Conjunctiva Upper Tarsal Conjunctiva

 Echymosis, the color of the eyelid changes as a result of blood extravatation after trauma.  Ectropion, is turning outward of the eyelids, could be found in elderly, paralise of the muscles, cikatriks and other.  Entropion, turning inward of the eyelids.In Trachomas patient the entropion usually happen in upper eyelids. Entropion could also happen due to parese of the muscles, cikatriks and senile condition.  Lagoftalmos: inabillity to close the eyelids completely.  Redness, inflamation, squama, tumour Merah, radang, keropeng skuama, tumor.  Pseudoptosis, difficulties to open the eyelids as if it is drooping. Happen on enophthalmos, phtisis bulbi, chalazion or the other eyelids tumour, eyelids edema and blepharochalazis.  Ptosis, drooping eyelids. Usually happen in elderly with history of intraocular surgery, Myasthenia gravis, Horner Syndrome, N III palsy, botulinum toxin injection  Cikatriks, scar on the eyelids  Trikiasis, silia atau bulu mata tumbuh salah arah sehingga dapat merusak kornea. Trikiasis dapat disebabkan blefaritis dan entropion.  Xantelasma, penimbunan deposit berwarna kekuning-kuningan pada kelopak, terutama nasal atas dan bawah. Xantelasma biasanya dihubungkan dengan hiperlipidemia dan dapat tanpa hiperlipidemia seperti pada histiosis dan retikulohistositoma. Abnormality of lower eyelids:  Similar with upper eyelids  Swollen of lacrimal sac, redness and sometimes pus came out when it be pushed.  Madarosis. Inerpalpebral Fissure  Normal  Narrow or small, if there is eyelids edema, blepharitis, ptosis, pseudoptosis, blepharophymosis  Wide or bigger, happened in hyperthyroid or intraocular tumour. Eyelids margin  Complete cilia  Trichiasis  Meibomian gland punctum secretion  Redness, pain and ulceration

2. Conjunctiva Upper Tarsal Conjunctiva

Can be checked by eversion the upper eyelids using finger or cotton tip applicator. Abnormality of the conjunctiva:  Cobble stone follicles, deposite of macrophages and lymphoid cells under the conjunctiva. Dome shaped appearance, about 1 mm. Most follicles can be seen in forniks area because in this area consist of a lot of lymphoid tissues.  Membrane, inflammatory cells beyond the conjunctiva that will be bleed iwhen excised. This membrane usually appears like mass surrounding tarsal or bulbar conjunctiva. It is consists of necrotic tissues, penetrated to the deeper layer and greyish, usually can be found in patient with bacteria conjunctivitis or rarely happened on viral conjunctivitis.  Pseudomembrane, membranes that not get bleed if excised. Happened in ocular pemphygoid and Steven Johnson Syndrome. Udayana University Faculty of Medicine, DME 51  Papillae, tiny dome shaped nodule that consist of hyperemic central core blood vessels of the conjunctiva that protrude up and perpendicular to the tarsal plate surrounded by edema and inflammatory cells  Giant Papillae, polygonal shaped, flat and coukd be found in vernal conjunctivitis, superior limbic keratitis, and iatrogenic conjunctivitis.  Cicatriks, in trachoma usually the direction of the cicatriks is parallel with eyelids margin.  Simblepharon, stickyness of tarsal and bulbar conjunctiva and kornea. Can be found in chemical trauma or Steven Johnson Syndromes  Hordeolum or Stye  Chalazion. Inferior tarsal conjunctiva Konjungtiva tarsal inferior The abnormalities could be:  Cobble stone follicles.  Papil.  cicatriks  Hordeolum or Stye.  Chalazion. Bulbar conjunctiva The abnormalities could be:  Discharge  Conjunctival Injection, vasodilatation of superior conjunctival arteries  Cilliary Injection, vasodilatation of pericorneal arteries or anterior cilliaris arteries.  Episcleral injection, vasodilatation of episcleral vessels  Subconjunctival bleeding.  Flickten, inflammatory surrounded with neovascularization on conjunctiva  Simblepharon.  Degeneration plaque  Pinguecula, conjunctival degeneration plaque in palpebral fissure area, triangular shape in nasal and temporal cornea  Pterygium, proliferation of fibrous tissues process with neovascularization on conjunctiva, triangular shape with the apeks toward the cornea  Pseudopterygium.  Flickten, inflammatory cells and neovascularization on the cornea.

3. Sclera