Post on 16-Oct-2014
Adivsor: dr. Abdi Kelana, Sp.MPresenter: Erliana Fani 2009061258 Monika Teresa P 2009061260
Hendrawan A 2009061264Ricky Fernando 2009061266Gerry Wonggo 2009061272Ido Genesio 2009061273
Patient IdentityName : Tn. SSex : MaleAge : 53 years oldEthnic : JavaneseReligion : Moslem Occupation : LabourAddress : Angke Indah
History takingChief complaint
Sudden blurry vision since 1 days before admission
Additional complaint: Pain, watery and redness on his right eye since
1 days before admissionHeadache since 1 day before admission.
History of present illness:Since 1 day before admission, when patient
was about to sleep, he felt a sudden blurry vision, pain, watery and redness. The blurry vision was lose his peripheral (side) vision. Patient felt throbbing headache especially around the right eye. History of trauma was denied. Usage of topical eye drops was denied. Halo around lights was denied. Nausea and vomiting was denied. Fever was denied.
Past occular history :History of using eye-glasses was denied.
History of past illnesesHypertension since 5 years ago, controlled with medication (captopril)He denied the following diseases:
Familial medical historyno previous history of
similar complaint systemic disease malignancy
‐diabetes mellitus
‐allergy - Heart disease
‐asthma ‐previous surgical operation
General StatusGeneral condition : look sick Level of consciousness : fully awakeBlood pressure : 100/60 mmHgHeart rate : 60 x/ minuteRespiratory rate : 20 x/ minuteTemperature : 36,8oC
Ophtalmic statusRight eye Left eye
Periocular appearence Normal Normal
General condition Redness Normal
Eyeball position Orthophoric Orthophoric
Eyeball movement Can move to 8 directions Can move to 8 directions
Visual acquity 1/300 5/5
Supercilia Full symmetric Full symmetric
Light Projection Well from 8 directions Well from 8 directions
Cilia Normal Normal
Palpebra Hyperemic -edema +
tenderness -nodule -
Hyperemic -edema -
tenderness -nodule -
Sup/Inf Margo Palpebra Well-positioned Well-positioned
Sup/Inf Tarsal Conjunctiva Hyperemic + Hyperemic -
Bulbar conjunctiva Injection conjunctiva +, mucoid discharge -
Injection conjunctiva -, mucoid discharge -
Cornea-Clearness-Edema-Infiltrate-Ulcer-Crust-Destruction-Sikatriks
Clear+-----
Clear------
Anterior Chamber Mild depth Clear
Normal depthClear
Iris Darkish brownCrypt (-)
Darkish brownCrypt (+)
Pupil CenterRound 4mm
Light reflex (-)/(-)Isochoric -
CenterRound 2mm
Light reflex (+)/(+)Isochoric -
Lens Clear Clear
Tonometry Schiotz 69,3mmHg 37,2mmHg
Summary 53 y.o. male, having blurry vision on his right eye, Pain, watery
and redness on his right eye for 1 day, headache since 1 day Ophthalmic status of right eye:
General Condition : Red and swelling Visual acquity : 1/300Palpebra : Edema +
Superior/Inferior Tarsal Conjunctiva : Hyperemic +Bulbar Conjunctiva : Injection conjunctiva +Cornea : Edema +Anterior Chamber : Mild depthIris : Crypt –Pupil : Mid dilatasi Tonometry schiotz : 69,3 mmHg
Ophthalmic status of left eye:Tonometry schiotz : 37,2 mmHg
Clinical diagnosisOD Acute GlaucomaOS Primary Closed Angle Glaucoma Chronis
Differential Diagnosis
OD Angle Closure GlaucomaOS Primary Open Angle Glaucoma
TreatmentTopical :
Pilocarpine 2% ED OD 1 drop/5 minutes ( for the first 1 hour), every hour ( for the first day)
Timolol Hemihydrate 0,5% ODS 2x1 dropsOral :
Asetazolamide 3x250 mg Kalium L-Aspartat 1x1 Asam Mefenamat 2 x500mg prn
Surgery : Laser iridotomy/peripheral iridectomy
Suggested examinationFunduscopyVisual field testGonioscopy PachymetryOptic nerve imaging
ComplicationsComplete and permanent blindness
Prevention Regularly visit opthalmologist every 6 months – 1 year, aviodance ingesting large quantites of fluid
Prognosis Quo ad vitam : bonam Quo ad functionam : dubia ad malamQuo ad sanationam : dubia ad malam
DefinitionGlaucoma is an abnormal condition of high
pressure within an eye. Caused by a blocking of the normal flow of the
watery fluid in the space between the cornea and lens of the eye (aqueous humour).
Acute pupil in an eye with a narrow angle between the iris and cornea opens too wide and causes the folded iris to block the flow of aqueous humour.
Chronic develops slowly and is an inherited disease
Causes and Incidence The aetiology of primary glaucoma is unknownPredisposing factors include
HeredityHyperopiavasomotor instability.
1.5% to 2% of Europeans over 40 years of age have glaucoma, and more than 12% of newly diagnosed cases of blindness are attributable to glaucoma.
Blacks and those with a family history are most susceptible.
Ninety percent of primary glaucoma cases are the open-angle type, which occurs most often after age 65
PathophysiologyIncreased intraocular pressure (IOP) is related to
an imbalance in the production, Inflow Inflow occurs through the pupil outflow of aqueous humour through the
meshwork at the juncture of the iris and cornea
In secondary glaucoma the meshwork becomes clogged by blood, fibrin, or inflammatory cells produced by an underlying ocular disorder
SymptomsOpen-angle glaucoma –
Often asymptomatic frequent changes in prescription for glasses mild headaches vague visual disturbances halos around lights difficulty adjusting to darkness
Closed-angle glaucoma Severe pain in and around eye tearing; coloured rainbow halos around lights recurring episodes of blurring and impaired vision mild dilation of pupils hazy cornea possible nausea and vomiting
Diagnostic Tests Tonometry - To measure elevation in Intra-Ocular
Pressure (IOP). Visual field studies - To detect impairment in central and
peripheral visual fields Gonioscopy - To detect cellular debris or adhesions and
differentiate open-angle from closed-angle type. Pachymetry is the measurement of the thickness of your
cornea uses an ultrasonic wave instrument to measure the thickness of your cornea.
Visual acuity test. This eye chart test measures how well you see at various distances.
Ophthalmoscopy - To visualise optic nerve.
Potential Complicationsprogressively diminishing visiondegeneration of the optic nerveblindness
Treatmentsa) Medicineseyedrops or pills
lower eye pressure cause the eye to make less fluid. Glaucoma medicines need to be taken regularly
b) Laser trabeculoplasty Laser trabeculoplasty helps fluid drain out of the eye makes several
evenly spaced burns that stretch the drainage holes in the meshworkc) Conventional surgery Conventional surgery makes a new opening for the fluid to leave the eye. Conventional surgery often is done after medicines and laser surgery
have failed to control pressure. trabeculectomy, is performed in an operating room. A small piece of
tissue is removed to create a new channel for the fluid to drain from the eye.
side effects cataract, problems with the cornea, inflammation, infection inside the eye, or low eye pressure problems
PreventionsRegularly visit their ophthalmologist at the following intervals:
Age 20-29 years: At least once during this period.Those with risk factors for glaucoma (people of African
descent or those whohave a family history of glaucoma) should be seen every 3-5
years.Age 30-39 years: At least twice during this period.
Those with risk factors for glaucoma (people of African descent or those who
have a family history of glaucoma) should be seen every 2-4 years.Age 40-64 years: Every 2-4 years.Age 65 years or older: Every 1-2 years. 3