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  3. Katholieke Universiteit Leuven (KU Leuven)
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  7. Zintuigen 1: Dermatologie oftalmologie (BKULE0C4)

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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)

Deze samenvatting gemaakt mbv slides en notities uit de les. hierbij zijn er nodige overzichtelijke schema's gemaakt om sommige zaken wat overzichtelijker te krijgen. Met glans erdoor geraakt dankzij deze samenvatting.

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  • December 9, 2024
  • 71
  • 2023/2024
  • Summary

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  • oftalmo
  • zintuigen 1
  • geneeskunde
  • master

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  • Katholieke Universiteit Leuven (KU Leuven)
  • Geneeskunde
  • 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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