Common Eye Disorders Dina Mohammed Abdulmannan Umm Al-Qura university

Chalazion

Inflammation of a meibomian gland Also called an internal hordeolum Usually requires no treatment, although if persistent may require surgical excision Hot compresses may be tried to help unblock meibomian gland

Blepharitis A common, chronic, inflammatory condition of the eyelid margins Signs: –waxy, shiny lid margins –oily/debris in tear film –itchy, irritated eyes –most common cause of dry eye

Blepharitis Treatment: –Eyelid hygiene is the mainstay of treatment. This helps to remove crusts/scales and helps unplug blocked meibomian glands –Warm compresses and eyelid massage –Natural tears give some relief, don’t cure problem –Occasionally AB’s for staphylococcal blepharitis

Conjunctivitis

Inflammation of the conjunctiva Signs: –redness –swelling –discharge –grittiness

Conjunctivitis Often viral infection Treatment is dependant on the cause. May be: –viral –bacterial –allergic –follicular –others

Abrasion

Corneal Abrasion Scraped area of corneal surface, accompanied by loss of epithelium. Abrasions of the epithelium heal within 72 hours and do not leave a scar. Deeper lesions, involving Bowman’s layer and below, heal with permanent opaque scarring.

Corneal Abrasion Treatment may be with artificial tears for a minor abrasion or patching/bandage contact lens (BCL) application for more severe abrasions

Keratoconus

Degenerative corneal disease Characterized by generalized thinning and cone-shaped protusion of the central cornea Typically bilateral Usually diagnosed in the second decade

Keratoconus Causes increase in myopia, astigmatism and surface irregularity In early stages, glasses or soft contact lenses may be used As disease progresses, need to use hard contacts to provide smooth refractive surface. Advanced cases may require penetrating keratoplasty

Foreign Body

Corneal Graft

Corneal Graft (Penetrating Keratoplasty) Replacement of a scarred or diseased cornea with clear corneal tissue from a donor. Usually reserved for severe cases, where there is a good chance of vision improving after surgery

Cataract

Cortical Cataract

Cataract Any lens opacity May be classified by age (congenital to senile), stage (early to hypermature), or type (NS, cort, PSC, etc) Some systemic diseases/conditions predispose to cataract (DM, RA, hypothyroid, smoking, corticosteroid use, etc)

Cataract Treatment: –always the same regardless of what type or stage of cataract. –CE with placement of either a AC or PC IOL. The power of the lens used is determined by the length of the eye (A-scan measurement) –Phacoemulsification is used (US) to break up the cataract and remove it from the eye. Uses much smaller incision then removal of whole lens. Shorter healing time, less chance of infection, etc.

ACIOL

PCIOL

PCO

Post Cataract Surgery Posterior capsule opacification (PCO) –a membrane that forms behind the IOL causing a decrease in vision. –may see Elschnig pearls on retroillumination –treatment is with a capsulotomy

YAG Capsulotomy

ON cupping

Acute Angle Closure Glaucoma

Glaucoma An optic neuropathy with characteristic optic nerve head changes Diagnosis is determined by ON evaluation, IOP measurements, and visual field findings.

Glaucoma Normal findings: –ON: cup to disc ratio (c/d) of 0.4 or less –IOP: mm Hg for average corneal thickness –VF: full field (no paracentral scotomas, diffuse depression, nasal steps or arcuate scotomas)

Glaucoma Treatment: –topical or oral medication (many different types) –laser surgery –incisional surgery

Bleb

Iritis Inflammation of the iris Signs: –red eye –pain –tearing –blurred vision –miosis (small pupil)

Iritis Cause is unknown Iritis is graded at the slit lamp based on the presence of cells and flare in the AC Associated with systemic inflammatory conditions (RA, SLE, etc) Treatment is with dilating drops and topical steroids to reduce inflammation Often have recurrent flare-ups

Anterior Uveitis

Posterior Uveitis

Uveitis Inflammation of the uvea (iris, ciliary body, choroid) Anterior uveitis (iridocyclitis) - iris or ciliary body Posterior uveitis - choroid

Uveitis Signs: –photophobia –decreased vision –small pupil (meiosis) –red eye (usually most prominent at limbus) –normal IOP

Uveitis Treatment is with topical steroids Steroids help to prevent secondary problems (cataract, uveitic glaucoma, adhesions of iris to lens) In severe cases, systemic steroids may be required Recurrence is common

Posterior Vitreous Detachment (PVD) Separation of the vitreous gel from the retinal surface Tends to occur with aging as the vitreous liquifies May also occur in the presence of high myopia and diabetes

Posterior Vitreous Detachment (PVD) No treatment is required in most cases Floaters tend to become less bothersome over time Treatment is required if there are retinal tears associated with the PVD which may lead to retinal detachment

Diabetic Retinopathy

Diabetic Retinopathy (DR) Spectrum of retinal changes that accompany long-standing diabetes mellitus Early stage is non-proliferative (dot and blot hemmorhages, hard exudates, microaneurysms) May advance to proliferative (neovascularization and fibrous tissue) if blood sugars not controlled

Diabetic Retinopathy (DR) Treatment of proliferative disease is with panretinal laser photocoagulation (PRP) Concept of treatment is that areas that are scarred require less oxygen, therefore, this should promote regression of new blood vessels (neovascularization)

Total Retinal Detachment

Retinal Detachment (RD) Separation of sensory retina from underlying pigment epithelium May be caused by a retinal tear or by fibrous tissue traction Symptoms are flashing lights, streaks of lights, curtain coming across the eye, loss of vision

Retinal Detachment (RD) Treatment is surgical and is usually done immediately A scleral buckle may be used in some cases

Age-related Macular Degeneration

ARMD

Age-Related Macular Degeneration (ARMD/AMD) Deterioration of the macula resulting in loss of clear central vision Peripheral vision is maintained Two major types are dry and wet Dry - aging spots in the macula, exudate Wet - abnormal new blood vessels grow under the macula and leak blood and fluid

Age-Related Macular Degeneration (ARMD/AMD) Treatment: –Dry: no treatment at present. Different types of supplements have been tried but nothing has been proven to work –Wet: Visudyne (dye and laser) is used to halt blood vessel growth and preserve vision

Retinitis Pigmentosa

Disease of the retina, often leading to functional blindness Usually presents by 20 years of age Characterized by night blindness and constriction of visual fields There is no treatment to cure this disease, only slow it’s progression

Strabismus

Eye misalignment caused by extraocular muscle imbalance Deviation may be horizontal (eso or exo) or vertical (hypo or hyper) Tropia - present at all times Phoria - present only after fusion has been broken

Strabismus Treatment is dependant on the cause of the eye turn Eyes may be straightened with patching, glasses, or surgery Visual maturity is reached at about 8 years of age Individuals with strabismus will never have fine stereoscopic vision