Stephanie Natalia - 406152051

Supervisor :
dr. Soviana, Sp.M

Ophthalmology Department Sumber Waras Hospital

Faculty of Medicine Tarumanagara University
2017

Interesting Case - Stephanie Natalia (406152051) 5/2/2019 1

 Title : Mr.
 Full name : W
 Date of birth : January 1st, 1962
 Place of birth : Tegal
 Age : 55 yo
 Gender : Male
 Address : Jl. Salak Barat VII No. 17 B, RT: 09/RW: 05,
Tanjung Duren Utara
 Occupation : Driver
 Education : Elementary School
 Marital Status : Married
 Religion : Moslem
 Race : Javanese

Interesting Case - Stephanie Natalia (406152051) 5/2/2019

2
 Auto-anamnesis was done on September
11th, 2017 in Ophthalmology Department
Sumber Waras Hospital

 Chief complaint: Recurrent temporary

loss vision on left eye since 1 year ago

 Additional complaint: Glare whenever

patient sees bright light
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
3
Patient came to Ophthalmology Department of Sumber Waras
Hospital complaining about his recurrent temporary loss vision
on left eye since 1 year ago. He complains that this problem is
suddenly happen and getting worse each day, especially when
patient throws up with the presence of sore eyes and headache
which is really annoying for the patient. There’s no way to
minimize or to prevent this. He also complains that he has blurred
vision on left eye and was having increasing difficulty with glare
from bright lights (patient usually uses glasses to minimize the
effect) and reading the newspaper. He also complains that he
sometimes sees black area on his left below visual field. There is
no history of trauma or surgery on his left eye. Before, he
complains that his left eye sometimes had red, sore, and watery. 1
month ago he visited the ophthalmologist and got medicine to
widen his eye and to minimize the inflammation of his eye but
there was Interesting
no improvement.
Case - Stephanie Natalia (406152051) 5/2/2019
4
 Family history : No family member experiences
the same complaint. Unknown diabetes mellitus,
hypertension and blurred vision history.
 Medical history :
• Hypertension (+)  controlled by anti-hypertensive
medicine (Amlodipine 10 mg daily)
• DM (+) on insulin therapy but his blood glucose is always
in the range of 400 – 560 mg/dL
• There’s no history of cough more than 3 weeks,
malignancy, joint swollen and pain

 Social history : alcohol (-), smoking (+) 

stopped since 5 years ago
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
5
 Visus :
• VOD : 6/15F1  S+1,50 C-1,25 x 95  6/10
• VOS : 1/60  PH (-)

Iris pigment
deposits

OD OS
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
6
 OD OS
Palpebra Edema (-) Edema (-)
Hiperemis (-) Hiperemis (-)
Sekret (-) Sekret (-)
Conjunctiva Bulbi Injeksi konjungtiva & Injeksi konjungitva &
siliar (-) siliar (-)
Nodul (-) Nodul (-)
Kemosis (-) Kemosis (-)
Corpus alienum (-) Corpus alienum (-)
Sekret (-) Sekret (-)
Tarsal Hiperemis (-) Hiperemis (-)
Papil (-) Papil (-)
Korpus alineum (-) Korpus alineum (-)

Sclera Warna: putih Warna: putih

Inflamasi (-) Inflamasi (-)
Cornea Kejernihan: jernih Kejernihan: jernih
Infiltrat (-) Infiltrat (-)
Defek (-) Defek (-)
Edema (-) Edema (-)
Interesting Case - Stephanie Natalia (406152051) Neovaskularisasi
5/2/2019 (-) Neovaskularisasi (-)
7
 Anterior Chamber Kedalaman: cukup Kedalaman: cukup
Hifema (-) Hifema (-)
Hipopion (-) Hipopion (-)
Iris Warna: coklat Warna: coklat
Sinekia (-) Sinekia (-)
Iridodenesis (-) Iridodenesis (-)
Neovaskularisasi (-) Neovaskularisasi (-)

Physical Nodul (-)

Heterochromia iridis (-)
Nodul (-)
Heterochromia iridis (-)

Examination Pupil
Atrofi (-)
Ukuran: 2 mm
Atrofi (-)
Ukuran: 2 mm
Bentuk: bulat, simetris Bentuk: bulat, simetris
Reflex cahaya langsung Reflex cahaya langsung
(+) (+)
Reflex cahaya tidak Reflex cahaya tidak
langsung (+) langsung (+)
Dandruff-like
appearance
Lens Kejernihan: Jernih Kejernihan: Jernih
Luksasio (-) Luksasio (-)
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
8
 Visual field : no visual field defects

 Extraocularmuscles : no extraocular
muscles defects

 Amsler grid hasn’t been done

 IOP :
• OD : 13
• OS : 15

Interesting Case - Stephanie Natalia (406152051) 5/2/2019

9
OD OS
 Optic disc:  Couldn’t be done because
• Shape: round
there is vitreous opacity.
• Margin: defined
• Color: yellow-reddish
• C/D ratio: 0,3
• A/V ratio: 2/3
 Retina:
• Hemorrhage: (-)
• Exudate: (+)  cotton wool
spots
• Ablatio: (-)
• Sikatriks: (-)
• Neovascularization: (-)
 Fovea & macule reflex: (+)
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
10
 Working Diagnosis :
• Chronic posterior uveitis OS
• Susp. Retinal detachment OS
• Susp. Diabetic retinopathy OD

 Differential Diagnosis
• Amaurosis fugaks
• Central Retinal Vein or Artery Occlusion
• Optic neuritis

Interesting Case - Stephanie Natalia (406152051) 5/2/2019

11
 Medical
• Methylprednisolone PO 1 x 32 mg
• Prednisolone acetate 1% eye drop 1 gtt @2
hours OD

 Non-medical
• Vitrectomy

Interesting Case - Stephanie Natalia (406152051) 5/2/2019

12
 Ad vitam : dubia ad bonam
 Ad sanationam : dubia ad malam
 Ad functionam : dubia ad malam

Interesting Case - Stephanie Natalia (406152051) 5/2/2019

13
 Uveitis  inflammation of the iris (iritis,
iridocyclitis), ciliary body (intermediate
uveitis, cyclitis, peripheral uveitis, or pars
planitis) or choroid (choroiditis).
 Uveitis affects people 20 – 50 yo  10 –
20% of cases of legal blindness in
developed countries.

Interesting Case - Stephanie Natalia (406152051) 5/2/2019

14
 Posterior uveitis
• Retinitis, choroiditis,
retinal vasculitis, and
papillitis
• Symptoms: floaters,
scotomas, decreased vision
• Complications: retinal
detachment (tractional,,
rhegmatogenous,
exudative), cataract,
glaucoma, vitreous
opacities, macular oedema,
optic nerve atrophy
• Prognosis: worse than
anterior uveitis
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
15
• Diagnostic clues:  Glaucoma
 Vitritis
 Age of the patient
 Morphology & location of
 Laterality lesions
 Symptoms:  Trauma  intraocular
 Reduced vision (macular foreign body,
lesion, retinal
sympathetic opthalmia
detachment)
 Ocular injection  Mode of onset
 Pain  Treatment based on
 Signs: the etiology & high-
 Hypopyon
 Type of uveitis
potent steroid
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
16
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
17
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
18
 Cunningham ET. Augsburger JJ, Correa ZM, Pavesio C. Uveal tract and sclera. In:
Riordan-Eva P, Cunningham ET, ed. Vaughan & Asbury’s general ophthalmology. 8th
ed. New York: McGraw-Hill, Inc; 2011. p318-96.
 Harman LE, Margo CE, Roetzheim RG. Uveitis: the collaborative diagnostic
evaluation. American Family Physician. 2014;90(10):711-16.
 Mustafa M, Muthusamy P, Hussain SS, Shimmi SC, Sein MM. Uveitis: pathogenesis,
clinical presentations and treatment. IOSR Journal of Pharmacy. 2014;4(12):42-7.
 Alexander KL, Dul MW, Lalle PA, Magnus DE, Onofrey B. Care of the patient with
anterior uveitis. St. Louis: American Optometric Association; 1994.
 Sitompul R. Diagnosis dan penatalaksanaan uveitis dalam upaya mencegah
kebutaan. Departemen Ilmu Kesehatan Mata FKUI. 2016;4(1):60-70.
 van Laar JAM, Rothova A, Missotten T, Kuijpers RWAM, van Hagen PM, van Velthoven
MEJ. Diagnosis and treatment of uveitis; not restricted to the ophthalmologist.
Journal of Clinical and Translational Research. 2015(2):94-99.
 Uveitis. In: Bowling B. Kanski’s clinical ophthalmology: a systemic approach. 8th ed.
China: Elsevier; 2016. p395-465.
 Kellogg Eye Center. Anterior Uveitis (Iritis). University of Michigan Health System.
Michigan: University of Michigan Health System. 2015. p1-3.
 Rosenbaum JT. Acute anterior uveitis. American Uveitis Society. 2003:1-3.
 Pinar V. Intermediate uveitis. India. 2015. 1-6.
 Garg DP, Venkatesh P, Verma L. Uveitis: approach to diagnosis & management. India:
All India Opthalmology Society; 2001.

Interesting Case - Stephanie Natalia (406152051) 5/2/2019

19
Interesting Case - Stephanie Natalia (406152051) 5/2/2019
20