Eye, Skin, and Arthritis Disorders

• These study notes cover various eye conditions, dermatological issues, arthritis, and common treatments/medications.

Musculo - Gangguan Mata (Eye Muscle Disorders)

• Astigmatism (Mata Silindris): Irregularly shaped cornea; blurry vision for both vertical and horizontal lines.
• Presbyopia (Mata Tua): Difficulty seeing both near and far; needs bifocal glasses.
• Myopia (Rabun Jauh): Nearsightedness with elongated eyeball; corrected with concave lenses.
• Hypermetropia (Rabun Dekat): Farsightedness; corrected with convex lenses.
• Rabun Senja: Night blindness, caused by Vitamin A deficiency.
• Keratomalasi (Mata Bubur): Severe Vitamin A deficiency causing corneal clouding, dry eyes, and blindness.
• Juling: Strabismus or crossed eyes due to uncoordinated eye muscles; corrected with surgery.
• Buta Warna: Color blindness due to dysfunctional cone cells.
• Katarak: Cataracts, where the lens becomes cloudy; requires surgery.
• Glaukoma: Glaucoma damages the optic nerve due to increased eye pressure, treated with medication or surgery.

Mata Internal (Internal Eye Anatomy)

• Optic Disk: The area in the retina where the optic nerve enters; it is the central area of vision.
• Aqueous Humor: Fluid between the lens and cornea maintaining intraocular pressure; contains ascorbate, lactate, and protein.
• Humor Vitreous: Gel behind the lens, remains for life.
• Normal Intraocular Pressure: 12-20 mmHg.
• Mata Kering (PMK): Dry eye disease caused by tear film instability.
• MKSS: Dry eye due to autoimmune issues.
• MKBSS: Another type of dry eye.
• Treatment for Dry Eye: Mucin secretagogues (Rebamipide/Diquafosol), artificial tears, warm compresses, antibiotics, and omega-3 supplements.
• Pathway of Light: Light travels through the cornea, aqueous humor, pupil, lens, vitreous humor, to the retina.

Glaucoma (cont.)

• Congenital Glaucoma: Arises from developmental embryological issues in the anterior segment of the eye and appears within the first year.
• Diagnosis: IOP and CAG (gonioscopy).
• 1st line treatment: Beta-blockers (Betaxolol, Carteolol, Levobunolol).
• Contraindicated: Prostaglandins/Brimonidine.
• Topical CAI (Carbonic Anhydrase Inhibitors): Brinzolamide, Dorzolamide.
• POAG (Open Angle Glaucoma): Impaired outflow of aqueous humor; chronic and simplex.
• Angle Closure Glaucoma: Obstruction due to iris periphery.
• Secondary Glaucoma: Caused by other diseases like Aphakia, Malignant glaucoma, neovascularization, or steroid use.

Konjungtivitis (Conjunctivitis/Pinkeye)

• Characterized by red, itchy, watery eyes due to inflammation; conjunctiva widens.
• Conjunctiva Characteristics: Thin, transparent with goblet cells.
• Klasifikasi (Causes): Bacteria, viruses (herpes, HIV, adenovirus), allergies, fungi (Candida sp).
• Treatment for Bacterial Conjunctivitis: Antibiotics (tetracycline), polymyxin-trimethoprim for gonorrhea, usually self-limited.
• Treatment for Viral Conjunctivitis: Self-limited, acyclovir for herpes (topical or oral).

Arthritis Rheumatoid (Rheumatoid Arthritis)

• Autoimmune destruction of cartilage and bone; characterized by inflammation in small joints (synovium).
• Progressive & kronis & autoimun: Progressive, chronic autoimmune; symmetrical symptoms, worsen in the morning.
• Mediators: TNF alpha, IL-1, IL-6, IL-7.
• Treatment Guidelines:
• Fase 1: Diagnose RA? yes, initiate MTX (bDMARD) + OAINS dose down. ex: hamil, hepato, punya infeksi TB, Leflunomid /Sulfasalazin + OAINS /glukokortiko, MTX onset in 6 months so predrisone prn.
• Fase 2: Good prognosis with RF/CPAT? yes, augment bDMARD; more specific ada anti IL &dkk ; ex: Anti TNF alpha -> etanercept, adalimumab; Anti IL-6 -> tocilizumab.rituximab; If no prognosis, augment bDMARD. ex: MTX + Sulfasalazin // MTX + Leflu.
• Fase 3: Switch bDMARD to more efficacious or JAK-inhibitor (Tofa citinib).

Arthritis Rheumatoid (cont.)

• MTX & Leflunomide not safe in pregnancy (Teratogenic):
• Monitoring 3-6 months; MTX inhibits DNA synthesis and leflunomide inhibits pyrimidine synthesis.

Osteoarthritis

• Progressive inflammation; worsened by activity, stiff, swelling, with crepitation.
• Primer Type: Unknown cause.
• Sekunder Type: Caused by inflammation, trauma, or metabolic problems.
• Treatment Knees & Hips:
• 1st Line: PCT (Paracetamol) 325-500mg 3x/day; if not work celecoxib 100mg daily.
• CI pct : topical NSAIDs (knee) //; intraarticular kortiko; z// tramadol // NSAIDS
• second line: opioid analgesik; operasi; Duloxetine (knee); intraarticular hyalu.
• 4/pasien≥75 yo: topical NSAID //capsaicin &//tramadol.
• Hand:
• 1st: Diclofenac (topial NSAIDs);
• Alt: Oral NSAIDs/ Capsaicin cream 4x/day/ Tramadol.

Osteoarthritis vs RA.

• OA: caused by age and obesity, asymmetric pattern, and unstable in patologis.
• RA: autoimmune, symmetric pattern.

Dermatology

• Osteofit: Bone spurs on the edges of bones.
• Dyarthrosis: Synovial joints.
• Synchondrosis: Hyaline cartilage.
• Synarthrosis: Sutures of the skull.

Otitis Media & Tinnitus

• Tinnitus : Ringing in the ears, originating in the middle ear. Causes: Injuries, earwax blockage, infections, or damage to cilia.
• Types: Subjective (patient perceives a sound) vs. Objective (caused by physiological processes).
• Meds that exacerbate: Aspirin, NSAIDs, gentamicin, erythromycin, vancomycin, cisplatin, vincristine, chloroquine, quinine, furosemide, valproate.
• Limbic System: Interpreting emotional responses, storing memories, & hormones (white noise).
• Antidepressants, Antipsikotik, Mood stabilizers, Sedatives.

Otitis Media (cont.)

• (ACOM): Acute inflammation in the middle ear lasting up to 6 weeks.
• Causes: Streptococcus pneumoniae, Haemophilus influenzae, upper respiratory tract infections.
• CSOM (Chronic): Ruptured eardrum with structural changes; Sinusitis, pus, mastoid cell infections.
• Diagnosis: Otoscopic, audiometry, tympanometry.
• Treatment: Surgical (Tympanoplasty, Mastoidectomy Ossiculoplasty), Gabapentin or Tramadol.
• Kortiko (Oral): Prednisolone or Triamcinolone.; Oral cocci -> Cef podoxime Clindamycin.

Dermatitis

• Bulosa: Caused by S. aureus, affects body and face.
• Krustosa: Caused by S. pyogenes, affects face, mouth, and nose.
• Eritrasma: Caused by C. minutissimum, presents as reddish-brown plaques on skin folds; coral red under Wood's lamp.
• Saboroik: dikepala 1st sampo keto // salep keto //; sele 2nd Hidrokortison Topikal.
• Atopic: 1St Hidrokortison 1% Triamsindon + betamet.

• Treatment-> Uniprtama Amok oral 30mg/kg/ 2x/hari 5 hari; mixed enrofloxacin marbofloxacin.

Scabies & Kutil

• Insect Bites & Warts.
• Gejala khas: Intense itching at night, contagious.
• Meds: Topikal & ORAL.
• Spesies: Sarcoptes Scabiei.
• Risk factors: crowding, direct contact, fomites, household.
• Transmission: indirect contact (linen/kain katun baju & furniture).
• Types: Classic (rare);Crusted (Norwegian Scabies)- autoimun HIV
• Higher risk older people, hospitalized patients & people w/weak Immune.
• Diagnosis : Microscope eggs & mites / Clinical / Skin Scrapping coloring dermoscopy.
• -Treatment : isolasi diri, poke antibiotik.

Scabies & Kutil (cont.)

• Algorithm Eropa: kalo basah dikompres NaCl; noresponse+ diagnosis = ➡️Common = 5% Permethrin 1st line or Balsam of Peru/Sulfur/Benzyl Benzoate;

• Algorithm Jarang di Indo (banned in ausii) : Ivermectin Oral 200μ/kg ; Kalo di Indo diganti jadi Loratadine; Crusted Scabies oral + 5% permethrin + Asam salisilat (langsung) -->Gabble buat bayi

• Indikasi: Sefalosporin / Azithromycin;

Acne

• (Acne Vulgare): Inflammation of pilosebaceous units.
• Faktor: Sebum, hormones, genetics, bacteria.
• Komedo (comedones): Early stage of acne.
• Tipe (Types): Blackheads, whiteheads, papules, pustules, nodules, cysts.

Acne (cont.)

• Terapi (Treatment):
• Ringan (Mild):
• Topikal "1st line": BPO, asam salisilat, retinoid ; benzal peroksida, Benzoyl radical ,
• Sedang (Moderate) -> atas all + oral : antibiotik oral ex Do, Azi, Tetra.
• Parah (Severe) -> AB + Topikal"
• Kalo tetep gabisa (Es): teragtonik * Oral" ;
• Laser (If severe and unresponsive)
• Alopecia = Progression by Genetics. " Faktor: Stress oxidatsf", genetic, penuaan ", autamun", hormon", defisiensi nuerisi", ES coat kanker ". "-Alopeica
• Androgenetic alopecia -> hormonal androngen" rusokdernnis" "

Tabir Suryal (Sunscreen)

• Sunblock -> nyerap = ZnO, Titanium oxide

• Sunscreen -> avobenzone, Oxybenzone, PABA

• Pengobatan: (Konsumsi PCT Ibuprofen & Vit.D)-

• .Sunscreen systemic: B-carotene, Vit. C, Retinol, Selenium, Aspirin "-tocopherols.

• topical: Inorganic-> ZnO, TiO?, CeOs, calamine, talc-

• = Broad spectrum== Benzophenos (Oxybenzone avibenzone -> Bisoctrizole (UVA)-> UVA -> ECOmSULe:->" B, UV =>" UBV = PABA deriates + Salicyrate, Padinate

NSAID

• NSAID : "=> Antiimflamasi Nonesteroid= hambat Enzim slkooKsicegnge (Cox); (Senywa kilmia aliami daLam trubru -> berasal asaimam) .Prostaglaudin- bukan hoimon mediator inflamasi Gaada ditubuh-> langsung kalau butuh,

• enzim Sikooksigenas -> arakidanot => prostaglanoin

guidline --> ES Infels !

Non seietif -) [Bucrot dikfot nagen apronen = humbat com:i)

• -Preferencial COX-2->meloxican -> doninan hambat COX-2

• K: pendaraahan S.cerna ,- Tukak lambung - Asma Bounical -Hipertens berot =>bikin valsosomtr

• Hamill " * ES Ibu bamil : PCI.