GAWAT DARURAT MATA

GLAUKOMA

Basic examinations :
visual acuity : optotype, finger, hand movement,
light perception
tonometri : digital, Schiots, GAT
funduscopy
gonioscopy

ACUTE ANGLE CLOSURE

Primary
: Acute Primary Angle Closure ( APAC )
Secondary : another primary eye diseases

History :
- monocular pain
- Photophobia
- Red eye
- Blurred vision
- Rainbow-colored halos, starburst around lights
- Nausea and vomiting
- may report previous attack in same or opposing eye

 Finding in examinations :
Common
- High IOP( usually > 40 mmHg )
- Decreased visual acuity
- Red eye w/ cobgested blood vessels
- corneal edema ( claudiness )
- shallow anterior chamber
- Aqueous cell and flare on slit lamp
examination
- Mid-dilated, sluggish or non reactive
pupil, often irregularly shaped
Less common
- Dense cataract
- Peripheral anterior synechiae
- Disc hemorrhage
Uncommon
- Bilateral condition

 Examination outline :
Check visual acuity
Check reactivity of pupil with penlight
Slit lamp examination
Check for corneal edema
Check anterior chamber depth and look for presence
of aqueous cells and flare
Examine iris for mid-dilation, irregular shape and
bowing forward ( iris bomb)
Examine lens for cataract
Measuer IOP

 Treatment
Lower IOP :
goals : preparing the patient for surgical procedure
reduce IOP prevent further damage of N II
clear cornea, reduce infalamation
prevent formation of synechia
1. Acetazolamide 3x 250 500 mg ( 5-10 mg/kgBW )
make sure patient does not have a sulfa allergy,
blood discrasia, kidney disease )
2. Timolol ED 0.5% 2 x 1 gtt ( if no contraindication to -blocker )
3. Topical anti inflamation
- Control pain and nausea ( analgetic non caffein )
- Pilocarpine 1-2 % ( 4-6 x 1 gtt )

HYPHEMA AND TRAUMATIC GLAUCOMA

History :
blunt trauma
pain and photophobia in affected eye
Decreased vision
Findings on examination:
- Hyphema
- associated ocular trauma :
corneal abrasion,
iris sphincter tear, traumatic iritis

Less common
Increase IOP may be acute or late, secondary to obstruction
of the TM by red cells or direct damage to intraocular structures
Corneal blood staining, usually with large hyphemas, rebleeding
and elevated IOP

Associated ocular and orbital trauma :

Lens sub luxation
Corneal or scleral ruptur
Intra ocular foreign body
Vitreus hemorrhages
Retinal edem ( commotio retinae) or detachment
Orbital fracture

Examination outline :
check visual acuity
check reactivity of pupil with penlight
check ocular motility
Slit lamp examination
Check cornea and sclera for rupture
Examine anterior chamber for red blood cells and grade hyphema
Check iris margin for sphincter tear
Look for lens subluxation
Measure IOP

Grading of hyphema :
Grade I : mycrohyphema : circulating red blood cells in COA w/o layering
Grade II : Layering < 1/3 of anterior chamber
Grade III : Layering 1/3- og anterior chamber
Grade IV : eight-ball or total hyphema

 Treatment
- Remain upright and elevate head of bed 45o
the blood settle inferiorly
- Limit activity to decrease incidence of rebleeding
( usually within 3-7 days )
- Decrease IOP medicamentous
- Topical steroid ( if there is no abration of corneal epithelial )

PHACOLYTIC GLAUCOMA
History :
- monocular pain
- red eye
- Blurred vision
- Haloes around lights
Finding on examination :
- Markedly decreased visual acuity
- Injection of conjunctiva
- Corneal edema
- Granulomatous keratic precipitates ( KP ): fluffy brown or white
deposits on the endothelial surface of cornea
- flare in COA
- mature/ hypermature cataract
- elevated IOP

 Examination outline :
check visual acuity
Check reactivity of pupil
Slit lamp examination : examine conjunctiva for injection,
corneal edema, flare, lens
check IOP