CASE PRESENTATION

PTERYGIUM GRADE II OD
Yudo Prabowo
I 11110017

Introduction

Pterygium is a fibrovaskuler growth of

conjunctiva which is degenerative and
invasive.

Literature review

PTERYGIUM

Definition

Pterygium is a fibrovaskuler growth of

conjunctiva which is degenerative and
invasive.

Epidemiology
The 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.

Etiology

Etiology 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 Factor
Age
Ultraviolet exposure
Geographic
Gender
Hereditary
Microtrauma

Pathogenesis And
Pathophysiology

UV-B activate matrix

metalloproteinase (MMP)
digestion of extracellular matrix
colagen degeneration
inflammation process
fibrovaskuler growth.

Clinical Feature

presents 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 side
an asymptomatic condition in the early
stages.
Visual disturbances occur when it
encroaches the pupillary area.

Staging
11

Diagnosis

no symptoms
redness, swelling, itching, irritation, and blurring
of vision
Wing-like fibrovaskuler growth in eye
minimal proliferation and a relatively atrophic
appearance.
rapid growth and a significant elevated
fibrovascular component

Differential Diagnosis

pseudopterygium

Pterygium must be differentiated from

pseudopterygium.

Pinguecula
Pingueculae 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.

Complication
15

Visual impairment
Impaired eye movement
Dry eye

Treatment
16

Medical Care
artificial tears
topical corticosteroid
Surgical care

Prevention
17

Use hat
Protective glasses

Prognosis
18

The 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.

Case

Anamnesis

Identity

Name
:
Age
: years old
Sex
: Man
Address
:
Occupation : field work, contractor
(pekerja lapangan)

Patient was examined on June 23th ,

2015.

Chief Complaint

Flesh growing in the right eye

History of Disease

Patient 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

Disease

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

History of Family Disease

There are no one of his family have the

same complaint

History of Treatment

He said that, he never go to public

health before to cure his complaint

Examination

General Exmination

Conciousness
: Compos Mentis
Blood Pressure : 130/80 mmHg
Heart Rate
: 80 times/ minutes
Respiration Rate
: 20 times/ minutes
Temperature
: 36,5C

Ophtamology Examination

Visual acuity:
OD : 5/5
OS
: 5/5
Add +3.00

Ophtamology Examination2
Right eye

Left eye

Orthotropia

Eye ball position

Orthotropia

ptosis (-), lagoftalmos (-),

Palpebra

ptosis (-), lagoftalmos (-),

edema (-)
Redness(+),Triangular flesh

Conjungtiva

edema(-)
Normal, Redness (-)

(+)
Clear, edema (-)

Cornea

Clear, edema (-)

clear, deep

COA

clear, deep

Iris colour : brown

Iris and pupil

Iris colour : brown

Pupil: circular, 3mm, isokor,

Pupil: circular, 3mm, isokor,

reactive to light

reactive to light

Clear

Lens

Clear

Negative (-)

Shadow Test

Negative (-)

Ophtamology Examination3
OS

OD

+
+

Resume

Patient 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.

Resume2

Vital 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 Diagnosis

OD: Pterygium gr II
OS: -

Differential Diagnosis

Pseudopterygium
Pingueculae

Plan Examination

Slit lamp
Glucose blood examination

Treatment

Non medicamentous: using of protective

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

Prognosis

Right eye

Ad vitam
: bonam
Ad functionam : dubia ad bonam
Ad sanactionam : dubia ad bonam.

Discussion

Patient 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 tissue
the 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.

conclusion

The 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.