Pterigium dan Perdarahan

Subkonjungtiva
Rasya Hapsari Danardhono
1910211078
PTERYGIUM
• A pterygium is an elevated, superficial, external ocular mass that usually
forms over the perilimbal conjunctiva and extends onto the corneal
surface. Pterygia can develop on the nasal and/or temporal limbus and
can affect either or both eyes.
• Pterygia can vary from small, atrophic quiescent lesions to large,
aggressive, rapidly growing fibrovascular lesions that can distort the
corneal topography, and, in advanced cases, they can obscure the
optical center of the cornea.
• Pterygia are benign (non-cancerous) growths, but they can permanently
disfigure the eye. They also can cause discomfort and blurry vision.
ETIOLOGY
• Risk factors for pterygium include
• increased exposure to ultraviolet light, including living in subtropical and
tropical climates
• engaging in occupations that require outdoor activities.
• A genetic predisposition to the development of pterygia appears to
exist in certain families.
• A predilection exists for males to develop this condition in
significantly higher numbers than females, although this finding may
represent an increased exposure to ultraviolet light in this portion of
the population.
Epidemiology
• Frequency
• . Though it occurs worldwide, its prevalence is high in
the “pterygium belt” between 30 degrees north and 30
degrees south of the equator
• Mortality/Morbidity
• A pterygium can cause a significant alteration in visual
function in advanced cases. It can become inflamed,
resulting in redness and ocular irritation.
• Sex
• Pterygium is reported to occur in males twice as
frequently as in females.
• Age
• It is uncommon for patients to present with pterygium
prior to age 20 years. Patients older than 40 years have
the highest prevalence of pterygia, while patients aged
20-40 years are reported to have the highest incidence
of pterygium.
Pathophysiology
• The pathophysiology of pterygium is
characterized by elastotic degeneration
of collagen and fibrovascular
proliferation, with an overlying covering
of epithelium. Histopathology of the
abnormal collagen in the area of
elastotic degeneration shows basophilia
with hematoxylin and eosin stain. This
tissue also stains with elastic tissue
stains, but it is not true elastic tissue, in
that it is not digested by elastase. 
Signs And Symptoms
• Pterygia usually occur on the side of the eye closer to the nose, but
they can also develop on the side closer to the ear as well and can
affect one eye or both eyes.
• Many people with mild surfer's eye may not experience symptoms or
require treatment. But large or growing pterygia often cause a gritty,
itchy or burning sensation or the feeling something is "in" the eye
(called a foreign body sensation). Also, these pterygia often become
inflamed, causing red eyes.
• If a pterygium significantly invades the cornea, it can distort the shape
of the front surface of the eye, causing astigmatism that affect vision.
CLINICAL GRADING
Diagnosis
Examination
Taking a detailed history • Check the visual acuity.
• How long has the growth been • Measure the size of the pterygium from the limbus to the
apex of the pterygium on the cornea.
present? • Look for any atypical features that might make you worry
• Ask the patient if it has been about dysplasia (early-stage cancer), such as leucoplakia
(an elevated, white, dry-looking patch), a raised
getting bigger. Some pterygia are gelatinous mass, oralarge, prominent feeder blood
vessel. Be especially alert if you live in Africa where there
inactive and have not grown for is a high prevalence of OSSN.
• Examine the eye movements to look for any evidence of
decades. restricted movement caused by the pterygium.
• What symptoms is the patient • Retinoscopy will reveal any with-the-rule astigmatism
that may be caused by the pterygium. Corneal
complaining of? topography can be valuable in detecting irregular
astigmatism and distortion caused or induced by
pterygium.
When to treat?
The most important indications for treatment are:
• Involvement of, or threat to, the visual axis
• Loss of vision from astigmatism
• Restriction of eye movement
• Atypical appearance suggesting dysplasia
• Increasing size (documented by an ophthalmologist)
TREATMENT
• Medical treatment of pterygium consists • The main indication for
of over-the-counter (OTC) artificial
tears/topical lubricating drops (eg, Refresh
pterygium surgery is visual
Tears, GenTeal drops) disturbance sec-ondary to
• occasional short-term use of topical encroachment over the pupillary
corticosteroid anti-inflammatory drops area or induced astigma-tism.
(eg, Pred Forte 1%) when symptoms are Other indications which can be
more intense.
considered are, restriction in eye
• Topical cyclosporine may be prescribed
for dry eye. movements, chronic redness and
• In addition, the use of ultraviolet-blocking
foreign body sensation, and
sunglasses is advisable to reduce the cosmetic concerns.
exposure to further ultraviolet radiation.
Complications
Intraoperative complications include: Early postoperative complications include:
• Persistent epithelial defects Dellen formation
• Perforation of the globe (an area of corneal thinning adjacent to limbal
• Thinning of sciera or cornea from swelling that prevents normal wetting of the
corneal surface)
dissection • Haematoma beneath the graft
• Intraoperative bleeding • Loss of the graft
• Excessive cautery • Pyogenic granuloma
Late complications include:
• Muscle damage • Recurrence
• Reversing the conjunctival autograft • Corneo-scleral necrosis
(placing it epithelial surface down) • Scleritis
• Endophthalmitis
Subconjunctival Hemorrhage
• Subconjunctival hemorrhage (SCH) is a common clinical condition of
eye that is characterized by blood accumulation in the subconjunctival
space. A ruptured vessel causes bleeding in the space between
Tenon’s capsule and the conjunctiva. 
Etiology
• The biggest risk factor for spontaneous SCH Systemic factors
is hypertension and other vascular
disorders like diabetes. These diseases can • Systemic factors that may lead to
cause blood vessels to become fragile and SCH are systemic vascular
spontaneously rupture.
diseases, systemic trauma, and
• Local trauma
drugs.
• Orbital injuries
• Acute inflammation of the conjunctiva
• Conjunctival tumors
• Contact lens usage
• Ocular surgery
• Ocular adnexal tumors
Epidemiology
• Subconjunctival hemorrhages, in general, do not have any gender
discrepancy. However traumatic SCH was shown to be more prevalent in
young males most likely related to performing heavy work and tendency
to do more aggressive activities.
• The rate of spontaneous vs. traumatic varies depending on the population
characteristics themselves.
• One study showed the incidence rate of non-traumatic SCH to be higher
in women with a men to women ratio of 0.8.  It is with wide consensus
that spontaneous SCH increases with age especially after the age of 50.
This is due to the higher probability of comorbidities such as
hypertension, hyperlipidemia, and diabetes mellitus.
Pathophysiology
• Subconjunctival hemorrhage results from bleeding of the conjunctival
or episcleral blood vessels and subsequently leaks into the
subconjunctival space. Blood vessels can wear and tear over time. The
elastic and connective tissues become fragile with age and underlying
comorbidities which can result in the ease of spread of the
hemorrhage in the elderly. Traumatic SCH is more localized to the site
of impact compared to spontaneous. There is a predilection for SCH
to develop on the temporal aspect of the eye since the bulbar
conjunctiva of the temporal aspect is larger than the nasal aspect.
History and Physical
• A careful history and physical examination are key to determine whether an SCH is benign
or a sign of something more malignant.
• Be sure to obtain past medical history especially vascular disorders like hypertension,
hyperlipidemia, and diabetes.
• Be sure to note any anticoagulant therapy, underlying coagulopathy or blood dyscrasia.
• Note any non-compliance with medications, use of contact lenses, and any prior ocular
surgeries.  
• On the physical exam, SCH is a painless, acute, sharply demarcated area of extravasated
blood just beneath the surface of the eye. SCH is generally unilateral. There is no reduction
in visual acuity. The inferotemporal aspect of the conjunctiva is the most common site.
• A simple SCH should not have any chemosis, proptosis, purulent discharge,
ophthalmoplegia.
Treatment
• Generally, there is no treatment indicated for SCH unless associated
with a certain serious condition. The blood is typically resorbed over
1-2 weeks depending on the amount of extravasated blood.
• Ice packs and artificial tears can be utilized to minimize tissue swelling
and provide some relief of discomfort respectively.
• Emergent ophthalmology consultation is warranted if SCH occurred
via trauma and intraocular or additional retinal trauma is suspected.
• Dilute brimonidine and oxymetazoline has been indicated to improve
patient comfort and decrease the incidence of SCH after intravitreal
injections.
Complications
• There are no complications surrounding subconjunctival hemorrhage
as most resolve around 2 weeks. Subconjunctival hemorrhage itself
may be a sign of a more underlying dangerous disorder such as
coagulopathy, severe asthma exacerbation, non-accidental trauma, or
severe orbital trauma.
DAFTAR PUSTAKA
• Doshi R, Noohani T. Subconjunctival Hemorrhage. [Updated 2019 Dec
6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK551666/
• Chui, J., Coroneo, M. T., Tat, L. T., Crouch, R., Wakefield, D., & Di
Girolamo, N. (2011). Ophthalmic pterygium: a stem cell disorder with
premalignant features. The American journal of pathology, 178(2),
817–827. https://doi.org/10.1016/j.ajpath.2010.10.037