Oogheelkundige pathologie
SAMENVATTING
Afb: umc utrecht
,Inhoudsopgave
Anatomie van de oogleden .................................................................................................................. 4
Epidermis ........................................................................................................................................... 4
Dermis ................................................................................................................................................ 4
Terminologie ..................................................................................................................................... 4
Aandoeningen: .......................................................................................................................................5
1.1 ENTROPION.............................................................................................................................5
1.2 ECTROPION .............................................................................................................................5
1.3 TRICHIASIS ..............................................................................................................................5
1.4 BLEPHARITIS ...........................................................................................................................5
1.5 EPICANTHUS ...........................................................................................................................5
1.6 DERMATOCHALASIS ............................................................................................................ 6
1.7 LAGOPTHALMOS .................................................................................................................. 6
1.8 MADAROSIS ............................................................................................................................ 6
1.9 POLIOSIS ................................................................................................................................. 6
1.10 CHALAZION ....................................................................................................................... 6
1.11 HORDEOLUM .................................................................................................................... 6
1.12 MOLLUSCULUM ................................................................................................................ 6
1.13 PAPILLOMA ........................................................................................................................ 7
1.14 XANTHELASMATA ............................................................................................................ 7
1.15 NAEVUS ............................................................................................................................... 7
1.16 HEMANGIOOM.................................................................................................................. 7
1.17 BASAAL CELL CARCINOOM............................................................................................ 7
1.18 CONGENITALE MALFORMATIES ................................................................................... 7
1.19 OOGLIDRETRACTIES OORZAKEN ............................................................................... 8
1.20 VARICES .............................................................................................................................. 8
1.21 BLEPHAROCHALASIS ...................................................................................................... 8
1.22 PTOSIS ................................................................................................................................. 8
1.21 MALIGNANT TUMOREN.................................................................................................. 9
Anatomie .................................................................................................................................................. 10
Histologie .................................................................................................................................................. 10
Functie ...................................................................................................................................................... 10
Pathologie ................................................................................................................................................. 10
Trachoom .............................................................................................................................................. 10
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 1
, Xeroftalmie ........................................................................................................................................... 10
conjunctivitis ........................................................................................................................................ 10
Symptomen........................................................................................................................................ 11
bacteriële conjunctivitis .................................................................................................................. 12
Chlamydia conjunctivitis ................................................................................................................ 12
Adenovirus conjunctivitis ............................................................................................................... 12
Allergische conjunctivitis ................................................................................................................ 12
giant papillary conjunctivitis .......................................................................................................... 13
Degeneraties ......................................................................................................................................... 13
pinguecula ........................................................................................................................................ 13
pterygium.......................................................................................................................................... 13
concrementen................................................................................................................................... 13
retentie cyste .................................................................................................................................... 14
tumoren ................................................................................................................................................ 14
Benigne ............................................................................................................................................. 14
maligne.............................................................................................................................................. 14
dermoïd cyste ................................................................................................................................... 14
Naevus (moedervlek)....................................................................................................................... 14
melanosis .......................................................................................................................................... 14
melanoom (kwaadaardige moedervlek ......................................................................................... 15
Pathologie: ................................................................................................................................................ 15
Dystrofie:........................................................................................................................................... 15
Degeneratie ...................................................................................................................................... 15
Degeneratie ...................................................................................................................................... 15
Differentiatie degeneratie & dystrofie ........................................................................................... 16
Anterior dystrofie................................................................................................................................. 16
MDF of EBMD .................................................................................................................................. 16
EBMD is een bilateraal anteriore corneadystrofie gekenmerkt door grijsachtige epitheliale
vingerafdruk lijnen, kaart achtige lijnen en stippen (of microcystes) op spleetlamp
onderzoek. ........................................................................................................................................ 16
Reis-Buckler dystrofie ..................................................................................................................... 16
Meesmann’s dystrofie ...................................................................................................................... 17
Lattice Dystrofie ............................................................................................................................... 17
Granulaire dystrofie ......................................................................................................................... 17
Crystalline dystrophy ...................................................................................................................... 17
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 2
, Maculaire dystrofie .......................................................................................................................... 17
Posterior dystrofie................................................................................................................................ 18
Fuch’s endotheel dystrofie .............................................................................................................. 18
Ectatische dystrofie.............................................................................................................................. 18
Keratoconus & Keratoglobus .......................................................................................................... 19
Degeneratie .............................................................................................................................................. 19
Pellucid marginale degeneratie ...................................................................................................... 19
Farinata ............................................................................................................................................ 20
Arcus senilis ......................................................................................................................................... 20
White Limbal Girdle of Vogt ............................................................................................................. 20
Crocodile Shagreen ............................................................................................................................. 20
Cornea guttata ..................................................................................................................................... 20
Lipide keratopathie............................................................................................................................. 20
Band keratopathie................................................................................................................................ 21
Spheroidale degeneratie ...................................................................................................................... 21
Terriens marginale degeneratie ......................................................................................................... 21
Salzmanns nodulaire degeneratie ...................................................................................................... 21
Overig: ................................................................................................................................................... 21
Lipid Kertopathy (stroma) .............................................................................................................. 21
Wilson disease .................................................................................................................................. 21
De ziekte van Fabry .........................................................................................................................22
Cornea 40 plus..................................................................................................................................22
Hyperemie ............................................................................................................................................22
Keratitis ............................................................................................................................................. 23
Herpes simplex ................................................................................................................................. 23
Virale conjunctivitis......................................................................................................................... 23
Bacteriële conjunctivitis ................................................................................................................. 24
Mooren ulcer ................................................................................................................................... 24
perifere ulceratieve keratitis (PUK) .............................................................................................. 24
Keratoconjunctivitis sicca (droge ogen) ....................................................................................... 24
Corneale refractiechirurgie .............................................................................................................25
Cataract .................................................................................................................................................... 26
risicofactoren cataract .................................................................................................................... 26
Traumatisch cataract .......................................................................................................................... 26
Metabolisch cataract ...........................................................................................................................27
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 3
, overige soorten: ....................................................................................................................................27
Doorverwijzen ......................................................................................................................................27
Complicaties refractiechirurgie lens ..................................................................................................27
Veranderingen in de traanfilm: ..................................................................................................... 29
Ziektebeeld ...................................................................................................................................... 30
Diagnose: ......................................................................................................................................... 30
Oogleden
Anatomie van de oogleden
Epidermis
Keratine
Granulaire cel laag (korrelige cellaag)
Stratum spinosum (polygonale cellen)
Basaal cellen
Dermis
Meibom klieren
Sebaceous klieren (zweetkliertje, smeermiddel)
Eccrine zweet klieren
Pilosebaceous units(omvatten haarzakjes met talgklieren)
Klieren van Moll (zweetkliertjes rond de wimperharen)
Klieren van Zeis (talgkliertjes rond de wimperharen)
Terminologie
Cyst (holte met vloeibare of taaie inhoud)
Plaque (afzetting)
Papule (huidknobbeltje)
Scale (verdikking)
Vesicle (blaasje)
Papilloma (“lus” achtig uitstulpsel)
Ulcer (lesie met verlies van de huid)
Pustule (pus gevuld blaasje)
Macule (vlek)
Crust (korst)
Nodule (nodulus, knobbel)
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 4
, AANDOENINGEN:
1.1 ENTROPION
- Naar binnen draaien van het ooglid
- Symptomen: Pijn, zandkorrel gevoel, tranen, rood oog
Bevindingen: Beschadiging op hoornvlies, Vaatinjectie (waarneembaar verwijde vaten)
conjunctiva door irritatie
Etiologie ectropion: Leeftijd gerelateerd, Verlittekening, Spasme, Congenitaal
Behandeling: Naar buiten tapen van het ooglid, Operatief behandelen, Zachte contactlens, Gel
(bevochtiging)
1.2 ECTROPION
- Naar buiten kerend ooglid
- Het afvoerbuisje van het traanvocht ligt niet meer aan de oogbol
- Symptomen: Epiphora(tranen), irritatie, roodheid en
- branden van de ogen.
- Soms geen klachten
Etiologie ectropion
- Congenitaal
- CN VII verlamming (Bell’spalsy)
- Leeftijd( meest voorkomende)
- Litteken
- Allergie
- Ooglid tumor
Behandeling ectropion: Gel om de klachten te verminderen, Operatief laten behandelen
Simpel om te onthouden: Entropion bevat het woord “enter” het gaat dus naar binnen in het oog
1.3 TRICHIASIS
Verkeerde groeirichting wimperharen
- Symptomen: zandkorrel gevoel, irritatie, pijnklachten,
- roodheid, tranen, CA tracking.
- Lijkt op distichiasis (extra rij wimpers)
Behandeling trichiasis, Verwijderen, Pincet, Elektrolyse, bevriezen of operatie, Zachte
contactlens
Simpel te onthouden: het ooglid kan 3 kanten op (recht, onder of boven) dus tri (van mogelijk 3
richtingen wimpergroei)
1.4 BLEPHARITIS
Ooglidrand ontsteking
- Anterieure blepharitis (gebied rond basis van de wimpers)
- Posterior blepharitis (Meibomitis, slecht functionerende of verstopte talgklieren, MGD)
Etiologie blepharitis: Chronische Blefaritis, Bacteriën (stafylokokken), Make-up, Zeep, Externe
factoren
Behandeling blepharitis: Ooglidhygiëne, Geen make-up, Behandelen met medicatie
1.5 EPICANTHUS
Ooglid aan nasale zijde bedekt de ooghoek
- Prominent
- Vaak voorkomend bij Aziaten en Europeanen
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 5
SAMENVATTING
Afb: umc utrecht
,Inhoudsopgave
Anatomie van de oogleden .................................................................................................................. 4
Epidermis ........................................................................................................................................... 4
Dermis ................................................................................................................................................ 4
Terminologie ..................................................................................................................................... 4
Aandoeningen: .......................................................................................................................................5
1.1 ENTROPION.............................................................................................................................5
1.2 ECTROPION .............................................................................................................................5
1.3 TRICHIASIS ..............................................................................................................................5
1.4 BLEPHARITIS ...........................................................................................................................5
1.5 EPICANTHUS ...........................................................................................................................5
1.6 DERMATOCHALASIS ............................................................................................................ 6
1.7 LAGOPTHALMOS .................................................................................................................. 6
1.8 MADAROSIS ............................................................................................................................ 6
1.9 POLIOSIS ................................................................................................................................. 6
1.10 CHALAZION ....................................................................................................................... 6
1.11 HORDEOLUM .................................................................................................................... 6
1.12 MOLLUSCULUM ................................................................................................................ 6
1.13 PAPILLOMA ........................................................................................................................ 7
1.14 XANTHELASMATA ............................................................................................................ 7
1.15 NAEVUS ............................................................................................................................... 7
1.16 HEMANGIOOM.................................................................................................................. 7
1.17 BASAAL CELL CARCINOOM............................................................................................ 7
1.18 CONGENITALE MALFORMATIES ................................................................................... 7
1.19 OOGLIDRETRACTIES OORZAKEN ............................................................................... 8
1.20 VARICES .............................................................................................................................. 8
1.21 BLEPHAROCHALASIS ...................................................................................................... 8
1.22 PTOSIS ................................................................................................................................. 8
1.21 MALIGNANT TUMOREN.................................................................................................. 9
Anatomie .................................................................................................................................................. 10
Histologie .................................................................................................................................................. 10
Functie ...................................................................................................................................................... 10
Pathologie ................................................................................................................................................. 10
Trachoom .............................................................................................................................................. 10
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 1
, Xeroftalmie ........................................................................................................................................... 10
conjunctivitis ........................................................................................................................................ 10
Symptomen........................................................................................................................................ 11
bacteriële conjunctivitis .................................................................................................................. 12
Chlamydia conjunctivitis ................................................................................................................ 12
Adenovirus conjunctivitis ............................................................................................................... 12
Allergische conjunctivitis ................................................................................................................ 12
giant papillary conjunctivitis .......................................................................................................... 13
Degeneraties ......................................................................................................................................... 13
pinguecula ........................................................................................................................................ 13
pterygium.......................................................................................................................................... 13
concrementen................................................................................................................................... 13
retentie cyste .................................................................................................................................... 14
tumoren ................................................................................................................................................ 14
Benigne ............................................................................................................................................. 14
maligne.............................................................................................................................................. 14
dermoïd cyste ................................................................................................................................... 14
Naevus (moedervlek)....................................................................................................................... 14
melanosis .......................................................................................................................................... 14
melanoom (kwaadaardige moedervlek ......................................................................................... 15
Pathologie: ................................................................................................................................................ 15
Dystrofie:........................................................................................................................................... 15
Degeneratie ...................................................................................................................................... 15
Degeneratie ...................................................................................................................................... 15
Differentiatie degeneratie & dystrofie ........................................................................................... 16
Anterior dystrofie................................................................................................................................. 16
MDF of EBMD .................................................................................................................................. 16
EBMD is een bilateraal anteriore corneadystrofie gekenmerkt door grijsachtige epitheliale
vingerafdruk lijnen, kaart achtige lijnen en stippen (of microcystes) op spleetlamp
onderzoek. ........................................................................................................................................ 16
Reis-Buckler dystrofie ..................................................................................................................... 16
Meesmann’s dystrofie ...................................................................................................................... 17
Lattice Dystrofie ............................................................................................................................... 17
Granulaire dystrofie ......................................................................................................................... 17
Crystalline dystrophy ...................................................................................................................... 17
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 2
, Maculaire dystrofie .......................................................................................................................... 17
Posterior dystrofie................................................................................................................................ 18
Fuch’s endotheel dystrofie .............................................................................................................. 18
Ectatische dystrofie.............................................................................................................................. 18
Keratoconus & Keratoglobus .......................................................................................................... 19
Degeneratie .............................................................................................................................................. 19
Pellucid marginale degeneratie ...................................................................................................... 19
Farinata ............................................................................................................................................ 20
Arcus senilis ......................................................................................................................................... 20
White Limbal Girdle of Vogt ............................................................................................................. 20
Crocodile Shagreen ............................................................................................................................. 20
Cornea guttata ..................................................................................................................................... 20
Lipide keratopathie............................................................................................................................. 20
Band keratopathie................................................................................................................................ 21
Spheroidale degeneratie ...................................................................................................................... 21
Terriens marginale degeneratie ......................................................................................................... 21
Salzmanns nodulaire degeneratie ...................................................................................................... 21
Overig: ................................................................................................................................................... 21
Lipid Kertopathy (stroma) .............................................................................................................. 21
Wilson disease .................................................................................................................................. 21
De ziekte van Fabry .........................................................................................................................22
Cornea 40 plus..................................................................................................................................22
Hyperemie ............................................................................................................................................22
Keratitis ............................................................................................................................................. 23
Herpes simplex ................................................................................................................................. 23
Virale conjunctivitis......................................................................................................................... 23
Bacteriële conjunctivitis ................................................................................................................. 24
Mooren ulcer ................................................................................................................................... 24
perifere ulceratieve keratitis (PUK) .............................................................................................. 24
Keratoconjunctivitis sicca (droge ogen) ....................................................................................... 24
Corneale refractiechirurgie .............................................................................................................25
Cataract .................................................................................................................................................... 26
risicofactoren cataract .................................................................................................................... 26
Traumatisch cataract .......................................................................................................................... 26
Metabolisch cataract ...........................................................................................................................27
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 3
, overige soorten: ....................................................................................................................................27
Doorverwijzen ......................................................................................................................................27
Complicaties refractiechirurgie lens ..................................................................................................27
Veranderingen in de traanfilm: ..................................................................................................... 29
Ziektebeeld ...................................................................................................................................... 30
Diagnose: ......................................................................................................................................... 30
Oogleden
Anatomie van de oogleden
Epidermis
Keratine
Granulaire cel laag (korrelige cellaag)
Stratum spinosum (polygonale cellen)
Basaal cellen
Dermis
Meibom klieren
Sebaceous klieren (zweetkliertje, smeermiddel)
Eccrine zweet klieren
Pilosebaceous units(omvatten haarzakjes met talgklieren)
Klieren van Moll (zweetkliertjes rond de wimperharen)
Klieren van Zeis (talgkliertjes rond de wimperharen)
Terminologie
Cyst (holte met vloeibare of taaie inhoud)
Plaque (afzetting)
Papule (huidknobbeltje)
Scale (verdikking)
Vesicle (blaasje)
Papilloma (“lus” achtig uitstulpsel)
Ulcer (lesie met verlies van de huid)
Pustule (pus gevuld blaasje)
Macule (vlek)
Crust (korst)
Nodule (nodulus, knobbel)
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 4
, AANDOENINGEN:
1.1 ENTROPION
- Naar binnen draaien van het ooglid
- Symptomen: Pijn, zandkorrel gevoel, tranen, rood oog
Bevindingen: Beschadiging op hoornvlies, Vaatinjectie (waarneembaar verwijde vaten)
conjunctiva door irritatie
Etiologie ectropion: Leeftijd gerelateerd, Verlittekening, Spasme, Congenitaal
Behandeling: Naar buiten tapen van het ooglid, Operatief behandelen, Zachte contactlens, Gel
(bevochtiging)
1.2 ECTROPION
- Naar buiten kerend ooglid
- Het afvoerbuisje van het traanvocht ligt niet meer aan de oogbol
- Symptomen: Epiphora(tranen), irritatie, roodheid en
- branden van de ogen.
- Soms geen klachten
Etiologie ectropion
- Congenitaal
- CN VII verlamming (Bell’spalsy)
- Leeftijd( meest voorkomende)
- Litteken
- Allergie
- Ooglid tumor
Behandeling ectropion: Gel om de klachten te verminderen, Operatief laten behandelen
Simpel om te onthouden: Entropion bevat het woord “enter” het gaat dus naar binnen in het oog
1.3 TRICHIASIS
Verkeerde groeirichting wimperharen
- Symptomen: zandkorrel gevoel, irritatie, pijnklachten,
- roodheid, tranen, CA tracking.
- Lijkt op distichiasis (extra rij wimpers)
Behandeling trichiasis, Verwijderen, Pincet, Elektrolyse, bevriezen of operatie, Zachte
contactlens
Simpel te onthouden: het ooglid kan 3 kanten op (recht, onder of boven) dus tri (van mogelijk 3
richtingen wimpergroei)
1.4 BLEPHARITIS
Ooglidrand ontsteking
- Anterieure blepharitis (gebied rond basis van de wimpers)
- Posterior blepharitis (Meibomitis, slecht functionerende of verstopte talgklieren, MGD)
Etiologie blepharitis: Chronische Blefaritis, Bacteriën (stafylokokken), Make-up, Zeep, Externe
factoren
Behandeling blepharitis: Ooglidhygiëne, Geen make-up, Behandelen met medicatie
1.5 EPICANTHUS
Ooglid aan nasale zijde bedekt de ooghoek
- Prominent
- Vaak voorkomend bij Aziaten en Europeanen
SAMENVATTING OOGHEELKUNDIGE PATHOLOGIE, FRANK VAN DOORN PAGINA 5
