CHAPTER IV

DISCUSSION
A male, 58 years old came to the hospital with the major complaint are
blurred vision in the left and right eyes since 2 months ago. Patient also complaint
fotofhobia in both eyes and watery. Patient admited using eyedrops cendo xitrol to
ease his eye problem since a month ago. He has hypertension and allergic but
disclaimed about history diabetes mellitus, wearing eye glasses, history of another
eyes disease and other systemic disease. Smoking (+), alcohol use (-). Family
history with the same complaint was denied.
The subjective side from the patient are blurred vision in his left and right
eyes, has hypertension and using eyedrops cendo xitrol. Meanwhile, the objective
side from the clinical examination:
Visual acuity
Diameter Pupil
Reflex pupil
Fundus

OD
OS
1/300
6/25 ph 6/15
>3mm
3mm
+
Pale papil, Cup disk ratio Cupping (+), cup disk

TIO

difficult to eveluate
43,7 mmHg

ratio 0,4 - 0,5.

34,9 mmHG

Based on the major complaint of the patients, come differential diagnosis

are included, such as glaucoma, cataract and refraction error. After anamnesis and
clinical examination, cataract can be excluded because there is no complainment
about cloudy vision, clear lens, and negative result in shadow test. Refraction erro
also can excluded because in the refraction test using pin hole, there wasnt any
improvement of his visus. So we can suspect there is a organic disorder.
Glaucoma is included because there is elevated intraocular pressure
(>20mmHg) and increased cup disc ratio. Patient history using eyedrops xitrol
that contain of dexamethason 0,1 %, neomisin sulfat 3,5 mg/ml, polimiksin B
sulfat 6000IU. Patient also has history of hipertension. The diagnosis of patient is
primary open angle glaucoma. Angle closure glaucoma is excluded because the

patient disclaimed about the eye pain, nausea and vomiting, and the anterior
chamber is deep and clear that can see in Illumination of the anterior chamber.
Primary open-angle glaucoma (POAG) is a chronic progressive optic neuropathy
with characteristic morphological changes at the optic nerve head and retinal
nerve fiber layer in the absence of other ocular disease or congenital anomalies.
Primary open angle glaucoma begins in middle-aged and elderly patients with
minimal symptoms that progressively worsen.
Riwayat penggunaan obat tets mata cendo xitrol.
Kortikosteroid intraokular, periokular, dan topikal dapat menimbulkan sejenis
glaukoma yahg mirip dengan giaukoma sudut terbuka primer, terutama pada
individu dengan riwayat penyakit ini pada keluarganya, clan akan memperparah
peningkatan tekanan intraokular pada para pengidap glaukoma sudut terbuka
primer. (vaughan)
Increased IOP with use of corticosteroids. Usually takes 2 to 4 weeks after starting
topical steroids. The rate of decrease relates to the duration of use and the severity
of the pressure increase. The IOP increase is due to reduced outflow facility of the
pigmented trabecular meshwork, and when this is severe, the IOP may remain
increased for months after steroids are stopped. (the wills)