy  pada
ultraviolet pengaruh collagen (solar
elastosis)
b. Keratoconus
• Penipisan & ectasia cornea progressive
tanpa inflamasi atau vaskularisasi
• Etiologi : unknown
• Biasanya bilateral, ada hubungan dg
Down syndrome, Marfan syndrome
Keratoconus.
• The tissue section is stained by periodic acid-Schiff to highlight the
epithelial basement membrane (ebm), which is intact.
• Bowman's layer (bl), situated between the epithelial basement membrane
and the stroma (s), is not a basement membrane.
• By tracing Bowman's layer from the right side of the photomicrograph
toward the center, one notices a discontinuity in this layer, diagnostic of
keratoconus.
• Patogenesa :
– Activasi colagenases, gelatinases, matrix
metalloproteinases
Morfologi :
• Cornea menipis, Bowman’s pecah-pecah
c. Fuchs Endothelial Dystrophies
• Ada pada anak-anak / dewasa muda,
progressive, autosomal recessive
• Rasa nyeri karena erosi epitel
d. Stromal Dystrophies
• Ada pada anak-anak / dewasa muda,
progressive, autosomal recessive
• Rasa nyeri karena erosi epitel
• Keratan sulfat, amyloid pada stroma
kornea
• Bentuknya ada 3 :
 Lattice dystrophy
 Granular dystrophy
 Avellino dystrophy
ANTERIOR SEGMENT
 1. Anatomi Fungsional
• Bag. depan dibatasi cornea, lateral dibatasi
trabecular messwork, posterior dibatasi iris
• Lens capsule, sbg basement membrane dari
epitel lensa
• Anterior segment : cornea, anterior chamber,
posterior chamber, iris, lensa
• Posterior segment : sisa dibelakangnya
 Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured with crypts and folds. Upper right, The normal flow of aqueous humor.
Aqueous humor, produced in the posterior chamber, flows through the pupil into the anterior chamber. The major pathway for the egress of aqueous humor is through
the trabecular meshwork, into Schlemm's canal. Minor outflow pathways (uveoscleral and iris, not depicted) contribute to a limited extent to aqueous outflow. Lower left,
Primary angle closure glaucoma. In anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens blocks the passage of aqueous
humor from the posterior chamber to the anterior chamber. Pressure builds in the posterior chamber, bowing the iris forward (iris bombé) and occluding the
trabecular meshwork. Lower right, A neovascular membrane has grown over the surface of the iris, smoothing the iris folds and crypts. Myofibroblasts within the
neovascular membrane cause the membrane to contract and to become apposed to the trabecular meshwork (peripheral anterior synechiae). Outflow of aqueous humor
is blocked, and the intraocular pressure becomes elevated.
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 Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured with crypts and folds. Upper right, The normal flow of aqueous humor.
Aqueous humor, produced in the posterior chamber, flows through the pupil into the anterior chamber. The major pathway for the egress of aqueous humor is through
the trabecular meshwork, into Schlemm's canal. Minor outflow pathways (uveoscleral and iris, not depicted) contribute to a limited extent to aqueous outflow. Lower left,
Primary angle closure glaucoma. In anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens blocks the passage of aqueous
humor from the posterior chamber to the anterior chamber. Pressure builds in the posterior chamber, bowing the iris forward (iris bombé) and occluding the
trabecular meshwork. Lower right, A neovascular membrane has grown over the surface of the iris, smoothing the iris folds and crypts. Myofibroblasts within the
neovascular membrane cause the membrane to contract and to become apposed to the trabecular meshwork (peripheral anterior synechiae). Outflow of aqueous humor
is blocked, and the intraocular pressure becomes elevated.
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 2. Cataract
• Cataract yaitu kekeruhan lentikular, dapat
acquired/kongenital
• Penyakit-penyakit :
– Systemic (galactosemia, DM, Wilson, Atopic)
– Radiation
– Trauma
– Intra ocular
• Cataract yg berhubungan usia  kekeruhan
nukleus
• Pigmen urochrome  warna coklat
• Migrasi epitel ke bagian belakang  posterior
subcapsular cataract
• Cortex lensa mencair  morgagnian cataract
• Protein berat molekul tinggi yang pecah dari
lensa  phacolysis  membendung
trabecular meshwork  glaucoma phacolytic
 3. Segmen anterior dan Glaucoma
• Yaitu kumpulan penyakit ditandai dengan
perubahan yang jelas dari gangguan pandang
& nerve opticum cup
• Biasanya dg peningkatan tekanan intra okular,
tetapi dapat juga normal (normal/low tension
glaucoma)
• Aqueous humor dibentuk oleh ciliary bodies
 masuk ke trabecular meshwork
 Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured with crypts and folds. Upper right, The normal flow of aqueous humor.
Aqueous humor, produced in the posterior chamber, flows through the pupil into the anterior chamber. The major pathway for the egress of aqueous humor is through
the trabecular meshwork, into Schlemm's canal. Minor outflow pathways (uveoscleral and iris, not depicted) contribute to a limited extent to aqueous outflow. Lower left,
Primary angle closure glaucoma. In anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens blocks the passage of aqueous
humor from the posterior chamber to the anterior chamber. Pressure builds in the posterior chamber, bowing the iris forward (iris bombé) and occluding the
trabecular meshwork. Lower right, A neovascular membrane has grown over the surface of the iris, smoothing the iris folds and crypts. Myofibroblasts within the
neovascular membrane cause the membrane to contract and to become apposed to the trabecular meshwork (peripheral anterior synechiae). Outflow of aqueous humor
is blocked, and the intraocular pressure becomes elevated.
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 Figure 29-11 Upper left, The normal eye. Note that the surface of the iris is highly textured with crypts and folds. Upper right, The normal flow of aqueous humor.
Aqueous humor, produced in the posterior chamber, flows through the pupil into the anterior chamber. The major pathway for the egress of aqueous humor is through
the trabecular meshwork, into Schlemm's canal. Minor outflow pathways (uveoscleral and iris, not depicted) contribute to a limited extent to aqueous outflow. Lower left,
Primary angle closure glaucoma. In anatomically predisposed eyes, transient apposition of the iris at the pupillary margin to the lens blocks the passage of aqueous
humor from the posterior chamber to the anterior chamber. Pressure builds in the posterior chamber, bowing the iris forward (iris bombé) and occluding the
trabecular meshwork. Lower right, A neovascular membrane has grown over the surface of the iris, smoothing the iris folds and crypts. Myofibroblasts within the
neovascular membrane cause the membrane to contract and to become apposed to the trabecular meshwork (peripheral anterior synechiae). Outflow of aqueous humor
is blocked, and the intraocular pressure becomes elevated.
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Jenis glaucoma :
• Glaucoma sudut terbuka primary
• Glaucoma sudut tertutup secondary
Primary glaucoma sudut terbuka :
• Mutasi pada GLC1A, pada chromosome 1 
myocilin
• Jenis glaucoma yg terbanyak
Secondary glaucoma sudut terbuka :
• Phacolysis pada chataract
• Darah (ghost cell glaucoma)
• Pigmen iris (pigmentary glaucoma)
• Oxytalan fibers (exfoliation glaucoma)
• Necrotic tumor (melanomalytic glaucoma)
Primary glaucoma sudut tertutup :
• Banyak pada hyperopia
• Terjadi papillary block  terjadi iris bombé
• Epitel lensa dapat rusak
Secondary glaucoma sudut tertutup :
• Kelebihan VEGF (Vascular Endothelial Growth
Factor)
• Neovascular glaucoma  karena nekrotik
tumor
• Endothel cornea berlebihan  menutup
meshwork
4. Endophthalmitis & Panophthalmitis

• Traumatic iridocyclitis
• Infeksi cornea
• Uveitis
• Anterior synechiae  iris & trabc. m. Melekat krn
• Posterior synechiae  iris & lensa exudate
fibrous metaplasia
anterior subcapsular
 Sequelae of anterior segment inflammation.
This eye was removed for complications of chronic corneal inflammation
(which cannot be discerned at this magnification). The exudate (e) present
in the anterior chamber would have been visualized at the slit lamp as an
optical "flare." The iris is adherent focally to the cornea, obstructing the
trabecular meshwork (anterior synechia, arrow), and adheres to the lens
(posterior synechiae, arrowheads). An anterior subcapsular cataract (asc)
has formed. The radial folds in the lens are artifacts.
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 Exogenous panophthalmitis.
Note the suppurative inflammation behind the lens and drawn up to the right of
the lens to the cornea, the site of the wound. The central portion of the vitreous
humor was extracted surgically (by vitrectomy). Note the adhesions to the
surface of the eye at the eight o'clock position, indicating that the intraocular
inflammation has spread through the sclera into the orbit: panophthalmitis.

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UVEA
Terdiri dari
– Iris
– Ciliary bodies
– Choroid
 1. Uveitis
• Adalah proses keradangan khronik dari salah
satu atau keseluruhan Uvea
• Misal : juvenile rheumatic arthritis, segmen
anterior/posterior
• Biasanya disertai keradangan retina
• Sebabnya :
– Infeksi bakteri (pneumocystis carnii )
– Idiopathic (sarcoidosis) : granulomatous uveitis
– Autoimune (sympathetic ophthalmia)
• Granulomatous Uveitis
– Anterior segment : exudate  mutton-fat
– Posterior segment : choroid dan retina
• Toxoplasma infeksi  choroid & retina
• Cytomegalovirus  retina
• Mycobacterium avium  uvea
• Sympathetic ophthalmia
– Bilateral granulomatous inflammation : seluruh
uvea
– Pertama didapatkan pada : Louis Braille  sel-sel
eosinophil
– Terdapat Ag retina  2 minggu  beberapa
tahun hypersensitivity delayed
 Sympathetic ophthalmia. The granulomatous inflammation depicted here was
identified diffusely throughout the uvea. The uveal granulomas may contain melanin
pigmentand may be accompanied by eosinophils.
 2. Neoplasma
Terbanyak metastase ke uvea (choroid)
Uveal nevi & Melanoma
• Melanoma uveal adalah tumor intra ocular
tersering pada dewasa
• Usia terutama dekade 7
• Nevus choroid sering terjadi, 10% pd Ca
• Penyebaran melanoma hematogenous, ke
liver, 5 YSR  80%
Figure 29-15 Uveal melanoma. A, Fundus photograph from a patient with a relatively flat pigmented lesion of the choroid near the optic
disc. B, Fundus photograph of the same patient several years later; the tumor has grown and has ruptured through Bruch's membrane.
C, Gross photograph of a choroidal melanoma that has ruptured Bruch's membrane. The overlying retina is detached. D, Epithelioid
melanoma cells are associated with an adverse outcome. E, Patterns rich in laminin (that are periodic acid-Schiff positive) surround
aggregates of melanoma cells; these patterns form a "fluid-conducting meshwork" in uveal melanoma and are associated with an
adverse outcome. (A to C from Folberg R: Pathology of the eye-an interactive CD-ROM program. Philadelphia, Mosby, 1996; E from
Maniotis AJ, Chen X, Garcia C, et al: Control of melanoma morphogenesis, endothelial survival, and perfusion by extracellular matrix.
Lab Invest 82(8):1031-1043, 2002.)
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Uveal melanoma. C, Gross photograph of a choroidal melanoma
that has ruptured Bruch's membrane. The overlying retina is
detached. D, Epithelioid melanoma cells are associated with an
adverse outcome.

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• Morfologi ada 2 jenis yaitu :
– Spindle  sel fusiform, sedikit atypic
– Epitheloid  sel spherical, sangat atypic →
prognosa buruk
• Dapat timbul :
– Retinal detachment
– Glaucoma
RETINA & VITREOUS
 1. Anatomi Fungsional
• Tidak ada aliran limphetic
• Pigmen epitel retinal  asal dari optic vesicle
• Retinal detachment  lepasnya neurosensory retina
dg pigmen epitel retina
• persistent hyperplastic primary vitreous  regresi
fetal vascular tdk sempurna
• Asteroid hyalosis  calcium soap dari debris vitreus
humor
• Posterior vitreous detachment  posterior face
humor lepas dari retina
 Figure 29-16 Clinicopathologic correlations of retinal hemorrhages and exudates. The location of the hemorrhage within the retina
determines its appearance by ophthalmoscopy. The retinal nerve fiber layer is oriented parallel to the internal limiting membrane, and
hemorrhages of this layer appear to be flame-shaped ophthalmoscopically. The deeper retinal layers are oriented perpendicular to the
internal limiting membrane and hemorrhages in this location appear as cross-sections of a cylinder or "dot" hemorrhages. Exudates that
originate from leaky retinal vessels accumulate in the outer plexiform layer.

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 2. Retinal Detachment
• Lepasnya neurosensory retina dari pigmen
epithelium
• Phlegmatogenous retinal detachment
 seluruhnya lepas
 proliferatif vitreoretinopathy
• Surgical procedure  retina pecah
• Non-rhegmatogenous retinal detachment
 tanpa pecahnya retina - tumor
- hipertensi
 Figure 29-17 Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. Retinal detachments are classified broadly
into non-rhegmatogenous (without a retinal break) and rhegmatogenous (with a retinal break) types. Top, In non-rhegmatogenous retinal detachment, the subretinal
space is filled with protein-rich exudate. Note in this sketch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can be seen in both non-rhegmatogenous and rhegmatogenous detachments. Middle, Posterior vitreous detachment involves the separation of the posterior
hyaloid from the internal limiting membrane of the retina and is a normal occurrence in the aging eye. Bottom, If, during a posterior vitreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting membrane of the retina, the vitreous humor will exert traction on the retina which will be torn at this point.
Liquefied vitreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this sketch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is being illustrated.
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 Figure 29-17 Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. Retinal detachments are classified broadly
into non-rhegmatogenous (without a retinal break) and rhegmatogenous (with a retinal break) types. Top, In non-rhegmatogenous retinal detachment, the subretinal
space is filled with protein-rich exudate. Note in this sketch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can be seen in both non-rhegmatogenous and rhegmatogenous detachments. Middle, Posterior vitreous detachment involves the separation of the posterior
hyaloid from the internal limiting membrane of the retina and is a normal occurrence in the aging eye. Bottom, If, during a posterior vitreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting membrane of the retina, the vitreous humor will exert traction on the retina which will be torn at this point.
Liquefied vitreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this sketch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is being illustrated.
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 Figure 29-17 Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. Retinal detachments are classified broadly
into non-rhegmatogenous (without a retinal break) and rhegmatogenous (with a retinal break) types. Top, In non-rhegmatogenous retinal detachment, the subretinal
space is filled with protein-rich exudate. Note in this sketch that the outer segments of the photoreceptors are missing. This indicates a chronic retinal detachment, a
finding that can be seen in both non-rhegmatogenous and rhegmatogenous detachments. Middle, Posterior vitreous detachment involves the separation of the posterior
hyaloid from the internal limiting membrane of the retina and is a normal occurrence in the aging eye. Bottom, If, during a posterior vitreous detachment, the posterior
hyaloid does not separate cleanly from the internal limiting membrane of the retina, the vitreous humor will exert traction on the retina which will be torn at this point.
Liquefied vitreous humor seeps through the retinal defect, and the retina is separated from the retinal pigment epithelium. Note in this sketch that the photoreceptor outer
segments are intact, suggesting that an acute detachment is being illustrated.
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 3. Retinal Vascular Disease
• Hypertension
– Arteriolosclerosis
arteriole & vena berjalan bersama, pd tempat
tertentu terdapat cross, pada arteriolosclerosis 
oclusi vena
– Hipertensi maligna  saluran rusak  Elschnig's
spots
– Occlusion retinal arteriole  cytoid bodies 
cotton wool spots
 The retina in hypertension. A,
The wall of the retinal arteriole
(arrow) is thick. Note the
exudate (e) in the retinal outer
plexiform layer.

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 Nerve fiber layer infarct.
The histology of a cotton-
wool spot-an infarct of the
nerve fiber layer of the
retina-is illustrated in the
photomicrograph. A focal
swelling of the nerve fiber
layer is occupied by
numerous red to pink
cytoid bodies
(arrowheads), bulbous
ends of severed axons.
Hemorrhage (arrows)
surrounding the nerve fiber
layer infarct as illustrated
here is a variable and
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• Diabetes Mellitus
– Penebalan basement membrane epitel pars
plicata
– Microangiopathy retinal : a. Preproliferatif
b. Proliferatif
a. Preproliferatif
- basement membrane menebal
- pericyte berkurang
 The ciliary body in chronic
diabetes mellitus, periodic acid-
Schiff stain. Note the massive
thickening of the basement
membrane of the ciliary body
epithelia, reminiscent of
changes in the mesangium of
the renal glomerulus.

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– Microaneurisma  microhemorrhages  macular
edema  gangguan visual
– VEGF, angiogenesis  microangiopathy 
neovascularization of the disc
– Traction retinal detachment  rhegmatogenous
detachment
– Neovascular iris  neovascular membrane 
kontraksi  adhesi iris dg trabecular meshwork 
glaucoma
The retina in diabetes mellitus. A, Note the tangle of abnormal vessels just beneath
the internal limiting membrane of the retina on the right half of the photomicrograph
(between arrows). This is an example of intraretinal angiogenesis known as
intraretinal microangiopathy (IRMA). Note the retinal hemorrhage in the outer
plexiform layer in the left half of this photomicrograph. Ophthalmoscopically, this
outer retinal layer hemorrhage would appear as a "dot" hemorrhage
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• Retinopathy of prematurity
– Genetik susceptible
– Bayi prematur
– VEGF   retinal angiogenesis  detachment
• Sickle Retinopathy, Retinal Vasculitis,
Radiation Retinopathy
a. Non proliferatif (intraretinal angiopathic
changes)
b. Proliferatif (retinal neovascularization)
Vascular occlusion : karena - VEGF 
- bFGF 
• Retinal Artery and Vein Occlusions
– Atherosclerosis pd retina  trombosis
– Emboli pd retinal karena trombi jantung
infark retina

cherry red spot
– Cherry red spot juga ada pada Tay-Sachs and
Niemann-Pick
– Dapat menyebabkan glaucoma sudut tertutup
Figure 29-22 The cherry-red spot in Tay-Sachs disease. A, Fundus photograph of the cherry-red spot in Tay-Sachs disease. B, Photomicrograph of the
macula in a patient with Tay-Sachs disease, stained with periodic acid-Schiff to highlight the accumulation of ganglioside material in the retinal ganglion
cells. The presence of ganglion cells filled with gangliosides outside the fovea blocks the transmission of the normal orange-red color of the choroid, but
absence of ganglion cells within the fovea (to the right of the vertical bar) permits the normal orange-red color to be visualized, accounting for the so-
called cherry-red spot. (A courtesy of Dr. Thomas A. Weingeist, Department of Ophthalmology & Visual Science, University of Iowa, Iowa City, IA; B
originates from the teaching collection of the Armed Forces Institute of Pathology.)

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4. Age Related Macular Degeneration (ARMD)

• Faktor penting yaitu usia

• Faktor penentu - rokok
- nutrisi
- vascular
• Bruch's membrane
 visual loss
Choriocapillaris
• Ada 2 jenis :
a. Atropic ARMD : - branch, membrane
- retinal pigmen epithel
b. Exudative ARMD
Figure 29-23 Age-related macular degeneration. A neovascular membrane is positioned between the retinal pigment epithelium (RPE)
and Bruch's membrane (BM). Note the blue discoloration of Bruch's membrane to the right of the label, indicating focal calcification.

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 5. Other retinal degeneration
• Retinitis pigmentosa :
– Inherited retinal dissorder  x linked
recessive, autosomal recessive / dominant
– Mutasi photoreceptor cell, epitel pigmen
retina  might blindness
 6. Retinitis
• Candida
• Cytomegalovirus
 7. Neoplasma
• Retinoblastoma
– Dari retinal cell ( neuronal )
– Prognosis tergantung penyebaran  o. nerve
 choroidal
– 40% diturunkan lewat germ line RB allele
Morfologi :
– Sel bulat, kecil, hyperchromatic
– Flexner-Wintersteiner rosettes, fleurettes
– Tingkat deferensiasi tak sesuai prognosis
– Therapy  chemotherapy
 laser / cryopexy
– Mutasi ke otak, bone marrow, paru
– Ada yang jinak  retinocytoma
 Figure 29-24 Retinoblastoma. A, Gross photograph of retinoblastoma. B,
Tumor cells appear viable when in proximity to blood vessels, but necrosis
is seen as the distance from the vessel increases. Dystrophic calcification
(dark arrow) is present in the zones of tumor necrosis. Flexner-
Wintersteiner rosettes-arrangements of a single layer of tumor cells around
an apparent "lumen"-are seen throughout the tumor, and one such rosette
is indicated by the white arrow.

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• Lymphoma
– Systemic lymphoma  ke uvea (iris, cilliary,
choroid)
– Retinal lymphoma
 sel2 besar lymphoma spt pada otak
 pd neurosensory retina dan retinal
pigmen epitel
OPTIC NERVE
 1. Anterior Ischemic Optic Neuropathy
(AION)
• Gangguan vascular
 ischemia  gangguan penglihatan
 optic infarct
• Infeksi  arteritis AION
• Emboli/trombosis  nonarteritis AION
 2. Papilledema
• Tekanan yg   tekanan pd syaraf mata
 tekanan pd cerebrospinal
• Tekanan intracranial 
– Bilateral  papilledema  tak ada
hubungan dengan visual loss
C, Normally, the termination of Bruch's membrane (arrowhead) is aligned with
the beginning of the neurosensory retina, as indicated by the presence of
stratified nuclei (arrow), but in papilledema, the optic nerve is swollen, and the
retina is displaced laterally. This is the histologic explanation for the blurred
margins of the optic nerve head seen clinically in this condition.

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 3. Glaucomatous optic nerve damage
• Normal tension glaucoma  ada mutasi pada gene
optineurin
• Morfologi
– Ganglion sel berkurang, lapisan serat syaraf tipis
– N. opticus menjadi cupped & atrofi
– Glaucoma timbul bila ada atrofi disertai cupping
– Pada anak, intraocular pressure buphthlalmos,
megalocornea
– Sclera tipis, staphyloma (elastic sclera)
– Edematous cornea, degeneratif pannus
Figure 29-26 The retina and optic nerve in glaucoma. A, The normal retina is illustrated in the left panel, and the retina in long-standing glaucoma is in
the right panel. Both pictures were taken at the same magnification. Note that the full thickness of the glaucomatous retina is captured (right), whereas
only a portion of the normal retina (left) can be seen-a reflection of the thinning of the retina in glaucoma. In the glaucomatous retina, the areas
corresponding to the nerve fiber layer (NFL) and ganglion cell layer (GC) are atrophic; the inner plexiform layer (IPL) is labeled for a point of reference.
B, Glaucomatous optic nerve cupping results, in part, from loss of retinal ganglion cells, the axons of which populate the optic nerve. C, The arrows
point to the dura of the optic nerve. Notice the wide subdural space, a result of atrophy of the substance of the optic nerve. The degree of cupping on
the surface of the nerve is striking in this eye, which was removed because of complications of long-standing glaucoma.
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Figure 29-26 The retina and optic nerve in glaucoma. A, The normal retina is illustrated in the left panel, and the retina in long-standing glaucoma is in
the right panel. Both pictures were taken at the same magnification. Note that the full thickness of the glaucomatous retina is captured (right), whereas
only a portion of the normal retina (left) can be seen-a reflection of the thinning of the retina in glaucoma. In the glaucomatous retina, the areas
corresponding to the nerve fiber layer (NFL) and ganglion cell layer (GC) are atrophic; the inner plexiform layer (IPL) is labeled for a point of reference.
B, Glaucomatous optic nerve cupping results, in part, from loss of retinal ganglion cells, the axons of which populate the optic nerve. C, The arrows
point to the dura of the optic nerve. Notice the wide subdural space, a result of atrophy of the substance of the optic nerve. The degree of cupping on
the surface of the nerve is striking in this eye, which was removed because of complications of long-standing glaucoma.
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 4. Optic Neuropathy lain
• Inherited : Leber hereditary optic neuropathy
• Sekunder :
– Defisiensi mutational : tobacco – alcohol
amblyopia
– Toxin : methanol
 5. Optic Neuritis
• Yaitu demyelinization nerve opticus
• Sebab utama : multiple sclerosis
• Dengan pengobatan bisa sembuh
Phthisis bulbi
• Trauma
• Radang intra ocular  atrophic  phthisis
• Retinal detachment bulbi
 Phthisis bulbi. The eye is small and internally disorganized. The
tension exerted on this hypotonic eye by the extraocular muscles
contributes to a square rather than round shape. Note the atrophic
optic nerve and the presence of intraocular bone posteriorly and
anteriorly.
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Morfologi :
• Exudate - ciliochoroidal effusion
• Darah  - cyclitic membrane
- retinal detachment
- optic atrofi
- intraocular bone  metaplasia
osseous dari epitel pigmen
retina
- sclera tebal