Management of Eyelid Defect

Dr.dr.Rodiah Rahmawaty Lubis, M.Ked(oph), SpM

Recostructive, Oculoplasty and Oncology Division Ophthalmology Departement, Faculty of Medicine
Universitas Sumatera utara, Medan

ABSTRACT
Eyelids are the protective mechanism of the eyes. The upper and lower eyelids have been formed
for their specific functions by Nature. Reconstruction of the eyelids is highly complex because
of their function and critical role in appearance. Optimal restoration of their form and function
depends on a firm understanding of normal eyelid position, the structural support system of the
eyelids, and the forces that act to keep the eyelids in precise balance. The surgical repair of eyelid
defect differs somewhat from that of most skin lacerations. The reasons for this include the need to
maintain a functional eyelid and ensure a cosmetic outcome as well as the fact that the eyelid is more
vascularized than many other skin regions. A functional upper eyelid is essential to maintain the
health of the globe itself. If the eyelid is incomplete or immobile, it is unable to physically protect the
eye and is unable to spread the tear film over the ocular surface.

Keywords: Reconstruction, eyelid defect, functional eyelid

INTRODUCTION
Eyelids are complex structures and pose firmly adherent over the pretarsal area and
a challenge for reconstruction. They play an over the medial and lateral canthal areas due
important role in protecting the globe from to the absence of subcutaneous tissue. It is
trauma, excessive light, and in maintaining lined with the conjunctiva on the inner side
the integrity of tear films and moving the tears and supported in the middle by the tarsal plate.
toward the lacrimal drainage system. The The conjunctiva is firmly adherent over the
beauty and expression to the eye is given by the tarsal plates, loose above it and while lining
lids and muscles in it. Upper and lower eyelids the fornices. The lid margin is about 2 mm
have been formed for their specific functions in width and represents the transitional zone
by Nature. To undertake the reconstruction of of the skin and conjunctiva. This junction is
the eyelids, it is very important to understand called the grey line and through it the lid can
few basic anatomical features of the eyelids.[1] be split into anterior lamella and posterior
lamella. The anterior lamella consists of the
Pertinent Anatomy skin and orbicularis muscle. The posterior
The outermost layer of the eyelid is skin. lamella consists of the conjunctiva and tarsal
The skin of the eyelid is very unique and is plate. The posterior edge of the lid margin is
the thinnest in the body. It becomes thicker sharper compared to the anterior edge which
as it approaches the eyebrow and cheek. It is is rounded. There are two rows of lashes in the
lower lid and three to four rows in the upper is done to get properly alignet lid.
lid. [1]
Beneath skin is the orbicularis muscle, the
contraction of which closes the eyelid. The
orbital septum is a fibrous sheet that lies beneath
the orbicularis muscle. This important structure
acts as a barrier between superficial preseptal
tissues and postseptal orbital anatomy. More
posteriorly, orbital fat separates the orbital Figure 1. Eyelid margin architecture[3]
septum from the levator muscle which is the Principles of lid repair[4]
main retractor of the eyelid. Mueller‟s muscle • Clean the wound at initial repair to remove
also aids the levator in elevation of the eyelid. dirt or foreign body to prevent subsequent
The conjunctiva lines the inner aspect of the tattooing.
eyelid and contacts the ocular surface[2] . • All wounds are examined carefully and any
Eyelid margin has slightly rounded anterior visible damage repaired.
edge and sharp posterior edge. Anatomical • Reconstruction should be done in layers as
structures in eyelid margin from posterior to per correct anatomical orientation.
anterior are (Figure 1)[3]. • Skin incision given along line of tension. In
• Mucocutaneous junction lower lid line of incision should be oriented
• Meibomian gland orifices perpendicular to lid margin.
• Gray line • Cut „Down hill to Up hill‟ to prevent blood
• Eyelash follicles from obscuring line of incision.
Intermarginal strip is 2 mm flat strip lies • Wounds should not be extended to explore
between anterior and posterior edge. It is structures unless the exploration is for
covered with stratified squamous epithelium suspected foreign body.
which forms transition between skin and • Extensive lid laceration can lead to damage to
conjunctiva. The sharp posterior border lies in orbital septum. While repairing lid orbital
contact with the ocular surface and responsible septum should not be sutured.
for proper spreading of tears. Immediately • Lid has excellent blood supply which allows
anterior to posterior border, ducts of meibomian tissue to survive as free graft. During
glands open in a single row. Gray line lies primary repair tissue should be preserved as
anterior to meibomian gland openings and much as possible. Do not unnecessarily cut
represents avascular plane between orbicularis or freshen the wound edges.
and the tarsus plate. It is the plane along with • Preferably do not add tissue at the time of
lid can be spilt into two halves. primary repair unless cornea is at risk. Wait
Anterior and Posterior lamella[3] for wound to settle for 3, 6 or 9 months
Functional anatomy of the lid can be before repairing defects
simplified by dividing lid into two parts along
gray line. Eyelid skin and orbicularis muscle Tissues Available for Reconstructions
forms anterior lamella while conjunctiva and Similar tissue should be used for
tarsal plate forms posterior lamella. reconstruction [Table 1]. Color match is
While repairing the lid, meticulous important for cosmesis of anterior lamella. A
reconstruction of anterior and posterior lamella full thickness skin graft which can match the
color should be chosen. When larger grafts Free skin grafts[4]
are required, split skin grafts can be utilized. Free skin grafts are harvested from a donor
The lining or the posterior lamella coming site and transferred to fill an anterior lamellar
in contact with the globe should be smooth, defect. Vascular supply to the free graft must
capable of producing mucus for lubrication. be provided by recipient site for the graft to
Table 1 survive.
Full thickness skin graft (FTSG) employs
entire thickness of epidermis and dermis
harvested from donor site. Upper eyelid skin
is the best choice for reconstruction of eyelid
defects. Other sites for harvesting FTSG
Donor tissue for reconstruction include retroauricular or pre auricular skin,
Spinelli and Jelks had divided the supraclavicular skin and upper inner arm skin.
periocular reconstructions into five zones, with Split thickness skin graft (STSG) is seldom
their own anatomic, functional, and esthetic used in eyelid reconstruction. It is useful when
consideration. It is simpler to denote each area a large area of skin needs to be covered and no
by its name.[5] myocutaneous flap can be mobilized. With
STSG, the colour, texture and thickness are
Techniques of Lid Repair often a poor match for eyelid skin.
Anterior lamellar defects not involving lid
margin[6] Eye lid margin repair[4,6]
Eyelid laceration involving lid margin
Primary closure with undermining requires meticulous approximation to avoid
Primary closure can be performed if notching which cause functional and cosmetic
redundant skin exists adjacent to the defect. problem. The wound should be carefully
Meticulous closure without tension is inspected to identify tarsus and lid margin
attempted. If required undermining of the landmarks like gray line, anterior lash line
surrounding skin done to mobiles skin for and posterior margin. If wound is ragged,
adequate closure. freshening the edges with a scalpel blade may
As eyelid skin has extensive blood supply, aid in structure recognition and apposition.
even apparently necrotic eyelid skin survives Repair should be carried out preferably under
after repair. Preservation of tissue done by operating microscope.
avoiding unnecessary excision. Repair of lid margin is done with three
vertical mattress sutures using a non-
Myocutaneous flaps absorbable 6-0 silk on a cutting needle. The
Myocutaneous flaps in the periocular area first bite is taken in the plane of meibomian
are formed of skin and orbicularis muscle that glands approximately 3 mm from wound
is dissected off the underlying orbital septum edge and 3 mm deep. The superficial bites
and stretched into position over the anterior are placed 1.5 mm behind and below the lid
lamellar defect. Because myocutaneous flap margin. The suture is pulled to determine
uses tissue adjacent to defect, the match for whether a satisfactory approximation of the
colour and texture is good. margin edges has occurred. A good apposition
with slight margin eversion should be the
goal. Two more sutures are passed in front and accomplished for injuries that have up to 40%
behind to approximate anterior and posterior tissue loss. However, it is often necessary
lid margin. These sutures are tied and left long. to “freshen up” the eyelid margins prior to
The tarsus is next closed with fine, interrupted, reconstruction.
partial-thickness sutures, such as 6-0 Vicryl.
The anterior lamella of the eyelid is closed Lateral canthotomy and cantholysis[4]
next, with interrupted sutures using 6-0 silk. When direct closure is attempted, additional
The long margin sutures are tied through these horizontal lengthening is provided by lateral
skin sutures to prevent the suture ends from canthotomy and cantholysis. In lateral
abrading the cornea (Figure 2). Sutures are canthotomy, horizontal limb of Y shaped lateral
removed after approximately 2 weeks. canthal ligament is incised. For cantholysis,
inferior or superior crus of lateral canthal
tendon is incised and separated from the bony
attachment and lid mobilized. Technique is
particularly useful to prevent suturing under
tension where laxity of tissue is less.

Repair of moderate defect (upto 1/2 of

horizontal length) [4]
In old patients or patients with lax skin,
mobilization of eyelid with lateral canthotomy
and cantholysis as described above can be done
to cover defects upto 50% of lid length.

Tenzel semicircular flap[4]

Figure 2. Lid margin repair [4] It is useful for reconstruction of upto 50%
Eyelid injuries with tissue loss[4,7] lid defects. It can be used for both upper lid and
Full thickness eyelid defects with tissue loss lower lid defects where some tarsus remains on
is classified depending on horizontal extent of either side of the defect.
defect into - A high arched semicircular flap of skin
Small defects (< 1/3) and orbicularis muscle is rotated from lateral
Medium defects (1/3 to 1/2) canthus after lateral cantholysis. The flap has
Large defects (>1/2) vertical diameter (approximately 22 mm) more
Repair of small defects (< 1/3 of horizontal than horizontal diameter (approximately 18
length) mm).
Direct closure[4] For upper lid defects the semicircle extends
If either the upper or lower eyelid has inferiorly and for lower lid the semicircle
sustained a full-thickness injury that results extends superiorly. After undermining of the
in less than 1/3 loss of tissue including the tissue the lid is pulled medially and direct
eyelid margin, the repair can generally be closure of wound margins carried out. New
closed primarily. In older patients, because lateral canthus created by suturing part of
of increased eyelid laxity, primary closure the new lid with intact limb of lateral canthal
of both the upper and lower eyelid may be tendon.
Repair of large defects (> ½ of horizontal in conjunction with an adequate mucosal lining
length) [4] posteriorly. A deep inverted triangle must be
excised below the defect to allow adequate
Cutler Beard Bridge technique rotation of the flap. The side of the triangle
Originally described for reconstruction of nearest the nose should be practically vertical.
the upper lid, this technique can be used for The advantage of this procedure is that it is a
reconstruction of the lower lid defect also, one-stage, complete lower lid reconstruction.
a procedure known as reverse Cutler- Beard.
Cutler Beard procedure is done in two stages. CONCLUTION
In first stage, after measuring the upper eyelid Repairing of eyelid defect requires
defect, a three-sided inverted U shaped incision knowledge and meticulous approach. Gentle
is marked on the lower eyelid, about 5 mm tissue handling and proper alignment should
below lid margin. After giving full thickness be done. Aim should be to achieve best
incision, the lower lid flap is pulled under the possible functional and cosmetic outcome.
bridge of lower lid and sutured in layers to the There are various techniques available for
upper lid defect. Since this flap is devoid of reconstructions of defects of eyelids starting
tarsus, autogenous cartilage from ear can be from the spontaneous healing after excising the
used. Separation of the flap is done 6 weeks lesion. While choosing a method, the specific
to 3 months later as second stage surgery. function of the area of the eyelid has to be kept
After cutting the flap, lid margin of newly in mind. As eyes are the focal point of the face,
formed upper eyelid is sutured with conjuctiva acceptable cosmesis in reconstruction should
covering the free margin. be a major requisite.

Hughes tarsoconjunctival flap technique REFERENCES

It is partial thickness posterior lamellar 1. Sirbamanian N. Reconstruction of eyelid defect.Indian
Journal of Plastic Surgery. 2011. 44(10: 5-13
flap harvested from upper lid to cover lower 2. Mustak H. In: Ocular Trauma: Principles and Practice,
lid defects. After everting upper lid, incision is Kuhn F, Pieramici D. New York. Thieme, 2002. p.38-
made through tarsus 4 mm above lid margin 52
3. Vichare N. Management of Lid Laceration. Ocular
and flap is mobilized. Flap is sutured with Trauma. DOS Times - Vol. 20, No. 8 February,
lower lid tarsus to create posterior lamella. 2015;33-38
Sufficient skin to cover the anterior surface of 4. Sushil Kumar, Sima Das , Zia Chaudhuri, Vandana
the flap can be obtained either by harvesting Kohli. Basic Principles of Lid Repair and
Reconstruction. DOS Times September, 2006;3:210-
a full-thickness skin graft or by advancing a 14.
myocutaneous flap from surrounding skin. 5. Spinelli HM, Jelks GW. Periocular reconstruction:
A systematic approach. Plast Reconstr
Mustarde cheek rotation flap Surg. 1993;91:1017–24. [PubMed]
6. Christine C. Nelson Review of management of eyelid
It is reserved for the reconstruction of trauma. Australian and New Zealand Journal of
very extensive lower eyelid defects usually Ophthalmology 1991;4: 357-63.
7. Carroll RP. Management of eyelid trauma. In: Hornblass
involving more than 75% of the eyelid. A large
A, ed. Oculoplastic orbital, and reconstructive surgery.
myocutaneous cheek flap is dissected and used Baltimore: Williams & Wilkins, 1988;45:409-414.
 Dear Friends and Colleagues,

I
t is our immense pleasure to invite you to the 43rd Annual Meeting of
the Indonesian Ophthalmologists Association (IOA) held in Padang,
West Sumatera, August 30th - September 1st, 2018. It is such an honor
for West Sumatera IOA to be chosen to host the Annual Meeting of IOA,
which is an annual scientific and professional ophthalmologists event. This
conference is a collaboration of all subspecialty fields of ophthalmology
who aims to share knowledge and skills that will be influential in improving
the quality of eye care services.
We are inviting experts from all fields of ophthalmology with an emphasis on innovation, eye
care, surgical technique and most developed technology with a clear objective to prepare current eye
practitioners for the ever-evolving future of eye care.
Padang is the gate to the beauty of Minangkabau tourisms. Needless to say that West Sumatera is
well known as one of the most attractive provinces to foreigners for its exotic beaches, mountains
and interesting traditions as well as traditional culinary which are internationally recognized. The
uniqueness of its culture has become a compelling attraction to people from all around the world.
We are proud to invite all of you to enjoy the natural attractions of our city and have a taste of our
famous spicy culinary.
We look forward to welcoming you to Padang, West Sumatera in August 2018.

Heksan, MD
• Head of IOA Padang
• Chairman of 43rd Annual Scientific Meeting of IOA in Padang

6
 Dear Friends and Colleagues,

I
t is with great pleasure that I greet you welcome to the 43rd Indonesian
OphthalmologistsAssociation annual meeting. This year we are meeting
in the beautiful city of Padang. Our colleagues from IOA Sumatra Barat
has worked so hard to continue our tradition and commitment in the field
of ophthalmology, and this year the theme of the meeting is “Innovations
in Ophthalmology Practices”. Technical and skill innovations have always
been an area of interest for many of clinicians in ophthalmology, due to its
practical use in the everyday services to our patients. Innovations in the area
of teleophthalmology has recently gained international attention as a branch of telemedicine. The
application of teleophthalmology in the future is limitless, from diagnostics, outcome predictions,
and overall patients’ personalized managements. We encourage teaching institutions to continue
working on their research and conduct studies that produces big data. Big data management will
require special software, and the development of artificial intelligence (AI) in ophthalmology could
assist its analysis and eventually integrated them to teleophthalmology. It is best to anticipate these
challanging advancement in technology will be available in the near future. It remains a challenge,
for in every new advancement in technology, an ethical concern would usually arise. Authenticity
and copyright of the original research should always be protected, ownership guarded, and is often a
challenge that we need to always keep an awareness of.
Towards the end of 2019 we are expected to prepare our report for the WHO Vision 2020 initiatives.
According to the Rapid Assessment of Avoidable Blindness (RAAB) conducted in 2014-2016, the
main cause of blindness in most Indonesian area (around 15 province in total), is indeed cataract.
Intervention has been ongoing, and hopefully in the remaining time we can continue to increase
the quality and quantity of cataract surgery with good patient selection and contributed further to
lowering the number of cataract blindness. We are hopeful that with this initiative, the cataract
numbers in Indonesia will reduce significantly and improve our people’s overall health.
I would like to extend our heartfelf thank you to all Indonesian and international faculty, and also
to the hardworking Perdami Sumatera Barat with their organizing committee for all the energy, time
and passion. To the participating ophthalmic and medical/pharmaceuticals industry, thank you for
your continued support throughout the years. And lastly, our spirits are high and full with gratitude,
for this scientific meeting will not be possible without the blessing of Allah SWT, and with collective
efforts and commitment from all parties mentioned. We are hopeful that this will become a joyful
and productive meeting, that our attendees and participant could bring home as an unforgettable
experience with lasting memories.
Sincerely Yours,

M. Sidik, MD
President Indonesian Ophthalmologists Association (Perdami)

7
ADVISOR

• Wirsma Arif, MD
• M. Sidik,MD
• M. Kautsar Boesoirie, MD
• Khalilul Rahman, MD
• Ari Djatikusumo, MD
• Julie D. Barliana, MD
• Syntia Nusanti, MD
• Susanti Natalya Sirait, MD
• Syarif Amal, MD
• Ardizal Rahman, MD

CHAIRMAN

• Heksan, MD

VICE CHAIRMAN

• Syahrial Haroes, MD

SECRETARY

• Havriza Vitresia, MD

VICE SECRETARY

• Mayasari Nasrul, MD
• Fitriliza Hamdy, MD

TREASURE

• Afiyarni Ibrahim, MD

SCIENTIFIC

• Fitratul Ilahi, MD (Coordinator)

• Fitriliza Hamdy, MD
• Hondrizal, MD
• Ewi Primadona, MD
• Reni Angraini, MD
• Diska Herriadi, MD

10
SCIENTIFIC TEAM

• Hendriati, MD (Coordinator)
• Khalilul Rahman, MD
• Muslim, MD
• Yaskur Syarif, MD
• Ardizal Rahman, MD
• Getry Sukmawati, MD
• Kemala Sayuti, MD
• M. Hidayat, MD
• Syahrial Haroes, MD
• Heksan, MD
• Harmen, MD
• Andrini Ariesti, MD
• Mardijas Efendi, MD
• Weni Helvinda, MD
• Fitratul Ilahi, MD
• Havriza Vitresia, MD
• Rinda Wati, MD
• Julita, MD
• Yanuhardi, MDYandrison, MD
• Yanuhardi, MD

11
 CONTENTS

Welcome Message ....................................................................................................................... 5

Organizing Committee ............................................................................................................... 9

Content ........................................................................................................................................ 13

Scientific Program Overview..................................................................................................... 29

INASCRS
Pearl On Posterior Capsular Opacity ....................................................................................... 35
Indri Wahyuni, MD

Single Phaco-Parameter to Make Easier and Faster in Phacoemulsification ....................... 43

Harka Prasetya, MD

One Handed Phaco ..................................................................................................................... 49

Jamaluddin, MD

Dynamic On Phacoe and How to Control It ............................................................................ 53

Zulhafdi Mugni, MD

Phacoemulsification in High Astigmatism................................................................................ 57

Novita Sitompul, MD

Basic Principles of Laser Eye Surgery...................................................................................... 61

Sjamsu Budiono, MD

Trans PRK to Joint Military and Police Forces....................................................................... 65

Henry Albar, MD

Fast Recovery and Excellent Visual Outcomes after ReLEx SMILE

Using 2.0 mm Incision ................................................................................................................ 69
Harka Prasetya, MD

Mastering The ReLEx SMILE‟s Learning Curve ................................................................... 73

Sita Pritasari, MD

Medical and Surgical Therapy for Keratoconus ..................................................................... 77

Prof. Suhardjo Pawiroranu, MD

14
Fashioned Corneal Donor : One for two .................................................................................. 87
Dini Dharmawidiarini, MD

Dealing with Aphakic Patients .................................................................................................. 91

Emmy Dwi Sugiarti, MD

Secondary IOL, When and Where ?......................................................................................... 97

Abrar Ismail, MD

Scleral Fixated IOL in the Vitrectomized Eye ......................................................................... 101

Nina Handayani, MD

Optimizing the Function of Bimanual Irrigation

and Aspiration on Phacoemulsification .................................................................................... 105
Harka Prasetya, MD

A to Z in Phaco for The Beginners ............................................................................................ 109

Sita Pritasari, MD

The Art of Soft Cataract for Beginner Phacosurgeon ............................................................. 113

Zoraya Ariefia Feranthy, MD

Management of Phacoemulsification in The Long Eye........................................................... 117

Novita Sitompul, MD

Phacoemulsification: A Skill Beyond Hands ............................................................................ 121

Gede Pardianto, MD

Preserving Corneal Endothelium During Phacoemulsification ............................................. 125

Edi Wibowo, MD

Phacoemulsification in Posterior Polar Cataract (PPC) ......................................................... 133

Dicky Hermawan, Wahono, MD

INAVRS
New Modality Imaging In Diabetic Retinopathy..................................................................... 143
Sauli Ari Widjaja, MD

Scleral Buckle Surgery; is It Still Usefull in Vitrectomy Era? ............................................... 151

Safarudin Refa, MD

15
Choice of Intraocular Tamponade................................................................................................. 155
Arief Wildan, MD

Patient Who Had Lattice Degeneration Should Do Laser Preventive before

Refractive Surgery ..................................................................................................................... 163
Ramzi Amin, MD

Myopia and Its Complication to Macula .................................................................................. 165

Gitalisa Andayani, MD

Central Serous Chorioretinopathy : When it Should be Treated?........................................... 171

Habibah Setyawati Muhibin, MD

Vitrektomi Fragmen Lensa: Pengalaman Pemula .................................................................. 177

Werlison Tobing, MD

IGS
Glaucoma: Rate of Progression................................................................................................. 185
Fifin Luthfia Rahmi, MD

Strategy of Target IOP ............................................................................................................... 187

M. Ma’sum Effendi, MD

Relationship Between Structure and Function ........................................................................ 189

Evelyn Komaratih, MD

Approach to Glaucoma Suspect ................................................................................................ 197

Fidalia, MD

Quality of Life in Glaucoma Patients ...................................................................................... 201

Prima Maya Sari, MD

Rhokinase Inhibitor (Rock‟in) A New Treatment in Glaucoma ............................................. 207

Noro Waspodo, MD

Laser Peripheral Iridotomy and Argon Laser Peripheral Iridoplasty

in Angle Closure Glaucoma ....................................................................................................... 209
Iwan Soebijantoro, MD

Optimizing Trabeculectomy ...................................................................................................... 215

Masitha Dewi Sari, MD

16
Maintaining Bleb AfterTrabeculectomy ................................................................................. 219
Fitratul Ilahi, MD

Hypotony After Trabeculectomy: What Should We Do? ..................................................... 221

Aulia Abdul Hamid, MD

Management Of Blebitis / Bleb-Related Endophthalmitis .................................................... 223

Novanita S Satolom, MD

Malignant Glaucoma Management ................................................................................. 229

Yulia Primitasari, MD

Complication of Glaucoma Drainage Devices (GDDs) implant

and their Management .............................................................................................................. 235
Andika Prahasta, MD

Glaukoma Pseudoexfoliatif ...................................................................................................... 241

Elsa Gustianti, MD

Glaucoma After Retinal Surgery ............................................................................................. 249

Maula Rifada, MD

Phaco in Acute Angle Closure .................................................................................................. 253

Rini Sulastiwaty, MD

Uveitic Glaucoma ...................................................................................................................... 259

Retno Ekantini, MD

Neovascular Glaucoma ............................................................................................................. 257

Ni Kompyang Rahayu, MD

Combined Phacotrab in Shallow AC and Small Pupil .......................................................... 273

I Made Agus Kusumadjaja, MD

Ghost Cell Glaucoma ................................................................................................................ 275

Maya Ekakristiani Suwandono, MD

Steroid Induced Glaucoma ....................................................................................................... 277

Tatang Talka Gani, MD

Low-cost nonvalved drainage device to control the neovascular glaucoma ........................ 283
Erin Arsianti, MD

17
Silicone Oil Induced Glaucoma in Pregnancy ......................................................................... 289
Nelandriani Yudapratiwi, MD

INOIIS
How to use and when to strat steroid and NSIAD in Ocular surface problems ................... 293
Ratna Sitompul, MD

Microbial Changing in Dry Eye ................................................................................................ 295

Prof. Winarto, MD

Effect Of Topical Genistein On Dry Eye Syndrome In Ovariectomy Mouse

Through The Role Of Epithelial And Goblet Conjunctival Cells And
Limba Epithelial Stem Cell ....................................................................................................... 297
Rosy Aldiana, MD

Lubricants as Adjunctive Therapy in Ocular Infections and Inflammations ....................... 301

Retno Sasanti Wulandari, MD

Blepharitis: What Is It and How Does It Impact Your Eyes ?................................................ 305
Fatma Asyari, MD

Pearls in Therapeutic and Tectonic Keratoplasty in “Hot Eyes” Success

Parameters and How to Achieve Them .................................................................................... 309
Prof. Suhardjo Pawiroranu, MD

Sterile and Infectious Corneal Ulcer, How Do We Distinguish Both Of Them? ................... 315
Havriza Vitresia, MD

Pattern of intermediate uveitis in a tertiary academic hospital ............................................. 317

Ovi Sofia, MD

Basic Immunology Which Needed To Get The Diagnosis ....................................................... 321

Prof. P.M Van Hagen, MD

Auto Inflammatory And Auto Immune Diseases : Diagnosis And Treatment........................ 323
Prof. P.M Van Hagen, MD

Bilateral Corneal Perforation in a Patient with Lamellar Ichthyosis .................................... 325

Liesa Zulhidya, MD

18
Septic Cavernous Sinus Thrombosis......................................................................................... 329
Getry Sukmawati, MD

Uveitis Related to Systemic Lupus Erythematosus (SLE) ...................................................... 337

Petty Purwanita, MD

Various Clinical Feature of HSV Stromal Keratitis ................................................................ 341

Dina Novita, MD

The Role of Cataract Surgery In Patients With Uveitis.......................................................... 345

IGN Puspajaya, MD

Cataract and CMV Retinitis in AIDS Patients ........................................................................ 349

Soedarman Sjamsoe, MD

The White Dot Syndromes......................................................................................................... 353

Halida Wibawaty, MD

Photoactivated chromophore corneal cross-linking for keratitis patients ............................ 355

Elfa Ali Idrus, MD

Necrotizing HSV Stromal Keratitis: Diagnosis And Treatment................................................363

Angga Fajriansyah, MD

Viral Conjunctivitis and Keratitis ............................................................................................ 371

Made Susiyanti, MD

Management of Bullous Keratopathy ...................................................................................... 379

Hasnah, MD

Flikten pada Tuberkulosis ...............................................................................................................385

Sammy Malingkas, MD

The Importance of Tarsal Conjunctival Evaluation in VKC ................................................. 391

Grace Sancoyo, MD

Scleritis : How To Explore More? ............................................................................................. 395

Eddyanto, MD

Opportunistic Infection in HIV ................................................................................................. 403

Randi Montana, MD

19
The Essential Path To Get Definitive Diagnosis Of Uveitis ..................................................... 411
Rifna Lutfiamida, MD

Psoriasis related to Uveitis ......................................................................................................... 413

Lady Kavotiner, MD

Demographic Features, Clinical Characteristics and Management

Outcome of Ocular Toxoplasmosis ........................................................................................... 417
Rien Widyasari,MD

Keratitis as A Manifestation of Ocular Rosacea ...................................................................... 425

Susi Heryati, MD

INAPOSS
Assessment visual acuity in children; which method? ............................................................ 429
Rusdianto, MD

Autorefractive Examination for Children :Is It Enough? ...................................................... 439

Norma D. Handojo, MD

Accommodative Insufficiency in Children ............................................................................... 443

Muhammad Asroruddin, MD

Prescribing glasses in pseudophakic and aphakic children .................................................... 449

Yulinda Indarnila Sumiatno, MD

The use of Topical Atropine in Management of Amblyopia.................................................... 451

Reni Prastyani, MD

Preoperative Factors influencing The Surgical Success in Patient with intermittent

exotropia at Jakarta Eye Center, Jakarta, Indonesia Year 2014-2017 ................................... 455
Devina Nur Annisa, MD

Simple method for V pattern Exotropia ................................................................................... 463

Gusti Gede Suardana, MD

Intermittent Exotropia with Amblyopia : How to manage ? .................................................. 465

Irma Praminiarti, MD

Management of Pediatric Orbital Cellulitis - A Case Report ................................................. 471

Aryani Atiyatul Amra, MD

20
Membranous Conjunctivitis in Children ................................................................................ 477
Kemala Sayuti, MD

Intermittent Exotropia Surgery : Type and Timing .............................................................. 479

Linda Trisna MD

Enucleation Bulbi in Intraocular Retinoblastoma, Cicendo Eye Hospital Experience :

The Survival Rate ..................................................................................................................... 481
Mayasari Wahyu, MD

Complication of IOL implantation in Children ..................................................................... 485

Julie Dewi Barliana, MD

Endophthalmitis Following Pediatric Cataract Surgery ....................................................... 487

Liana Ekowati, MD

Chronic adult hypertropia ....................................................................................................... 493

Lely Retno Wulandari, MD

Traumatic Bilateral Sixth Nerve Palsy .................................................................................... 495

Luki Indriaswati, MD

Acute Acquired Corneal Opacity in Baby .............................................................................. 499

Feti Karfiati Memed, MD

Approach to Vertical Strabismus ............................................................................................ 401

Anna Puspitasari Bani, MD

Management of Pediatric Glaucoma ....................................................................................... 503

Florence Manurung, MD

Surgical Management of Bilateral Persistent Pupillary Membrane .................................... 505

Hariwati Moehariadi, MD

Technique in Secondary Implant IOL ..................................................................................... 507

Primawita Oktarima Amiruddin, MD

Basic Suturing Technique in Ophthalmology ......................................................................... 511

Sri Inakawati, MD

Management Of Eyelid Defect ................................................................................................. 515

Rodiah Rahmawaty Lubis, MD

21
Levator Resection in Ptosis ........................................................................................................ 521
Hernawita Suharko, MD

Orbital Lymphoma..................................................................................................................... 523

Ardizal Rahman, MD

Orbital Examination .................................................................................................................. 525

Soetjipto, MD

Management of Distichiasis / Trichiasis ................................................................................... 527

M. Siska Trisanti, MD

Management of Canaliculitis ..................................................................................................... 533

Yana Rosita,MD

Management of Punctal Eversion ............................................................................................. 535

Debby Shintiya Dewi, MD

Ocular Surface Neoplasma ........................................................................................................ 539

A. Kentar Arimadyo, MD

Endoscopic Dacryocystorhinostomy ......................................................................................... 545

Yunia Irawati, MD

Conventional or External Dacryocystorhinostomy (Dcr) with Silicone

Tube Intubation .......................................................................................................................... 551
Ratna Doemillah, MD

Eyelid Malignancies ................................................................................................................... 557

Tri laksana Nugroho

Benign Eyelid Tumor............................................................................................................................. 559

Susy Fatmariyanti, MD

Tarsal Fixation in Lower Lid Epiblepharon ............................................................................ 567

Ardining Rejeki Sastrosatomo, MD

Management of Involutional Entropion ................................................................................... 571

Elza Iskandar, MD

Reconstruction of Small Eyelid Defect ..................................................................................... 577

Hendriati, MD

22
Penanganan Kelainan Soket ...................................................................................................... 579
Darmayanti Siswoyo, MD

Evisceration with Dermatofat Graft ......................................................................................... 581

Halimah Pagarra, MD

Technique Enucleation with Dermatofat Graft ....................................................................... 585

Riani Erna, MD

Repair of Canalicular Laceration ............................................................................................. 591

Shanti F Boesoirie, MD

Blow Out Fracture ..................................................................................................................... 593

M. Rinaldi Dahlan, MD

Mechanism of Grave‟s Ophthalmopathy ................................................................................. 595

Hendrian Dwi Soebagjo, MD

Pseudotumor vs Grave‟s Ophthalmopathy .............................................................................. 601

Neni Anggraeni, MD

Current Updates on Surgical Management of Graves Orbitopathy ..................................... 609

Agus Soepartoto, MD

Flap dan Graft ............................................................................................................................ 611

Ira Sudarmadji, MD

INARVOS
The Issues of Controling Myopia Progression and Its Risk Factors ..................................... 619
Christina Aritonang, MD

Should Glasses Will Be Prescribed in All Hyperopia Children?............................................ 625

Ani Ismail, MD

Options in Treating High Astigmatism ..................................................................................... 631

Rinda Wati, MD

The Current Concept in Treating Refractive Amblyopia ....................................................... 633

Ariesanti Trihandayani, MD

23
When to Use Toric SCL / RGP for Astigmatism Correction ................................................. 639
Sagung Gede Indrawati, MD

Non Surgical Management Of Keratoconus ............................................................................ 643

Damara Andalia, MD

Orthokeratology Lens : Screening, Fitting Dan Evaluation ................................................... 651

Fatima Dyah Nur Astuti, MD

Safety and Efficacy of Orthokeratology in myopia control .................................................... 657

Lucia Setiawati Sutedja, MD

Critical Issues In Implementing of Low Vision Care .............................................................. 663

Eva Kumalasari, MD

Visual Rehabilitation After Cataract Surgery in Children..................................................... 669

Nanda Wahyu Anandita, MD

Occupational Therapy of Low Vision Rehabilitation.............................................................. 673

Ria Sandy Deneska, MD

Distance Visual Acuity ............................................................................................................... 675

Ria Sandy Deneska, MD

Near Visual Acuity Assessment in Low Vision Patients .......................................................... 677

Nanda Wahyu Anandita, MD

INANOS
The Role Of Neuroprotective In Ischemic Optic Neuropathy ................................................ 683
Bobby Sitepu, MD

Optic Atrophy in Childhood ...................................................................................................... 691

A.A Mas Putrawati, MD

Neuroophthalmic Manifestation in Intracranial Disease in Children ................................... 695

Batari Todja Umar, MD

Clinical algorithm for double vision ......................................................................................... 701

Yunita, MD

24
Single Oculomotor Nerve Palsy Management ......................................................................... 707
Lukisiari Agustini, MD

Double Vision Caused by Brain Lesion .................................................................................... 715

Antonia Kartika

Which One is The Trouble: The Big or Small One ? ............................................................... 719
Devi Azri Wahyuni, MD

Visual Field Examinations in Neuro-Ophthalmology ............................................................. 727

Hartono, MD

An Obese Woman With Chronic Papil Edema ........................................................................ 733

Riski Prihatningtias, MD

A Case Of Conjugate Right Gaze Palsy With See Saw Nystagmus in

Patient with Left Hemiparesis ................................................................................................... 737
Yunita, MD

Miller Fisher Syndromes ........................................................................................................... 741

Devi Azri Wahyuni, MD

OPHCOM
Strengthening Eye Care System at District Level: Learning from the
„Inclusive System for Effective Eye Care‟ (I-SEE) Project ..................................................... 749
Manfred Moerchen, MD

NGO Role In Eye Care In NTB Province................................................................................. 753

Phuc Huynh Tan

Hasil Kajian Rapid Assessment of Avoidable Blindness ......................................................... 757

(RAAB) di Indonesia Tahun 2013-2016
Lutfah Rif’ati, MD

Sosialisasi Peta Jalan Penanggulangan Gangguan Penglihatan

di Indonesia Tahun 2017 – 2030 ................................................................................................ 765
Cut Putri Arianie, MD

25
Provincial Planning based on RAAB Result and District Model ........................................... 767
Implementation
Syumarti, MD

Metode LIHAT untuk skrining Gangguan Penglihatan Berat

oleh Kader Kesehatan ................................................................................................................ 769
Lutfah Rif’ati, MD

Key Informant as Front Liners ................................................................................................. 771

Nirawan Putranto, MD

Smartphone-based screening for visual impairment in Kenyan school

children: a cluster randomised controlled trial ....................................................................... 773
Marisa Kristianah

Komunikasi Kesehatan yang Efektif Dalam Advokasi Program

Oftalmologi Komunitas Effective Communication Dealing with
Advocacy in Ophthalmology Community ................................................................................ 783
Prof. Rizanda Machmud, MD

Elimination of Blindness in Indonesia (The Role of Advocacy in

Elimination of Blindness Programs) ......................................................................................... 793
Siti Farida Ismariatun Santyowibowo, MD

Roles of Health Economics in Advocacy ................................................................................... 799

Prof. Hasbullah Thabrany, MD

Ethic
Etika dan Protokol Pemberian Informasi Kepada Pasien Dengan Prognosis Buruk .......... 803
Dr. Siswanto, SpM., SpKL

Tata Laksana/Prosedur/Mekanisme Penyelesaian Kasus oleh DKEDK PERDAMI ......... 805

Soemardoko, MD

BANK MATA
Present Situation of Indonesian Eye Bank System .................................................................. 809
Tjahjono D. Gondhowiardjo, MD

26
Peran Keberadaan Bank Mata pada Pusat Pendidikan Dokter Spesialis Mata .................. 811
Prof. Suhardjo Pawiroranu, MD

Corneo-scleral Rim Excision Training and It‟s Preservation Requirements ........................ 817
Kukuh Prasetyo, MD

ARSAMI
Universal Health Coverage and Universal Eye Health In Eye Hospital Perspective ........... 827
Rastri Paramita, MD

Cost Effective Analysis and Utility in Eye Hospital: Health Technology

Assessment (HTA) ..................................................................................................................................831
Ir. Rakhmat Nugroho, MBAT

Certified Training Program for Eye Care Professionals ........................................................ 839

Achmad Soebagio Tancarino, MD

REFERENCES
1. Sirbamanian N. Reconstruction of eyelid defect.Indian
in conjunction with an adequate mucosal Journal of Plastic Surgery. 2011. 44(10: 5-13
lining posteriorly. A deep inverted triangle 2. Mustak H. In: Ocular Trauma: Principles and Practice,
must be excised below the defect to allow Kuhn F, Pieramici D. New York. Thieme, 2002. p.38-
52
adequate rotation of the flap. The side of the 3. Vichare N. Management of Lid Laceration. Ocular
triangle nearest the nose should be Trauma. DOS Times - Vol. 20, No. 8 February,
practically vertical. The advantage of this 2015;33-38
4. Sushil Kumar, Sima Das , Zia Chaudhuri, Vandana
procedure is that it is a one-stage, complete
Kohli. Basic Principles of Lid Repair and
lower lid reconstruction. Reconstruction. DOS Times September, 2006;3:210-
14.
5. Spinelli HM, Jelks GW. Periocular reconstruction:
A systematic approach. Plast Reconstr
CONCLUTION Surg. 1993;91:1017–24. [PubMed]
6. Christine C. Nelson Review of management of eyelid
Repairing of eyelid defect requires trauma. Australian and New Zealand Journal of
knowledge and meticulous approach. Gentle Ophthalmology 1991;4: 357-63.
tissue handling and proper alignment should 7. Carroll RP. Management of eyelid trauma. In: Hornblass
A, ed. Oculoplastic orbital, and reconstructive surgery.
be done. Aim should be to achieve best Baltimore: Williams & Wilkins, 1988;45:409-414.
possible functional and cosmetic outcome.
There are various techniques available for
reconstructions of defects of eyelids starting
from the spontaneous healing after excising
the lesion. While choosing a method, the
specific function of the area of the eyelid has
to be kept in mind. As eyes are the focal
point of the face, acceptable cosmesis in
reconstruction should be a major requisite.
27