Corneal Dystrophies
 LASIK is Laser - Assisted In Situ Kerato-
 Is a group of disorders, characterized by a
non-Inflammatory, inherited, bilateral part
of the cornea
 They are characterized by deposits in the
corneal layers.
 Decreased vision is caused by the irregular
corneal surface and corneal deposits.
Management
 A bandage contact lens is used to flatten the
bullae, protect the exposed corneal nerve
endings, and relieve discomfort.
 Hypertonic eye drops or ointment may
reduce the epithelial edema, lowering the
IOP also reduces stromal edema.
Keratoconus
 a condition characterized by a conical
thinning on protrusion and irregular
protuberance of the cornea with progressive
astigmatism.
 This hereditary condition has a higher
incidence among women.
 Onset occurs at puberty; the condition may
progress for more than 20 years and is
bilateral.
 Corneal scarring or in severe cases. Blurred
vision is the prominent symptom.
Management
 Rigid, gas-permeable contact lenses to
correct irregular astigmatism and improve
vision
 Penetrating keratoplasty is indicated when
contact lens correction is no longer effective
 a condition characterized by a conical
protuberance of the cornea with progressive
thinning on protrusion and irregular
astigmatism.
Refractive Surgeries
 Are cosmetic, elective procedures performed
to re-contour corneal tissue and correct
refractive errors so that eyeglasses or contact
lenses are no longer used.
 PHOTOREFRACTIVE
KERATECTOMY and LASIK use an
excimer LASER (193-nm-wavelength argon
fluoride laser) that can evaporate corneal
tissue very cleanly with almost no damage
to the epithelial cells
mileusis
KERATITIS
 Inflammation of the cornea
 Usually associated with infection
 Treated with anti-infective agents and good
hygiene
 Prevent transmission in case contagious
Care for Removable Contact Lenses
 Follow the prescribed schedule of wearing
and removing the lens based on doctor's
advise
 Use standard cleaning solutions
 Disinfect the lens before wearing if it was
stored for 30 days or more
 Water and contacts do not mix remove it
when swimming, diving, bathing, etc.
 Remove the lens when going to bed or sleep
RETINAL DETACHMENT
 Refers to separation of the retinal pigment
epithelium layer (RPE) from the sensory.
Retinal Detachment
 If the retina is pulled loose the result will be
hemorrhaging in the eye, spots in ones
vision or complete loss of vision. In this
case, it also causes flashes of light.
4 TYPES:
 Rhegmatogenous detachment
 Traction retinal detachment
 Combined and traction rhegmatogenous
 Exudative type
RHEGMATOGENOUS
 A hole or a tear develops in the sensory
retina, allowing some of the liquid vitreous
to seep through the sensory retina ad detach
it from the RPE.
Risk Factors:
 Those with myopia
 Aphakia (after cataract extraction)
  Trauma
TRACTION RETINAL DETACHMENT
 Caused by a pulling force.
 This condition usually results from scarring
secondary to diabetic retinopathy, vitreous
hemorrhage or retinopathy of prematurity
EXUDATIVE
Due to production of serous fluids under the retina
from the choroids.
Predisposing factors:
 Uveitis
 Macular degeneration
MANIFESTATIONS
1. Floaters in the field of vision.
 Floaters are thick strands or clumps of solid
vitreous gel that develop as the gel ages and
breaks down.
 Floaters often app as dark specks, globs,
strings, or dots. Floaters may also be caused
by loose blood or pigment from retina tears.
2. Flashes of light or sparks when eyes or head is
moved.
 These are easier to see against a dark
background. The brief flashes occur when
the vitreous gel tugs on the retina (vitreous
traction).
 These flashes usually appear at the edge of
the visual field.
3. A shadow or curtain effect across part of your
visual field that does not go away.
 Detachments usually affect peripheral vision
first that grows bigger.
4. New or sudden vision loss.
 Vision loss caused by retinal detachment
tends to get worse over time.
*Sudden vision loss is a medical emergency.
MANAGEMENT:
Surgery
1. Scleral buckle
2 Cryopexy and Laser Photocoagulation
3. Pneumatic retinopexy
4. Vitrectomy
PARS PLANA VITRECTOMY (PPV)
 involves removal of the vitreous gel of the
eye)
 is the most common surgery performed for a
retinal detachment today
RECOVERY:
 usually within 2 weeks
 Advise client to avoid eye straining, heavy
lifting and other similar activities
 Retinal detachment may recur: early
recurrences occur within 6 weeks following
the first surgery and late recurrences more
than 6 weeks later
WARNING:
 The scleral buckle usually remains in place
permanently. In addition to the scleral
buckle, cryopexy (freezing) or laser is
applied to the retinal tear to seal it closed
 Segmental buckles fade over time, and after
6 months, if there has been inadequate
retinopexy, the retina will reattach.
RETINAL ARTERY AND VEIN
OCCLUSIONS
CENTRAL RETINAL VEIN OCCLUSION
 Blood supply to and from the ocular fundus
is provided by the central retinal artery and
vein.
 This condition is relatively common and
found most often in people older than 50
years of age.
Manifestations:
 decreased visual acuity
 blurring of vision
Direct ophthalmoscopy will reveal:
1. optic disc swelling
2. venous dilation and tortuousness
3. retinal hemorrhages
4. cotton-wool spots
5. "blood and thunder" appearance of the retina.
The better the initial visual acuity, the better the
general prognosis.
MANAGEMENT
 Laser pan retinal photocoagulation may be
necessary to treat the abnormal
neovascularization and neovascular
glaucoma
CENTRAL RETINAL ARTERY OCCLUSION
 if the central retinal artery gets occluded,
there is complete loss of vision in that eye
(even though the fovea is not affected).
 This is a true ocular emergency!
Viewed with diagnostic exam
- CHERRY RED SPOT
- PALE OPTIC NERVE
MANIFESTATIONS
 The entire retina becomes pale and swollen
and opaque while the central fovea still
appears reddish (this is because the choroid
color shows through).
 This is the basis of the famous "Cherry red
spot" seen on examination of the retina on
fundoscopy of a central retinal artery
occlusion (CRAO).
MANAGEMENT
 Ocular massage
 Anterior chamber paracentesis
 IV hyper osmotics like Acetazolamide
 High concentration Oxygen
 MACULAR DEGENERATION
 Commonly called degeneration (AMD) age-
related macular
 Characterized by tiny yellowish spots called
DRUSEN beneath the retina.
 Central vision is generally the most affected
 Most patients retaining peripheral vision
1. DRY TYPE:
 about 85-90% of people with AMD have
this type.
 The outer layer of the retina slowly breaks
down. With this breakdown comes the
appearance of drusen!
 If drusen appears outside the macular area,
the patient is asymptomatic
 If drusen comes within the macula, there is
gradual blurring of vision that patients may
notice when they try to read
MANAGEMENT:
 NO TREATMENT can cure this type of
AMD. (DRY TYPE)
 Studies however have shown that use of
antioxidants (vit C, E and beta-carotine) can
slow the progression of AMD and vision
loss for people at high risk for developing
advanced AMD.
WET TYPE OR EXUDATE TYPE
 Results from proliferation of the abnormal
blood vessels growing under the retina,
within the choroid layer of the eye, a
condition known as choroidal
neovascularization.
 May have an abrupt onset, patients complain
that straight lines appear crooked and
distorted or that letters in words appear
broken.
MANAGEMENT:
 ARGON LASER to stop the leakage
 However, this treatment is not ideal because
vision may be affected by the laser treatment
and abnormal vessels often grow back after
treatment
TRAUMATIC AND INFECTIOUS EYE
DISEASES
ORBITAL TRAUMA
 Injury to the orbit is usually associated with
a head injury, hence, the patient's general
medical condition must be stabilized first
before conducting an ocular examination.
Buckling Theory
 Maintains that an anterior force is
transmitted back into the orbit
 the rim buckles and orbital rim transmits
forces to the orbital walls, resulting in an
orbital wall fracture
 (Bone)
Retropulsion Theory
 Advanced by Smith and Regan refers to a
fracture of the orbital floor caused by
sudden increase in IOP
 A fracture may result from the hydraulic
forces cavity generated by the closed orbital
  Most frequently caused by blows from a fist
or objects larger than the horizontal diameter
of the orbit
 (ORBITAL FLOOR)
Buckling is indirect blow - the ripples cause the
fracture
Retropulsion is direct blow - increased orbital
and ocular pressure cause the fracture
MANAGEMENT
 Will depend on the nature and extent of the
injuries
May be due to:
 lid surface or epithelial abnormalities related
to systemic diseases (thyroid disorders)
 infection, injury, or complications of
medications like antihistamines.
The tear film has three main components: lipid,
aqueous and mucin.
OUTER LIPID
The lipid layer's most important function is to
prevent the evaporation of tears. The Meibomian
Glands manufacture the lipid layer.

 Surgery depending on the injury MIDDLE AQUEOUS

 Medication like corticosteroids, analgesics,
anti-infective
 Note: Immediate visual loss after an ocular
injury is usually PERMANENT.
Foreign body trapped in the eye
• Usually tolerable except:
The largest portion of the tear film is made up of
aqueous with different types and concentrations of
mucins (sticky proteins) throughout. Most tear film
components are dissolved in this layer, including
the oxygen supply to the cornea. The Lacrimal
Gland creates most of the aqueous layer.
INNER MUCIN

✓Copper The thickest concentration of mucins is at the eye's

surface. This layer helps to spread tears and
✓ Iron
stabilize the tear film, which works to prolong the
✓vegetable material from plants and trees tear break-up time. Goblet celts produce the mucin.
• If metallic object: no IRI MANIFESTATIONS
• Do not attempt to remove solid object  Photophobia
 Burning sensation
• Cover the eye with metal shield or stiff paper cup
 Eye sting
until medical treatment is obtained
 Redness
INFECTIOUS EYE DISEASES
 Decreased tears
Dry Eye Syndrome
Diagnostic results show:
Conjunctivitis
 Absent or interrupted tear meniscus •
*Bacterial- usually messy Thickened conjunctiva
 Hyperemia
*Viral - has longer infectivity
MANAGEMENT
*Allergic type- is non infectious
Artificial tears at daytime
 Uveitis - involves the iris, ciliary body and
the choroid  Eye ointment at night

 Blepharitis  Cyclosporine ophthalmic emulsion

Dry Eye Disease
 Deficiency in the production of any of the
aqueous, mucin or lipid tear components
(Restasis) - increases tear production
 NSAIDs
Surgery for advanced cases:

 Multifactorial condition with an underlying  Punctual occlusion

inflammatory component
 Grafting procedures

✓Lateral tarsorrhaphy
PERMANENT TARSORRHAPY
MANIFESTATIONS: BLEPHARITIS
 Performed if tearing does not occur after
partial occlusion or a repeated Schirmer's  Redness of the eyelids.
result of 2mm or less  Flaking of skin on the lids
 Crusting at the lid margins Cysts at the lid
 Schirmer's test uses filter paper to measure margin (hordeolum).
tear production.  Red eye
 Debris in the tear film, seen with
Conjunctivitis magnification
 Gritty sensation of the eye.
• inflammation of the conjunctiva  Reduced vision.
• the most common ocular disease HORDEOLUM (STYE)
worldwide.
 An acute, localized swelling of the eyelid
• is characterized by a pink appearance that may be external or internal and usually
(hence the common term pink eye) is a pyogenic (typically staphylococcal)
because of sub conjunctival blood infection or abscess
vessel congestion.
 Nodule and swelling are common
CONJUNCTIMTIS-TYPES
CHALAZION
 Microbial
• Viral
 Granulomatous inflammation of the lid
• Bacterial
margins' meibomian gland; lump either
internal or external
 Allergic
 Toxic  With pressure, vision is affected
MANIFESTATIONS:
 Managed with warm compress, antibiotics
and surgical excision
 Redness of the eyelids
 Sore eyes TRACHOMA
 Gritty sensation of the eye
 Reduced vision  Chronic infectious form of conjunctivitis
 Glare caused by Chlamydia trachomatis
 Exudates/ discharges from the eye
 One of the common causes of blindness
ALLERGIC CONJUNCTIVITIS worldwide

 A hypersensitivity reaction that occurs as  Managed with antibiotics although chronic

part of allergic rhinitis forms are hard to manage and can lead to
blindness
 Characterized by pruritus, epiphora (too
much tears), severe photophobia MANAGEMENT: EYE INFECTIONS

 Most mild forms are self- limiting but severe
conjunctivitis requires antibiotics, anti-
inflammatory, etc.
UVEITIS
 dark glasses for photophobia
 mydriasis for ciliary spasm
 cyclopentolate atropine and (Cyclogyl)
 Local corticosteroid drops like Pred Forte
1% to reduce inflammation

 inflammation of the uveal tract that can TUMORS

affect the iris, the ciliary body and/ or the
choroids.  Benign tumors of the Orbit
Two types:  Benign tumors of the Eyelids
a. non granulomatous (more common)
b. granulomatous (rare)
 Benign tumors of the Conjunctiva
BLEPHARITIS
 Malignant tumors of the Orbit
 chronic inflammation of the eyelid, the
 Malignant tumors of the Eyelid
severity and time course of which can vary.
  Malignant tumors o the Conjunctiva

Malignant tumors of the Globe