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66533251 Presentasi Kasus Glaukoma Akut

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Adivsor: dr. Abdi Kelana, Sp.M Presenter: Erliana Fani 2009061258 Monika Teresa P 2009061260 Hendrawan A 2009061264 Ricky Fernando 2009061266 Gerry Wonggo 2009061272 Ido Genesio 2009061273

Patient Identity: Tn. S y Sex : Male y Age : 53 years old y Ethnic : Javanese y Religion : Moslem y Occupation : Labour y Address : Angke Indahy Name

History takingy Chief complaint y Sudden blurry vision since 1 days before admission y Additional complaint: y Pain, watery and redness on his right eye since 1 days before admission y Headache since 1 day before admission.

History of present illness:y 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.

y Past occular history : y History of using eye-glasses was denied. y History of past illneses

Hypertension since 5 years ago, controlled with medication (captopril) He denied the following diseases:diabetes mellitus asthma allergy - Heart disease previous surgical operation

y Familial medical history y no previous history ofy y y

similar complaint systemic disease malignancy

General Statusy General condition

: look sick y Level of consciousness : fully awake y Blood pressure : 100/60 mmHg y Heart rate : 60 x/ minute y Respiratory rate : 20 x/ minute y Temperature : 36,8oC

Ophtalmic statusRight eye Periocular appearence General condition Eyeball positionEyeball movement

Left eye Normal Normal OrthophoricCan move to 8 directions

Normal Redness OrthophoricCan move to 8 directions

Visual acquity Supercilia Light Projection Cilia

1/300 Full symmetric Well from 8 directions Normal

5/5 Full symmetric Well from 8 directions Normal

Palpebra

Hyperemic edema + tenderness nodule Well-positioned

Hyperemic edema tenderness nodule Well-positioned

Sup/Inf Margo Palpebra

Sup/Inf Tarsal Conjunctiva

Hyperemic +

Hyperemic -

Bulbar conjunctiva

Injection conjunctiva +, mucoid discharge -

Injection conjunctiva -, mucoid discharge -

Cornea - Clearness - Edema - Infiltrate - Ulcer -

Clear + -

Clear -

Anterior Chamber

Mild depth Clear

Normal depth Clear

Iris

Darkish brown Crypt (-)

Darkish brown Crypt (+)

Pupil

Lens

Center Round 4mm Light reflex (-)/(-) Isochoric Clear

Center Round 2mm Light reflex (+)/(+) Isochoric Clear

Tonometry Schiotz

69,3mmHg

37,2mmHg

Summaryy 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 y Ophthalmic status of right eye:General Condition : Red and swelling

Visual acquity Palpebra

: 1/300 : Edema +

Superior/Inferior Tarsal Conjunctiva : Hyperemic + Bulbar Conjunctiva : Injection conjunctiva + Cornea : Edema + Anterior Chamber : Mild depth Iris : Crypt Pupil : Mid dilatasi Tonometry schiotz : 69,3 mmHgy Ophthalmic status of left eye: Tonometry schiotz : 37,2 mmHg

Clinical diagnosis OD Acute Glaucoma OS Primary Closed Angle Glaucoma Chronis Differential Diagnosis OD Angle Closure Glaucoma OS Primary Open Angle Glaucoma

Treatment y Topical :y Pilocarpine 2% ED OD 1 drop/5 minutes ( for the first 1 hour),

every hour ( for the first day) y Timolol Hemihydrate 0,5% ODS 2x1 drops

y Oral :y Asetazolamide 3x250 mg y Kalium L-Aspartat 1x1 y Asam Mefenamat 2 x500mg prn

Surgery : Laser iridotomy/peripheral iridectomy

Suggested examination Funduscopy Visual field test Gonioscopy Pachymetry Optic nerve imaging Complications Complete 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 malam Quo ad sanationam : dubia ad malam

Definitiony Glaucoma is an abnormal condition of high pressure within an eye. y 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). y 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. y Chronic develops slowly and is an inherited disease

Causes and Incidencey The aetiology of primary glaucoma is unknown y Predisposing factors include y Heredity y Hyperopia y vasomotor instability. y 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. y Blacks and those with a family history are most susceptible. y Ninety percent of primary glaucoma cases are the open-angle type, which occurs most often after age 65

Pathophysiologyy Increased intraocular pressure (IOP) is related to an y imbalance in the production, y Inflow Inflow occurs through the pupil y outflow of aqueous humour through the meshwork at the juncture of the iris and cornea y In secondary glaucoma the meshwork becomes clogged by blood, fibrin, or inflammatory cells produced by an underlying ocular disorder

Symptomsy Open-angle glaucoma y Often asymptomatic y frequent changes in prescription for glasses y mild headaches y vague visual disturbances y halos around lights y difficulty adjusting to darkness y Closed-angle glaucoma y Severe pain in and around eye y tearing; y coloured rainbow halos around lights y recurring episodes of blurring and impaired vision y mild dilation of pupils y hazy cornea y possible nausea and vomiting

Diagnostic Testsy y y y

y y

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 Complicationsy progressively diminishing vision y degeneration of the optic nerve y blindness

Treatmentsa) Medicines eyedrops or pills y lower eye pressure y cause the eye to make less fluid. y Glaucoma medicines need to be taken regularly b) Laser trabeculoplasty y Laser trabeculoplasty helps fluid drain out of the eye makes several evenly spaced burns that stretch the drainage holes in the meshwork c) Conventional surgery y Conventional surgery makes a new opening for the fluid to leave the eye. y Conventional surgery often is done after medicines and laser surgery have failed to control pressure. y 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. y side effects cataract, problems with the cornea, inflammation, infection inside the eye, or low eye pressure problems

Preventionsy Regularly visit their ophthalmologist at the y following intervals: y y y y

Age 20-29 years: At least once 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 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