Secondary Open Angle

Glaucoma :
Posner Scholsmann Syndrome

STEROID INDUCE

DEASY MENDALA
 Case 1 : RDJ, Male 50 yo
Cc: Pain in the left eye, radiating to the back of the head.
History :
Patient came to ER on 25/02/23 because pain in his both eyes, and
getting worse in the left eye since 1 day BATH. The pain scale is 8/10 and
radiated to the back of the head. Complaints accompanied by nausea
and vomiting. Patient vomited 8-10 times since dawn. He also complaint
of redness on both eyes, watery eyes+, and blurry vision+ which has
been felt for a long time and getting worse each day. He had this kind of
problem 8 months ago, but after take some medication he got better.
From the past MR (29/07/22) he’s been dx as acute glaucoma with open
angle and have medication Steroid ed 6x1 LE, Timol ed 2x1 LE.
Asetazolamide 3x1 p.o, Potassium 1x1 p.o, Nadic 2x50 mg, MP 3x8 p.o,
Antasida 3x1 p.o. Therapy was not continued because the patient
already felt much better and there’s no complaints.
He didn’t have history of DM,HT, but suffered from gastritis more than 5 years ago
 Exam report 29/7/22
UCVA RE: 6/24
UCVA LE : 6/38
IOP RE: 16 mmHg
IOP LE : 49 mmHg
Anterior Segmen RE : within normal limit
Anterior Segmen LE:
Oedema eyelid+, CVI+, PCVI+, Oedema cornea+,
cell flare on BMD+, round 2-3 mm pupil, clear lens.
 25/02/23
VITAL SIGN no abnormality , VAS : 8/10

OPHTALMOLOGY FINDING
UCVA OD: 6/24 UCVA OS: 6/24
IOP OD: 28 IOP OS: 64
ANTERIOR SEGMENT (ODS)
Conjungtiva: CVI+, PCVI+
Cornea: Oedema
BMD: Cell+1, Fl+2
Iris: Regular+
Pupil: Round, Mid-Dilatation, Pupil Reflex +
Lens: Clear
Treatment : -Patient hospitalized , MP ed 6x1 OU , Timol 0,5% 2x1 OU,
Brimonidine + Brinzolamide ed 3x1 OU
-Asetazolamide 3x1, Potassium 1x1
-Nadic 2x50 mg
-Antacida 3x1 ac
-Ondancentron 3x8mg IV (if needed)
 ASSESSMENT
• RLE SECONDARY OPEN ANGLE GLAUCOMA
Susp. Posner-Schlossman Syndrome
 FOLLOW UP Ophthalmology Diagnose Management
Findings
25/02/23 Pain in both eyes UCVA RE: 6/24 ODS Posner Treatment : -Patient
since 1 day ago, UCVA LE: 6/24 scholsmann hospitalized , MP ed
radiated to back IOP OD: 32 mmHg Syndrome 6x1 OU , Timol 0,5%
of the head. IOP OS: 45 mmHg -- Iridocyclitic 2x1 OU, Brimonidine
+ Brinzolamide ed
Anterior Segment ODS crisis 3x1 OU
CVI+, PCVI +, Oedema -Asetazolamide 3x1,
Cornea, AC cell +1, fl+1 Potassium 1x1
-Nadic 2x50 mg
26/03/23 Both eyes getting UCVA RE: 6/24 -Antacida 3x1 ac
better than UCVA LE: 6/15f -Ondancentron
before. The vision IOP RE: 12mmHg 3x8mg IV (if needed)
is clearer. IOP LE: 27 mmHg
CVI+, PCVI+, Oedema - OCT
cornea ceased out, AC - Laboratory test
cell +1, Pupils mid- (full blood test, BT,
dilated on tropin. CT, BS, BUN, SC )
Posterior Segment
ODS Vitreous:
Floaters+ susp
koagulum.
 4TH MARCH 2023
Complaint Physical Findings Ophthalmology Findings Diagnose Management
04/03/23 Getting better UCVA RE: 6/38 RLE Posner -Th continue
But sometime still UCVA LE: 6/12f scholsmann -Consult with
felt pain on both TIO RE: 12mmHg Syndrome Internist to find the
eyes, especially LE TIO LE : 27 mmHg -- Iridocyclitic causes of
History of sudden CVI+, PCVI+, Oedema leukocytosis/ high
pain on his eye 1 cornea ceased out, AC crisis neutrophile
day ago after he cell +1, Pupils mid-
ate spicy food. The dilated on tropin
pain felt better Posterior Segment ODS
after using Vitreous: Floaters+ susp
medication coagulum.
ONH distinct border,
slightly hyperemi
RE,CDR 0,3-04
 Case 2 : Idcmv, male, 33 yo
• Patient came to Ophthalmologist with
complaints of pain on the both eyes, dominant
on the right side, since 1 day BATH, redness, and
blurry vision on the both eyes. He also felt
nausea and vomited since morning.
• He had cough, cold, and hard to breathe since 5
days ago and took some medication such
dexamethasone 0,5mg, salbutamol, cefadroxil,
and paracetamol. History of Asma bronchiale
• Vital sign & St. General within normal limits.
 January 7th, 2023
ANAMNESIS Ophthalmology Findings Diagnose Management
January 7th, 2023 IOP OD: 72 mmhg ODS Acute Asetazolamide 1x500mg
IOP OS: 84 mmhg Glaucoma Glycerin aa 50 ml and
observed 30 minutes.
After take Asetazolamide
1x500 mg, Glycerine Consult to
IOP OD: 23 mmhg Ophthalmologist at
IOP OS: 25 mmhg Glaucoma Division (today)
Applanation
IOP OD 45 mmhg
IOP OS 44 mmhg

January 7th, 2023 Anterior Segment OD: ODS Acute Angle

Conjunctiva: CVI, PCVI, Closure
Corneal: Oedema, COA: Van- Glaucoma Susp.
Herick 2, Iris: regular, Pupil: Drug Induced
Mid-dilatation 4-5mm, Lens:
Clear, Intumesence
 Ophthalmology Findings Diagnose Management

He felt better but ODS Funduscopy: CDR 0,3 ODS Acute Angle Stop taking
January there’s still ODS Gonioscopy: ODS SL+ at Closure Glaucoma Dexamethasone
9th, 2023 redness on the every quadrants. Susp. Drug Tonor 0,5% ED 2x1
right eye. Felt UCVA OD: 6/9,5 Induced OU
pain if he UCVA OS: 6/9.5f Hyperosmotic
touched the BCVA ODS: Add +0.75 6/6, agent ED 4x1 OU
eyes. PD 67/65 Carpin 2% ED 3x1
NCT ODS 11.3 OU
Sodium diclofenac
Anterior Segment OD: ed 4x1 OU
Conjunctiva: CVI, PCVI,
Corneal: Oedema, COA: Van- Asetazolamide
Herick 2, Iris: regular, Pupil: 3x250mg p.o
Mid-dilatation 4-5mm, Lens: Potassium1x600mg
Clear, Intumessen.
Anterior Segment OS:
Conjunctiva: CVI, PCVI, If the IOP is still
Corneal: Oedema, COA: Van- high, planning:
Herick 2, Iris: regular, Pupil: Trabeculectomy + 5
round, 3 mm, Lens: Clear FU under local
January anasthesia.
11th,
2023
 Ophthalmology Findings Diagnose Management

He felt better UCVA OD: 6/6f ODS Acute Angle Stop taking
January UCVA OS: 6/6 Closure Glaucoma Dexamethasone
16th, NCT OD 15.7, OS 15.3 Susp. Drug Tonor 0,5% ED 2x1
2023 Induced OU
Anterior Segment OD: Carpin 2% ED 3x1
Conjunctiva: CVI, PCVI, OU
Corneal: clear, COA: Van- Sodium diclofenac
Herick 2, Iris: regular, Pupil: ed 4x1 OU
Mid-dilatation 4-5mm, Lens:
Clear, Intumessen. Asetazolamide
Anterior Segment OS: 3x250mg p.o
Conjunctiva: CVI, PCVI, Potassium1x600mg
Corneal: Oedema, COA: Van- IF the IOP is still
Herick 2, Iris: regular, Pupil: high, planning:
round, 3 mm, Lens: Clear Trabeculectomy + 5
ODS Funduscopy: CDR 0,3 FU under local
distinct border anasthesia.

January
23th,
 Ophthalmology Findings Diagnose Management

He felt better UCVA OD: 6/6f ODS Acute Angle Stop taking
Feb 16 ,
th
sometimes blurry UCVA OS: 6/6 Closure Glaucoma Dexamethasone
20 vision on the NCT OD 15.7, OS 15.3 Susp. Drug Betaxolol 0,5% ED
right eye, Induced 2x1 OU
And he felt itchy Brinzolamide 3x1
and any spots on ODS
the both eyes. Sodium diclofenac
ed 4x1 OU
Interhistin 1x1

planning:
Trabeculectomy + 5
FU under local
anasthesia.