Advisor:dr.AbdiKelanaPutra,Sp.

M
SendyPerdana
IreneMargaretha
DianaLilim
FilbertKurniawan

Presentedby:
(2011.061.008)
(2011.061.067)
(2011.061.068)
(2011.061.070)

Name
:Mr.JB
Sex
:Male
Age
:47yearsold
Ethnic
:Javanese
Religion
:Moslem
Occupation
:Fisherman
Education
:Elementary
Maritalstatus:Married
Address
:MuaraAngke

ChiefComplaint
The patient has red eye and blurred vision on
his left eye.

AdditionalComplaint
Patientfeelspainandburningonhislefteye.

Historyofpresentillness
12 days before admission, the patients left eye was
exposed by waste water.
2 days before admission, the patient has red eye and
blurred vision on his left eye, and he felt pain on his left
eye.

Past Ocular History

He denies any previous ocular history.
General Medical History
Familial Medical History
No previous history of the same complaints.

Generalcondition
Levelofconsciousness
Bloodpressure
Heartrate
Temperature

:well
:composmentis
:125/85mmHg
:90x/min
:37,4oC

OD

OS

Normal

Perioccular
appearance

Normal

Well

General condition

Unwell

Orthophoric
(-)
(-)

Eyeball position
Enophthalmus
Exophthalmus

Orthoporic
(-)
(-)

Eyeball movement
5/5

Visual acuity

Full, symmetric

Cilia

Full, symmetric

Well-positioned
Well-positioned

Margo Palpebra
Superior
Inferior

Well-positioned
Well-positioned

OD

OS

Normal
Normal

Tarsal Conjunctiva
Superior
Inferior

Normal

Bulbar Conjunctiva

Clear
(-)
(-)
(-)
(-)
(-)
(-)

Cornea
Clearness
Edema
Arcus Senilis
Infiltrate
Ulcer
Crust
Erosion

Cloudy: scar
(-)
(-)
(-)
(-)
(-)
(-)

Normal

Anterior Chamber
Depth

Normal

Normal
Nomal
Conjunctiva injection
Triangular
Encroachment

OD
Darkish brown
(+)

OS
Iris
Color
Crypt

Darkish Brown
(+)

(+)
(+)
(+)

Pupil
Position
Shape
Size
Light Reflex:
-Direct
-Indirect
Isochoric

Clear

Lens

Cloudy

(-)
(-)
(-)
(-)

Palpebra
Hyperemic
Edema
Tenderness
Nodule

(-)
(-)
(-)
(-)

Center
Round
3 mm

Center
Round
3 mm
(+)
(+)
(+)

47yearoldmalecamewithcomplaintonhislefteye
wasexposedbywastewater.He has red eye and
blurred vision on his left eye. He feelspainon
it.
Any previous ocular history is denied.
Eye examination :

conjunctival injection, hyperemic, triangular

encroachment on the left eye
Cloudy scarred cornea of the left eye

Fromtheslitlampexamination,wefoundtriangularon
hislefteye.

Pterygium

Pseudopterygium
Pinguecula

Slitlamp

Cendoxitrol
4timesaday1drop
Corticosteroid

Quoadvitam
Quoadfunctionam
Quoadsanationam
Quoadcosmeticam

:bonam
:dubiaetbonam
:dubiaetbonam
:dubiaetbonam

Pterygium

A pterygium is a fleshy, triangular

encroachment of a pinguecula onto the
cornea, usually on the nasal side bilaterally

1:2
> 40 years old
incidence in the upper latitudes &
relatively incidence in lower latitudes
elevated levels of ultraviolet light exposure
in the lower latitudes

Ultraviolet light
Drying and windy environments, sunny,
dusty, or sandy, windblown surroundings.

UV radiation can cause mutations in genes such

as the p53 tumor suppressor gene, resulting in
its abnormal expression in pterygial epithelium
A segment of limbal epithelium, the migrating
limbus, invades the cornea centripetally
followed by conjunctival epithelium
Vascularization occurs in the conjunctiva
adjacent to pterygia
Ocular hypoxia triggers this neovascularization
by recruiting EPCs [stimulated by (VEGF), stem
cell factor (SCF), and substance-P (SP)] derived
from the bone marrow via the production of
systemic and local cytokines

The pterygium cells invading over

Bowmans layer produce elevated MMP-1,
MMP-2, and MMP-9 expression, which
probably are the main MMPs responsible for
the dissolution of Bowmans layer
Pterygium cells may also cause activation of
fibroblasts at the head of the pterygium,
leading to the initial cleavage of fibrillar
collagen in Bowmans layer by the
production of MMP-1

1.

Anamnesis
Asymtomatic, and patients usually come with
complaints such as:

The eyes feel hot and itchy

The eyes feel watery and become red quickly
There was a lump on the eye thing
Decrease the visual acuity

Asking risk factors, such as workplace

environment, such as: exposure to sunlight often,
dusty/sandy/windy workplace environment

2. Status Ophtalmology
Eye Examination
Palpebra: redness, edema, and tenderness : (-)
Conjunctiva: pterygium tissue will look a
triangular shape that grew out from conjunctiva
bulby (usually at nasal regio), widened to the
cornea, and there are small capillaries at the
pterygium tissue.
Cornea: Clear, and on the edge of the cornea will
appear pterygium tissue (depending on the
degree of pterygium)
Iris: according to race, krypti (+)
Pupil: in the central location, spheris shape, direct
and indirect reflex (+),
If the pterygium tissue cover the pupil will
decrease the visual acuity
Lens: Clear

Visual Acuity Examination

Can be found astigmatism in the pterygiun
eye.
This is because of the cornea is attracted
by the growth pterygium.
Usually : "with the ruleAstigmatis or
irregular astigmatism (causing visual
impairment)
At advanced pterygium (grade 3 and 4),
may cover the pupil so the visual acuity
also decreased

3. Additional Examination

a.
b.
c.

d.

Examination of visual acuity: can be found Astigmatism

Examination with Slit Lamp: to see a whole field of the eye,
and can be used to determine the degree pterigium
The degree of pterygium : determined by the cornea covered
by the growth of pterygium, which can be divided into four :
Degree 1: If the pterygium is limited to the corneal limbus
Grade 2: If the pterygium had passed the corneal limbus but not
more than 2 mm
Grade 3: If pteryium already trough Grade 2 but not cover the
edge of pupils in normal light conditions (pupil normally about 3-4
mm)
Grade 4: If the pterygium is growing through the pupil and make
impairment of the vision.
Corneal Topography Examination: a computerized examination
to check the curvature of the cornea
Histopathological examination for pterygium: The epithelium
becomes irregular, there is a hyaline degeneration of the corneal
stroma, in Bowman's membrane is replaced by hyaline and
elastine tissue.

Conjungtival autograft
Surgical
Topical anti-tumor agent

Mitomycin C
(0.1 ml of 0.15 mg/ml) Injected subconjunctivally
IFN- -2b (Interferon agent)
1 Million units/mL 4 times a day as eye drops

Radiotherapy
Single dose after post operative within 24
hour (2500 to 3500 rads).
Chemotherapy
5 Fluorourasil

Reccurency rate
5.4% to 36.6% depending on exposure
Most of patient have good prognosis