BLINDNESS

OUTLINE
INTRODUCTION
EPIDEMIOLOGY
CAUSES
CATARACT
GLAUCOMA
CHILDHOOD BLINDNESS
 INTRODUCTION
 WHO DEFINED BLINDNESS AS VISUAL
ACUITY < 3/60 IN THE BETTER EYE.
 EPIDEMIOLOGY
 WOLRDWIDE IN DISTRIBUTION
 MAJORITY IN ASIA , AFRICA & LATIN
AMERICA
 PREVALENCE;0.15-0.25% IN DEVELOPED
COUNTRIES & UP TO 8.2% IN
DEVELOPING COUNTRIES.
 1% IN NIGERIA
 CAUSES
 CATARACT
 GLAUCOMA
 TRACHOMA
 ONCHOCERCIASIS
 CORNEAL BLINNDNESS IN CHN; XEROPHTALMIA,
MEASLES, OPHTALMIA NEONATORUM
 TRAUMA
 OPTIC ATROPHY; CONGENITAL, HEREDITERY,
MENINGITIS, HYDROCEPHALOUS, BRAIN TUMOURS,
ALCOHOL INTOXICATION, HEAD &
 CAUSES CONTD
 ORBITAL INJURIES
 CONGENITAL CATARACT
 CONGENITAL GLAUCOMA
 SYSTEMIC DISEASE;DM, HT
 RETINAL DETACHMENT
 UVEITIS
 CORNEAL SCAR;INFECTIONS PTHYSIS BULBI
 UNCORRECTED REFRACTORY ERROR
 CATARACT
 OUTLINE
 INTRODUCTION
 EPIDEMIOLOGY
 CLASSIFICATION
 FEATURES
 INVESTIGATION
 RX
 COMPLICATIONS
 DIFFERENTIALS
 INTRODUCTION
 CATARACT MEANS OPACITY OF THE
LENS. IT IS THE COMMONEST CAUSE OF
TREATABLE BLINDNESS WORLDWIDE
 EPIDEMIOLOGY
 MAJORITY OF CATARACT OCCUR IN
OLDER PEOPLE BECAUSE OF EXPOSURE
TO ENVTAL AND OTHER IFLUENCES;
INCRESED BLOOD GLUCOSE & UV
RADIATION
 GREATER THAN 20 MILLION PPL
WORLDWIDE ARE BLIND DUE TO
BILATERAL CATARACT.
 CLASSIFICATION
 AETIOLOGICAL
 SENILE
 TRAUMATIC
 PHYSICAL;PENETRATING/BLUNT
 RADIATION
 METABOLIC; DM, GALACTOSEMIA
 TOXIC;STERIODS,CPZ, BUSULPHAN
 MATERNAL INFXN;CMV,RUBELLA,TOXO
 MATERNAL DRUGS;THALIDOMIDE, STER
 PRESENILE
 ATOPIC DERMATITIS
 SYNDROMES;MARFAN, DOWN
 HEREDITARY
 SEC/COMPLICATING; ANT UVEITIS, HIGH MYOPIA
 CLASSIFICATION CONTD
 MORPHOLOGICAL
 CAPSULAR
 SUBCAPSULAR
 CORTICAL
 NUCLEAR
 LAMELLA
 SUTURAL
 CLASSIFICATION CONTD
 STAGE OF DEVELOPMENT
 IMMATURE
 MATURE
 HYPERMATURE
 INTUMESCENT
 MORGANIAN
 CLASSIFICATION CONTD
 ACCORDING TO AGE
 CONGENITAL
 INFANTILE
 JUVENILE
 PRESENILE
 SENILE
 CLINICAL FEATURES
 WHITE REFLEX
 NYSTAGMUS, IF BILATERAL
 SQUINT, IF UNILATERAL
 OTHER OCCULAR
ABNORMALITIES;MICROPHTALMOUS
 IMPARIED VISUAL ACUITY
 INVESTIGATIONS
 MATERNAL ANTIBODIES IN RUBELLA
 ENZ STUDY IN GALACTOSEMIA
 BLOOD SUGAR
 URINE CHROMATOGRAPHY IN LOWE’S
 SERUM CALCIUM
 CHR ABNORMALITIES IN OTHER DZS
 TREATMENT
 IN ADULT, IF INTERFERS WITH
PATIENT’S QUALITY OF LIFE
 URGENTLY TREATED IN CHN
 MAINSTAY IS SURGERY
 SURGERY
 INTRACAPCULAR CATARACT EXRACTION
 Displaced vitreous humour
 Zonular rupture
 Marfan’s synd
 Pt is too sick for ICCE
 SURGERY CONTD
 METHODS
 CRYOEXTRACTION
 VECTIS

 WIRE EXRACTION

 VACCUM

 THUMBLING

 EXTRACAPSULAR CATARACT
EXTRACTION.
 COMPLICATIONS
 PRE-OP
 TISSUE DAMAGE
 HAEMORRHAGE
 NERVE INJURY
 COMPLICATIONS CONTD
 INTRA-OP
 HAEMORRHAGE
 PERFORATION OF EYEBALL

 TRAUMA TO OPTIC NERVE

 CENTRAL RETINAL OCCLUSION

 IRIS TEAR

 HYPHEAMA

 POST CAPSULE RENT

 LENS LOST INTO VITREOUS

 VITREOUS LOSS
 COMPLICATIONS CONTD
 EARLY POST-OP
 INFECTION
 SUB-CONJUNCTIVAL HAEMORRAGE
 CHEMOSIS
 WOUND BREAKDOWN
 IRIS PROLAPSE
 SHALLOW/FLAT ANT CHAMBER
 CHOROIDAL DETACHMENT
 HYPHEMA
 HYPOYON
 UVEITIS
 GLAUCOMA
 COMPLICATIONNS CONTD
 LATE POST-OP
 EPITHELIAL INGROWTH
 CORNEAL OPACITY
 GLAUCOMA
 UVEITIS
 POST CAPSULAR OPACITY
 ENDOPHTALMITIS
 RETINAL DETACHMENT
 OPTIC ATROPHY
 MACULAR OEDEMA
 ASTIGMATISM
 REHABILITATION
 INTRAOCCULAR LENS IMPLANT
 CONTACT LENS
 SPECTACLES
 GLAUCOMA
 OUTLINE
 INTRODUCTION
 EPIDEMOLOGY
 AETIOPATHOGENESIS
 RISK FACTORS
 CLASSIFICATION
 CLINICAL TYPES
 INVESTIGATIONS
 TREATMENT
 COMPLICATIONS
 DIFFERENTIAL DIAGNOSIS
 INTRODUCTION
 A MULTIFACTORIAL OPTIC NUEROPATHY
CHARACTERISED BY VISUAL FIELD LOSS
AND CUPPING OF OPTIC DISC USUALLY
CAUSED BY RAISED INTRAOCCULAR
PRESSURE.
 EPIDEMIOLOGY
 IT IS WORLDWIDE IN DISTRIBUTION
AND AFFECTS PPL OF ALL AGE GROUPS.
 IT IS THE COMMONEST CAUSE OF
IRREVERSIBLE BLINDNESS.
 IT AFFECTS AN ESTIMATED 1% OF THE
POPULATION.
 AETIOPATHOGENESIS
 IMBALANCE BETWEEN THE PRODUCTION
AND DRAINAGE OF AQUEOUS HUMOUR
 MECHANICAL COMPRESSION
 ISCHAEMIA OF THE OPTIC NERVE
 NORMAL INTRAOCCULAR PRESSURE
 10-21mmHg BY APPLANATION
 12-25mmHg BY INDENTATION
 RISK FACTORS
 PAISED INTRAOCCULAR PRESURE
 AGE >40 YEARS
 AFRICAN DECENT
 POSITIVE FAMILY HISTORY
 SYSTEMIC DISEASE; DM, HT, VASCULITIS,
HYPOTENSION
 MYOPIA
 PROLONGED STERIOD USE
 TRAUMA
 MIGRAINE
 CLASSIFICATION
 DEVELOPMENTAL
 CONGENITAL
 INFANTILE
 ACUIRED
 PRIMARY
 OPEN ANGLE
 CLOSED ANGLE
 SECONDARY
 TRAUMA
 OCCULAR SURGERY
 ASSCTED OCULAR; UVEITIS
 STEROID INDUCED
 RAISED EPISCLERAL VENOUS PRESURE
PRIMARY OPEN ANGLE GLAUCOMA
 THE TRABECULAR MESHWORK IS CLEAR
 THERE IS INCREASED RESISTANCE TO THE
OUTFLOW OF AQUEOUS WHICH LEADS TO
INCREASED IOP
 CAUSES;
 THICKENING OF THE TRABECULAR MESHWORK
WHICH REDUCES PORE SIZE
 REDUCTION IN THE NUMBER OF LINING
TRABECULAR CELLS
 INCREASED EXTRACELLULAR MATERIAL IN THE
TRABECULAR MESHWORK
 CLINICAL PRESENTATION
 USUALLY ASYMPTOMATIC UNTIL LATE
 OCCULAR PAIN
 HALOES
 DEFECTIVE VISION
 TIRED EYES
 EXAMINATION
 REFRACTION
 FUNDOSCOPY
 GONIOSCOPY
 SLIT LAMP EXAMINATION
 TONOGRAPHY
 TONOMETRY
 PERIMETRY
 ASSOCIATED FACTORS
 FAMILY HX OF GLAUCOMA
 MYOPIA
 RETINITIS PIGMENTOSA
 RETINAL VEIN OCCLUSION
 DM
 DIFFERENTIAL DIAGNOSIS
 ISCHAEMIC OPTIC NEUROPATHY
 LOW TENSION GLAUCOMA
 OCCULAR HYPERTENSION
 CLOSED ANGLE GLAUCOMA
 THERE IS MECHANICAL CLOSURE OF THE
AQUEOUS DRAINAGE DUE TO CONTACT
BTW THE IRIS & TRABECULAR
MESHWORK OR PERIPHERAL IRIS &
CORNEA
 CLINICAL PRESENTATION
 HX OF PAST SIMILAR EPISODES
 SUDDEN DEFECTIVE VISION
 HEADACHE
 UNIOCCULAR PAIN
 NAUSEA
 VOMITTING
 HALO
 CONJUNCTIVAL CONGESTION
 CORNEAL CLOUDINESS & OEDEMA
 SHALLOW ANT CHAMBER
 FLARE
 SEMIDILATED & NON-REACTIVE
 NORMAL TENSION GLAUCOMA
 THERE ARE VISUAL FIELD LOSS & CUPPING OF THE
OPTIC DISC
 CONGENITAL GLAUCOMA
 MAY BE PRESENT AT BIRTH OR WITHIN THE FIRST
YEAR
 SYMPTOMS VIZ; EXCESSIVE TEARING, INCREASED
CORNEAL DIAMETER, PHOTOPHOBIA,DIFFUSE
CORNEAL OEDEMA
 ASSCTED SYND; STURGE-WEBER,LOWE,S
 SECONDARY GLAUCOMA
 TRAUMA,UVEITIS ETC
 TREATMENT
 MEDICAL
 B-BLOCKERS
 PARASYMPATHOMIMETICS
 SYMPATHOMIMETICS
 PROSTAGLANDIN ANALOGUES
 CARBONIC ANHYDRASE INHIBITORS
 TREATMENT CONTINUED
 LASER
 LASER TRABECULOPLASTY
 LASER IRIDOTOMY
 CYTOPHOTOCOAGULATION
 SURGERY
 TRABECULECTOMY