AKUT GLAUCOMA

1. Definition
Glaukoma  Neuropati optik terkait dengan penurunan fungsi visual & tekanan intraokular
elevation (IOP)  one of primary risk factor
2. Flow of Aqueous Humor
Ciliary body  produksi aqueos humor  mengalir ke anterior chamber  keluar ke trabecular
meshwork
3. Patophysiology
Cairan tidak dapat mengalir dgn baik melewati trabecular meshwork IOP meningkat 
kerusakan pada saraf optic  kehilangan penglihatan
4. Tipe :
Open angle glaucoma Close Angle glaucoma

Glaukoma akut  closed angle glaucoma, masalah di TM

Glaukoma kronis  Open angle glalukoma

5. Risk factor
a. Ras
b. Family history
c. Age
d. Refraction anomaly
e. History of ocular disease
f. History of systemic disease
6. Symptom
• Chronic glaucoma : • Acute glaucoma :
– Chronic – Acute
– Slowly progressive – Pain
– Insidious onset – Redness
– Painless – Blurred vision
– Asymptomatic until late in – Headache
the course of disease – Nausea
– Jadi tidak sakit tapi – Vomiting
berbahaya – Malaise
– Mendadak, dan nyeri
7. Ophthalmology examination
Pasien tidak bisa membuka mata, sakit luar
biasa, tanda akut glaucoma
• Decrease Visual acuity
• Anterior segment : cornea oedem, CVI
(+), PCVI (+), shallow anterior chamber,
midilatation pupil, decrease until negatif
pupil reflex
• High Intraocular pressure
• Abnormal Optic Nerve Head
• Visual field defect (pakai tes konfrontasi)
• Closed Angle
• Struktur Iris tidak tampak
• Conjunctiva bening
• Pupil tidak ada reflek cahaya

CVI : Conjungtiva Vascular Injection

PCVI : Peri Cornea Vascular Injection

Tekanan glaucoma sampai >50,

bahkan sampai 80, normal 21

Mata merah infeksi = Sekret, tidak

ada keluhan mual muntah dll.
8. Intraocular Pressure examination Beda dgn G.A
a. Digital
respon mata terhadap tekanan yang diberikan oleh ujung jari tangan pemeriksa.
- Indents easily – low IOP
- Firm to touch – normal IOP
- Hard to touch – high IOP
b. Schiotz tonometry
c. Non contact tonometry
d. Portable tonometry / Tonopen
e. Goldman applanation Tonometry
9. Optic nerve head examination
a. Direct funduscopy
b. Indirect funduscopy
c. Slit lamp biomicroscope (lens 81,90,78D)
d. Optical coherence tomography (OCT) / Pakai Laser
OCT Examination:
Structural measure of the Optic Nerve Head (ONH) & Retinal Nerve Fiber Layer (RNFL) :
- Impression of the disk
- Size & shape of the disc
- Evaluation of the neuroretinal rim
- Atrofi peripapillaris
- Abmalities Nerve fiber layer
- Vertical cup disc ratio & asimetry

Optic Nerve Head:

 Konfrontasi Tes

10. Visual Field

a. Konfrontation tes
 Menilai lapang pandang

b. Goldman perimetry
c. Automated perimetry (Humphrey/Optopol)
 Glaucoma Visual Field with 40% Visual Loss

11. Initial treatment

- timolol 0.5% ed 2x1 gtt
- acetazolamide tablet 2-3x500mg
- kalium tab 2-3 x 1
- pilocarpine 2% 4x1 gtt
- mannitol 1g / kg (i.v.)
- perifer iridectomy (PI) laser
Perifer Iridectomy
12. Perifer Iridectomy (PI)
Membuat saluran dari bilik mata belakang dan depan, sehingga iris bombe kambuhnya bisa
dicegah
- Do as soon as possible
- Ensure P.I. Patency
- Suppress inflammation with steroids
- Perform gonioscopy post P.I.

Perifer Iridectomy