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Introduction: Lacrimal gland tumors have 1: 1,000,000 cases per year, accounting for one-fourth of lesions that occupy the orbital space. The rarity of lacrimal gland tumors and the many types of tumors with various types of lesions make determining optimal treatment difficult. A myoepithelial tumor is a rare epithelial neoplasm of the lacrimal gland. This paper aims to report a good outcome case of myoepithelial carcinoma. Case Report: A 30-year-old male complained of protruding his left eye since 2014, accompanied by pain and clear white discharge. The vision was getting blurry and also double vision. Patients with Human Immunodeficiency Virus (HIV) disease since 2013 on Anti Retro Viral (ARV) therapy. Right eye visual acuity was 6 / 7.5, and good eyeball examination. The left eye was 6/10 with no pinhole improvement, non-axial proptosis, and superolateral mass. The movement of his left eye was restricted. Other anterior and posterior segments were promising. The patient was diagnosed with pseudotumor and was given oral methylprednisolone. The eye condition is said to be getting better. The patient complained that the left eye was more prominent and protruding three years later, with blurred vision accompanied by infection. Left eye visual acuity becomes Light Perception Bad Projection with non-axial proptosis, retraction of palpebra and pus. Orbital exenteration was performed, and anatomical pathology examination revealed myoepithelial carcinoma of the lacrimal gland. The patient was planned for radiotherapy. Conclusion: These rare cases have made setting up a regimen in randomized controlled trials difficult. The rapid development of therapy gives more hope to treating patients with lacrimal gland tumors.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is an infectious disease characterized by severe acute respiratory syndrome caused by the coronavirus 2. The implementation of lockdown and social distancing is the efforts made by the government to prevent the spread of this virus. The COVID-19 pandemic has affected the incidence rate of ocular trauma in several means. AIM: This study aimed to evaluate the factors that can cause ocular trauma, from the patient’s characteristics, clinical presentation, etiology, and mechanism of ocular trauma of patients who came to the emergency unit of Sanglah Central General Hospital (RSUP) during the COVID-19 pandemic. METHODS: This study is an observational analytic study with simple random sampling method to evaluate the characteristics of patients with ocular trauma from March 2020 to March 2021. The secondary data were obtained from the medical records including age, gender, address, examination data (visual acuity, duration between trauma and time of seeking medical care, diagnosis, trauma etiology, trauma mechanism, and surgery performed on the patient). RESULTS: In this study the most common was the presence of corpus alienum/foreign body in the cornea, chemical trauma, corneal erosion, canaliculi rupture, and keratitis which are usually caused by photoelectric injury. During the COVID-19 pandemic, new regulations were implemented including patient screening, COVID-19 test before undergoing surgery, patient treatment, and also the use of personal protective equipment for the examiners. Moreover, there were behavioral changes of the people caused by the enforcement of lockdown system and also people’s fear of going to the hospital, especially to a COVID-19 referral hospital such as Sanglah General Hospital; therefore, some patients delayed seeking medical treatment and refused to have surgery at Sanglah General Hospital. CONCLUSION: Our study concluded that the trend of ocular trauma in the COVID-19 era tends to occur in the male population and involves trauma to the cornea, with the most common etiology is caused by the presence of foreign bodies such as gram, wood, or metal. Our finding also showed that despite the implementation of social distancing policies in the COVID-19 pandemic situation, ocular trauma can still be found related to the implementation of the lockdown that has been relaxed during this research.

Introduction: Orbital melanoma (OM) is the most common type of primary intraocular neoplasm in adults. Although the incidence of OM is only 5% of melanoma tumors, OM causes death in 13% of melanoma tumors. The management of orbital melanoma originating from the uveal tissue is still controversial between surgical and nonsurgical therapy. Case Report: A male patient, 63 years old, complained that the patient's right eye was said to have appeared a lump since five months ago with a size of 6 x 6 x 7 cm, blackish red in color with clinical signs of malignancy. The patient underwent orbital exenteration and the patient's condition had no recurrence or other complaints until four months after the procedure. Conclusion: Orbital melanoma of uveal origin is a complex malignancy that requires a multidisciplinary approach to therapy and management. Early detection and adequate therapy are very important in increasing survival rates. Pendahuluan: Melanoma orbita (MO) merupakan tipe yang paling sering dari neoplasma primer intraokular pada dewasa. Meskipun insiden MO hanya 5% dari tumor melanoma, namun MO menimbulkan kematian pada 13% akibat tumor melanoma. Tatalaksana melanoma orbita yang berasal dari jaringan uvea sampai saat ini masih kontroversial antara terapi bedah dan nonbedah. Laporan Kasus: Seorang pasien laki-laki, 63 tahun, mengeluh mata kanan pasien dikatakan muncul benjolan sejak lima bulan yang lalu dengan ukuran 6 x 6 x 7 cm, berwarna merah kehitaman dengan klinis mengarah keganasan. Pasien dilakukan eksenterasi orbita dan kondisi pasien tidak terdapat kekambuhan ataupun keluhan lain hingga empat bulan setelah tindakan. Simpulan: Melanoma orbita yang berasal dari uvea merupakan keganasan yang kompleks yang membutuhkan pendekatan multidisiplin dalam terapi dan tatalaksana. Deteksi dini dan terapi yang adekuat sangat penting dalam upaya meningkatkan angka ketahanan hidup.

Introduction: Ocular malignant melanoma is a rare but deadly disease that most often appears in the uvea, conjunctiva or orbit. Melanoma can be asymptomatic or give symptoms and signs depending on development of neoplasm. This case report aims to discuss the clinical sign of conjunctival malignant melanoma and the treatment given to better understand the disease.Case Report: Female patient, 57 years old complained lump in the left eye since 1 month ago. Red eyes, pain and blurry vision (-). Previously, patients with a history of malignant melanoma in the left eye and had performed surgery 5 times since 2015. Ophthalmology examination obtained visual acuity on right eye 6/18 and left eye 6/45. Anterior segment evaluation of the left eye found mass on palpebra, size 2x1 cm, color according to skin, mobile (-), tenderness (-). In conjunctiva found CVI (+) and symblepharon. There are 3 masses in conjunctiva. First mass in bulbi conjunctival superior to limbus with round shape, diameter 3 mm, brown color and smooth surface. The second mass in superotemporal conjunctival fornix, brownish color, size 1,5x1,5 cm with solid consistency, mobile (+). The third mass in the superior tarsal conjunctival, oval shape, 5x3 mm, brownish color and smooth surface. Lens of right and left eye found hazy. Segmen posterior on both eye within normal limit. Patient was diagnosed with post wide excision + cryotherapy + 5 fu (8 months) + suspected conjunctival tumor ec malignant melanoma + right left eye immature senile cataract. Patient underwent tumor multiple excision + cryotherapy + PA with general anesthesia. The biopsy results showed histomorphology consistent with malignant melanoma. There were no regional or distant metastasis.Conclusion: There are several therapeutic modalities for conjunctival melanoma, such as wide local excision with adjuvant therapy (brachytherapy, cryotherapy, and the use of topical chemotherapeutic agent like Mytomicin C). If tumor become a multiple recurrence or rapidly growing local tumor, the exenteration is needed. Pendahuluan: Melanoma maligna okular merupakan suatu penyakit yang jarang dengan angka kematian yang tinggi dan paling sering muncul pada uvea, konjungtiva maupun orbita. Melanoma dapat bersifat asimptomatis hingga menimbulkan sekumpulan gejala dan tanda tergantung dari perkembangan neoplasma. Laporan kasus ini bertujuan untuk membahas tanda klinis melanoma maligna konjungtiva dan tatalaksana yang diberikan untuk lebih dapat memahami mengenai penyakit ini. Laporan kasus: Pasien wanita, 57 tahun, mengeluh muncul benjolan pada mata kiri yang disadari sejak 1 bulan yang lalu. Mata merah, nyeri, keluhan kabur (-). Sebelumnya pasien dengan riwayat melanoma maligna pada mata kiri dan telah dilakukan operasi sebanyak 5x sejak tahun 2015. Pemeriksaan oftalmologi didapatkan tajam penglihatan mata kanan 6/18 dan mata kiri 6/45. Evaluasi segmen anterior pada mata kanan ditemukan lensa keruh minimal. Evaluasi segmen anterior mata kiri ditemukan massa pada palpebra, ukuran 2x1 cm, warna sesuai dengan kulit, mobile, padat, nyeri tekan (-). Pada konjungtiva ditemukan conjunctival vascular injection (CVI) (+) dan simblefaron inferior di konjungtiva serta ditemukan 3 buah massa. Massa pertama pada konjungtiva bulbi superior hingga limbus, bentuk bulat, diameter 3 mm, batas tegas, permukaan licin, warna kecoklatan. Massa kedua di konjungtiva fornix superotemporal, warna kecoklatan, teraba bulat, ukuran 1,5x1,5 cm, permukaan rata, konsistensi padat kenyal, mobile, nyeri tekan (-). Massa ketiga di konjungtiva tarsal superior, bentuk oval, uk 5x3 mm, warna kecoklatan, permukaan licin. Lensa keruh minimal dan segmen anterior lain dalam batas normal. Evaluasi segmen posterior mata kanan dan kiri dalam batas normal. Pasien didiagnosis dengan oculi sinistra (OS) post wide eksisi + cryotherapy + 5 fluorouracil (5fu) (8 bulan) + suspek tumor konjungtiva rekuren ec melanoma maligna dan oculi dekstra et sinistra (ODS) KSI dan dilakukan tindakan eksisi tumor multiple + cryotherapy + patologi anatomi (PA) dengan general anesthesia (GA). Hasil histopatologi dari open biopsy sesuai untuk melanoma maligna. Tidak ditemukan adanya metastase regional maupun metastase jauh.Simpulan: Terdapat beberapa modalitas terapi untuk melanoma konjungtiva yaitu wide local excision dengan terapi adjuvant seperti brachytherapy, cryotherapy, dan penggunaan agen topikal kemoterapeutik (mytomicin C). Apabila dalam perjalanannya penyakit menjadi rekurensi multipel atau tumor lokal yang berkembang pesat maka tindakan eksenterasi sangat diperlukan.

Introduction: Optic Nerve Gliomas (ONG) are the most common primary Cerebral Nervous System tumor in childhood with greatest tendency for growth in the first 3-5 years of life (Huang, 2020). Most children diagnosed with ONGs have neurofibromatosis type 1 (NF-1) (Simmons,2013) with painless and slowly progressive decreace of vision. Imaging investigation with CT-scan or MRI is important to diagnose patient with ONG. The aim of this paper is to report a case of optic pathway glioma resulting rapid death of a child.Case Illustration: A 7-year-old girl complained that her eyes could not see in the past 1 year and protrusion with a white spot that is getting wider in the middle of the eye on her right eye since 3 months ago. Her left eye could not see in the past 3 weeks. She also complained about pain on her head. From ophthalmology examination visual acuity both eyes are no light perception. On her right eye we found protrusion with scleral show and lagophthalmos on her right eye, periconjunctival injection with corneal edema, deep anterior chamber and IOP 47. On the left eye we found midilated pupil with decreased reflex and the posterior segment we found optic nerve head hazy demarcated, cup-disc ratio difficult to be evaluated, good retina, decreased macular reflex and macular star (+). From right eye USG we found severe vitreous opacity. The MRI result from June 15th 2020 is suggested for optich pathway glioma dd/ pylocystic astrocytoma and suspected expand to internal auditory canal dextra. The patient was diagnosed with OD Proptosis ec retrobulbar tumor susp optic nerve glioma that expand from chiasma / cerebrii + vitreous bleeding+secondary glaucoma. OS Optic Nerve Edema ec intracranial mass. The patient was planned for OD extended enucleation join op Tumor Removal from Neuro Surgery under General Anesthesia. However, the surgery was postponed due to unstable condition and patient died from septic shock 2 months after the first arrival at the eye clinic.Conclusion: Optic Nerve Glioma are the most common primary Cerebral Nervous System tumor in childhood. This patient came with decrease of vision, protrusion on her right eye and pain with MRI finding suggested for optic nerve glioma. This patient should have done surgery but her condition was unstable. Good handling and multidisciplinary cooperation in the diagnosis and management of intraocular and intracranial masses are needed to provide a good outcome for the patient. Pendahuluan: Glioma Saraf Optik (GSO) merupakan tumor otak primer yang paling banyak terjadi pada 1 dekade kehidupan dengan kecenderungan terjadi pada usia 3-5 tahun. Anak-anak yang didiagnosa dengan GSO biasanya memiliki neurofibromatosis tipe 1 (NF-1) yang timbul secara sporadik. GSO memiliki gejala penurunan penglihatan tanpa adanya rasa nyeri yang dirasakan perlahan. Pemeriksaan penunjang dalam menegakkan diagnosis GSO bisa menggunakan CT-scan ataupun MRI. Tujuan dari makalah ini adalah untuk melaporkan sebuah kasus bagaimana cara mendiagnosa glioma saraf optic pada anak-anak.Ilustrasi kasus: Pasien perempuan, 7 tahun, datang (2 Juni 2020) dengan keluhan kedua mata tidak dapat melihat sejak 1 tahun yang lalu dan mata kanan menonjol sejak 3 bulan disertai bintik putih yang semakin melebar di bagian tengah mata. Mata kiri dikatakan tidak bisa melihat sejak 3 minggu yang lalu. Nyeri kepala sering dikeluhkan oleh pasien di seluruh kepala. Pemeriksaan oftalmologi didapatkan visus kedua mata no light perception (NLP), proptosis dengan scleral show dan lagoftalmos 2 mm pada mata kanan. Konjungtiva mata kanan didapatkan injeksi perikorna dengan edema kornea. Bilik mata depan mata kanan kesan dalam. Tekanan intraokular mata kanan 47 mmHg. Middilatasi dengan penurunan reflek pupil didapatkan pada mata kiri, lensa jernih dan pada pemeriksaan segmen posterior didapatkan papil nervus optik batas kabur, cup-disc ratio (CDR) sulit dievaluasi, retina kesan baik, reflex makula menurun dengan macular star. Hasil USG mata kanan didapatkan kesan kekeruhan vitreous berat. Pada 15 Juni 2020 pasien dilakukan MRI dengan kesan mengarah pada optic pathway glioma dd/ pylocytic astrocytoma dan suspek perluasan ke regio internal auditory canal dextra. Pasien didiagnosis dengan OD proptosis ec tumor retrobulber susp glioma saraf optik yang berasal dari chiasma / cerebri + perdarahan vitreus + glaukoma sekunder, OS Papil edema ec massa intracranial dan direncanakan OD extended enukleasi join op tumor removal oleh Bedah Saraf dengan General Anestesi. Namun, pasien belum dilakukan operasi karena keadaan pasien memburuk dan meninggal akibat syok sepsis 2 bulan pasca kedatangan pertama ke poli mata. Simpulan: Glioma saraf optik merupakan tumor yang sering ditemukan pada anak-anak. Pada pasien sudah didapatkan nyeri, penurunan tajam penglihatan dan proptosis serta gambaran MRI yang mendukung diagnose glioma saraf optic. Sebaiknya pasien dilakukan tindakan pembedahan namun keadaan umum pasien tidak memungkinkan. Penanganan yang baik dan kerjasama multidisiplin dalam penegakan diagnosis dan tatalaksana massa intraocular maupun intracranial dibutuhkan untuk memberikan luaran yang baik bagi pasien.

Exophthalmometry is a routine examination procedure for proptosis or ocular protrusion patients. Hertel exophthalmometer is the most commonly used device, including in Sanglah General Hospital as tertiary care centrein Bali. The exophthalmometric measures tend to vary with age, sex, and race. Therefore, many investigators conducted researches to determine the normal value of exophthalmometry result in their populations, however there is no prior study on Indonesia population, specifically in Bali. This research is an observational study with cross sectional approach using data that were collected retrospectively based on medical record of patients with proptosis condition in ROO division, eye clinic of Sanglah General Hospital Bali in period between January 2017 to June 2018. Hertel Exophthalmometer was used to measure eyeball position toward orbital space in normal eyes and proptosis eyes, especially in axial proptosis type. The subjects were 97 patients with proptosis, which is 51 patients (65 eyes) with axial type. Mean exophthalmometry value on normal eyes (37 eyes) in this study was13.86 ± 0.51 mm and for the eyes with proptosis condition (65 eyes) the mean value 17.32 ± 0.37 mm.

We report clinical characteristic, imaging studies, and management of a rare case of expansion epithelial malignancy due to squamous cell carcinoma (SCC). A man was admitted with protrusion of the left eye due to orbital medial tumor mass. The patient had undergone removal surgery, chemotherapy, and radiotherapy two years ago. Imaging and histopathological studies were conducted to determine protrusion of the left eye due to Non-keratinizing sinonasal SCC. The left eye exenteration was conducted and continued with the chemotherapy procedure. This case demonstrates that even aggressive and repetitive surgical may not be adequate in preventing worse outcomes.

Background: Kaposi’s sarcoma (KS) is malignant neoplasm of the vascular endothelium, caused by Human Herpes Virus 8 (HHV 8). Clinical variants consist of classic KS, iatrogenic KS, and AIDS KS. The manifestation of KS in the eye may occur in the eyelids, the lacrimal sac or gland, the orbit and bulbar or palpebral conjunctiva. This case study aims to demonstrate the incidental finding of conjunctival Kaposi sarcoma (KS) leading to acquired immunodeficiency syndrome (AIDS) diagnosis.Case Presentation: A 34-years old male patient presented with a three-month history of progressively growing reddish mass in bulbar conjunctiva of the left eye. A mass with notable aggressive tumor characteristics heightened the suspicion for KS and comprehensive assessments were done accordingly. The patient was found to suffer from human immunodeficiency virus (HIV)/AIDS. Multistep approach treatment was commenced to treat AIDS-related KS and prevent recurrence in this case.Conclusion: Patients with undiagnosed HIV infection would benefit from early diagnosis initiated by AIDS-defining illnesses such as KS. Given early identification and comprehensive management, KS abridged the time to diagnosis of HIV infection.

Pterygium is an eye disease with multifactorial etiopathogenesis. Molecular factors such as cell proliferation and inflammatory mediators are associated with increased calcium mobilization and activation of nuclear factor kβ mediated by histamine-1 receptors (H1R). This study aims to determine whether the expression of H1R primary pterygium tissue is higher than normal conjunctival tissue and the expression of H1R based on pterygium grades. This study was an analytic observational study with a case-control study approach at Sanglah General Hospital, Bali Mandara Eye Hospital, and Mangusada Hospital. The study was conducted from November 2017 to April 2018. The pterygium and conjunctival tissues obtained from 28 subjects in the same eye and examined for H1R expression by immunohistochemistry. The results of this study obtained 64.3% of women with a mean age of 54.2 ± 7.8 years. There was no difference in mean H1R expression between pterygium grades in the final score (P = 0.759). There was a mean difference of H1R between primary pterygium (42.50) and normal conjunctival tissue (14.50) with P

Retinoblastoma, a rare eye malignant tumor of childhood, is generally responsive to chemotherapy or radiation therapy, but the survivors have high risk to development of second primary tumors (SPTs) due to genetic susceptibility and/or prior radiation therapy. The SPTs predominantly occured among heritable form of Retinoblastoma and show worse prognosis than Retinoblastoma itself. A 13 years old girl underwent enucleation to remove tumor mass within her left orbit. This tumor initially appeared 4 years after the patient undergoing right bulbar enucleation and receiving chemotherapy due to Retinoblastoma in her right eye. Clinical and radiologic examination suspected the left one as a late presentation of bilateral Retinoblastoma, but microscopic examination revealed a combined Extraskeletal Chondrosarcoma. The histologic type of this SPT is rare, so does it occurance at younger age and in a survivor with unilateral Retinoblastoma wihout a history of radiation therapy. The treatment of choice is combine surgery and chemo/radiation therapy, and the prognosis is poor.

Background: Orbital metastases are rare in pulmonary adenocarcinoma and can be manifested as glaucoma.Case: A 64-year-old male patient complained of swelling, redness, painful and protruded left eye. Physical and radiological examination revealed mass in the right lung, retrobulbar intraconal mass of the left oculi, and metastases in the ribs, liver, brain, and vertebrae. Result of bronchial mucosal biopsy showed adenocarcinoma. Epidermal growth factor receptor (EGFR) mutation examinations detected exon 19 deletions, therefore Gefitinib was given. Left orbital exenteration was performed and obtained a biopsy result of adenocarcinoma metastases.Conclusion: Orbital metastasis occurs by hematogenous pathway due to direct access of systemic circulation to left orbital blood flow. Glaucoma as a symptom of orbital metastases can appear before primary tumor symptoms, because lung cancer often does not show specific symptoms until advanced stage. Definitive treatment consists of targeted therapy and surgical management for metastases.

BACKGROUND: Pterygium is an eye disease with multifactorial etiopathogenesis. Molecular factors such as cell proliferation and inflammatory mediators are associated with increased calcium mobilization and activation of nuclear factor kβ mediated by histamine-1 receptors (H1R). AIM: This study aims to determine whether the expression of H1R primary pterygium tissue is higher than normal conjunctival tissue and the expression of H1R based on pterygium grades. METHODS: This study was an analytic observational study with a case-control study approach at Sanglah General Hospital, Bali Mandara Eye Hospital, and Mangusada Hospital. The study was conducted from November 2017 to April 2018. The pterygium and conjunctival tissues obtained from 28 subjects in the same eye and examined for H1R expression by immunohistochemistry. RESULT: The results of this study obtained 64.3% of women with a mean age of 54.2 ± 7.8 years. There was no difference in mean H1R expression between pterygium grades in the final score (P = 0.759). There was a mean difference of H1R between primary pterygium (42.50) and normal conjunctival tissue (14.50) with P

Retinoblastoma is a primary intraocular tumor on childhood. It has a good prognosis with early detection. Aim of this study is to know Pathological Risk Factors (PRF) profile of enucleated retinoblastoma at Sanglah General Hospital. This study is an observational retrospective study based on patient’s medical record and pathological examination. Twenty patients were included in this study, 50% were female and 50% male within age ranging from 7 month – 12 years old. Unilateral retinoblastoma was found in 18 patients (90.5%), bilateral retinoblastoma was found in 2 patients (9.5%). Majority PRF profile found that cancer cell invasions was 60% choroid infiltration and 45% of anterior segment invasion, 60% of optic nerve infiltration, and 50.1% scleral invasion. Tumor cell aggregation showed 61.9% poorly differentiated malignant cells. None of the patients had family history of retinoblastoma. This study revealed optic nerve and choroid invasion were the major PRF found in retinoblastoma, but there is a significant association between scleral infiltration and tumor cell differentiation (p = 0.025). There was no statistical difference of PRF based on age, gender, and laterality.

BACKGROUND: Incomitant exotropia is one of ocular complication that has been reported after intranasal surgery. This case report aims to describe the causes of exotropia in a patient with a history of nasal polyp surgery.CASE PRESENTATION: A 50-years-old male, came with the main complaint of double vision 1 month after nasal polyp surgery. He also complained his right eye turned outward. The visual acuity on the right eye was 6/7.5 with his head turn to the left. On the examination, the Hirschberg test was XT 45°, and the Krimsky test > 95 ∆BI. Duction and version test on the right eye were -4 adduction. There was no shifting on the cover-uncover test. Ishihara test was within normal limit, and there was suppression on the right eye in WFDT. On force generation test, we found limited adduction on the right eye and no restriction in force duction test. Head MRI showed atrophy of medial recti on the right eye, 2.2 mm in size. The patient underwent vertical muscle transposition procedure surgery, and it was found atrophy of medial recti without any rupture. Two months after surgery, the double vision was decreased, the result of the Hirschberg test was XT 30° and Krimsky test 65°∆BI. DISCUSSION: Nasal polyp surgery-related incomitant exotropia mostly caused by extraocular muscles rupture. In this case, we found no rupture. Therefore, we suspected the abnormalities of muscles vascularisation, supported by the atrophy of medial recti.

Background: Pterygium is a common ocular disease with etiology that has not yet well understood. Study on adult populations show the prevalence of pterygium tend to begin at fifth decade of age. The aim of this study is to determine the prevalence of pterygium and its relation to age, gender, educational level, occupation, hours spent outdoors per day, use of protective equipments, hypertension, and smoking as risk factors of pterygium among population age 50 years and above in Bali. Method: An analytic cross sectional study was conducted among population age 50 years and above in Bali between November to December 2015. The data were collected by interview using questionnaire and examinations. There were 720 subjects involved in this study. Chi square and multivariate analysis using Poisson regression were used for detecting association between risk factors with pterygium. Results: Pterygium was found in 36.4% subjects. Multivariate analysis showed pterygium was significantly related with educational level and occupation (APR 0.858; 95% CI 0.741-0.995 and APR 1.755; 95% CI 1.302-2.366, respectively). Conclusion: Prevalence of pterygium in population aged above 50 years in Bali was 36.4%. Pterygium was significantly associated with educational level and occupation in population aged above 50 years in Bali.