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Samenvatting oftalmo 2e master GNK KULEUVEN

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Course
Zintuigen 1: Dermatologie oftalmologie (BKULE0C4)

Institution
Katholieke Universiteit Leuven (KU Leuven)

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Uploaded on December 9, 2024
Number of pages 71
Written in 2023/2024
Type Summary

oftalmo
zintuigen 1
geneeskunde
master

Institution
Katholieke Universiteit Leuven (KU Leuven)
Education
Geneeskunde
Course
Zintuigen 1: Dermatologie oftalmologie (BKULE0C4)

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OFTALMOLOGIE SAMENVATTING
INHOUDSTAFEL

H1: ANATOMIE EN FYSIOLOGIE ................................................................................................................ 4
1. de oogbol .................................................................................................................................................. 4
1.1. Algemeen .................................................................................................................................................... 4
1.2. Cornea & sclera = stevig omhulsel dat de bolvorm van het oog behoudt .................................................. 4
1.3. Voorste oogsegment = tussen voorzijde cornea & achterzijde lens ........................................................... 5
1.4. Lens = eiwitrijkste orgaan van het lichaam (35%) ...................................................................................... 5
1.5. Uvea = choroidea + corpus ciliare + iris ...................................................................................................... 6
1.6. ACHTERSTE OOGSEGMENT = vitreum + retina ........................................................................................... 7
2. adnexen .................................................................................................................................................... 8
2.1. Oogleden .................................................................................................................................................... 9
2.2. Conjunctiva = slijmvliezen .......................................................................................................................... 9
2.3. Traanwegen en film .................................................................................................................................... 9
3. orbita en uitwendige oogspieren ............................................................................................................. 10
3.1. Orbita ........................................................................................................................................................ 10
3.2. uitwendige oogspieren ............................................................................................................................. 11
3.3. vascularisatie en innervatie (herhaling).................................................................................................... 12
4. het visuele systeem ................................................................................................................................. 12
H2: HET OOGONDERZOEK EN DE ONDERZOEKSTECHNIEKEN ...................................................................14
1. ANAMNESE ............................................................................................................................................. 14
1.1. Klachten .................................................................................................................................................... 14
1.2. oftalmologische VG................................................................................................................................... 14
1.3. Algemeen medische VG ............................................................................................................................ 14
1.4. Familiale anamnese .................................................................................................................................. 14
2. ALGEMEEN OOGHEELKUNDIG ONDERZOEK ............................................................................................. 15
3. BIJZONDERE OOGHEELKUNDIGE ONDERZOEKEN ..................................................................................... 17
H3: REFRACTAIRE AFWIJKINGEN EN OPTISCHE CORRECTIES ....................................................................20
1. inleiding .................................................................................................................................................. 20
2. emmetropie en ammetropie ................................................................................................................... 20
2.1. Emmentropisatie = groeiproces ............................................................................................................... 20
2.2. Ametropiën ............................................................................................................................................... 21
2.3. opmerkingen............................................................................................................................................. 22
3. accommodatie& presbyopie.................................................................................................................... 22
3.1. Accommodatie.......................................................................................................................................... 22
3.2. Presbyopie of ouderdomsleeszwakte ....................................................................................................... 23
4. correctie van ametropien (herhaling supra)............................................................................................. 23
5. meten van refractie ................................................................................................................................. 24
6. Refractie in de praktijk ............................................................................................................................ 24
6.1. Bril............................................................................................................................................................. 24
6.2. Contactlezen ............................................................................................................................................. 25
6.3. Refractie chirurgie .................................................................................................................................... 26
H4: HET RODE OOG .................................................................................................................................27
1. rode pijnloze oog .................................................................................................................................... 27
1

, 1.1. Conjunctivitis ............................................................................................................................................ 27
1.2. Episcleritis ................................................................................................................................................. 28
1.3. Subconjunctivale bloeding........................................................................................................................ 28
1.4. Pterygium en pingueculum....................................................................................................................... 29
2. rode pijnlijke oog .................................................................................................................................... 29
2.1. Acute conjunctivitis en keratitis ............................................................................................................... 29
2.2. Droge ogen = keratoconjunctivitis sicca ................................................................................................... 32
2.3. Keratitis: lagoftalmie en neuropalytisch ................................................................................................... 32
2.4. cornea-erosie: scherpe pijn ...................................................................................................................... 32
2.5. Episcleritis en scleritis ............................................................................................................................... 33
2.6. Acute iritis: pijn en fotofobie .................................................................................................................... 33
2.7. acuut gesloten hoek glaucoom: ernstige pijn uitstralend naar het hoofd + misselijkheid ....................... 34
H5: TRAGE VISUDALING BIJ UITWENDIG NORMAAL OOG........................................................................36
1. Cataract .................................................................................................................................................. 36
2. Chronisch open hoek glaucoom ............................................................................................................... 38
3. Chronisch nervus opticus lijden ............................................................................................................... 40
3.1. Compressie van de nervus opticus door een tumor ................................................................................. 40
3.2. Neuritis optica .......................................................................................................................................... 41
3.3. Erfelijke opticus neuropathie ................................................................................................................... 41
4. Chronische iritis bij JIA : momenteel geen wiki vragen ............................................................................ 41
5. Choroidea- en retina aandoeningen ........................................................................................................ 41
5.1. Maculadegeneratie: vroege (AMD) en leeftijdsgebonden maculadegeneratie (LMD)............................. 41
5.2. Retinitis pigmentosa ................................................................................................................................. 42
5.3. Maligne melanoom en choroidale metastasen momenteel geen wiki vragen ......................................... 43
H6: PLOTSE VISUSDALING BIJ UITWENDIG NORMAAL OOG .....................................................................44
1. occlusie van de arteria centralis retinae .................................................................................................. 44
2. retinaal-ventraal veneuze occlusie (RVO) => CRVO en BRVO ................................................................... 45
3. anterieure ischemische opticusneuropathie (AION) => N-AION en A-AION .............................................. 46
4. opticusneuropathie (door tumorcompressie en verhoogde intracraniele druk) ....................................... 47
4.1. door tumorcompressie ............................................................................................................................. 47
4.2. door verhoogde intracraniele druk........................................................................................................... 47
5. acute neuritis optica................................................................................................................................ 47
6. LEBER HERIDITAIRE OPTICUSNEUROPATHIE (LHON) momenteel geen wiki vragen .................................. 48
7. AGVL – GLASVOCHTBLOEDING ................................................................................................................ 49
8. retinaloslating- retinascheur ................................................................................................................... 49
H7: BELANGRIJKSTE SYSTEEMZIEKTEN MET OFTALMOLOGISCHE AFWIJKINGEN ......................................50
1. ARTERIELE HYPERTENSIE ......................................................................................................................... 50
1.1. hypertensieve retinopatie ........................................................................................................................ 50
1.2. Choroidopathie ......................................................................................................................................... 50
1.3. hypertensieve neuropathie ...................................................................................................................... 50
2. DIABETES ................................................................................................................................................ 51
3. INTRACRANIELE OVERDRUK .................................................................................................................... 52
H8: OFTALMOLOGISCHE MEDICATIE .......................................................................................................53
1. oogdruppels ............................................................................................................................................ 53
2. andere medicatie in de oftalmo............................................................................................................... 54

2

, 2.1. mydriatica-miotica .................................................................................................................................... 54
2.2. Anti-microbiele middelen ......................................................................................................................... 54
2.3. corticosteroiden ....................................................................................................................................... 55
2.4. lokale anesthetica ..................................................................................................................................... 55
2.5. middelen bij droge ogen ........................................................................................................................... 55
2.6. middelen bij allergische conjunctivitis...................................................................................................... 55
2.7. anti-VEGF .................................................................................................................................................. 55
2.8. andere....................................................................................................................................................... 55
H9: OOGLEDEN, ORBITA EN TRAANWEGEN .............................................................................................56
1. Oogleden ................................................................................................................................................ 56
1.1. Blefaritis .................................................................................................................................................... 56
1.2. Hordeolum en chalazion ........................................................................................................................... 56
1.3. Xanthelasmata .......................................................................................................................................... 56
1.4. Basaalcelcarcinoom (BCC) ........................................................................................................................ 56
1.5. Aandoeningen van de oogstand ............................................................................................................... 57
2. Orbita ..................................................................................................................................................... 58
2.1. cellulitis orbitae ........................................................................................................................................ 59
2.2. ziekte van Graves of basedow - Graves orbitopathie ............................................................................... 59
3. Traanwegen ............................................................................................................................................ 60
3.1. Traanwegobstructie – dacryostenosis ...................................................................................................... 60
3.2. Dacryocystitis............................................................................................................................................ 60
H10: KLEURENZIENSTOORNISSEN (herhaling H2) ....................................................................................61
1. normaal kleurenzicht .............................................................................................................................. 61
2. verworven kleurenstoornissen ................................................................................................................ 61
3. Aangeboren kleurenstoornissen .............................................................................................................. 61
4. kleuren visus testen ................................................................................................................................ 61
H11: OOGTRAUMATA .............................................................................................................................62
1. voorkomen.............................................................................................................................................. 62
2. indeling naar onstaanswijze: mechanisch – chemisch – thermisch – actinisch.......................................... 62
2.1. Mechanische ontstaanswijze .................................................................................................................... 62
2.2. Chemische ontstaanswijze ....................................................................................................................... 64
2.3. Thermische ontstaanswijze ...................................................................................................................... 64
2.4. Actinische ontstaanswijze (door straling) ................................................................................................. 64
H12: kind ................................................................................................................................................65
1. visuele ontwikkeling................................................................................................................................ 65
1.1. Normale visuele ontwikkeling .................................................................................................................. 65
1.2. Vertraagde of afwezige visuele ontwikkeling: OZ en oorzaken ................................................................ 65
2. ooginfecties bij kind ................................................................................................................................ 66
3. dacryostenose (= verstopte of vernauwde traanbuis) en DD.................................................................... 66
4. leukokorie (witte pupil/witte schijn in oog van de baby) ......................................................................... 66
4.1. Cataract (uni/bilateraal) ........................................................................................................................... 67
4.2. Retinoblastoma en DD .............................................................................................................................. 68
5. congenitaal glaucoom (= buftalmie) en DD .............................................................................................. 69
6. premature retinopathie (ROP) ................................................................................................................. 70
7. strabisme (scheelzien) ............................................................................................................................. 71

3

, H1: ANATOMIE EN FYSIOLOGIE
1. DE OOGBOL
= sclera + cornea + voorste oogsegment + lens + uvea + achterste oogsegment

1.1. Algemeen
- Gelegen on de orbita
- sfeer = 24,2mm (= gemiddelde voorachterwaartse diameter)
o BIJZIEND indien oog te groot (=lang)
o VERZIEND indien oog te kort
- ADNEXEN = Ondersteunende structuren door accessoire structuren = oogleden + conjunctiva + traanapp
- optische media = cornea + lens + glasvocht

1.2. Cornea & sclera = stevig omhulsel dat de bolvorm van het oog behoudt

CORNEA SCLERA
= voorste gedeelte van de oogbol = HOORNVLIES = buitenste laag van oogbol = harde oogrok = wit deel
- gem corneale diameter = 12mm De cornea gaat ovder in de sclera
- gemiddelde corneale dikte = 600um

5 lagige opbouw cornea:
1) 5-6 cellagige epithelium (hier zenuwuiteinden)
2) membraan van bowman
3) stroma
4) membraan van Dua (pre-descemet) ~ acellulair
5) membraan van descemet ~ lamina basalis
6) 1 lagig endotheel met beperkte celdeling

- Corneale gevoeligheid -> zeer rijk aan sensibele
zenuwen: minste beschadiging lokt zeer veel pijn uit
- Corneale helderheid -> door parallele opbouw
cornea lamellen & pompfunctie van endotheelC - (geringe) bloedvoorziening via de cillaire arteriën
- Niet gevasculariseerd
- Voeding door pompmechanisme vanuit
kamerwater in voorste oogkamer
- Traanfilm = essentieel voor functioneren cornea

Lichtbreking door de cornea = 58 dioptrie

Optisch systeem
- lichtbreking cornea : 58 dioptrie ó lens : 42 dioptrie
- traanfilm : essentieel voor functioneren cornea
- endotheel : helderheid

4

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