lapang pandang adalah gangguan lapang pandang neurooftalmologi skotoma, hemianopia, anopia, quadranopia

1. GANGGUAN LAPANG PANDANG
REFERAT
DISUSUN OLEH GABRIELLA CEREIRA ANGELINA
PEMBIMBING :
NIM G4A015080

2. PENDAHULUAN
KETAJAMAN
PENGLIHATAN
LAPANG
PANDANG
PENGLIHATAN
WARNA
RESPON
PUPIL
FUNDUSKOPI
PENILAIAN KLINIS NERVUS OPTICUS

3. perluasan perifer dari dunia visual
(James, Chew, & Bron, 2005)
LAPANG PANDANG
orang normal
50o ke arah superior,
60o ke arah nasal,
70o ke arah inferior,
100o ke arah temporal.
sisi temporal bintik buta : 10o - 20o
(Eva & Whitcher, 2009; Kanski, 2003)
Jaringan neural penglihatan terjadi
apabila ….
Gangguan lapang pandang Pemeriksaan Lapang Pandang

4. PEMERIKSAAN
LAPANG PANDANG
TUJUAN :
DIAGNOSTIK
FOLLOW UP
ACTIVITIES OF DAILY LIVING
BERBAGAI
METODE
PEMERIKSAAN

7. perluasan perifer
dunia visual
sebagai proyeksi
ruang pada area
pengelihatan
retina
(Crick & Khaw, 2003; James, Chew,
& Bron, 2005).
Gangguan lapang
pandang
direpresentasikan
ke dalam 3 kategori
yaitu monocular,
binocular, dan
junctional.

9. Anatomical Location Visual Phenomena Other Neurological and Medical Findings Possible Etiologies
Retina
Transient monocular visual loss Hollenhorst's plaque
Carotid disease, giant cell arteritis, migraine,
vasospasm, cardiac emboli
Acute monocular visual loss Cherry-red spot, box-carring Central retinal artery occlusion
Subacute monocular visual loss
Retinal hemorrhage, cotton wool spots,
dilated retinal veins
Central retinal vein occlusion
Subacute monocular visual loss Vitreous opacification Vitreous hemorrhage
Impaired visual acuity Metamorphopsia
Central serous chorioretinopathy, macular
degeneration
Optic nerve
Ipsilateral visual loss (decreased acuity,
decreased color vision, central scotoma,
altitudinal field defect)
Optic atrophy, optic disc swelling
Optic neuritis, ischemic optic neuropathy,
compressive lesions
Optic chiasm
Bitemporal hemianopsia, decreased acuity
and color vision
Optic atrophy
Pituitary adenoma, craniopharyngioma, optic
glioma, meningioma, aneurysm
Optic tract
Contralateral incongruous homonymous
hemianopia
Contralateral relative afferent pupillary
defect, “bowtie” optic atrophy
Pituitary adenoma, craniopharyngioma,
aneurysm
Optic radiations Contralateral homonymous hemianopia
Preserved visual acuity, intact pupillary
response, decreased OKN to side of lesion,
sensory loss, hemiparesis
MCA stroke, temporal or parietal mass lesion
Occipital lobe
Contralateral congruous homonymous
hemianopia (with or without macular
sparing), quadrantic field defect,
homonymous hemianopic central scotoma,
cortical blindness (if bilateral)
Usually isolated deficits
PCA stroke, migraine, Alzheimer's,
hypertensive encephalopathy
Association cortex
Cerebral hemiachromatopsia Lingual and fusiform gyri lesion
Alexia without agraphia
Left occipital lobe and splenium of corpus
callosum lesion
Visual agnosia, prosopagnosia Bilateral medial occipitotemporal lesions
Defective motion perception
Lateral occipitotemporal lesion (Brodmann
area 39)
Left hemifield visual neglect Auditory and tactile neglect in left hemifield Right parietal lesion
Balint's syndrome (optic ataxia,
simultanagnosia, ocular apraxia)
Bilateral occipitoparietal lesions
Palinopsia Temporo-occipital lesion(s)

11. ANAMNESIS
silau atau cahaya berwarna
(fotopsia), garis bergerigi, halusinasi
visual
Keluhan utama
(Goetz, 2007)
FENOMENA NEGATIF
FENOMENA POSITIF
hilangnya penglihatan seperti
penglihatan kabur atau mendung.

12. 1 mata / 2 mata
Tengah / tepi
LOKASI ONSET KUAL,KUAN
KRON, PROG KP RIWAYAT
Akut
Subakut
kronik
Dahulu
Keluarga
Sosek
Tanda >TIK
Defisit neuro lain
Didahului trauma?
Semakin parah?
FYMB, MR

13. PEM. FISIK
KU/KES
ketajaman penglihatan,
lapang pandang,
penglihatan warna,
funduskopi,
respons pupil
TANDA VITAL
ST. GENERALIS
ST. LOKALIS

14. PEMERIKSAAN PENUNJANG
Tujuan :
mencari
penyebab
• Lab
laju endap darah (LED) dan C-
reactive protein (CRP) dapat
menunjukkan adanya arteritis
cranial
• Radiologi
MRI,
CT Scan
CT angiography
PEMERIKSAAN KHUSUS
• Electro-oculography (EOG)
• Electro-retinography (ERG dan
PERG)
• Visually evoked response (VER)

15. Syndrome Neuroimaging Electrophy-siology Fluid and Tissue Analysis
Neuropsy-chological
Tests
Other Tests
Retina
MRA: carotid occlusion,
stenosis, or dissection
Abnormal
electroretinogram if
photoreceptors are affected
Elevated ESR in giant cell
arteritis
N/A
Vascular occlusion on
fluorescein angiography
Thromboembolic source on
cardiac echography, carotid
ultrasound, or formal
angiography
Optic nerve
MRI with gadolinium and
fat saturation, coronal
views: optic nerve
enlargement or
enhancement, or
compressive mass lesion
Visual evoked potentials:
decreased amplitude or
increased latency
Elevated ESR in giant cell
arteritis. CSF pleocytosis if
inflammatory
N/A N/A
Optic chiasm
MRI with gadolinium, thin
coronal and sagittal cuts
through sella: chiasmal
enlargement or
enhancement, or sellar
compressive mass
N/A
CSF pleocytosis if
inflammatory, endocrine
studies showing evidence
of hypopituitarism or
hormone hypersecretion
N/A N/A
Optic tract MRI: compressive mass N/A N/A N/A N/A
Lateral geniculate body MRI: infarction N/A N/A N/A N/A
Optic radiations
MRI: infarction or tumor
N/A N/A
Deficits in spatial
ability and attention
Thromboembolic source on
cardiac echography or carotid
ultrasound
MRA: carotid or MCA
occlusion
Occipital lobe
MRI: infarction or tumor
N/A N/A N/A
Thromboembolic source on
cardiac echographyMRA: posterior circulation
occlusion
Higher cortical areas MRI: infarction or tumor N/A N/A
Deficits in color
perception or object
or face recognition
Thromboembolic source on
cardiac echography
Visual hallucinations MRI: infarction or tumor
Epileptiform discharges on
EEG if hallucinations are
due to seizures
N/A N/A N/A
Other positive visual
phenomena
MRI: infarction or tumor
Epileptiform discharges if
positive phenomena are
due to seizures
N/A N/A N/A

16. PEMERIKSAAN LAPANG PANDANG

17. ANALISIS
GANGGUAN
LAPANG
PANDANG
BERDASARKAN
LETAK LESI
??
- BI/MONOKULAR
- SENTRAL/
PERIFER/HEMIAN
OPIA
- (IN)CONGRUENT

18. OPTIC NERVE HEAD
GLAUKOMA PAPILLEDEMA AION KONGENITAL

20. NERVUS OPTICUS
NEURITIS
OPTICA
NEUROPATI
OPTIK
ISKEMIK
KOMPRESI
NUTRISION
AL DAN
TOKSIK
TRAUMA HEREDITER
INFILTRASI
NEOPLASMA

21. CHIASMA OPTICUM
ADENOMA
HIPOFISIS
KRANIOFA-
RINGIOMA
ANEURISMA
A. CAROTIS
INTERNA

22. TRACTUS OPTICUS

23. CORPUS GENICULATUM LATERAL

24. RADIATIO OPTICA – KORTEKS VISUAL

25. KESIMPULAN
• Lapang pandang merupakan perluasan perifer dari dunia visual
yang dibaratkan sebagai bukit penglihatan.
• Lapang pandang dapat diperiksa menggunakan berbagai metode
seperti uji konfrontasi, kampimeter, perimeter, dan kisi kisi Amsler.
• Gangguan lapang pandang dapat menunjukkan letak lesi pada
jaras visual dan membantu menegakkan diagnosis dari gangguan
penglihatan.
• Terapi dan prognosis pada gangguan lapang pandang sangat
bergantung pada lokasi, onset, dan etiologi dari penyebab
gangguan lapang pandang.

26. DAFTAR PUSTAKA
Anonim. (2016, Desember 17). Barnell. Retrieved Maret 4, 2017, from Tangent Screen: https://www.bernell.com/category/972
Ari, B. (2011, Maret 17). Nervus Optikus. Retrieved April 4, 2017, from Nervus Optikus:
http://yayanakhyar.files.wordpress.com/2009/01/nervus-optikus_files-of-drsmed.pdfCogan
Baehr, M., & Frotscher, M. (2012). Diagnosis Topik Neurologi Duus. Edisi 4. Jakarta : EGC.
Crick, R. P., & Khaw, P. T. (2003). A text Book of Clinical Ophtalmology. 3rd Edition. Singapore: World Scientific.
Eva, P. R., & Whitcher, J. P. (2009). Vaughan & Asbury : Oftalmologi Umum. Edisi ke-17. Jakarta: EGC.
Fox, S. T. (2003). Sensory Physiology. In Fox Human Physiology. 8th Edition. Oxford England: McGraw Hill Company.
Ginsberg, L. (2005). Neurologi : Lecture Notes. Edisi kedelapan. Jakarta: Erlangga.
Goetz, C. G. (2007). Textbook of Clinical Neurology. 3rd Edition. New York: Saunders.
Ilyas, S., & Yulianti, S. R. (2015). Ilmu Penyakit Mata. Edisi kelima. Jakarta: Badan Penerbit FKUI.
James, B., Chew, C., & Bron, A. (2005). Lecture Notes : Oftalmologi. Edisi kesembilan. Jakarta : Erlangga.
Kedar, S., Ghate, D., & Cobert, J. J. (2011). Visual Fields in Neuro-Ophtalmology. Indian Journal Ophtalmology. 59(1), 103-109.
Lumbantobing, S. M. (2010). Saraf Otak : Dalam Neurologi Klinik Pemeriksaan Fisik dan Mental. Jakarta: Penerbit FKUI.
Madge, S. N., Kersey, J. W., Hawker, M. J., & Lamont, M. (2007). Clinical Techniques in Ophthalmology. New York: Elsevier.
Mardjono, M., & Sidharta, P. (2010). Saraf Otak dan Patologinya dalam Neurologi Klinis Dasar. Jakarta : Dian Rakyat.
Snell, R. S. (2010). Clinical Neuroanatomy. 7th Edition. New York: Lippincott William & Willkins.
Walsh, T. J. (2011). Visual Fields : Examination and Interpretation. London: Oxford University Press.

27. TERIMAKASIH