Scenario 2

GROUP 5
Skenario
The 70-year-old man came to the emergency room with painful eye complaints. Painful pain -
throbbing in the right eye since 1 day ago taking medication does not subside. Pain is felt in the
right eye, around it until it feels on the right side of the head, red right eye, known since 1 day
together with pain, blobok (-), water (-), nausea vomiting (+), blurred (+) since it felt this hurt,
look like seeing Halo.
Information
1. Diabetes Mellitus (-) 8. Tod n + / palpation
2. Controlled Hipertension (+) takes Vos N / palpation
medication
9. Palette edema (-)
3. Never been sick like this before
10. PCVI Conjunctival Hyperemia
4. The history of using the glasses is far near
11. Cornea Edema
5. TD: 140/90 mmHg
12. BMD: Shallow
6. Head to toe: dBn
13. Iris: difficult to evaluate
7. VOD: 1/60
14. Pupils: difficult to evaluate
VOS: 5/60
15. View Field : difficult to evaluate
Keyword
1. Male 70 years old
2. Eye pain since 1 day ago
3. Painful right-sided throbbing radiates to the
right head
4. Red right eye with pain 1 day ago
5. Swelling (-), secretions (-)
6. Already needed medication but did not
subside
7. Have never been sick like this
8. Since eye pain blurs, it's like seeing Halo
9. History of hypertension, controlled taking
medication
10. The usage history of the glasses is far close
11. Nausea vomiting (+)
Questions
1. What is the Differential Diagnosis of the scenario?
2. Why does the patient look like Hello?
3. What is the initial management carried out in the case?
4. What is the relationship between hypertension and patient complaints?
5. What is the interpretation of the results of the examination?
Answer
1. Closed angle glaucoma, Keratitis, Ocular
hypertension, Red eye
2. High eyeball pressure which subsequently causes
damage to the eye nerve. Increased eye pressure can
be caused by accumulation of fluid that is present in
the eye. Symptoms that appear are severe headache,
eye pain, nausea and vomiting, blurred vision, halo
circles around the light and red eyes.
3. Providing treatment for precipitating factors
resulting in high pressure on the eyeball (IOP)
4. Hypertension directly affects the high pressure on
the eyeball (IOP) where higher blood pressure is
associated with increased perfusion in the optic nerve.
5. VOD 1/60: With a hand wave test, it can be stated
that the patient's vision is worse than 1/60. Normal
people can see movement or waving of a hand at a
distance of 1 meter, meaning that vision is 1/300.
VOS 5/60: If vision is 5/60 it means that it can only be
seen at a distance of 5 meters that normal people can
see at a distance of 60 meters.
PCVI Conjunctiva Hyperiperemia
Cornea Edema
BMD: Shallow
Mind Mapping
Learning Objective
1. Know & Explain DD from a scenario
2. Know & Explain Job Diagnosis from a scenario
3. Know & Explain the pathophysiology of the scenario
4. Know & Explain the Clinical Manifestations of the scenario
5. Know & Explain the etiopathogenesis and risk factors of the scenario
6. Know & Explain the management of the scenario
7. Know & Explain the complications and prognosis of the scenario
8. Know & Explain the Islamic view of the scenario
 LO 1 Differential Diagnosis
Red eyes without decrease in vision:
Konjungtivitis
Perdarahan subkonjungtiva
Pterigium

Red eyes with decrease in vision::

Glaucoma akut
Keratitis akut
Endoftalmus
Uveitis kornea
Ulkus kornea
Differential Diagnose
History & Physical Examination Acute primary closed angle glaucoma Acute Keratitis Bacterial

Eyes painful 1 day ago, spread to the

√ √
right side of the head

Hiperemia eyes √ √

Like seeing HALO √ √

Naussea and vomiting √

VOD 1/60; VOS 5/60 √ √

TD 140/90 (HT) +/- -

TOD n+/palpation + -

PCVI: konjungtiva hiperemi, kornea

√ √
edema

Shallow front chambers √ -

LO 2 Diagnosis
Acute glaucoma
It is an eye abnormality that occurs because intraococcal pressure (IOP) increases rapidly as a
result of the closure of the frontal eye angle (BMD) in total and sudden due to pupillary block due
to the primary condition of the eye with a small anterior.
Complaints:
- see the color of the rainbow around the light source (hello)
- nausea and vomiting
Clinical features:
- Superficial BMD
- conjunctival hyperemia
- Cornea edema
LO 3 Pathophysiology
Decreased vision in glaucoma occurs because of the apoptosis of
retinal ganglion cells which causes thinning of the nerve fiber layer and
core layer in the retina and reduced axons in the optic nerve. The optic
disc becomes atrophic with an enlarged optical cup. Nerve damage can
be affected by increased intraocular pressure. The higher the intraocular
pressure the greater the nerve damage to the eyeball
LO 4Clinical Manifestation
symptoms sign

• Occular pain • Conjunctival &

• Headeche circumcorneal congestion
• Blurred vision • Cornea : hazy
• Halos • Anterior chamber : shallow
• Nausea • Pupil : mid dilated, sluggish,
• Vomiting irregular
• Optic nerve head may be
swollen
• IOP : high
LO 5 Ethiopathogenesis and risk factors
LO 6 Therapy
ACUTE PRIMARY CLOSED-ANGLE GLAUCOMA THERAPY
1. First aid: Lower IOP 2. Next help: open the corner
a. Hyperosmotic: if IOP is very high a. Removing the pupillary block: Hyperosmotic
Glycerin: 1gr / kg BB in 50% solution The vitreous volume shrinks so that the lens is pulled
posteriorly and the pupillary block is released and then
Mannitol: 1- 1.5 gr / kg bb i.v aquosses from BMB to BMD, pressing the iris posteriorly
so that the angle is open
b. Reduce production of Akuos humor:
b. Make a hole in the peripheral iris: iridectomy
Accetazolamide 500 mg per oal
peripheral (IP) by:
Timolol 0.5% topical 2 dd
Laser: PI laser
1% topical brinzolamide 2dd
Surgery: IP surgery
Dorzolamide 2% topical 2dd
Brimonnidine 0.15% - 1.2% topical 2 dd
c. Press the inflammatory reaction
Topical steroids
LO 7 Complications and prognosis
When therapy is delayed, peripheral irises can attach to trabecular webbing (anterior
sinekia) resulting in irreversible front room corner occlusion
Prognosis is very dependent on early discovery and treatment. If you don't get the right
and fast treatment, blindness will occur in a very short time. Supervision and observation of the
part of the eye that does not get glaucoma is very necessary because it can give the same
condition as a glaucoma eye
 LO 8 Islamic View
The eye is one of the limbs that is very important for our lives. With our eyes we can
see the creation of Allah the Almighty, interact with the environment easily. Therefore, we
should be grateful for the blessings given by Allah SWT.
"He is the one who created you and made for you hearing, sight, and heart, (but) you are very
little grateful" (Surat al-Mulk [67]: 23).
It was narrated from the Imam Ahmad of the Musnad of Usamah bin Suraik, that the
Prophet said,
ُُ ‫ت اْألعْر‬
ُ ُ‫ فق‬، ‫اب‬
‫ال‬ ُِ ‫ وجاء‬، ُ‫للاُ عل ْي ُِه وسلَّم‬ ُ ‫ي ِ صلَّى‬ ُُ ‫ ُك‬: ُ‫ أنتداوى؟ فقال‬، ‫للا‬
ُ ‫نت ِع ْندُ النَّ ِب‬ ُِ ُ‫س ْول‬ ُِ ُ‫نع ُْم يا ِعباد‬
ُ ‫يا ر‬: ‫للا‬
ِ ‫إ َُِِإ د ِإاُ ًءالُِإ وضعُ ل ُهُ ِشفا ًُء غيْرُ داُ و‬،‫إَ َِ ِإ‬،. ‫قالُوا‬: ُ‫ما ُهو؟ قال‬: ‫ْالهر ُُم‬
ُ‫احد‬
"I was once beside the Messenger of Allah b. Then came a group of Arab hamlets. They
asked, "O Messenger of Allah, may we seek treatment?" He replied: "Yes, O servants of Allah,
seek treatment. Because God I did not put a disease but put the medicine, except for one
disease. "They asked:" What disease is it? "He replied:" Old disease. "(Narrated by Ahmad, Al-
Bukhari in Al-Adabul Mufrad, Abu Dawud , Ibn Majah, and At-Tirmidhi, he said that this hadith
hasan saheeh. Syaikhuna Muqbil bin Hadi Al-Wadi'i menhahahkan this hadith in his book Al-
Jami 'Ash-Shahih mimma Laisa fish Shahihain, 4/486)
 THANK YOU 
 People will also change from old age to old age and old age; namely from the age of 70
years to the end of the age set by Allah SWT, according to the division of Ibnul Jauzi. A human
being will still be called an old man, even though he reaches the age even further than that,
until he meets his death.
In this age stage, humans will usually be overwritten by weaknesses in all five senses
and limbs, so there are times when they are completely helpless or powerful again. Allah has
said:
"God who created you is weak, then made you strong after being weak, then made him
weak and old after being strong. God makes what He wants, while He is Knower and Ruling.
"(Q.S. 30:54)