CASE REPORT

Viona
I11109064

CASE

PATIENT IDENTITY

Name
: Mrs. I
Sex
: male
Age
: 57 years old
Address
: Jl.Rajawali, Pontianak
Job
:
Religion
: Islam
Patient was examined on January 21, 2014

ANAMNESIS
Main complaint :
Blurred of vision in both eyes
History of disease :
Blurred of vision in both eyes 2 years ago,
gradually. Latterly it is more blurred.
Sometimes lacrimation of the eyes.
Cloudy of the sight
Rainbows aroud the object
There were no history of eye trauma and red
eye and itching.
Consume DM 4 years ago and hypertension
drugs

ANAMNESIS
Past clinical history :
Has Diabetes Mellitus since 7 years ago and
hypertension 1 year ago.

Family history: Parents had Diabetes mellitus dan

hypertension. Brother and sister also had
diabetes mellitus and hypertension.

GENERAL PHYSICAL
ASSESSMENT

General condition : Good

Awareness
: Compos Mentis
Vital sign:
Blood Pressure : 170/100 mmHg
Pulse
: 70x/minute
Respiratory Rate
: 22x/minute
Temperature
: 36,8 oC

OPHTHALMOLOGICAL STATUS

Visual acuity :
OD

: 1/60
OS : 1/4/60

Intraocular pressure: undone

Ocular eyes movements

OPHTHALMOLOGICAL STATUS
Right eye

Left eye

Ortho

Eye ball position

Ortho

Ptosis (-), lagoftalmos (-),

Palpebra

Ptosis (-), lagoftalmos (-),

edema (-)

edema(-)

Normal, injeksi (-)

Conjungtiva

Normal, injeksi (-)

Clear, edema (-)

Cornea

Clear, edema (-)

clear and deep, hifema (-),

COA

clear and deep, hifema (-),

hipopion (-)
iris brown,isocore

hipopion (-)
Iris and pupil

iris brown, isocore

synechiae (-), circular

synechiae (-), circular pupil,

pupil, the direct light reflex

the direct light reflex (+),

OPHTHALMOLOGICAL STATUS
Right Eye

Left Eye

Opaque

Lens

Opaque

can not be assessed

Fundus

can not be assessed

Negative

Shadow Test

Negative

Eye field test (Confrontation test)

OD

: normal
OS : normal

OPHTHALMOLOGICAL STATUS

DIAGNOSIS

Diagnose
: Anterior uveitis
Diferential Diagnoses : suspect. panuveitis

PLAN FOR LABORATORY AND SPECIAL

INVESTIGATIONS

full

blood counts
erythrocyte sedimentation rate
mantoux test
chest X-ray
sacro-iliac joint X-ray
syphilis serology (Treponema
pallidumhemagglutination test)

TREATMENT
Prednisolone oral 1 mg/kg/day divided in 2 doses for 14 days,
tapering off
Prednisolone acetate 1% 2 drops 4 times /day
Ranitidine 150 mg x 2 for 14 days
Atropine 1% 2 drops x 4
Combination of neomycin/polymixin B/gramicidin 2 drops x 6
(every 4 hours)

PROGNOSIS

OD :
Ad

vitam
: dubia ad bonam
Ad functionam
: dubia ad bonam
Ad sanationam
: dubia ad bonam

OS :
Ad

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

DISCUSSION

SYMPTOMS

Pain or discomfort sensation come from the

structure around the eye (cornea, sclera,
conjunctiva, iris, eyelids, etc)

Red eyes cardinal sign of ocular

inflammation
Ciliary injection

pain sensation, lacrimation (no secret), and pupil irregular

in size

SYMPTOMS

Blurred vision alteration of eyes refractive

media or from the organic disease
No correction with pinhole underlying
organic disease

Blurred vision linked with inflammation of the eye usually

because of the inflammation of the cornea or uveal tract

SYMPTOMS

Photophobia The conjunctiva, cornea,

sclera, and uvea (iris, ciliary body, and
choroid) are densely innervated with
trigeminal fibers, and exquisitely sensitive to
pain. Any painful stimulus to these areas (e.g.
iritis, uveitis) invariably causes photophobia

Headache reffered pain

OPHTHALMOLOGICAL
EXAMINATION

Uveitic conditions chronic inflammatory

debris in the anterior chamber to stick to
the inner surface of the endothelium
keratic precipitate

Hypopion
a
feature of
intense
inflammation cells settle in the inferior
part of the anterior chamber and form a
horizontal level

OPHTHALMOLOGICAL
EXAMINATION
Unclear (anterior chamber)

indication of

inflammation

Irregularity of iris posterior synechia (adhesion

of the iris to the capsule of the lens)

The adhesion may alter the sphincter pupils

muscle movement pupil reflex (-)

OPHTHALMOLOGICAL
EXAMINATION
Red reflex disapper in OS, appear a half in
OD
Vitreous body involvement:
aggregation of inflammatory cells/ hemorrhage
in vitreous body opacity of the vitreous
light cannot pass through the vitreous no light
reflection from retina absence of red reflex

Run

USG for examining retina and choroid

involvement

OPHTHALMOLOGICAL
EXAMINATION

The intraocular pressure (IOP) decreased in

both eyes

the inflammation induced decrease in aqueous

production

DIAGNOSIS
Chronic anterior uveitis
Suspicion involvement of vitreous body and
retina/choroid (panuveitis)

INVESTIGATIONS

Ultrasound biomicroscopy evaluate the

involvement of vitreous body, choroid and retina
Fundus fluorescein angiography indentify
active inflammation of the retinal vessels as seen
in vasculitis

INVESTIGATIONS

Mantoux test and chest X-ray TB

Sacro-iliac joint X-ray ankylosing spondylitis
Syphilis serology syphillis

TREATMENT

Mydriatic agent
relieving spasm of the ciliary muscle and pupillary sphincter
to break down recently formed posterior synechiae

Corticosteroids drugs of choice in most types of

uveitis.

inhibit the inflammatory process by suppressing the arachidonic

acid metabolism and activation of complement

TREATMENT

Antibacterial agent

treatment of the ocular infection

prevention for further inflammation

Vitrectomy

therapeutic option when uveitis persists despite maximum

tolerable medical treatment with corticosteroids and/or
other immunosuppressants.
visual loss occurs due to complications of longstanding
inflammations, such as a densely opacified vitreous, scar
tissue pulling on the ciliary body causing hypotony, cystoid
macular edema, or a tractional retinal detachment.

LITERATURE REVIEW

ANATOMY OF UVEA

ANATOMICAL CLASSFICATION

Type

Primary site of inflammation

Include

Anterior uveitis

Anterior chamber

Iritis,

Vitreous

Anterior cyclitis
Pars planitis, Posterior

Intermediate uveitis

Iridocyclitis,

cyclitis, Hyalitis
Posterior uveitis

Retina or choroid

Focal,

multifocal,

diffuse

choroiditis,

Chorioretinitis,
Retinochoroiditis,
Retinitis, Neuroretinitis

Panuveitis

Anterior chamber, vitreous, and

retina or choroid

or

ANATOMICAL CLASSFICATION

ANTERIOR UVEITIS

Ciliary injection

endothelial dusting by cells

Miosis

aqueous flare and cells

aqueous flare and cells

Posterior synechiae

hypopyon

Keratic precipitates

INTERMEDIATE UVEITIS

Pars planitis/intermediate uveitis with

snowballs

Choroidal neovascularization
in multifocal choroiditis with
uveitis

POSTERIOR UVEITIS

Retinitis

active
lesions
are
characterized by whitish retinal opacities
with indistinct borders due to surrounding
oedema

Choroiditis round, yellow nodule

vasculitis is characterized by yellowish or

grey-white, patchy, perivascular cuffing

PANUVEITIS

Diagnosis of panuveitis is established in the presence of the

following clinical signs:

Evidence of choroidal or retinal inflammation such as

choroiditis (focal, multifocal or serpiginous), choroidal
granuloma, retinochoroiditis, retinal vasculitis, subretinal
abscess, necrotizing retinitis or neuroretinitis

Evidence of vitreous inflammation (vitreous cells or vitritis)

Presence of signs of anterior uveitis (cells and flare in the

anterior chamber, keratic precipitates or posterior
synechiae)

RESUME

A female, 35 years old, came to ophthalmologic clinic with the

main complaint of pain in both eyes.
There is redness, with symptoms of lacrimation, blurred and
loss of vision, sensitive to the light.
Physical examination:
cilliary

injection
keratic precipitate in the cornea
unclear anterior chamber with hypopion
irregular iris with posterior synechia with loss of pupil reflex in both
eyes
The red reflex was absence in left eye.
The intraocular pressure were decreased in both eyes
anterior uveitis with suspicion of involvement of the vitreous body and retina
(panuveitis)

THANKS FOR YOUR

ATTENTION