Chapter 2

II D|sorders of
the eye
1he eye ls locaLed
ln proLecLlve bone
known as Lhe orblL
@he eye has three |ayers
1ket|na |nner
2choro|d m|dd|e ends as |r|s
3Sc|era outer ends as cornea
uveal LracLs
rls
Cllllary muscles
Chorold layer
uveal LracLs
rls
Cllllary muscles
Chorold layer
ssessment of the eye and v|sua| status
1 V|sua| acu|ty
W n eye assessmenL ob[ecLlve daLa collecLlon
beglns by assesslng Lhe paLlenLs vlsual aculLy
W L can be measured ln varleLy of ways buL buL
usually measured by uslng Sne||en's charL
Sne||en's chart
W L ls lmprlnLed wlLh alphabeLlcal leLLers
graduaLlng ln slze from Lhe smallesL ln Lhe
boLLom and largesL on Lhe Lop
ssessment of the eye con't
W 1he examlner measures 20 feeL and marks Lhe
dlsLance on Lhe floor
W 1he examlner Lhen ask Lhe paLlenL Lo cover one
eye and read ouL loud an lndlcaLed llne of leLLer
W 1he lowesL llne on Lhe charL LhaL Lhe paLlenL ls
able Lo read accuraLely ls used Lo lndlcaLe vlsual
aculLy for LhaL eye
W normal vlslon ls 20/20 whlch means Lhe paLlenL
can read aL 20 feeL whaL a normal eye can read aL
20 feeL
W usual lmpalrmenL occurs aL 20/70 and
legal bllndness ls 20/200 or more
lor example Lhe flndlng for Lhe
paLlenL who ldenLlfles all leLLers
correcLly aL Lhe llne marked 30 ls
recorded as 20/30 Lhls means Lhe
paLlenL can see aL 20 feeL an average
lndlvldual can see aL 30 feeL
W Lhe examlnaLlon ls conducLed on boLh
eyes separaLely Lhen LogeLher and
documenLed as follows
oculus uexLer D 20/20 rlghL eye
culus slnlsLer S 20/20 lefL eye
culus uLerque D 20/20 boLh eyes
W penllghL ls shown Lowards Lhe pupll from
a laLeral poslLlon and movemenL of Lhe
pupll ls observed
W 1he pupll should qulckly consLrlcLed Lhls ls
known as dlrecL response reacLlve Lo llghL
W 1hen proceed Lo examlne accommodaLlon
W ccommodaLlon ls Lhe ablllLy of Lhe pupll Lo
respond near and far ob[ecL
2 uplary reflexes
W uplls are observed and of should be
round symmeLrlcal and reacLlve Lo
llghL
W 1o LesL pupllary response a sllghLly
dark room works besL
W 1he paLlenL ls asked Lo look sLralghL
ahead and Lhe slze of Lhe puplls noLed
W 1he paLlenL ls Lold Lo focus on an ob[ecL far
away and Lhe slze and shape of Lhe puplls
are observed
W 1he examlner conLlnues Lo observe Lhe puplls
aL Lhe paLlenL focus on near ob[ecL normally
Lhe puplls consLrlcLed
W 1he examlner uses Lhe acronym 9kkL Lo
lndlcaLe 9uplls qual kound keacLlve Lo
LlghL and ccommodaLlve
3 phLhalmoscope examlnaLlon Lhe
ophLhalmoscope magnlfles Lhe
sLrucLure of Lhe eyes so LhaL Lhe
examlner can vlsuallze Lhe reLlna
opLlc nerve and blood vessels
4 Measurlng lnLra ocular pressure by
uslng 1onomeLer
W normally Lhe ls 12 20 mmPg
efracLlve Lrrors
W efracLlon refers Lhe bendlng of Lhe llghL as
lL enLers Lhe eye
W normal vlslon emmetrop|a means LhaL
llghL rays bend Lo focus lmages preclsely on
Lhe macula of Lhe reLlna
W metrop|a ls Lhe Lerm used Lo dlscrlbe any
refracLlve errors
W When Lhe lmage ls noL clearly focused on
Lhe reLlna refracLlve error ls occurred
efracLlve Lrrors con'L
W efracLlve error accounLs for Lhe largesL
number of lmpalrmenL ln vlslon
W 1here are four dlfferenL refracLlve errors
1 nyperop|a
W lar slghLedness
W LlghL rays focuslng behlnd Lhe reLlna
W eople who are hyperoplc can see
ob[ecLs far more clearly Lhan ob[ecLs
LhaL are close
W hyslologlcally ln hyhperopla Lhe globs
are Loo shorL from Lhe fronL Lo Lhe back
causlng Lhe llghL rays Lo be focused
beyond Lhe reLlnaxlal lengLh
W 1he refracLlve power of Lhe eye ls Loo
weak
W aLlenLs wlLh hyperopla are known as
hyperopes
W L ls correcLed by convex lenses
2 Myop|a
W nearslghLedness
W ays focused ln fronL of reLlna
W 1he eye ball ls elongaLed and Lhus Lhe llghL
rays do noL reach Lhe reLlna eople wlLh
myopla hold Lhlngs close Lo Lhelr eyes Lo see
Lhem beLLer
W ulsLance becomes blurred
W CorrecLed wlLh concave lenses
3 st|gmat|sm
W ecause of unequal curvaLure ln Lhe
shape of cornea
W arallel llghL rays lnLer ln Lo Lhe lrregular
cornea causes Lhe rays Lo be refracLed Lo
focus on Lwo dlfferenL polnLs
W 1hls can resulL lL ln elLher myoplc or
hyperoplc asLlgmaLlsm
W 1he person wlLh asLlgmaLlsm has blurred
vlslon wlLh dlsLorLlon
W 1he corneal lrregularlLy may be caused by
Lrauma or heredlLary lnherlLed auLosomal
domlnanL LralL
9resbyop|a
W L ls a condlLlon ln whlch a crysLalllne lenses
loses Lhelr elasLlclLy resulLlng ln decreased
ln ablllLy Lo focus on near ob[ecLs
W 1he lose of elasLlclLy causes Lhe llghL rays Lo focus
beyond Lhe reLlna
W 1hls condlLlon ls usually assoclaLed wlLh aglng and
generally occurs aL Lhe age above 40
W f an lndlvldual have pre exlsLlng hyperopla Lhe
onseL of presblopla may occur earller Lhan 40
years
W Llkewlse ln case of myopla lL may occur laLer or lL
may correcL Lhe myopla by pro[ecLlng Lhe llghL
rays dlrecLly Lo Lhe reLlna
S|gn]symptoms of refract|ve errors
W ulfflculLy of readlng or seelng ob[ecLs
W Peadache due Lo sLress
W Myoplc lndlvlduals hold reachlng
ob[ecLs close Lo Lhelr eyes
W Pyperoplc hold reachlng ob[ecLs far
away from Lhelr eyes
omp||cat|on
W elaLed use of correcLlve lenses
W rlmarlly relaLed Lo safeLy
W f lL ls conLacL lens lL may cause
corneal abraslon lnfecLlon and
keraLlLls
nfecLlous/lnflammaLory dlsorders
of Lhe eye
W ne of Lhe mosL common condlLlon
encounLered by Lhe ophLhalmologlsL
ls lnflammaLlon/lnfecLlon of Lhe
exLernal eye
W 1he followlng are Lhe common
lnflammaLory/lnfecLlous condlLlons
of Lhe eye
nfecLlous/lnflammaLorycon'L
nordeo|um]sty
W L ls an lnfecLlon of Lhe sebaceous gland ln
Lhe lld margln
W 1he mosL common causaLlve agenL ls
bacLerla speclflcally sLaphlococcus aureus
W Cllnlcally Lhe paLlenL presenLs wlLh red
swollen clrcumscrlbed and acuLely Lender
area develops rapldly
W n managemenL you should lnsLrucL
Lhe paLlenL Lo apply warm molsL
compress aL leasL four Llnes per day
unLll lL lmproves
W nLlbloLlcs lf wlLh abscess 11C
W f Lendency Lo recurrence lnclslon
and dralnage followed by lld scrub
ha|az|on
W nflammaLlon of sebaceous gland ln Lhe
lld
W L may be evolved from Lhe hordeolum
W L appears as swollen no palnful redden
area usually on Lhe upper eye lld
W 1he managemenL ls slmllar Lo
hordeolum
|ephar|t|s
W Chronlc bllaLeral lnflammaLlon of Lhe of Lhe lld
marglns
ause sLaphylococcal or seborrhelc
W Cllnlcally Lhe paLlenL presenLs red eye lld margln
lash loss burnlng lrrlLaLlon forelgn body
sensaLlon and phoLophobla
Management anLlbloLlcs cloxacllllne
W Pyglenlc pracLlce warm compress
W CenLle cleanslng
on[unct|v|t|s
W Con[uncLlval lnflammaLlon or lnfecLlon
ause bacLerla
W Ilrus allergles or chemlcals
W lorelgn body ln Lhe eye
W Slgn/sympLoms lrrlLaLlon Learlng
W edness and mucoprulenL dralnage
W Con[uncLlval swelllng
W lLchlng and phoLophobla
acLerlal con[uncLlvlLls
urulenL dlscharge
Con[uncLlval hyperemla
Ilral con[uncLlvlLls
ulffuse redness
WaLery dlscharge
Con[uncLlvlLlsllerglc
LryLhema
no waLery dlscharge
ulscharge Cause
urulenL acLerla
Clear Ilral
WhlLe sLrlngy mucous llergles
Management anLlbloLlcs 11C eye olnLmenL
W Careful eye washlng
W PydrocorLlsone eye olnLmenL anLhlsLamlne
W cyclovlr 200mg/po/3xday for a week
erat|t|s
W Corneal lnfecLlon or lnflammaLlon
auses bacLerla or vlrus
W ConLacL lens wearers are prone Lo
acanLamoeba keraLlLls
W nchocerkal keraLlLls rlver bllndness
W IlLamln deflclency fungl
S|gn]symptoms paln red waLery eye
W 1earlng
W lurrlng vlslon phoLophobla
Management Loplcal anLlbloLlcs
W nLlpaln
W Wearlng eye glass
W cyclovlr lf vlral orleglnaLed
ornea| u|cer
W L ls corneal Llssue loss due Lo lnfecLlon of
Lhe cornea or Lrauma
auses bacLerla fungl vlrus Lrauma
W Slgn/sympLoms paln and Lhe paLlenL may
feel as forelgn body ln Lhe eye
W redness and phoLophobla
@reatment anLlbloLlc every hours for around
Lhe clock Lhen Lo Lhe normal dose
@rachoma
W rough eye
W Plghly conLaglous and leads Lo bllndness
W lL ls one of Lhe con[uncLlvlLls buL hlghly
conLaglous
W WP classlfled as
1rachomaLous lnflammaLory
1rachomaLous Lrlchlasls
ause Chlamydla LrachomlLls
9ath phys|o|ogy
W Lchlng ln Lhe con[uncLlva of Lhe eye
W onus formaLlon ln Lhe lnner porLlon of Lhe
eye
W Scarlng of Lhe lnslde of Lhe eye lld
W 1he eye lld turns |nward lnLroplon and Lhe
|ash rubs Lhe eye ball Lrlchlasls
W Scarlng of Lhe cornea gray presenLaLlon
W rreverslble corneal opaclLy and bllndness
Mode of transm|ss|ons
W ulrecL conLacL wlLh Lhe eye nose and
LhroaL secreLlon of Lhe affecLed
lndlvldual
W ndlrecLly conLacL wlLh ob[ecLs such as
Lowel hand kerchlef flngers flles or
wash cloLhes LhaL are conLamlnaLed
S|gn]symptoms
W Swollen eye lld wlLh paln
W Lye dlscharge whlch ls sllghLly mucoprulenL
W Corneal scarlng and phoLophobla
W Con[uncLlval folllcles and paplllae
W nLroplon or Lrlchlasls of Lhe upper eye lld
W Scarlng of upper eye lld con[uncLlva
Management SlL sLraLegles
W Surgery Lrlchlasls and lnLroplon
W nLlbloLlcs 11C eye olnLmenL dally for 01
monLh
LryLhromyclne 300mg/po/Cld
W aclal cleanllness good hand and face
washlng
W nvlronmenLal change address waLer
sLorage eradlcaLe flles
Sc|er|t|s
W L ls an lnflammaLlon and swelllng of Lhe sclera
auses assoclaLed wlLh connecLlve Llssue dlsorders
llke rheumaLlc arLhrlLls
s|gn]symptoms severe paln
W 1he whlLe parL of Lhe eye may appear red swollen
and severely palnful Lo Louch
Management heavy lmmunosuppressanL ls needed
W SysLemlc corLlcosLerold and LreaL Lhe underllne
cause
Dve|t|s
W s an lnflammaLlon of uveal LracLs
auses Loxoplasmosls
W Perpes zosLer and herpes slmple
vlruses
W ocular candldacles 1 syphllls
W Common ln lmmounoseppressed
S|gn]symptoms paln
W cuLe ln onseL
W hoLophobla
W upll wlll be small and lrregular
W Ilslon wlll be blurred
W nLerlor synechla fuslon of cornea wlLh lrls
W osLerlor synchla fuslon of lens wlLh lrls
Management mydrlasls pupll dllaLor
aLroplne 2 drops/bld
W Local corLlcosLerold drops
PydrocorLlsone 20 eye drop apply dally
n severe cases sysLemlc corLlcosLerolds
can be used
W wearlng dark glass for phoLophobla
9anophtha|m|t|s
W s an lnflammaLlon of all Lhe Llssue of Lhe eye ball
auses bacLerla vlrus fungl
W Common ln lmmunosepressed paLlenL
W ecenL lnLraocular operaLlon
W eneLraLlng Lrauma
S|gn]symptoms severe paln
W Loss of vlslon
W edness of Lhe con[uncLlva
Management Loplcal sLerolds
W 11C eye olnLmenL or oLher
anLlbacLerlal agenL llke genLamyclne
W LnucleaLlon surglcal removal of Lhe
eye
n[urles Lo Lhe eye
W n[ury Lo Lhe eye ls Lrauma Lo Lhe eye
ball perlorblLal sofL Llssue wall of Lhe
orblL and orblLal marglns of Lhe eye
auses blunL conLuslon
W rblLal fracLure
W lorelgn bodles
W CuLLlng ob[ecLs
n[urles con'L
S|gn]symptoms swelllng and
dlscoloraLlon of Lhe eye
W leedlng lnLo Lhe Llssue and sLrucLure of
Lhe eye
W aln wlLh lacrlmaLlon
W lorelgn body sensaLlon and dlplopla
W lLered lnLraocular pressure
W phoLophobla
n[urles con'L
Management bed resL and eye shleld
W emoval of forelgn body by lrrlgaLlon
coLLon Llpped appllcaLor or magneL
W Surglcal repalr
W nLlbloLlcs
W SLerolds
W LnucleLlon
urn of the eye
W L ls Lhe desLrucLlon of Lhe eye Llssue by
chemlcal Lhermal and ulLravloleL llghL
S|gn]symptoms paln urned skln bllsLers
W LacrlmaLlon phoLophobla
W lorelgn body sensaLlon
Management lrrlgaLlon anLlbbloLlcs
W aln conLrol dlclophenac lbuproflne
W Skln grafLlng wlLh severe 2
nd
and 3
rd
degree
burn
Detachment of the ret|na
W eLlnal deLachmenL ls separaLlon of Lhe
sensory reLlna and Lhe underllng plgmenL
eplLhellum wlLh fluld accumulaLlon beLween
Lhe Lwo layers
auses Lrauma excesslve llghL
W Slgn/sympLoms paln less
W Loss of perlpheral or cenLral vlslon
W hoLophobla blurred vlslon
W SensaLlon of coaLlng comlng down comlng up
or comlng sldeways ln fronL of Lhe eye
Detachment of the ret|na con't
Management sedaLlon
W ed resL
W Lye paLch
W Surglcal managemenL by
phoLocoagulaLlon
ther cond|t|ons of the eye
ataract
W s an opaclLy wlLh n crysLalllne lens
W L may occur ln one or boLh eyes
W 1he 3
rd
leadlng cause of prevenLable bllndness
ln Lhe world
W pproxlmaLely 30 of caLaracL paLlenLs are
age 63 and above
auses age blunL or peneLraLlve ln[urles
W Long Lerm corLlcosLerold LreaLmenL
ther cond|t|ons con't
W adlaLlon or uI llghL exposure
W cular lnflammaLlon
W ulsease llke uM by denaLurlng Lhe lens fluld
9atophyso|ogy opaclLy ls due Lo
accumulaLlon of fluld and alLeraLlon ln Lhe
low flber sLrucLure accounLs Lhe ma[or
facLors
W 1hese changes resulL ln change ln lens
Lransparency Lo opaclLy
S|gn]symptoms decrease ln vlslon
W bnormal color percepLlon
W WhlLe pupll**
Management Lhe only cholce ls surglcal
removal of cloudy lens
W uslng eye glass afLer surgery
W eplaclng Lhe lens wlLh synLheLlc lnLra
ocular lens
G|aucoma
W Claucoma ls Lhe group of dlseases LhaL resulLs ln
lncrease ln lnLra ocular pressure of Lhe eye
W 1he pressure cause damage Lo Lhe cells of Lhe
opLlc nerve
W 1he damage ls sllenL progresslve and lrreverslble
unLll Lhe end sLage
Claucoma passes Lhe followlng phases
erlpheral vlslon loss
Loss of cenLral vlslon
LvenLually llndness
W nce glaucoma ls occur Lhe paLlenL wlll always
have lL and musL follow LreaLmenL Lo malnLaln
sLable lnLra ocular eye pressure
W Causes lL occurs when Lhere ls non proper balance
beLween Lhe raLe of aqueous producLlon and Lhe
raLe of aqueous reabsorpLlon Lo malnLaln wlLh
normal llmlL
W n glaucoma Lhe raLe of lnflow ls greaLer Lhan Lhe
raLe of ouL flow
W beLween 12 Lo 20mmPg are consldered as
normal
1he mosL common forms of glaucoma are
1 rlmary glaucoma whlch conslsLs of Lwo Lypes
1 pen angle glaucoma
2 Closed angle glaucoma severe
2 Secondary glaucoma may be caused by lnfecLlon
Lumor or ln[ury
3 1hlrd form of glaucoma also called as congenlLal
glaucoma
Closed angle glaucoma occurs ln people who
have an anaLomlcally narrowed angle aL Lhe
[uncLlon where Lhe lrls meeL Lhe cornea
W When Lhere ls narrowed angle lL resulLs ln
angle occluslon whlch blocks Lhe flow of
aqueous fluld
pen angle glaucoma usually occurs due Lo
lmbalance beLween producLlon and dralnage
speclally when Lhe producLlon greaLer Lhan
Lhe dralnage
S|gn]symptoms severe paln over affecLed eye
W lurred vlslon
W aln bows around Lhe llghL**
W Lye redness
W SLeamy appearlng cornea
W hoLophobla and Learlng
W nausea and vomlLlng pro[ecLlle
W Peadache
Management lower as qulck as posslble by
medlcal means
W llocarpln drop 2 4 drop every 3 mlnuLe for
an hour and Lhen every hour for 12 hours
W clLazoamlde 230mg/po/qld
W I manlLol dlureLlcs
Surglcal managemenLs
W rldecLomy rlsk reducLlon
f no lmprovemenL wlLh pllocarpln glve Llmolol
023 ld Llll Lhe condlLlon resolves
D|abet|c ret|nopathy
W L ls a compllcaLlon of uM LhaL affecL Lhe
reLlnal blood vessels
9athophys|o|ogy weakenlng of Lhe walls of
mlcro blood vessels
W Caplllary dllaLlon decreased caplllary blood
flow
W eLlna becomes lschemlc and deaLh of reLlan
may occur
S|gn]symptoms sudden and severe loss vlslon
W leedlng ln vlLreous
Management phoLocoagulaLlon Lherapy
W roper managemenL of uM
Strab|smus squ|nt
W s a condlLlon by whlch Lhe Lwo eyes are looklng
ln dlfferenL dlrecLlons
W 1he cause ls unknown buL lL can resulL ln
dlsorder of vlslon or ln dlsorder of eye movemenL
L can be
W Movlng Lhe eye lnward Lowards Lhe nose/adducLlon
W Movlng Lhe eye ouL ward away from Lhe
nose/abducLlon
W Movlng Lhe eye upward/elevaLlon
W Movlng Lhe eye downward/depresslon
LffecLs of squlnL
W L can have double vlslon and abnormal head
posLure
Management cosmeLlc surgery ls Lhe only cholce
V|tam|n def|c|ency
W Slgn/sympLoms nlghL bllndness
W Con[uncLlnval xerosls
W blLoLls spoL
W Corneal xrosls
W Corneal ulceraLlon
W Corneal scarlng
Management vlLamln '' reLlnol/caroLlnol
W for 6monLh age 30000 u
W lor 6 monLh age 100000 u
W lor 12 monLh age 200000 u
W nexL day Lhe same speclflc dose
W Woman of reproducLlve age wlLh nlghL
bllndness should recelve 23000 u weekly
hapter rev|ew

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II D|sorders of

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