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POST CATARACT ENDOPHTHALMITIS ○○ Anaesthesia in the distribution of infraorbital nerve

ƒƒ Delayed onset exogenous endophthalmitis can occur after

(cheek,lower lid,upper lip & teeth).
ƒƒ Investigations in a case of blowout # P
cataract surgery or Glaucoma filtration operation. ○○ Hanging drop sign on Water’s view X-ray/ 300 Occipito-
mental view.
ƒƒ The cardinal features of endophthalmitis are pain,swelling of lids
R

FO
and decreased vision (here due to hypopyon). ○○ Tear drop sign on antral CT Scan
ƒƒ A high index of suspicion arises in post operative cases (here the ƒƒ T/t : Reconstruction of floor by elevation + Fixation. Orbital floor
patient is presenting few weeks post cataract surgery). exploration, if there is trapping of inferior rectus.
ƒƒ M/c causative organism includes Staphylococcus epidermidis.
Propionibacterium acne is also common. Prolonged surgery >
N Important negative points: Orbital # i
�  NOT seen in blow out # → Ptosis, Exopthalmos
60 minutes, vitreous loss and diabetes mellitus are risk factors for
�  NOT involved in blow out # of orbit → # of orbital Rim.
M

IN
development of endophthalmitis.
ƒƒ Treatment:
○○ Intravitreal antibiotics are TOC and are injected after taking PRESCRIPTION OF GLASSES
samples for cultures.
○○ If there is no improvement after 48 hrs - Repeat vitreous tap ƒƒ There are 2 major types of eye glasses/lenses: spherical and E
○○ If no response after 2 intravitreal injections i.e. patient not cylindrical.
responding to medical therapy→ procede for vitrectomy which ○○ Spherical glasses have a single dioptric power and create a

penetration of the antibiotics..

GE
is used to remove the infected vitreous and facilitate better single point of focus. Their power is same in all meridians and

○○ Steroid therapy may be used concurrently with caution.

BLOW OUT FRACTURE OF ORBIT
ƒƒ Orbital floor fracture is also known as “blowout” fracture of the
ED
orbit.
ƒƒ Typically caused by sudden increase in orbital pressure from
external impact by an object of larger diameter than orbit. e.g. a
fist/ a cricket ball or a tennis ball
ƒƒ Blow out fracture of orbit occurs when there is a fracture of one
of the walls of orbit but the orbital rim remains intact.
ƒƒ The anatomy of the orbital floor predisposes it to fracture.
○○ Bones of lateral wall & roof are usually withstand trauma d/
RA
curvature is of a single radius.
○○ Cylindrical glasses are used for myopia and hyperopia not S
useful in astigmatism.
ƒƒ Prescriptions used for correction of astigmatism include :
spherical power, cylindrical power, and axis. The axis designates U
the meridian of the lens that only has the sphere power from 1 to
180; the full cylinder power is located 90o away from the axis.
ƒƒ A sample prescription for astigmatism is given below: P
○○ OD -.50 -1.00 × 180
○○ OS -.50 -2.00 × 175
ƒƒ Here the OD or spherical component of the right lens is -.50, P
means that the patient is slightly myopic. The cylindrical power
is -1.00, means the patient has astigmatism in the right eye. To
L

to thick wall. determine the full power of cylindrical glass, which is present
○○ By contrast, the bone of the orbital floor overlying the
90o away from the axis, it is necessary to combine the powers of
neurovascular bundle (thin bone covering infraorbital canal)
sphere & and cylinder using formula: -.50 · (-1.00) + -1.50
is predisposed where isolated orbital floor fractures invariably
occur. ƒƒ There are seven major categories of refractive errors to which
prescriptions can fall:
E
ƒƒ It is estimated that about 10% of all facial fractures are isolated
orbital wall fractures (the majority of these being the orbital Eye condition Basis Prescription
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floor), and that 30-40% of all facial fractures involve the orbit.
Simple myopic - (-) minus plane glass
ƒƒ The inferior orbital neurovascular bundle comprising the
astigmatism
infraorbital nerve and artery) courses within the bony floor of
EX

the orbit.
ƒƒ Signs of blow out #
Simple myopia - (-) minus Sphere
E
Compound myopic - major meridian will be (-) (-) on
○○ Diplopia on looking upward and laterally (d/to trapping of
astigmatism both 90o and 180o axis
inferior rectus m/s and traumatic enophthalmos).
○○ Proptosis Simple hyperopia - (+) Sphere N
○○ Periorbital edema Simple hyperopic - (+) Sphere
○○ Emphysema of eyelids involving medial wall astigmatism
(Contd...)
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These Updates are from Primes Supplement 2018
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Eye condition Basis Prescription Changes Findings

Compound - major meridian will be (+)(+) on Late changes Arcuate (Bjerrum )scotoma, P
hyperopic both 90o and 180o axis Sphere Ring /double arcuate scotoma
astigmatism
Advanced Tubular vision: Only a small island
R

FO
Mixed astigmatism - major meridian will be opposite glaucomatous of central vision accompanied by
i.e. changes temporal island
(-)(+)(+)(-) on both 90o and 180o
axis Sphere
No light perception: Complete
visual field defect (temporal island i
is the most resistant i.e. lost in last)
RULE OF THUMB FOR PRESCRIBING PRESBYOPIC
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GLASSES STAPHYLOMA
ƒƒ Presbyopia is physiological weakness of accommodation due to
advancing age leading to progressive diminution in near vision.
ƒƒ A rough guide to prescribe presbyopic lenses is given below.
ƒƒ Staphyloma is the localised bulging of the outer coats of the
eyeball (cornea and sclera) lined by the uveal tissue. E
ƒƒ Extensive thinning of the sclera makes it incapable of withstanding
Start with +1D presbyopic lens at the age of 40 and increase by
the normal IOT and leads to protrusion of the thinned region of
0.5 D at every 5 years.
the sclera known as staphyloma.
Age Required lens
GE
35 0.5 D
Remember

Eye pathology Clinically Diagnostic clue

S
40 +1 D
45 +1.5 D Staphyloma localised bulging In high myopia
50 +2D of the outer coats
(cornea & sclera) of
U
ED
55 +2.5D
the eyeball
60
65
+3D
+3.5D Keratoconus Progressive cone
shaped bulging of
P
ƒƒ Laser vision enhancement is presbyopia correcting IOL(Intra central cornea
ocular lens) surgery in a patient with a high level of pre-existing
astigmatism (i.e. >3 D), a bioptics approach (ie, IOL followed by
Corneal dystrophy Recurrent corneal
erosions
P
laser vision enhancement may be needed.
○○ For minor astigmatism → Limbal Relaxing Incisions (LRI) Bupthalmos Large cornea
L
RA

are useful. Keratomalacia Dry and cloudy Seen in Vitamin A

○○ Presbyopia-correcting IOL surgery followed by LASIK or cornea deficiency
PRK is also used.

VISUAL FIELD CHANGES IN GLAUCOMA

Late stages of
primary open angle
Frequent change of
presbyopic glasses
Also seen in DM,
intumescent cataract E
glaucoma

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Hypermetropia Small eye, small

ƒƒ Temporal island is the most resistant in advanced changes.
cornea, shallow AC
Temporal vision remains till last.
ƒƒ Depending on the location, staphylomas may be: Anterior,
EX

Changes Findings
Early non-specific Isopter contraction
Intercalary ( between the anterior pole and the ciliary region of
the eye), Ciliary or Equatorial E
changes Baring of blind spot ƒƒ Treatment options include staphylectomy, use of sclera patch
grafts, or sclera buckling.
Early significant
changes
Peripheral nasal step,
Small wing shaped paracentral
N
scotoma, Siedel’s sickle-shaped
scotoma
(Contd...)
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These Updates are from Primes Supplement 2018