Unilateral Primary Glaucoma

with Immature Senile Cataract

Suci Purnamasari
I11109023
Patients Identitiy
Name : Mrs. L
Gender : Female
Age : 72 y/o
Address : Jln. Tanjung Raya II Gg. H.
Ghani, Parit Mayor
Race : Bugis
Occupation : -
Religion : Moeslem

Anamnesis and physical examination was performed
on September 11
th
2014.


Patients History
Chief Complaint
Vision lost
Current Medical History
The patient report vision lost of the right eye since 2013. The vision
is gradually loss. Firstly, the patient see the black spot in her vision
that becomes bigger in size so that she can not see as wide as
usual. But she still can see the lights and can read the big size of
number one by one. Now, the patient report that the right eye is
totally blind, can not see even just a light. Red eye, pain of the eye,
vomiting, and headache is not reported.
The patient use the left for her vision. But, she also complaint that
the left eye is going under the vision problem since one month ago.
The vision becomes dim and makes the patient can not see well.
Red eye, pain of the eye, vomiting, and headache is also not
reported. With the function left, the patient still can do some activity
by herself, for example walking, bathing, cooking, washing
clothes,and take the medicine.

Patients History
Past Medical History
The patient never feel this problem before, the ophthalmic problem
that the patient have previously just like conjunctivitis with the
purulent discharge. The patient was diagnosed with immature
cataract on both of eye, she was under the ophthalmologist
observation to get some operation therapy for the left eye. The
ophthalmologist told her that operating the right one will not result in
good vision again. The ophthalmologic medicine that the patient
consume ar Lyters, Floxa, and Timol.
The systemic problem that the patient have is asthma and arthritis.
She routinely consume the medicine to heal her asthma and
gastritis, such as using salbutamol and antalgin. The patient deny
any history of diabetes mellitus, hypertension, and/or trauma to
either eye.

Patients History
Family Medical History
There is no other family member with similar symptom with the
patient. There is no glaucoma, cataract, and hypertension history in
her family. Her daughter was died due to diabetes mellitus.

Physical Examination
General condition : Good
Awareness : Compos mentis
Vital signs
o Blood pressure : 130/90 mmHg
o Heart rate : 88 times/menit
o Respiratory rate : 20 times/menit
o Temperature : 37,2
o
C

Ophthalmological Status
Visual acuicity:
OD : 0
OS : 6/60 +ph no improvement

External Examination


Ophthalmological Status
Ophthalmological Status
Palpation of Intraocular Preasure:
No significance difference

Visual field test
OD : Can not be performed
OS : Normal

Eyeball Movement

Resume
A 72 years old woman complain total blindness of OD with
gradually vision lost history since 2013. She also complain
dim vision of OS since one month ago. Red eye (-), pain (-),
vomiting (-), headache (-). History of the same complain (-),
asthma (+), arthritis (+), hypertension (-), diabetes (-), trauma
(-). No glaucoma, cataract, and hypertension history in her
family, diabetes history (+).

Visual acquity of OD=0, OS=6/60, anisochor pupil (4 mm/2
mm), direct light reflex (-/+), indirect light reflex (-/+), shadow
test (+/+).

Diagnosis
Working diagnosis
OD : Primary glaucoma with immature senile cataract
OS : Immature senile cataract

Differential diagnosis
OD : Secondary glaucoma et causa senile cataract
OS : -

Plan of Examination
Indirect funduscopy
Perimetry examination
Gonioscopy examination
Tonometry examination
Treatment
OD :
Timolol ophthalmic 0,5% 2x1

OS :
Surgical treatment for cataract by using ECCE
technique

Prognosis
OD :
Ad vitam : dubia ad malam
Ad functionam : dubia ad malam
Ad sanationam : dubia ad malam

OS :
Ad vitam : dubia ad bonam
Ad functionam : dubia ad bonam
Ad sanationam : dubia ad bonam

Discussion
Total blindness in the
right eye with the history
of gradually vision loss
since 2013, no redness
Cataract
Glaucoma
Retinopathy
The patient is a 72-
years old woman with
no history of
hypertension, diabetes,
leukemia or anemia
leading the diagnosis
to cataract or
glaucoma
Discussion
Ensure by External examination
Opacity in both of lens with positive shadow test immature
cataract not suitable visual acuity Exploration of
glaucoma and retinopathy.
Anisochor pupil, mid-dilate pupil in the right eye, diminish
pupil reflex pathognomonic sign for glaucoma confirm
by funduscopy cupping disc cdr 0,9 glaucoma
CLASIFIED!!
Discussion
Primary glaucoma
feseably open angle
gonioscopy
Secondary glaucoma
lens intumescence
(phacomorphic
cataract)
Discussion
Left eye funduscopy normal result visual problem may
due to immature senile cataract.
Performed surgery.
Glaucoma screening to detect the asymptomatic glaucoma.

Conclusion
A 72-years old woman complain the total blindness in the
right eye and dim vision in the left eye. Physical examination
reveal that there is anisochor pupil with mid-dilate pupil and
diminish pupil reflex in the right eye, the shadow test show
the positive result for both eye, visual acuity is 0 for the right
eye and 6/60 for the left eye, in funduscopy examination the
right eye shows the glaucomatous fundus. Working diagnose
for this patient is primary glaucoma with immature senile
cataract for the right eye and immature enile cataract for the
left eye. The therapy include -blocker agent to control
intraocular preasure and surgery to eliminate the cataract in
the left eye.