Eye trauma occurs from accidents and from debris in the air.

Not using safety goggles or glasses when

sanding or operating weed trimmers and various types of power equipment accounts for most
incidents of foreign bodies landing in the eyes.

Removal of Foreign Bodies from the EyeIf the foreign body is not deeply embedded in the tissues of
the eye, it can easily be removed by irrigation. Irrigation with clear, lukewarm water or sterile water
or saline is used to remove a foreign body sticking to the cornea. Continuous irrigation can be done
with small tubing, and a bottle of solution or an irrigating syringe or bottle can be used. The nurse
must be very careful not to touch the eye with the tip of the irrigating device. Sometimes a speck of
foreign matter on the cornea can be removed with a moistened, sterile cotton swab. Have the patient
tilt the head back. Hold the eyelids open to prevent blinking.

If a foreign body is sticking out of the eye, no attempt to remove it should be made. Both eyes should
be patched to prevent further eye movement, and the patient should be transported to the
emergency department or to an ophthalmologist. If the patient continues to complain of a sensation
that a foreign body is still in the eye after it appears to have been removed by irrigation, or complains
of continuing pain, refer to a physician immediately, as there may be a corneal abrasion.

The physician will apply a stain to the eye to assess whether the cornea is abraded. If there is an
abrasion, medicated ointment will be prescribed, and the eye will be patched. The patient must be
given instructions on how to instill the ointment (see Box 26-1). A thin line of eye ointment is applied
from the inner canthus to the outer canthus along the lower eyelid inside the conjunctival sac (Figure
27-4). The patient closes the eyelid and moves the eyeball around in the socket to distribute the
ointment. Excess medication is gently wiped away with a tissue, moving from the inner to the outer
canthus. If an eye patch is not applied, the patient is warned that the ointment may blur vision for a
while. A corneal abrasion is painful; a nonsteroidal anti-inflammatory drug may be used for
discomfort.

Chemical burns should be treated by lengthy, continuous irrigation. An IV bag of normal saline is the
preferred solution; otherwise, tap water will do. Place the patient supine with his head turned to the
affected side. With gloves on, direct the stream of fluid to the inner canthus so that the stream flows
across the cornea to the outer canthus, holding the lids apart with your thumb and index finger. At
intervals, stop and have the patient close his eyes to move secretions and particles from the upper
eye to the lower conjunctival sac; then begin again. The patient should be seen by a physician as soon
as possible. All commercial businesses where exposure to chemicals is a possibility must comply with
Occupational Safety and Health Administration (OSHA) standards and have an eyewash station within
the facility as close as possible to the area where chemicals are likely to be used.

Enucleation

If the eye is too damaged by trauma to be salvaged, or is irreparably damaged by disease or tumor,
enucleation (removal of the eye) is performed. An implant is created to maintain the orbital anatomy
while a matching artificial eye is created. The implant is sutured to the muscle structures. When the
artificial eye is placed, the muscle attachments allow for coordinated eye movement.

Postoperatively, observe for signs of complications such as excessive bleeding, swelling, increased
pain, elevated temperature, or displacement of the implant. Losing an eye is a devastating experience
even when there has been a long period of painful blindness preoperatively. Understanding of the
emotional impact and support of the patient are prime nursing responsibilities. The permanent
prosthesis is placed about 6 weeks after the surgery.

Care of an Artificial Eye

The procedure for cleansing and caring for an artificial eye is similar in many ways to the care of
dentures. Both require basic principles of cleanliness, careful handling, and proper storage. An
artificial eye is very expensive and must be handled very carefully.

The artificial eye is cleansed with gentle soap and water, unless the patient, his family, or the
physician directs otherwise. Keep it in a safe place to avoid damage. When the eye is to be reinserted,
it should be cleansed again with soap and water. When inserting or removing the prosthesis, have the
head over a padded surface. The patient’s upper lid is lifted, and the eye is inserted with the notched
end toward the nose. After the prosthesis is placed as far as possible under the upper lid, the lower lid
is depressed, allowing the eye to slip into place.

Signs, Symptoms, and Diagnosis

In addition to the blurred vision that is typical of opacity of the lens, with cataracts
laucoma

Etiology

The term glaucoma comprises a complex group of disorders that involve many
different pathologic changes and symptoms, but have in common an optic
neuropathy that damages the optic disc, causing atrophy and loss of
peripheral vision. The neuropathy often is caused by increased IOP
(National Eye Institute, 2011). Glaucoma may come on slowly and cause
irreversible visual loss without presenting any other noticeable symptoms,
or it may appear abruptly and produce blindness in a matter of hours.
Glaucoma can be present at birth, or can develop at any age. It can result
from genetic predisposition, trauma, or another disorder of the eye.
Glaucoma frequently is a manifestation of diseases and pathologies in
other body systems. The amount of increased IOP that causes damage differs
from one person’s eye to another. Blindness is preventable if the
disorder is treated early.

image

Think Critically

How can you include inquiries about family history or predisposing risk
factors for glaucoma into your patient care?

Pathophysiology

The IOP is determined by the rate of aqueous humor production and the
outflow of the aqueous humor from the eye. Aqueous humor is produced in
the ciliary body and flows out of the eye through the canal of Schlemm
into the venous system (Concept Map 27-1). An imbalance may occur from
overproduction by the ciliary body or by obstruction of outflow. Increased
IOP greater than 22 mm Hg requires thorough evaluation. Increased IOP
restricts the blood flow to the optic nerve and the retina. Ischemia causes
these structures to lose their function gradually. The vision impairment
from damage to the optic nerve or retina is permanent. Glaucoma may be
secondary to eye infection, trauma, eye surgery, or ocular tumor.

image

CONCEPT MAP 27-1 Pathophysiology of glaucoma.

There are three types of glaucoma: narrow-angle or angle-closure (acute)

glaucoma, open-angle (chronic) glaucoma (Figure 27-6), and associated or
secondary glaucoma. The terms narrow angle (angle closure) and open angle
refer to the angle width between the cornea and the iris. Acute and chronic
refer to either the onset or duration of the problem. These two major types
differ in their clinical signs and symptoms, treatment, and effects on
vision. Associated glaucoma may occur with diabetes mellitus,
hypertension, or extreme myopia, or after retinal detachment.

image

FIGURE 27-6 Comparison of open-angle (wide, chronic) and narrow-angle

(closed, acute) glaucoma.

Open-Angle Glaucoma

Signs and Symptoms

Open-angle, or chronic, glaucoma, in which there is no angle closure, is

much more insidious and more common, occurring in about 90% of people with
glaucoma. It often is an inherited disorder that causes degenerative
changes in the aqueous humor outflow tracts. It may be caused by a mixture
of factors of overproduction of aqueous humor and anatomical problems
within the eye. It usually is bilateral and can progress to complete
blindness without ever producing an acute attack. Its symptoms are
relatively mild, and many patients are not aware that anything is wrong
until vision has been seriously impaired.

image

Health Promotion

Danger Signals of Glaucoma

The National Society for the Prevention of Blindness lists the following
symptoms as danger signals of open-angle glaucoma:
• Glasses, even new ones, that do not seem to clarify vision

• Blurred or hazy vision that clears up after a while

• Trouble in getting used to darkened rooms, such as in movie theaters

• Seeing rainbow-colored rings around lights

• Narrowing of vision at the sides of one or both eyes

Encourage a complete eye examination if any of these signs is present.

Diagnosis

People at high risk for glaucoma are:

• Diabetics

• African Americans (at least four times as many African Americans as

non–African Americans have glaucoma-related blindness)

• Individuals with a family history of glaucoma

A commonly used screening technique for early detection of glaucoma is

to measure IOP with an air tonometer. A puff of air is directed at the
cornea, which causes a momentary indentation while a pressure reading is
taken (WebMD, 2010). The test is painless, and nothing but the air touches
the eye. Verification of the diagnosis of glaucoma may require the use
of a more complex instrument called an applanation tonometer (Figure 27-7).
The cornea is flattened and pressure is measured with a slit-lamp
biomicroscope.

image

FIGURE 27-7 Applanation tonometer.

Treatment

The initial treatment of choice for chronic (open-angle) glaucoma is

medication rather than surgery. If drugs are not effective, or if they
produce worrisome side effects, surgery is performed.

Drugs prescribed are intended to enhance aqueous humor outflow, decrease

its production, or both (Table 27-1). They do this by constricting the
pupil (miotics) or by inhibiting the formation of aqueous humor. Miotics
cause blurred vision for 1 to 2 hours after use. Adjustment to dark rooms
is difficult because of pupil constriction. Pilocarpine is available in
an eye medication disk that resembles a contact lens. The disk is inserted
into the conjunctival sac in a patient’s lower eyelid, where it can remain
for up to 7 days. The medication is slowly released. Use of the disk does
not prevent the wearing of contact lenses. Diuretics may be prescribed
to reduce the production of aqueous humor fluid. Not all diuretics reduce
IOP, and a substitute should not be used for the specific drug prescribed.

imageTable 27-1

Pharmacologic Management of Eye Disorders

Classification Examples Action/Nursing Implications

Drugs Used for Glaucoma

Miotics Prostaglandin analogs: latanoprost (Xalatan), bimatoprost
(Lumigan), travoprost (Travatan)Unoprostone isopropyl (Rescula)
Increase outflow of aqueous fluid through the ciliary muscle by
relaxation of the muscle.

Cholinergics: pilocarpine HCl (Isopto Carpine), pilocarpine nitrate

(Ocusert Pilo-20, Ocusert Pilo-40), carbachol (Miostat) Constrict the
pupil, promote outflow of aqueous humor, and reduce intraocular pressure.
Reduce visual acuity in dim light; advise patient to avoid driving at night.
Ocusert is placed in conjunctival sac and replaced weekly.

Cholinesterase inhibitors: echothiophate iodide (Phospholine iodide),

demecarium bromide (Humorsol) Produce miosis, increase aqueous humor
outflow, and decrease intraocular pressure. Avoid touching tip of bottle
to eye; moisture may interfere with drug potency.

Beta-adrenergic blockers: timolol maleate (Timoptic), betaxolol

(Betoptic), levobunolol (Betagan), metipranolol (OptiPranolol),
carteolol (Ocupress) Reduce production of aqueous humor, thereby
reducing intraocular pressure. Betoptic reduces intraocular hypertension.
Monitor pulse and blood pressure during initiation of therapy. Blurred
vision decreases with continued use. Use beta blockers cautiously in
patients with a history of asthma.

Carbonic anhydrase inhibitors Acetazolamide (Diamox), dorzolamide

(Trusopt), brinzolamide (Azopt)Interfere with carbonic acid production,
thereby decreasing aqueous humor formation and decreasing intraocular
pressure. Taken orally or as eyedrops (TruSopt). When taken orally, these
drugs have a diuretic action; observe for dehydration and postural
hypotension. Monitor electrolytes. Confusion may occur in the elderly.
Check interaction with other drugs patient is receiving.

Sympathomimetics Epinephrine (Epifrin), dipivefrin (Propine),

apraclonidine (Iopidine) Reduce intraocular pressure by increasing
aqueous outflow. May cause brow headache, headache, eye irritation, and
blurred vision. Used for open-angle glaucoma only. May cause tachycardia
and rise in blood pressure.

Alpha-2 adrenergic agonist Brimonidine tartrate (Alphagan) L Acts

on alpha receptors in the blood vessels, decreasing the production of
aqueous humor. Do not use with soft contact lenses. Contraindicated in
heart disease.

Anti-inflammatories Corticosteroids: Pred Forte, Ocu-Pred,

Ophtho-TateNSAIDs: ketorolac (Acular), flurbiprofen
(Ocufen)Prostaglandin analog: latanoprost (Xalatan) Decrease
inflammation and swelling; reduce miosis. Interact with contact lens
materials.

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NYSTAGMUS: 26 NYSTAGMUS MECHANISM * repetitive involuntary movements of one or both

eyes ETIOLOGY * Congenital * Brain tumors * CV lesions * Ear lesions * Alcohol/drug abuse

PowerPoint Presentation: 27 SYMPTOMS AND SIGNS * Eye Movements *Horizontal, vertical,

circular, or combination * blurred vision DIAGNOSIS * viewing of the eyes - involuntary
movement * complete neurological tests TREATMENT * Treat the underlying condition * Congenital
stays for life

STRABISMUS (CROSS EYED): 28 STRABISMUS (CROSS EYED) MECHANISM* Failure of eyes to look in
the same direction at the same time * Weakness of muscles of one eye (superior oblique, interior
oblique, lateral) ETIOLOGY in childhood : associated with amblyopia (decreased vision in one eye)
(reversible after 7 years of age) in adults: Usually caused by disease: i.e. diabetes, high blood pressure,
brain trauma
PowerPoint Presentation: 29 SYMPTOMS AND SIGNS * TYPES: 1. Esotropia (convergent-cross eye
of one eye) 2. Exotropia (divergent- one eye turns outward) 3. Diplopia (adults strabismus) 4.
Congenital (no strabismus exists)

PowerPoint Presentation: 30 DIAGNOSIS * complete ophthalmic examination * Diagnose underlying

disease TREATMENT * Treat early * Corrective glasses * orthoptic training * surgery to restore eye
muscle balance * treat underlying disorder

DISORDERS OF THE EYE LID : 31 DISORDERS OF THE EYE LID HORDEOLUM (STYE) CHALAZION
(MEIBOMIAN CYST) BLEPHARITIS ENTROPION ECTROPON CONJUNCTIVITIS (PINK EYE)

HORDEOLUM (STYE): 32 HORDEOLUM (STYE) MECHANISM Inflammatory infection of the hair

follicle of the eye lid ETIOLOGY staphylococcal infection usually associated with Blepharitis
SYMPTOMS AND SIGNS occurs on the outside Pain/swelling/redness/pus patient feels something in
the eye

PowerPoint Presentation: 33 DIAGNOSIS * Visual exam * culture if needed TREATMENT * Hot

compress to alleviate pain * Topical or systemic antibiotics

CHALAZION (MEIBOMIAN CYST): 34 CHALAZION (MEIBOMIAN CYST) MECHANISM Collection of fluid

or soft mass cyst ETIOLOGY Blockage of meibomian gland SYMPTOMS AND SIGNS Pea size cyst
painless slow swelling of the inner part of eye lid Could become infected

PowerPoint Presentation: 35 DIAGNOSIS * Visual Examination TREATMENT * small ones usually

disappear spontaneously after a month or two * large ones usually need surgical removal

PowerPoint Presentation: 36

BLEPHARITIS: 37 BLEPHARITIS MECHANISM * Inflammation of the margins of the eye lids ETIOLOGY
* Ulcerative: staphy infection * nonulcerative: allergies, smoke, dust, chemicals, seborrhea, stye,
chalazions SYMPTOMS AND SIGNS * Persistent redness & crusting on eyelids * itching / burning
sensation * feeling something in the eye * Ulcers can cause eye lashes to fall out * Scales can get into
eye causing conjunctivitis

PowerPoint Presentation: 38 DIAGNOSIS * visual examination * Culture (confirm staphy infection)

TREATMENT Salt & water cleansing for 2 weeks If unsuccessful - local antibiotics or sulfonamide
PowerPoint Presentation: 39

ENTROPION: 40 ENTROPION MECHANISM * Inversion of eye lid into eye ETIOLOGY * aging (course
fibrous tissue) SYMPTOMS AND SIGNS * Foreign body sensation * Tearing / itching / redness *
Continuous rubbing causes conjunctivitis or corneal ulcers Decreased visual acuity if not corrected

PowerPoint Presentation: 41 DIAGNOSIS * visual examination TREATMENT * clean up on its own *

if not, minor surgery

PowerPoint Presentation: 42

ECTROPON: 43 ECTROPON MECHANISM * Outurned eye lids ETIOLOGY * elderly (weakness of eye lid
muscles) SYMPTOMS AND SIGNS * dryness of the exposed part of the eye * tears run down the
cheeks * if not treated can cause ulcers and permanent damage to cornea

PowerPoint Presentation: 44 DIAGNOSIS * visual examination TREATMENT * minor surgery if

doesn’t disappear

PowerPoint Presentation: 45

BLEPHAROPTOSIS (PTOSIS): 46 BLEPHAROPTOSIS (PTOSIS) MECHANISM * weakness of eye muscle

that raises eyelid (superior rectus, superior oblique) ETIOLOGY * familial * trauma * diabetes mellitus
* muscular dystrophy * myasthenia gravis * brain tumors

PowerPoint Presentation: 47 SYMPTOMS AND SIGNS * “drooping eye” * Blocks vision

DIAGNOSIS * ophthalmic examination * blood work to rule out underlying disease
TREATMENT * Surgery (strengthen muscles) * eye glasses with raised eyelid support * treat
underlying disease

Conjunctivitis : Conjunctivitis ANATOMY: It is the mucous membrane covering the under surface of
the lids and anterior part of the eyeball up to the cornea. 48
PowerPoint Presentation: Palpebral ; covering the lids—firmly adherent. Forniceal ; covering the
fornices—loose—thrown into folds. Bulbar ; covering the eyeball—loosely attached except at limbus.
Also marginal and limbal parts and plica semilunaris. 49

PowerPoint Presentation: Nerve supply – Sensory: Ophthalmic division of trigeminal Blood supply:
Posterior conjunctival arteries derived from arterial arcade of lids which is formed by palpebral
branches of nasal and lacrimal arteries of the lids. Anterior conjunctival arteries derived from the
anterior ciliary arteries – muscular br. of ophthalmic artery to rectus muscles. Venous drainage;
Palpebral and Ophthalmic veins. 50

Physiology physiology : : Physiology physiology : Smooth surface. Secretes mucin and aqueous
component of tear film. Highly vascular: supplies nutrition to the peripheral cornea. Aqueous veins
drains from anterior chamber maintenance of IOP. Lymphoid tissue helps in combating infections.
Basic secretion—reflex secretion. 51

PowerPoint Presentation: 52

PowerPoint Presentation: 53

CONJUNCTIVITIS (PINK EYE): 54 CONJUNCTIVITIS (PINK EYE) MECHANISM * inflammation of the

conjunctiva. ETIOLOGY * Viral / bacterial * irritants (allergies, chemicals, UV light)

Acute Bacterial Conjunctivitis: Acute Bacterial Conjunctivitis Mucopurulant conjunctivitis Caused by:
Staph epidermidis and Staph aureus –usually. Strep pneumonae, H influensae and Morexella
lucanatae occasionally 55

PowerPoint Presentation: 56 Symptoms: *Acute onset of redness, grittiness, burning and discharge.
*Photophobia may be present (corneal involvement) *Stickiness of the eyelids *Usually bilateral
disease Signs: *Conjunctival hyperaema *Mild papillary reaction *Mucopurulant discharge *Lid
crusting *No lymphadenopathy. *Normal VA

PowerPoint Presentation: Purulant cojunctivitis (Adult gonococcal ) Symptoms: *Hyperacute

condition *Extremely profuse, thick, creamy puss from the eye or eyes 57

PowerPoint Presentation: Signs: *Severe conjunctival chemosis *May be membrane formation

*Periocular edema *Ocular tenderness *Gaze restriction *Lamphadenopathy *Corneal involvement
Treatment Systemic and topical antiboitics 58
VIRAL CONJUNCTIVITIS: VIRAL CONJUNCTIVITIS The leading cause of a red, inflamed eye is viral
infection A number of different viruses can be responsible 59

PowerPoint Presentation: Signs & symptoms: Vary from moderate to severe. Eye redness (hyperemia)
is a common Swollen, red eyelids More tear production in the eyes than usual Make you feel as
though there is something in the eye Creamy white or thick yellow drainage. Sensitivity to light
(photophobia) 60

Allergic Conjunctivitides: Allergic Conjunctivitides Allergy is an altered or exaggerated susceptibility to

various foreign substances or physical agents which are harmless to the great majority of individuals.
It is due to an antigen antibody reaction. Allergens is an agent capable of producing a state or
manifestation of allergy. 61

PowerPoint Presentation: 62 Symptoms: Itching, lacrimation, photophobia, FB sensation, burning.

Signs: Giant papilla, ptosis, hyperemia, mucus, trantas dots, punctate keratopathy, corneal ulcer.

PowerPoint Presentation: 63

PowerPoint Presentation: 64

DIAGNOSIS : 65 DIAGNOSIS Ophthalmic examination Culture discharge Slit lamp examination

TREATMENT Warm compress 3-4 times daily (10-15 min.) If bacterial (antibiotics) If viral- self limiting

Prevention:: Prevention: Highly contagious Spread by direct contact with infected people Proper
washing and disinfecting can help prevent the spread Wash your hands frequently, particularly after
applying medications to the area Avoid touching the eye area Never share towels or hankies Change
bed linen and towels daily if possible Disinfect all surfaces, including worktops, sinks and doorknobs
To reduce pain from conjunctivitis use a cold or warm compress on the eyes 66

Applying Eye Drop Medicine: 67 Applying Eye Drop Medicine STEP ONE: Tilt your head back. Using
your middle finger, gently press the corner of the eye by the side of the nose. STEP TWO: Use your
index finger to pull down the lower lid. Then apply the eye drop medicine. STEP THREE: After applying
the eye drop, let go of your lower lid. Close the eye and keep the middle finger in place for at least
two minutes. If you’re applying more than one type of drop, wait at least 15 minutes for the next
application. Use a facial tissue to wipe away excess drops on eyelids .
Ptregium : Ptregium Definition Of Pterygium: A pterygium is a fleshy growth that invades the cornea.
It is an abnormal process in which the conjunctiva grows into the cornea. Definition Of Pterygium It
is a fibro vascular, triangular and degenerative condition of conjunctiva. 68

PowerPoint Presentation: Types of Pterygium : There are two types: Progressive Pterygium : These
types of pterygium are those which progress day by day. Non Progressive Pterygium : Those which
after limited growth has been occur than stop their generation. 69

PowerPoint Presentation: Etiology: The exact cause is not known. The probable causes are: i.
Commonly occurs in people living in hot & dry climate. ii. Dusty atmosphere. iii. Common in outdoor
workers. iv. Common in males. v. It may occur nasal than temporal side. 70

PowerPoint Presentation: Symptoms: Redness Irritation Dryness Tearing May cause decreased vision
( when it reaches the visual axis of cornea) Sign : Visible triangular fold of conjunctiva. Triangular
shape with the apex, or head, extending onto the cornea. 71

PowerPoint Presentation: Treatment 1. Local: i. Lubricant eye drops. ii. Topical steroids for
inflammation. 2. Surgical: i. Surgical excision when the pterygium progressive towards the cornea . 72

PowerPoint Presentation: Precautions: Use sun glasses. Protect from sunlight Use eye goggles when
working. (laborers, welders) Wash eye with water after work in sunlight. 73

Trachoma:: Trachoma: Trachoma is the world’s leading cause of preventable blindness Trachoma is a
contagious bacterial infection in the eye which causes blindness after multiple reinfections. 74

PowerPoint Presentation: Trachoma is caused by the bacterium Chlamydia trachomatis Chlamydia

trachomatis is spread through direct contact with an infected person. Flies also play a major role in
the spread of the disease. Poor sanitation, dirty water, and lack of hygiene are causes of trachoma. 75

Intervention:: Intervention: S urgery for trichiasis. A ntibiotics . F acial cleanliness to prevent

transmission. E nvironmental change to prevent transmission. 76

DISORDERS OF THE GLOBE OF THE EYE: 77 DISORDERS OF THE GLOBE OF THE EYE KERATITIS CORNEAL
ABRASION OR ULCER SCLERITIS CATARACT GLAUCOMA MACULAR DEGENERATION DIABETIC
RETINOPATHY RETINAL DETACHMENT UVEITIS
Anatomy of cornea:: Anatomy of cornea: 78

PowerPoint Presentation: 79

KERATITIS: 80 KERATITIS MECHANISM * inflammation and ulceration of the cornea ETIOLOGY *

herpes simplex virus (cold sores) * other bacteria & fungi * trauma * dry air or intense light (welding)

PowerPoint Presentation: Bacterial keratitis. Viral keratitis Fungal keratitis 81

PowerPoint Presentation: 82 SYMPTOMS AND SIGNS * pain or numbness of the cornea *

decreased visual acuity * irritation * tearing * photophobia * mild conjunctivitis

PowerPoint Presentation: 83 DIAGNOSIS * examination of cornea using slit lamp * medical history *
previous upper respiratory tract infection TREATMENT * eye patch to protect from photophobia

CORNEAL ABRASION OR ULCER: 84 CORNEAL ABRASION OR ULCER ETIOLOGY * foreign bodies *

trauma (fingernail, contact lenses) SYMPTOMS AND SIGNS * pain / redness & tearing * something
constantly in eye * vision impairment

PowerPoint Presentation: 85 DIAGNOSIS * visual examination * fluorescien (stain) TREATMENT *

remove foreign bodies * eye wear for protection. * eye dressing to reduce movement

SCLERITIS: 86 SCLERITIS MECHANISM * Inflammation of sclera ETIOLOGY * rheumatoid arthritis *

digestive disorders (Crohn’s) SYMPTOMS AND SIGNS * Dull pain * Intense redness * loss of vision
(posterior sclera inflammation) * if untreated can lead to perforation or loss of eye

PowerPoint Presentation: 87 DIAGNOSIS * ophthalmic examination * Blood work to uncover

underlying cause TREATMENT * MILD : eye drops (antibiotics) * SEVERE : immunosupressive drugs *
PERFORATION : surgery

The lens: : The lens: The crystalline lens is the only structure continuously growing throughout the life.
Changeable refractive media. Capsule, epithelium and lens fibers. Congenital anomalies and effect of
systemic diseases. Cataract. 88
Anatomy of lenses:: Anatomy of lenses: Location posterior to iris anterior to vitreous Shape biconvex
Structure lens capsule lens cortex lens nucleus 89

PowerPoint Presentation: 90

PowerPoint Presentation: Equator Anterior capsule Posterior capsule Diameter:9-10mm

Thickness:4-5mm Lens zonule 91

Physiology of lens:: Physiology of lens: No vessel, nerve and transparent. Derive nutrients from the
aqueous humor Significant refractive medium Accommodative function No immediate relation with
adjacent tissues Complex metabolism Simple disorders: transparency and location change 92

CATARACT: 93 CATARACT Definition: *

PowerPoint Presentation: 98

GLAUCOMA: GLAUCOMA What is it? A disease of progressive optic neuropathy with loss of retinal
neurons and their axons (nerve fiber layer) resulting in blindness if left untreated.

GLAUCOMA: GLAUCOMA “Glaucoma describes a group of diseases that kill retinal ganglion cells.”
“High IOP is the strongest known risk factor for glaucoma but it is neither necessary nor sufficient to
induce the neuropathy.”

GLAUCOMA: GLAUCOMA Angle Anatomy

GLAUCOMA: GLAUCOMA How do we measure IOP? Applanation Tonopen Schiotz Air Non-contact

GLAUCOMA: GLAUCOMA Tonometry Applanation Schiotz

Glaucoma: what is happening: Glaucoma: what is happening Either: the drain blocks here Or poor
blood supply here Damages the optic nerve..looks ‘caved in’, called ‘cupped’

PowerPoint Presentation: Characteristic pattern to loss of visual field Rim of optic nerve becomes
thinner as disc caves in and becomes more cupped
Types of glaucoma: Types of glaucoma Congenital Secondary Juvenile Chronic open angle Acute
closed angle Many different types

GLAUCOMA: 107 GLAUCOMA Chronic Open-Angle Glaucoma MECHANISM * Increased intraocular

pressure due to a malfunction in eyes aqueous humor drainage system - can lead to optic nerve
damage ETIOLOGY * trauma * overuse of steriods

PowerPoint Presentation: 108 SYMPTOMS AND SIGNS * Gradual loss of peripheral vision. * If
untreated - eventually complete vision loss DIAGNOSIS * ophthalmic examination * tonometry
(pressure measure) TREATMENT * Medication that helps decrease aqueous humor production or
opens drainage system * laser to open drainage * surgery (bypass)

PowerPoint Presentation: 109 Acute Angle-Closure Glaucoma MECHANISM * complete blockage of

aqueous humor drainage system ETIOLOGY * trauma

PowerPoint Presentation: 110 SYMPTOMS AND SIGNS * Blurred vision * severe eye pain * redness
of the eye * nausea & vomiting * photophobia (sees “halo” around light) * hazy cornea (elevated
pressure) * if untreated --> blindness DIAGNOSIS * goniolens (special lens to view the opening)
TREATMENT * LASER IRIDOTOMY (creation of a hole in the iris between the anterior and posterior
chamber) * medications to reduce pressure

Acute glaucoma: Acute glaucoma Emergency Can be more gradual Red eye Achy, abdominal pain
Misty vision Go from light into dark Small eye, shallow anterior chamber, pupil mid dilated, Iris lens
contact Push the iris forward Eye feels hard

Chronic glaucoma: Chronic glaucoma Painless, common in elderly Don’t notice anything wrong
detected by optometrist Screening vital field, pressure, disc

PowerPoint Presentation: RETINA : light-sensitive layer of tissue sends visual messages through the
optic nerve

Retina :: Retina : 114

Retinal detachment : Retinal detachment Definition: The separation of neurosensory retina (NSR)
from the retinal pigment epithelium (RPE) by subretinal fluid (SRF). 115
PowerPoint Presentation: pulled away from the underlying choroid small areas of the retina torn =>
retinal tears or retinal breaks retinal cells deprived of oxygen if not promptly treated => permanent
vision loss 116

Types of RD: Types of RD Rhegmatogenous RD (RRD) Tractional RD Exudative RD Combined

tractional-rhegmatogenous RD 117

Rhegmatogenous RD (RRD) : Rhegmatogenous RD (RRD) Affect about 1 in 10,000 of the population

each year. Both eyes may eventually involved in about % of cases. Acute PVD (Posterior Vitreous
Detachment): A separation of the cortical vitreous from the internal limiting membrane (ILM) of the
sensory retina posterior to the vitreous base. Myopia: Over 40% of all RDs occur in myopic eyes.
Trauma: Responsible for about 10% of all cases of RD and is most common cause in children. 118

Tractional Retinal detachment : Tractional Retinal detachment 1. PDR ( proliferative diabetic

retinopathy ) 2. ROP ( retinopathy of prematurity ) 3. Penetrating posterior segment trauma 119

Exudative Retinal detachment : Exudative Retinal detachment 1. Choroidal tumor: Melanomas,

metastases 2. Inflammation: Posterior scleritis 120

PowerPoint Presentation: 121

PowerPoint Presentation: SYMPTOMS floaters - bits of debris in field of vision that look like spots,
hairs or strings

PowerPoint Presentation: SYMPTOMS : floaters light flashes shadow or curtain over a portion of visual
field blur in vision

PowerPoint Presentation: C an occur as a result of: t rauma a dvanced diabetes a n inflammatory

disorder, such as sarcoidosis s hrinkage of the jelly-like vitreous that fills the inside of the eye

PowerPoint Presentation: vitreous liquid leaks through retinal tear and accumulates underneath
retina retina can peel away from underlying layer of blood vessels
PowerPoint Presentation: Factors that may increase risk of retinal detachment: aging - more common
in people older than 40 previous retinal detachment in one eye family history of retinal detachment
extreme nearsightedness previous eye surgery previous severe eye injury or trauma

PowerPoint Presentation: TREATMENTS Retinal tears: laser surgery (photocoagulation) freezing

(cryopexy) Retinal detachment: pneumatic retinopexy scleral buckling vitrectomy

PowerPoint Presentation: PHOTOCOAGULATION

PowerPoint Presentation: CRYOPEXY

PowerPoint Presentation: PNEUMATIC RETINOPEXY

PowerPoint Presentation: PNEUMATIC RETINOPEXY

PowerPoint Presentation: SCLERAL BUCKLING

PowerPoint Presentation: VITRECTOMY

PowerPoint Presentation: 136

PowerPoint Presentation: Corneal foreign body is foreign material on or in the cornea, usually metal,
glass, or organic material.

PowerPoint Presentation: Symptoms: Foreign body sensation, Tearing, History of

trauma ,photophobia , pain , red eye Signs: Corneal foreign body with or without rust ring, edema of
the lids, conjunctiva, and cornea, foreign body can cause infection and/or tissue necrosis. 138

PowerPoint Presentation: Workup 1.History and document visual acuity. One or two drops of topical
anesthetic may be necessary to control pain. 3.Slit-lamp Examination: If there is no evidence of
perforation, evert the eyelids and inspect for foreign bodies. 4.Dilate the eye and examine the
vitreous and retina 5.Consider a B-scan US, CT of the orbit. 139
PowerPoint Presentation: Treatment 1.Apply topical anesthetic, remove the foreign body with a spud
or forceps at a slit lamp. If multiple superficial foreign bodies, its easier to remove with irrigation.
2.Measure the size of the resultant corneal epithelial defect. 3.Treat as for corneal abrasion. 140

Blindness:: Blindness: DEFINITIONS: blindness : visual acuity of less than 3/60 or its equivalent. low
vision : visual acuity of less than 6/ 18 but ≥ 3/60 or corresponding to visual field loss to less than 20°
in the better eye with best possible correction. avoidable blindness : blindness which could be either
treated or prevented by known cost-effective means. 141

CAUSES OF BLINDNESS:: CAUSES OF BLINDNESS: In Developed Countries : accidents, glaucoma,

diabetes, vascular diseases(hypertension),cataract and degeneration of ocular tissues esp. of the
retina and hereditary conditions. In Developing Countries : cataract-62.6% refractive errors-19.7%
glaucoma-5.8% post. segment disorder-4.7% surgical complication-1.2% 142

PowerPoint Presentation: Causes Of Childhood Blindness : refractive errors, trachoma, conjunctivitis,

xerophthalmia , congenital cataract , retinopathy of prematurity. Causes Of Avoidable Blindness :
cataract, trachoma, childhood blindness, refractive errors, glaucoma, diabetic retinopathy 143

Reheblitation :: Reheblitation : Skills person with blindness or low vision may need Compensatory
skills Visual efficiency skills Literacy and Braille skills Listening skills Orientation and mobility skills
Social interaction skills Independent living skills Recreation and leisure skills Career and transition
skills 144

PowerPoint Presentation: In general, students with blindness and low vision should learn the same
information as general education students although more time and accommodations might be
needed. Counseling to deal with reactions from others Possible teaching of care for prosthetic eye
Adaptations for color or visual discrimination problems Responding to traffic signals, etc. Provide a
copy of teacher’s notes Read aloud Supply audio tapes/CDs of print materials Use hands-on models
and manipulatives 145

PowerPoint Presentation: Assist through touch and sound, more than sight, for those with little or no
functional vision. Use specialized equipment. Provide equal access to the core curriculum. Do not
re-arrange the furniture or leave items in the path. Determine the LRE based on student needs and
strengths, preferences, and related services needs. In general, provide appropriate lighting, tactile
materials, necessary print size, and decrease visual clutter. 146
PowerPoint Presentation: Use programs to magnify computer screens. Scan materials for access.
Provide Braille if the student uses it. Use of a guide dog may be needed. May scan in materials and
use a synthesizer that reads the text to the student Voice recognition software applications 147

PowerPoint Presentation: Request large print materials in advance. Get training on the use of optical
devices and software. Encourage student relationships and interaction. Support emotional and
learning needs. Provide daily cues. Consult with vision specialist regularly. Use tactile materials.
Reduce glare on materials. Speak in normal tones. Tell the student when you are leaving the room.
Maintain high expectations and give regular feedback. 148

BASIC REHABILITATION: BASIC REHABILITATION The activities on the basic rehabilitation are directed
at rehabilitating the person’s social functions with the purpose of optimum accomplishing a
self-dependent life . The following basic rehabilitation activities take place at the NRCB : 149

Training in orientation and mobility this training helps students to move in new conditions - : Training
in orientation and mobility this training helps students to move in new conditions - 150

Visual rehabilitation the better usage of poor sight: Visual rehabilitation the better usage of poor sight
151

Cooking : Cooking 152

Useful skills rehabilitates the previous everyday skills and assists the acquisition of new ones under
the conditions of bad damaged or missing sight: Useful skills rehabilitates the previous everyday skills
and assists the acquisition of new ones under the conditions of bad damaged or missing sight 153

Braille training assists the overcoming of the informational deficit : Braille training assists the
overcoming of the informational deficit 154

Physical education : Physical education 155

Computer training for blind people, operating a computer with synthetic speech or a Braille display
Computer training for visually impaired people, operating a computer with a visual monitor:
Computer training for blind people, operating a computer with synthetic speech or a Braille display
Computer training for visually impaired people, operating a computer with a visual monitor 156
VOCATIONAL TRAINING: VOCATIONAL TRAINING 157
‘CATARACTA’(LATIN) = MEANING ‘WATERFALL’ Cataract: