Case Presectation Immature Senile Cataract

Case PresentationPTERYGIUM GRADE II ODYudo Prabowo I 111100171IntroductionPterygium is a fibrovaskuler growth of conjunctiva which is degenerative and invasive.Literature review

PTERYGIUM

DefinitionPterygium is a fibrovaskuler growth of conjunctiva which is degenerative and invasive.

EpidemiologyThe prevalence rates of pterygium obtained for a number of populations vary widely, from 1.2% in urban, temperate white people to 23.4% in the black population of tropical Barbados.Research in Indonesia in Riau showed 17.0% prevalence of pterygium.

EtiologyEtiology of pterygium is not definitely known.But the disease is more common in people living in hot climates. Therefore, the most accepted view is that it is a response to prolonged effect of environmental factors such as exposure to sun (ultraviolet rays), dry heat, high wind and abundance of dust.Risk FactorAgeUltraviolet exposureGeographicGenderHereditaryMicrotrauma

Pathogenesis And PathophysiologyUV-B activate matrix metalloproteinase (MMP) digestion of extracellular matrix colagen degeneration inflammation process fibrovaskuler growth.

Clinical Featurepresents as a triangular fold of conjunctiva encroaching the cornea in the area of palpebral aperture.usually on the nasal side, but may also occur on the temporal sidean asymptomatic condition in the early stages.Visual disturbances occur when it encroaches the pupillary area.Staging

11Diagnosisno symptoms redness, swelling, itching, irritation, and blurring of visionWing-like fibrovaskuler growth in eyeminimal proliferation and a relatively atrophic appearance.rapid growth and a significant elevated fibrovascular component

Differential Diagnosis

pseudopterygiumPterygium must be differentiated from pseudopterygium.

PingueculaPingueculae are extremely common in adults. They appear as yellow nodules on both sides of the cornea (more commonly on the nasal side) in the area of the palpebral aperture.

ComplicationVisual impairmentImpaired eye movementDry eye15TreatmentMedical Careartificial tearstopical corticosteroidSurgical care

16PreventionUse hatProtective glasses17PrognosisThe visual and cosmetic prognosis following excision of pterygia is good. The procedures are well tolerated by patients, and, aside from some discomfort in the first few postoperative days, most patients are able to resume full activity within 48 hours of their surgery.18CaseAnamnesisIdentityName: Age: years oldSex: ManAddress: Occupation: field work, contractor (pekerja lapangan)Patient was examined on June 23th , 2015.Chief ComplaintFlesh growing in the right eye

History of DiseasePatient complained there is something like a meat growing in his right eye and he complain his right eyes become redness and sometimes itchy, watery and pain when exposed to wind.Patient had no complaint about eyes discharge. he claimed, there were no history of eye trauma and did not consume any drugs before. This complains have percieved since a year ago.History of Previous Disease and Occular DiseasePatient claims that there is no history of the same symptoms before.He said that he never have hypertension and diabetes mellitus. He also disclaim about another eyes disease, systemic disease and another disease because he never did a medical check upHistory of Family DiseaseThere are no one of his family have the same complaintHistory of TreatmentHe said that, he never go to public health before to cure his complaintExaminationGeneral ExminationConciousness: Compos MentisBlood Pressure: 130/80 mmHgHeart Rate: 80 times/ minutesRespiration Rate: 20 times/ minutesTemperature: 36,5C

Ophtamology ExaminationVisual acuity:OD : 5/5OS: 5/5Add +3.00Ophtamology Examination2Right eyeLeft eyeOrthotropiaEye ball positionOrthotropiaptosis (-), lagoftalmos (-), edema (-)Palpebra ptosis (-), lagoftalmos (-), edema(-)Redness(+),Triangular flesh (+)Conjungtiva Normal, Redness (-)Clear, edema (-)Cornea Clear, edema (-)clear, deepCOAclear, deepIris colour : brownPupil: circular, 3mm, isokor, reactive to lightIris and pupilIris colour : brownPupil: circular, 3mm, isokor, reactive to lightClear Lens Clear Negative (-)Shadow TestNegative (-) Ophtamology Examination3++++++++++++++++ODOS

ResumePatient complained there is something like a meat growing in his right eye and he complain his right eyes become redness and sometimes itchy, watery and pain when exposed to wind. This complains have percieved since a year ago. Patient had no complaint about eyes discharge. he claimed, there were no history of eye trauma and did not consume any drugs before. Patient claims that there is no history of the same symptoms before. He said that he never have hypertension and diabetes mellitus. He also disclaim about another eyes disease, systemic disease and another disease because he never did a medical check up. There are no one of his family have the same complaint.

Resume2Vital signs of the patient are in normal range. Visual acuity of right eye is 5/65 and visual acuity of left eye is 5/5. Conjunctiva of OD, redness (+), wing-like growth from nasal confined to the limbus. Conjunctiva of OS, redness (-).

Working DiagnosisOD: Pterygium gr IIOS: -Differential DiagnosisPseudopterygiumPingueculae

Plan ExaminationSlit lampGlucose blood examination

TreatmentNon medicamentous: using of protective glasses, wear hat.Medicamentous: artificial tear 1-2 gtt prn, naphazoline eyedrop 0,1% 2-4 x 1gtt.topical vasoconstrictor

PrognosisRight eyeAd vitam: bonamAd functionam: dubia ad bonamAd sanactionam: dubia ad bonam.

DiscussionPatient complained there is something like a meat growing in his right eye and he complain his right eyes become redness and sometimes itchy, watery and pain when exposed to wind, this complains have percieved since a year ago. Patient had no complaint about eyes discharge from both of eyes and he claimed, there were no history of eye trauma and did not consume any drugs before.There are no one of his family have the same complaint.Visual acuity is for 5/5 for OD and 5/5 for OS. From clinical assestment, There is triangular flesh in the right eye and redness in conjungtiva OD.

From resume above, the diagnosis for the right eye of patient was pterygium grade II based on the apparance of the growth in conjunctiva and grade II because Fibrovaskular tissue growth has been through limbus but not greater than 2 mm across the cornea.The flesh growing its because a matrix metalloproteinase (MMP) activation by ultraviolet light (UV) and subsequent MMP activity against interstitial tissuethe redness of the right eye its because the inflamation reaction from the pyteregium.Recomended therapy for this patient includes nonmedicamentous such as wearing protective glasses and hat to protect from ultraviolet light and dust. Medicamentous therapy for this patient is with artificial tear to lubricate the ocular surface and to fill in defects in the tear film and topical vasoconstrictor to reduce eye redness.Surgery is not indicated for OD since the pterygium is grade II.

conclusionThe diagnosis of this patient is pterygium grade II in his right eye. The therapy for the pterygium include wearing protective glasses and hat, artificial tear, topical vasoconstrictor and surgery but in this patient surgery is not indicated for OD since the pterygium is grade II.