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