1. Ophtha Case Presentation By: Cristal Ann G. Laquindanum Year Level 8 Ateneo School of Medicine and Public Health
2. Identifying data VR, 59 yr old male Blurring of vision, OU Informant reliability: 80% OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
22. Given Acetazolamide250 mg 2 tabs then TID for 3 daysOphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
23. Review of Systems VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS No history of trauma No weight loss No cough and cold No rashes No changes in hair/nails No changes in color No tinnitus No nosebleeds No hemoptysis No chest pain No syncope No changes in bowel habits OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
24. Past Medical History VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma No known history of asthma and/or COPD No known history of diabetes No known history of urinary stones OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
25. Past Medical History VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Medications: Losartan and Betahistine Acetazolamide 250 mg 2 tab, then 3x/day for 3 days OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
26. Family History VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Paternal history of Pulmonary tuberculosis Maternal history of Diabetes mellitus Maternal history of Hypertension No known family history of the following: - cancer - stroke - asthma - allergies OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
27. Personal and Social History VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Inactive carpenter 43 pack year smoker Non-alcohol beverage drinker Lives with his wife Has four children with families of their own Poor health-seeking behavior Financial constraints OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
28. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Awake, ambulatory, not in cardiorespiratory distress BP: 160/80 (hypertensive) HR: 75(normal) RR: 20 (normal) OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
29. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive HENNT No TPC, No CLAD Neck veins not dilated Intact tympanic membrane Midline septum, no discharge No neck rigidity Dry lips, moist buccal mucosa Nonhyperemic pharynx OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
30. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Chest/Lungs Symmetrical chest expansion Resonant on percussion Equal tactile and vocal fremiti No retractions No rales No wheezes OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
31. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Heart Adynamicprecordium No heaves or thrills Apex beat is at 5th ICS MCL Normal rate, regular rhythm No murmurs OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
32. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Abdomen Flat, soft abdomen No tenderness No organomegaly No masses Normoactive bowel sounds OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
33. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Extremities Full pulses No edema, no cyanosis Good turgor No rashes, no lesions Equally distributed hair No clubbing CRT <2sec OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
34. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Neuro Awake, cooperative, coherent Motor: 5/5 on all extremities Sensory: 100% on all extremities Gait: normal, very slow GCS 15 Cranial Nerves: intact OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
35. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Ophthalmologic Visual Acuity OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
36. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS Ophthalmologic Gross Examination OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
37. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS mid-dilated, poorly reactive, OS Ophthalmologic Gross Examination OS OD OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
38. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS mid-dilated, poorly reactive, OS Ophthalmologic Extra-ocular Movements OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
39. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS mid-dilated, poorly reactive, OS Ophthalmologic Tonometry OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
40. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS Mid-dilated, poorly reactive, OS Increased IOP, OS Ophthalmologic Fundoscopy OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
41. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS Mid-dilated, poorly reactive, OS Increased IOP, OS Ophthalmologic Neovascularization, OS OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
42. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS Mid-dilated, poorly reactive, OS Increased IOP, OS Iris neovascularization, OS Ophthalmologic Optic nerve OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
43. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS Mid-dilated, poorly reactive, OS Increased IOP, OS Iris neovascularization, OS Ophthalmologic Peripheral anterior synechiae with trabecular meshwork seen OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
44. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS Mid-dilated, poorly reactive, OS Increased IOP, OS Iris neovascularization, OS Ophthalmologic Closed angle OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
45. Physical Examination VR, 59 yr male CC: blurring of vision, OU Eye pain, OS Diagnosed with cataract, OU T/C ARMD, OD T/C Narrow angle glaucoma, OS Unknown history of hypertension 2 months PTC, patient had right sided weakness No history of ocular trauma Family history of PTB, DM, hypertension Hypertensive Light perception, OS Mid-dilated, poorly reactive, OS Increased IOP, OS Iris neovascularization, OS Ophthalmologic OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
69. Iris neovascularization, OS OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
70. Differential Diagnosis OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
71. At the OPD Brimonidinetartrate Possible valve implant, OS Anti-VEGF injection, OS CP clearance Hypertension work-up (IM referral) HPN Stage II BP Monitoring for two weeks Captopril 25 mg ½ tab OD OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
72.
73. historically, it has been referred to as hemorrhagic glaucoma, thrombotic glaucoma, congestive glaucoma, rubeotic glaucoma, and diabetic hemorrhagic glaucoma
74. secondary ocular and systemic diseases that share one common element, retinal ischemia/hypoxia and subsequent release of an angiogenesis factorOphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
81. treating the underlying disease that led to the ischemic insult OphthaCase Presentation By: Cristal Ann G. Laquindanum Year Level 8, Ateneo School of Medicine and Public Health
90. Ophtha Case Presentation By: Cristal Ann G. Laquindanum Year Level 8 Ateneo School of Medicine and Public Health
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Sudden blurring of vision of both eyes… the exact date not known. Basta the patient noted that he can still see properly during the barangay elections which was last week of October Worse at nightEye pain OSNo medications were taken No consult was done
Symptoms persisted which prompted consult in another institution where he was diagnosed to have mature cataract of both eyeHe was being worked up for hypertension and lab tests were requested but due to financial constraints, he was not able to do them
Few days after that consult the patient’s left eye became red and very painful. He can only perceive light. This prompted him to consult our institution for the first time
Few days after that consult the patient’s left eye became red and very painful. He can only perceive light. This prompted him to consult our institution for the first time
Asthma and/or COPD – limit the use of topical beta blockersSystemic hpn – systemic beta blocers may mask elevated IOPDiabetes – increasingly prevalent and associate with open angle and neovascular glaucomaUrinary stones – limit systemic carbonic anhydrase inhibitors
Asthma and/or COPD – limit the use of topical beta blockersSystemic hpn – systemic beta blocers may mask elevated IOPDiabetes – increasingly prevalent and associate with open angle and neovascular glaucomaUrinary stones – limit systemic carbonic anhydrase inhibitors
Asthma and/or COPD – limit the use of topical beta blockersSystemic hpn – systemic beta blocers may mask elevated IOPDiabetes – increasingly prevalent and associate with open angle and neovascular glaucomaUrinary stones – limit systemic carbonic anhydrase inhibitors
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Aqueous humour is secreted into the posterior chamber by the ciliary body, specifically the non-pigmented epithelium of the ciliary body(pars plicata). It flows through the narrow cleft between the front of the lens and the back of the iris, to escape through the pupil into the anterior chamber, and then to drain out of the eye via the trabecular meshwork. From here, it drains into Schlemm's canal by one of two ways: directly, via aqueous vein to the episcleral vein, or indirectly, via collector channels to the episcleral vein by intrascleral plexus and eventually into the veins of the orbit.[edit]
almost always ischemic in nature. Under hypoxic conditions, diffusible angiogenic factors, including vascular endothelial growth factor, have been detected in the human and animal retina and vitreous, promoting new vessel growth. Clinically, the three most common conditions responsible for NVG are diabetic retinopathy, central retinal vein occlusion and carotid artery obstructive disease.Anterior segment neovascularization involving the iris, the angle or both is accompanied by the formation of a fibrovascular membrane that is seen histologically.
This membrane initially obstructs the aqueous outflow through the trabecular meshwork and results in open-angle glaucoma, which may be amenable to pharmacological management of the elevated IOP as the disease progresses, the proliferating myofibroblasts of the fibrovascular membrane contract, leading to ectropionuveae, peripheral anterior synechiae and, ultimately, total synechial angle closure. This stage is not reversible by PRP. The resultant secondary glaucoma is often refractory to pharmacological management and requires surgical intervention.
three most common conditions responsible for NVG are diabetic retinopathy, central retinal vein occlusion and carotid artery obstructive disease.
Intravenous fluorescein angiogram and electroretinography (ERG) to assess retinal ischemiaB-scan ultrasoundOptical coherence tomography2- Images observed per grade of neovascular glaucomaGrade 1: No modificationGrade 2: A slightly hyper-reflective linear iris secondary to neovascularizationGrade 3: A thickened hyper-reflective iridocorneal angle with possible iridocorneal synechiaeGrade 4: Closed iridocorneal angle associated with iris contraction and uveae ectropion
