Test Hirschberg

Test Hirschberg inspection purposes

are:
This check is performed to identify any irregularities
eyeball position by observing the position of the light
reflex on the cornea.
Determine the amount of heterotropia quantitatively,
taking into account the position of the light reflex on the
cornea.

 Basic Examination Test Hirschberg is:

People Orthophoria the corneal light reflex is in the middle of the pupil or rather to
the nasal bit.
In exotropia, corneal light reflex position located at the nasal cornea, exotropia is
expressed by the initials = XT
In esotropia, corneal light reflex position located at the temporal cornea, esotropia is
expressed by the initials = ET
In Hypertropia, corneal light reflex position located at the bottom of the cornea. This
need is expressed in the eye which Hypertropia. Suppose that Hypertropia RIGHT eye
then we give the initials = RIGHT HYPERTROPIA, which is often written: R / L
In Hypotropia, corneal light reflex position located at the top of the cornea. This need
is expressed in the eye which Hypotropia. Suppose that Hypertropia RIGHT eye then we
give the initials = RIGHT HYPOTROPIA, which is often written: L / R
The shift of the center of the pupil light reflexes of 1 mm, equivalent to the deviation:
7 degrees.

Means / tools:

Techniques / Procedures
Examination:

Point / Lamps for fixation

Distance inspection:

Far: 20 Feet (6 meters)

Close: 14 Inch (35 cm)

Ask the patient to always pay attention to the point / lamp

fixation

Examiner put himself in front of the patient in such a way, so

as to properly assess the position of the light reflex on the
cornea of the patient.

Attention ditijukan examiner in the eye that the irregularities

poisi eyeball.

Value light reflex position on the cornea of the eye that

deviates / deviate.

Glaucoma ACUTE
DEFINITIONS
Glaucoma is an eye disorder characterized by increased
pressure within the eyeball (Intra Ocular Pressure = IOP)
that accompanied the downsizing concave optic disc
and visual field. High eye pressure will also result in
damage to the optic nerve which is located inside the
eyeball, and there will be disturbances of visual field.
Acute glaucoma is glaucoma that occurs suddenly with
blockage of the flow of humor akueus more complete.
Other names are of primary angle-closure glaucoma.

Epidemiology

It occurs in 1 in 1000 people aged over 40 years with the

incidence increasing with age

Women: men in this disease is 4: 1

It often happens in both eyes

Easy occur in the eye that has flair angle eyes closed
chambers, such as pd hypermetropia

Etiology

A disease characterized by elevation of intraocular pressure

is, due to:

Increased eye fluid production by the ciliary body

Reduced discharge chamber angle of the eye area or dicelah

pupil.

RISK FACTOR
Age
history of family members affected by glaucoma. For certain types of
glaucoma, family members of patients with glaucoma have a six times
greater risk of developing glaucoma
eyeball pressure above 21 mmHg at high risk for glaucoma
Drugs
Steroid users routinely example: User eye drops containing steroids that are
not controlled by doctors, inhalers for asthma sufferers, steroid medication
for arthritis and drug users who use steroids are routinely others.
History of trauma (injury accident) in the eye.
Other diseases. A history of cataracts, diabetes (diabetes), hypertension and
migraine

CLASSIFICATION
There are 4 types of glaucoma:
1. open-angle glaucoma
2. The angle-closure glaucoma
3. glaucoma kongenitalis
4. Secondary glaucoma
All four types of glaucoma are characterized by increased
pressure within the eyeball, and therefore all can cause
progressive damage to the optic nerve.

Pathogenesis
Clinical manifestations
o sudden blurred vision
Etiology:
Hyperopia
Prebiopia
DM
Changes in the shape of the eyeball
Change the position of the lens

DIAGNOSIS
History
sudden blurred vision
severe pain around the eyes or back of the head
nausea
vomiting
see the halo (rainbow around the object or lamu pliers
views)
complaint is often reduced when people see a strong
beam resulting in smaller pupil

PHYSICAL EXAMINATION
Visus greatly decreased
IOP rises
Red eye
Cornea gloomy / cloudy
Injection siliar
shallow anterior Room
Details of the iris does not appear
pupils slightly widened, less / no reaction to light
The optic discs appear red and swollen
At the touch porch eyes hard as marbles

SUPPORTING INVESTIGATION
1. tonometry. This tool is useful for assessing the intraocular
pressure. Normal eye pressure ranges between 15-21 mmHg.
2. Gonioskopi. Anterior chamber angle is the distribution out humor
akueus. By gonioskopi we tried to assess the state of the angle,
whether open, closed or narrow or there are abnormalities in the
corner.
3. Assessment of the optic disc. By using opthalmoskop we can
measure the CDR. CDR exceeding 0.5 indicates a significant
increase in intraocular pressure.
4. Examination of visual field. It is important to diagnose and follow
patients with glaucoma. Glaucoma visual field will be reduced due
to increased IOP will damage the optic nerve papillae.

DIAGNOSIS Banding
Keratitis
corneal ulcers
Uveitis

TREATMENT
1. drugs (medical emergencies and short-term)
semiotic: to release the iris of the eye tissue so that the angle trabekulum front booth will
be open
pilocarpin 2%, eye drops 1 drop every minute for 5 minutes,
then followed by 1 drop every hour up to 6 hours
Carbonic anhydrase inhibitors: to decrease the formation of aqueous humor
acetazolamide, 250 mg per tablet, 2 tablets at a time, followed by 1 tablet every 4 hours
to 24 hours
drug hiperosmotik: to increase the plasma osmotic power
50% glycerin solution orally, a dose of 1-1.5 g / kg (0.7-1,5 cc / kg or 1 cc / kg), while
drunk
mannitol 20%, per infusion 60 drops per minute
morphine: to reduce pain and shrink the pupil injected 10-15 mg

 2. Surgery
Performed after treatment with drugs to the eye pressure <25 mmHg and reduced red eye
iridektomi perifer
Indications:
glaucoma in phase prodomal
Acute glaucoma recent
precautions in the left eye
Technique: made a hole in the iris to the peripheral temporal side above
Filtration Surgery
indications:
Acute glaucoma longstanding
patient has entered the stage of chronic congestive glaucoma
Technical :
trepanation Elliot: small holes measuring 1.5 mm were made in the area kornea- skleral, then covered by the conjunctiva in order aqueous flow directly
from the anterior chamber to the subconjunctival space.
sklerotomi scheie cornea-skleral: cauterized so that the wound is not closed completely, with the aim that the aqueous flow directly from the anterior
chamber to the subconjunctival space.
trabeculectomy: lift trabekulum forming slits for eye fluid drain into the Schlemm canal.
PROGNOSIS
Acute glaucoma is an emergency OPHTHALMOLOGY so if not immediately dealt with bad prognosis
COMPLICATIONS
Blindness