Dwi Permana Putra

Tanjungpura University
Staphyloma refers to a localised bulging
of weak and thin outer tunic of the eyeball
(cornea or sclera) lined by uveal tissue
which shines through the thinned out of
fibrous coat
Anatomically:
Anterior
Intercalary
Ciliary
Equatorial
posterior staphyloma
An ectasia of
psuedocornea (the
scar formed from
organised exudates
and fibrous tissue
covered with
epithelium)
It results after total
sloughing of cornea,
with iris plastered
behind it
It is a bulge in limbal area lined
by root of iris
It results due to ectasia of weak
scar tissue formed at the
limbus, following healing of a
perforating injury or a
peripheral corneal ulcer.
there may be associated
secondary angle closure
glaucoma due to the
progression of bulge if not
treated
Treatment consists of localised
staphylectomy under heavy
doses of oral steroids.

it is the bulge of weak
sclera lined by ciliary
body occurs about
2-3 mm away from the
limbus
Its common causes
thinning of sclera
following perforating
injury, scleritis and
absolute glaucoma
It results due to bulge of
sclera lined by the
choroid in the equatorial
region
Its causes are scleritis
and degeneration of
sclera in pathological
myopia
Occurs commonly at
the regions of sclera
which are perforated by
vortex veins
It refers to bulge of weak
sclera lined by the choroid
behind the equator
common causes are
pathological myopia,
posterior scleritis and
perforating injuries
The area is excavated
with retinal vessels
dipping in it (just like
marked cupping of optic
disc in glaucoma)
it is diagnosed on
ophthalmoscopy

Glaucoma refers to a group of conditions with
heterogeneous causes that results in damage
to the optic nerve head and loss of visual field
It is usually associated with an increase in
intraocular pressure (IOP) above the normal
value usually estimated at 21 mmHg
Primary open angle glaucoma is the most
common type of glaucoma, accounting for
over 70 % of cases
1. Primary Glaucoma
In open-angle
glaucoma, the channel
where the flow of
aqueous humor is open,
but the flow of fluid from
the anterior chamber is
too slow.
Pressure will gradually
damage to the optic
nerve
progressive decline in
visual function

2. Primary Closure-Angle
Glaucoma
If the iris by the pupil (by the
center of the iris) touches the
lens too much, the fluid is
prevented from traveling
through the pupil
Pressure from the flow of the
aqueous trying to get through
the pupil pushes the iris by the
trabecular meshwork forward
(called iris bombe) cause
the iris to bow forward too
much, resulting in a complete
blockage of the drainage
meshwork

3. Secondary Glaucoma
Is an increasing of intraocular pressure
occurring as one manifestation of some other
eye disease
Caused by pigmentation, changes in lens,
changes in uveal tract, tumor, trauma,
surgery, neovascular and steroid
Treatment involves controlling intraocular
pressure by medical and surgical means but
also dealing with the underlying disease if
possible

Name : Mr. S
Sex : Male
Age : 28 years old
address : Parit Bugis
St.
Occupation : Employee
Ethnic : Bugis
Religion : Moslem
Medical Record Number : -
Hospital Entry Date : March 20th 2014

Sore in the right eye
In 1997
Admitted had an injury to his right eye
Due to exposure of wood
2 until 3 days later, he felt his right eye was swollen felt there was a black line in front of
him
Several days later, the swollen was bigger than before difficulties to see anything
Taken to the hospital cant see anymore
In 2011
the patient felt his eye was sore, redness, painful when after he was seeing of the light
the doctor said he suffered from glaucoma and the doctor gave him medications. After several
days consumed the drugs cured
Since a
week ago
patient felt sore, redness, pain , and watery of his right eye after he was seeing of light. also,
he felt there was something that blocked of his right eye, so that he came to the
ophthalmologist to consult of his symptoms
Patient had an eye injury of his right eye
when he was at 11 years old. Patient had
suffered from typhoid 5 years ago
He ignored when he was asking from
experiences of hypertension, diabetes
mellitus and consumption of steroid drugs
He admitted his family never suffered the
disease like he experienced with. There
was no history of hypertension and
Diabetes Mellitus of his family
An interview was conducted on 20th March
2014, at 11.30 a.m
General Condition : Good
Awareness : Compos Mentis

Vital Sign
Blood Pressure : 140/80 mmHg
HR : 64 x/minute
RR : 24 x/minute
Temperature : 36, 8
o
C

Ophtalmologic Status
Visual Acuity :
OD : 0
OS : 6/7,5

OD OS
exotrophia Eye ball Position orthotrophia
Movement (+), spasm (+), pain (+) Palpebra Movement (+), spasm (-) Normal
Redness (+), watery (+) Conjungtiva Redness (-). watery (-) Normal
Cloudy (+), edema (+), fibrous (+) cornea Clear, edema (-), fibrous (-) normal
Cannot be described Anterior Chamber Clear, deep
Color of iris : cannot be described
Iris : cannot be described
Pupil : cannot be described
Light reflex : cannot be described
Iris/pupil Color of iris: Brownies
Iris: regular
Pupil circular, 3 mm, isochor, Direct
reflex (+), Indirect Reflex (+)
Canno be described Lens clear
Cannot be described Vitreous clear
Cannot be described Fundus normal
Shadow test :
OD : Negative
OS : Negative
Tonometry
OD : Cannot be examined
OS : cannot be examined
Visual Field Examination
OD : cannot be described
OS : Normal

The patient, male 28 years old came to the clinic
with sore, pain and watery of his right eye when he
was seeing of light and he felt there was
something that blocked in his right eye since a
week ago
When he was at 11 years old, he had an injury in
his right eye and made him got swollen to his eye
and was taken to the hospital for further treatment,
because he had no longer to see clearly anymore.
He had diagnosed by his doctor that he cannot see
anymore, because of the severe damage of his
injury
3 years ago the patient has diagnosed suffered from
glaucoma by his doctor. The doctor only able to remove his
symptoms by medications. History of fever, nausea, vomiting,
headache, smoking were ingnored
In family history, he ignored that his family have never
experienced with glaucoma, hypertension and diabetes
mellitus.
From physical examination, there were:
OD : eye ball position is exotrophia, movement of palpebral was normal,
palpebral was spasm, pain, conjunctiva was redness and watery, cornea
was cloudy, iris/pupil was not clear enough because of cloudy. OS:
palpebral was no pain and spasm, conjunctiva ws no redness, no edema
and cloudy of the cornea, COA was clear and deep, iris and pupil were
normal (direct or indirect reflex (+), isochor, 3mm)

Diagnose
OD : Secondary glaucoma due to staphyloma
OS : Normal

Differential Diagnose
OD
Leucoma
Secondary Glaucoma to trauma

Planning for additional examination
Ultrasonography
Treatment
Timolol eye drops 0,25 % 2 x 1
Sodium Hyaluronate 0,1% drops every hour
Indometacin 100 mg tablets 2 x 1

Prognosis
OD
Ad vitam : bonam
Ad functionam : malam
Ad sanactionam : malam

OS
Ad vitam : bonam
Ad functionam : bonam
Ad sanactionam : bonam

The diagnosis to the patient is secondary
glaucoma due to staphyloma
Firstly, the formation of the staphyloma, because of
the trauma about 17 years ago, It results due to
ectasia of weak scar tissue formed at the limbus,
following healing of a perforating injury or a
peripheral corneal ulcer or called as intercalary
staphyloma
So that, in the right eye of the patient there is
localised bulge in limbal area lined by root of iris.
There may be associated secondary angle
glaucoma, which may cause progression of bulge
if not treated

The manifestation of secondary glaucoma
is an increasing of intraocular pressure
occurring as one manifestation of some
other eye
Treatment involves controlling intraocular
pressure by medical and surgical means
but also dealing with the underlying
disease if possible
Firstly is leucoma. Is the condition when the cornea is
damaged by an infection the collagen laid down in
the repair processes is not regularly arranged, with the
result that an opaque patch called a leukoma, may
occur

Secondly, secondary glaucoma to trauma is
associated with the history of injury from the patient.
Contusion injuries of the globe may be associated with
an early rise in intraocular pressure due to bleeding
into the anterior chamber (hyphema)
Free blood blocks the trabecular meshwork, which is
also causing edematous by the injury

Timolol
eye drops 0,25% is useful to suppress of aqueous production
The major contraindications to their use are chronic
obstructive airway disease particularly asthma and cardiac
conduction defects
Sodium hyaluronate 0,1% eye drops functions as a
tissue lubricant and is thought to play an important role in
modulating the interactions between adjacent tissues. It forms
a viscoelastic solution in water which makes it suitable
for aqueous and vitreous humor
Mechanical protection for tissues (iris, retina) and cell layers
(corneal, endothelium, and epithelium) are provided by the
high viscosity of the solution. Elasticity of the solution assists
in absorbing mechanical stress and providing a
protective buffer for tissues.
Indometacin 100 mg tablets is a non-
steroidal anti-inflammatory drug (NSAID)
commonly used as a prescription
medication to reduce fever, pain, stiffness,
and swelling. It works by inhibiting the
production of prostaglandins, molecules
known to cause these symptoms

To conclude, glaucoma is a condition in
which the eye is characterized by the
increase intraocular pressure, decreased
visual acuity, visual field constriction, and
optic nerve atrophy
The cause of glaucoma is poorly
understood, it could be due to trauma /
impact, or because of other eye diseases
such as cataracts (cataract hipermatur),
uveitis, and the influence of drugs
This patient should need several
treatments such as Timolol eye drops
0,25 % 2 x , Sodium Hyaluronate 0,1%
drops every hour and Indometacin 100 mg
tablets 2 x 1