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CHAPTER IV
DISCUSSION
A woman, 55 years old, came to ophthalmologist with the complain pain in
the left eye and headache since 6 months ago, with a little bit decreased vision
with cloudy. Since 4 months ago, pain in her eye and head are become worse,
with the decreased vision is also become blurred. Patient have felt the pain in the
eye ball and around the eye. About a week ago, pain in her left eye and head are
become worse than before, with watery eye and a poignant sensation in her nose.
On 20 January 2014, she come to an ophthalmologist, and diagnosed as Acute
Congestive Glaukoma and treated with oral acetazolamide and potassium
chloride, eye drops latanoprost, timolol, pilocarpine and polydex. Patient will
schedule for surgery. On 27 January 2014, patient come for control, the complain
has been reduced. Patient complains coughing since 3 days ago.
Visual acuity is 6/15 for OD, 6/60 for OS. There is no complain with the right
eye. For the left eye, the cornea is clear; camera oculi anterior seems shallow to
moderate; and there is posterior synechiae; the pupil is dilate, irreguler, and have
(-) reflex; the lens seems cloudy. Intraocular presure for OD 21 mmHg, for OS 16
mmHg. Cup disk ratio for OD 0,6 and OS 0,8. Shadow test for left eye is positive.
Confrontation test for the right eye is normal, and for the left eye, there is visual
defect 45 temporal.
Differential diagnosis for normal eye with gradually vision loss, there is
cataract, glaucoma and retinopathy. Because of the patient doesnt have history
about systemic disease especially diabetes mellitus and hypertension, we can
eliminate the retinopathy. According to the patient complain, there are severe pain
in the left eye and head, and the eye also watery, with decreased vision. But it also
cloudy vision in the left eye. From the examination, there is cloudy lens and
positive result for shadow test, so we can conclude in the left eyes there is
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immature cataract. But cataract doesnt give symptom like patient complain. We
have to suspicious that the patient have acute congestive glaucoma.
There is 3 sign in glaucoma, there are increased IOP, decreased of the visual
field, and papil atrofi. And there is also 3 sign in acute congestive glaucoma, there
are unilateral hyperemia, non reaktif midriasis pupil, and if we do the tonometri
digitalis, the eye ball will felt hard like stone.
Acute angle closure is characterized by sudden onset of visual loss
accompanied by excruciating pain, halos, and nausea and vomiting. Other
findings include markedly increased intraocular pressure, a shallow anterior
chamber, a steamy cornea, a fixed, moderately dilated pupil, and ciliary injection.
It is important to perform gonioscopy on the fellow eye to confirm the anatomic
predisposition to primary acute angle closure. Acute angle closure is an
ophthalmic emergency!
Treatment is initially directed at reducing the intraocular pressure. Intravenous
and oral acetazolamidealong with topical agents, such as beta-blockers and
apraclonidine, and, if necessary, hyperosmotic agentswill usually reduce the
intraocular pressure.
Cataract can cause glaucoma because changing of the lens. In physiological
process the lens will reduce the flexible curve, however the lens may take up
considerable fluid during cataractous change, increasing markedly in size. It may
then encroach upon the anterior chamber, producing both pupillary block and
angle crowding and resulting in acute angle closure. Treatment consists of lens
extraction once the intraocular pressure has been controlled medically. The lens
may take up considerable fluid during cataractous change, increasing markedly in
size. It may then encroach upon the anterior chamber, producing both pupillary
block and angle crowding and resulting in acute angle closure. Treatment consists
of lens extraction once the intraocular pressure has been controlled medically.
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CHAPTER V
CONCLUSION

The diagnosis of this patient is Post Acute Congestive Glaucoma with
Immature Cataract for the left eye. The therapy for OS is doing the treatment of
glaucoma and surgery for the iridektomi.