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A MANUAL FOR .~::~

• I~ALTH WORKERS
H13.45 ; MINISTRY OF HEALTH
P93 "
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DOH-CENTRAL lIBRAHY
•
I TABLE OF CONTENTS
~
Page

I Introduction 1

II Contents 3

III Objectives 4

IV How will this manual help you? 5

V How to examine the eyes 7

VI Eye Examination and Recording 10

VII The Human 'Eye 16

VIII Conditions Affec.ting the Eyelids 21

IX Conditions Affecting the Conjunctiva 29

X Conditions Affecting the Cornea 41

XI Conditions Affecting the Pupil 51

XII Other Eye Conditions that may be Recognized 54

XIII Safety Awareness 59

XIV How to make and apply an eyepatch 62

XV How to make an eyeshield . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 63

XVI Forms and Reporting 65

XVII Hchabilitation of the Blind 66

XVIII Glossary 67

XIX Vitamin A Treatment Schedule 74

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0435
H13.45 P931 Primary eye care
•
INTRODUCTION

In the Bicol Region, there are approximately 26 blind people in the average barangay of

1,000 people. These are the statistics resulting from a recent blindness prevalence survey done

in the province of Albay and Camarines Sur. H nothing is done about this, the number of

blind people will definitely increase. This will then create a detrimental socio-economic set-

back in the community since the blind people are not able to contribute to the community's

economic growth. Aside from being non-productive, they still consume the same amount of foods,

goods and services like a sighted person. They will also need the time of a sighted person to

care for them and this wastes the time that the sighted person will otherwise use for work or

study.

A good number of blind people could have been helped from becoming blind either by

themselves, their families or by others in the community. Many of them become blind because

they or the people around them lack the knowledge about eye health and eye care. However,

just as many blind people become blind because there was no adequately prepared or trained

persons available to give the immediate treatment for their eye ddseases. The prevention and the.

early treatme.'1t of common eye diseases are therefore very vital in the reduction of the number of

hI ind people and these two components of health care constitute what we call PRIMARY EYE
CARE.

Primary Eye Care is thus defined as a "vital component of Primary Health Care that includes

the promotion of eye health and the prevention and treatment of conditions that may lead to

visual loss.

In the Bicol Region, this means a joint effort to combat blindness by the people III the com-

munity, the BHA, and the RHU. As the first referral center for eye patients that the BHA

cannot manage locally, your role is a very important one and your services in support of the

BHA's and RHM's are ultimately a great contribution to the eye. health of the people in this
• Region.

1
 CONTENTS

This manual gIves a brief description of:

1) The normal structure and function of the eye,

2) How to measure vision,

3) How to recognize, manage and prevent common eye diseases.

Diagrams are included to further illustrate conditions described. The eye diseases that are

included here are those recognizable by just taking a good look at the eye with a penlight in

addition to getting a good history of the eye complaint or problem. Some of the diseases

mentioned are not really common but were in eluded here because they are potentially blind-

ing. This includes the most important aspect III their recognition, management and early refer-

ral to the specialist. Included also are conditions where the eyes "look normal' but the vision is

still poor .

3
 OBJECTIVES ..
This manual was prepared 'to help you manage common eye diseases that may lead to

blinn ness. It is similar to the manual for BHA's except for the management (action) aspect.

The objectives are the same.

To provide knowledge:

1) To recognize eye diseases,

2) to decide whether to treat or refer and

3) to prevent eye diseases.

•
 How Will This Manual Help You?
,.'

A patient may come to you with any of the following common eye complaims or problems:

1) Pain or headaches associated with VISIOn,

2) Loss or disturbance of vision,

3) Redness with or without discharge.

4) Injury or foreign body.

You should be able to decide whether the patient's eye problem can be managed at your

clinic or not. To make this decision, you should be able to recognize common eye diseases which

you can treat at your clinic, and eye diseases which you have to refer to the (RHU or) hospital

for further evaluation or treatment by the eye specialist. You should be able to know eye

diseases which you can prevent either by early recognition of signs and symptoms, by eye health

education, or hy immediate treatment. You can pass on this knowledge to the patients you talk

to .

5
EXAMINING A BABY'S EYES

If necessary I you can. hold his head

between your knees

Figure A
 I. How To Examine The Eyes

Rememher the 5 rules for a normal, healthy eye: •

1) The CORNEA should he CLEAR.

2) The PUPIL should be BLACK.

3) The WHITE PART (sclera and conjunctiva) should be

WHITE.
4) The EYELIDS should OPEN AND CLOSE PROPERLY.

5) The VISION should be GOOD.

A) First, watch the patient's eyes as you talk to him or her. Listen to what he tells you so that

you will have a better idea of what to look for.

B) When you actually start to examine the eyes, use a flashlight. If you do not have one, tell

your patient to stand near the window facing the daylight.

C) Be sure that you and your patient are comfortable. Be sure that your patient's eyes are open

so that you can see well enough to examine them. You can use your index finger to hold the

upper lid open and your thumb to hold the lower lid open. Hold your flashlight with the

other hand.

D) Start with the 4 rules:

1) Look at the cornea:

a) Is it clea"?

b) Is there an infection or ulcer?

c) Is there a scar?

d) Is there an injury? (abrasion, laceration, foreign body,

blood behind the cornea)

2) Look at the pupil:

a) Is it black?

L) Is it grey or white?

, 7.
 c) Is it round or irregular in shape?

d) Does it react to light (the pupil should constrict when you shine your light

into it).

3) Look at the white part (conjunctiva).

a) Can you see the white sclera?

b) Is the conjunctiva red?

c) Does it look yellow?

d) Is there an injuriy? (foreign body, laceration)

4) Look at the eyelids:

a) Do they open and close properly?

b) Are they clean?

c) Are there any lumps in there?

d) Is there an injury? (foreign body, laceration).

e) Pull the lower eyelid down to look inside.

£) Evert the upper eyelid to look for infection, allergic swelling or bumps, or a

foreign body.

5) Do the eyes move together and in all directions? Ask the patient to look up, down

and to each side. He should follow your light (do not shine the light directly

into his eyes) or your pencil in each direction, always from the center position out-

ward.

6) Record anything that is not normal. Record what you see and on which eye, or if

it is on both eyes.

7) You will continue your examination by measuring the vision.

8
 VISION TEST

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,·w P "It T .. \\ ...
"uz ,.TTl;

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3 METERS
/
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Figure B
 EYE EXAMINATION AND RECORDING

AIeasuring the Vision and Recording

The most important part of the eye examination IS measunng the vision or Visual Acuity

Testing.

You measure the visron by usmg the letter chart or the "E" chart provided in your kit.

Instructions for Measuring Vision

1) You must have good light to measure vision. You can do this inside or outside, wher-

ever there is good light.

2) The chart should be at eye level.

'3) Your patient should stand at 3 meter. from the chart. Use your measuring string in your
kit to measure 3 meters.

4) Always measure the right eye first.

5) Cover his left eye with the card from your kit.

6) Ask your patient to start reading from the top line (line 1) then ask him to read line 2,
line 3, line 4 and line 5.

7.) You record the Visual Aeuity of the patient as the last line that he can read. For exam-
ple, if your patient read all the way 10 the bottom line (line 5) record line 5. If he can
read up to line 4, then record line 4 and so on with lines 3, 2 and 1.

8) Now cover his right eye and repeat ins tructions 6 and 7.

Note: Remember to measure the vision 01 only one eye at a time.

9) If the patient cannot see anything on the chart with an eye, cover his other eye and ask
him to connt your fingers from a distance of one (1) meter. Keep the distance shorter
nntil he can see and count your fingers. Keep changing the number of fingers, ask him to
count. If he can count your fingers, record Count Fingers (CF) at 3 feet, 2 feet, or 1 foot
as the case may be.

]0
 10) If your patient cannot count your fingers, slowly wave your hands in front of his eye and

ask him if he can see it. If he can see Hand Moving, record Hand Movement (HM).

11) If he can only perceive light but cannot tell which direction it is coming from, record

his vision as Light Perception (LP).

12) If the. patient cannot still perceive light with that eye, record the VISIon of the eye as

Cannot See. (Negative Light Perception NLP)

RI';MEMBER:

There should be one recorded Visual Acuity lor each eye.

POINTS TO REMEMBER:

1) The patient should stand 3 meters from the vision chart.

2) If the patient wears glasses all the time and not just for reading books and close work,
• he should wear the glasses for the distance vision test.

3) Measure the right eye I irst.

4.) Be patient with people, especially child ren and old people.

S'I The examiner should start with the big "E" at the top of the chart and go down. Do not
go back up..

6) The examiner should use a closed pen to point to the "E's". A closed pen will protect the

chart. Do not cover the "E's", but point underneath each one.

7) The examiner should instruct the patient on how to point her finger in the same direction

as the "E'5".

• 11
8) The eye should be covered by a card or a patient's hand, not by the fingers, People can

peak through their fingers,

9) The patient should point in each direction and should not say the direction. They usually

mix up the left and right sides, especially children.

10) Be patient, Children are often afraid of examinations, Old people are afraid you will

tell them they are going blind. Be encouraging so that they will try their best.

11) Record the number beside the smallest line that the patient could see.

12) Anyone who cannot see the "E's' below the colored line should go to the EENT physician

at the hospital for further examination.

12

I
 Eye Form RHM-l (Ipakitao po ini
sa RHU

RHM EYE REFE~ FORM !O THE RHU

• Probensiya __ Ngaran kan Pasyente _

Munisipyo Edad Lalake ~Babae, __
Barangay Petsa kan Pag-eksamen\..- _

VISUAL ACUITY (Pagsukol kan Paghiling)

(Bugtakan nin sarong check ( ) an para sa Tuong mata asin sarong check
para sa Walang mata).
TuOng Walang
Nakakahiling sagkod sa: Mata Mata
- Lenya 5 0 c:
- Lenya 4 ..........................• 0 o
- Lenya 3 0 ci
- Lanya 2 • • • • . . • • . . . • • . . . • . . . • • . . . •• 0 ci
- Lanya 1 ••••.•.••....•.••.•••..••.. 0 cr
Nakakahiling nin Muro sagkod t metro ••••• 0 ci
. (Count Fingers)
Nahihiling an Paghiro kan Kamot •••••••••
(Hand Movement)
0 cr
Nakakahiling nin Liwana~ ••••••••••••••••
(Light Perception)
0 cz
I.
Dai Nakakahiling (-) Light Perception •••• CJ CJ
Rason sa Pagduman sa ROO. _

Mga Ginibo (Bolong/Serbisyo)

RHM Sinature
• • • • • • • • • • • • • •• • • • • ••• • ••• • ••• •• •••••••••••• •• •••••••••••••••••••• ••••••• •• ••••• •
(Putulon an nasa ibabang porma (Return Slip). asin ipatao sa RHM para sa pagpa-
check-up) •
Eye Form RHM-2 (Ipakiwalat po ini sa RHM)
RETURN SLIP
(From RHU to RHM)
Ngaran kan Pasyente _
Edad Babae ___ lalake _

Kga Ginibo (Bolong/Serbisyo)

Follow-up kan Rlil'J _

MHO Signature
 EXAMINING A YOUTH OR ADULTS EYES

n. WE I
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.mEwa;,
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POOR'VISION CAN CAUSE PAINFULL EYES

Figure C
..
I
 PRIMARY EYE CARE KIT FOR RHU

to

i
W E ..
3 ill mE ..
l

1
E
cardboard E
FLIP CHART
PARA SA
SALUD KAN
MATA SA
: II aE LlJ :1 m .. 5
;. W E m3 E W '•• 4 COMMUNIDAD

vision chart flip' chart

ocluder

; penlight

battery 3 meter string

s;
eye shield
gauze

~
plaster tape
eye patch pattern
vitamin A
cotton
antibiotic eye
ointment

Figure D
 THE HUMAN EYE

PUPIL ~?::~:---- EYEll D

~--SCLERA
(white port)

CORNEA CONJUNCTIVA
(Clear
IRIS (Cleorcoverlng of the
covering white port of the eye)
of colore d
port of the
eye)

LENS \ RETINA

Figure I
 DOH-CENTRAL UBRARY

STRUCTURE AND FUNCTION OF THE EYE

•

The eye is actually a ball. Without special equipment, we can only see the front of the eye-

ball and the tissue that COvers it. If you look at the diagram on the opposite page, you will see

the front of an eye as we normally look at it.

The following parts are described:

1) EYELIDS - The eyelids are folds of tissue that open and close to expose or

cover the front of the eye. Thcre IS an upper and lower eyelid.

2) CORNEA - The cornea is the dear, circular front window of the eye. It

allows light and color to enter the eye. It covers the colored

part of the eye.

3) CONJUNCTIVA - The conjunctiva IS a thin, transparent membrane that lines the

eyelids as well as the white pan of the eye. It does not cover
. the cornea.

4) SCLERA - The sclera is the white covermg of the eyeball. It covers all

the eyeball, except the cornea. It gives shape to the eye.

5) IRIS - The iris is the colored part of the eye that is seen through

thc cornea. The color of the eye depends on the color of the

iris. In Filipinos, the iris is usually brown. The iris spreads

out around a hole called the pupil and changes the pupil'S

SIze.

6) PUPIL - The pupil IS a circular black hole in the center of the iris.

It is seen through the cornea. It allows light to get to the

17
 back part of the eye. By becoming smaller or bigger, the

pupil controls the amount of light going inside the eye. •

7) LENS -The lens is located behind the pupil. It is a small transparent

structure that cannot be seen unless diseased. It also allows

light to get to the back of the eye.

UNLESS LIGHT REACHES THE BACK OF THE 'EYE PROPERLY, WE WILL NOT BE ABLE
TO SEE.

..

18 •
 Take a look at the cross-section diagram which shows the back part of the eye. When an

• eye is cut from the cornea to the back of the eye, the parts that could he seen inside are:

1) RETINA - The retina lines the inside of the eyeball except its front parts.

It receives the light that is allowed to enter by the front parts

of the eye and sends messages to the brain. The brain then

"tells us what we see".

2) CHOROID - The choroid is the vascular coat of the eye. It covers the same

part of the eye as the retina, and is located between the retina

and the sclera. The choroid "nourishes" the eye.

3) VITREOUS - The vitreous is the gelatin-like substance that fills up the

shell of the eye. The shell of the eye is composed of the

sclera, choroid and retina. The vitreous and the shell give

sha pe to the eyeball.

4) OPTIC DISC -The optic disc is the end part of the optic nerve that can be

seen on the retina. The optic nerve is the connection between

the eyeball and the brain.

The lens, retina, choroid, vitreous and optic disc can all be seen with very special eqmp-

ment and instruments in an eye clinic. These devices make it possible for an eye specialist to

evaluate an eye problem thoroughly.

The whole eyeball, except its front part is protected by the bony orbit that is part of the

skull.

19
In summary, there are five rules that apply to a NORMAL, HEALTHY eye:

1) The CORNEA should be CLEAR.

2) The PUPIL should be BLACK.

3) The WHITE PART should be WHITE.

4) The EYELIDS should OPEN AND CLOSE PROPERLY.

5) The VISION should be GOOD.

20
 CONDITIONS AFFECTING THE EYELIDS

1) STYE

Description

A) A stye is a painful lump at the eyelid margin. It is due to an infected eyelash follicle.

• Stye
Figure 2

Signs and Symptoms

A) Red lump at the lid margin. It may be inside or outside the eyelash.

B) Painful, swo'llen eyelid.

C) May be multiple.

Action

A) Measure the VISIOn of each eye and record.

B) Apply warm, wet compresses for 15 minutes 4 times a day for 1 week.

C) If the patient is a referral of a BHA and has been putting compresses to no relief,

the RHU physician may prescribe anti-inflammatory analgesics (papase, tanderil ] for 2

days plus oral anti-biotics if the patient is a child.

D) If the stye is affecting the vision or does not disappear after a week, refer to an eye

.. specialist.
Department of Heallh

I~I~I I I I I ~IIII~I
21

D435
H13.45 P93
 Prevention

A) Good hygiene for the eyelids.

B) If the styes are multiple, advise a course of systemic antibiotics. (at the RHU only)

C) If the vision is poor, refer to the EENT physician for evaluation.

2) CHALAZION

Description

A) A lump inside the eyelid. Usually painless. A chalazion IS a blocked Meibomian (oil)

gland in the eyelid. It may start as a stye.

,
Chalazion

Figure 3

Signs and Symptoms

A) A lump in the eyelid.

Action

A) Measure the vrsion of each eye and record.

B) Apply warm, wet compresses for 15 minutes, 4 times a day for 2 weeks.

C) Ask the patient to return after two weeks if the chalazion is not better.

D) If the patient returns, or has multiple chalazia, refer to the EENT physician at the

hospital for treatment.

22
•
 Prevention

A) Good hygiene for the eyelids.

3) ENTROPION

Description

A) The eyelid is rolled iriward. This is most commonly caused by an infection called tracho-

rna.

The eyelid is rolled inward

Figure 4

Signs and Symptoms

A) Eyelid turns inward.

III Eyelashes Jllay he scratching the cornea (trichiusis ) making it hazy.

C) There may be redness of the eyes.

Action

j\) Measllre the vision of each eye and record.

B) You Jllay .pull out tho eyelashes touching the cornea hy everting the eyelid and pulling

lashes with a forceps or tweezers.

C) Hefer to the EENT physician at the hos pitn] for evaluation. The patient should have an

operation to turn the eyelid outward again. If this 15 not done, the tweezed eyelashes

will grow inward again and ssratch the cornea more as they grow.

• 23
 Prevention

A) Good hygiene to prevent blindness.

NOTE: Trachoma is found in people living in areas with little water and poor sanitation.

It is easily passed from one person to another by dirty hands and use of common

towels.

4) ECTROPION

Description

A) The eyelid turns ouuoard. Most often found in old people but can also result from

burn scars or injury to the eyelids and face.

The eyelid turns outward

Figure 5

Signs and Symptoms

A) Eyelids turn outward.

B) Tears run down the cheek.

C) The eye may be dry because the eyelids do not close properly. There is exposure of pain.

Action \

A) Measure the vision of each eye and record.

B) Refer to the EENT physician at the . hospital for treatment.

,
24
 Prevention

A) Safety education to prevent burns.

5) BRUISE

Description

A) Bruise in the eyelids after a blunt or direct injury. Commonly called "black eye".

Bruise
(Black eye)

Figure 6
Signs and Symptoms

A) Blue-black discoloring of the eyelids.

B) The eyelids are often swollen.

Action

A) Measure the vision of each eye and record.

B) Ask when and how the injury happened.

C) Carefully check for subconjunctival hemorrhage and hyphema (blood bebind the cornea).

D) If the vision is good and there are no other injuries, reassure the patient. The bruise

will go away in two weeks.

'E) If there JS a subconjunctival hemorrhage and no other mjurres, this will also go away in

two weeks.

F) If the VIsion is poor or if there is hyphema, refer to the EENT physician at the hospital

for evaluation.

25
 Prevention

A) Safety education to prevent injury. •

6) LACERATION

Description

A) A cut in the eyelid from a sharp ohject.

Figure 7

Signs and Symptoms

A) Eyelid laceration.

B) Bleeding.

Action

A) Measure the vision of each eye and record.

B) Carefully look for any laceration in the cornea or sclera.

C) Apply a protective eyeshield.

D) Refer to the EENT physician at the hospital for treatment.

NOTE: A lid laceration should always be sutured by an eye specialist to be sure that
there is good approximation of the lid margin. An improperly sutured lid injury
will lead to improper lid function later on.

26
•
 Prevention.

A) Safety education to prevent injury.

7) FOREIGN BODY

Description

A) Any piece of dirt or material (insects, rice husks, eyelash, dust) that goes under the
eyelids.

~~~,rr!t,,.I{!I~I
{~
,-"""-
7;;'~ ,',,' , .....

~,':-
Foreign body

Figure 8

Signs and Symptoms

A) Scratching and irritation when blinking.

B) Tearing.

C) The patient complains of pain.

Action

A) Measure the vision of both eyes and record.

B) Turn the upper eyelid to look for the foreign body,

C) Try to remove the foreign body with a damp cloth or a cotton swab.

D) If there is infection, apply antibiotic eye ointment 3 times a day for 5 days.

,
21'
E) If you cannot remove the foreign hody:

1) Apply antibiotic eye ointment.

2) Apply pressure patch.

3) Refer to the RHU or EENT physician at the hospital for treatment.

Prevention

A) Safety education in the home, school and industry.

,
28
 CONDITIONS AFFECTING THE CONJUNCTIVA

1) CONJUNCTIVITIS

Description

A) The small blood vessels in the conjunctiva arc swollen because of infection, allergy or in-
jury, The conjunctiva over the sclera (bulbar) and inside the eyelids (palpebral) is
red.

Conjunctivitis
Figure 9

Signs and Symptoms

A) Itching and burning.

B) Discharge.

1) Pus (bacterial).

2) Water (viral).

3) Stringy (mucus).

Action

A) Measure the vision of each eye and record.

B) Wipe the eyes with a moist cloth.

C) For infection, apply antibiotic eye ointment four times a day for seven days and record.

D) If the eyes are not belter in one week or if the cornea is hazy also, refer to the EENT
physician at the hospital for evaluation.

29
 Prevention

A) To prevent reinfection and the spread to ",ther family members, educate about:

1) Personal hygiene (clean eyes).

2) A separate towel for persons with infected eyes.

B) Wash your hands after touching infected eyes, so you do not spread the infection to other
patients or to yourself.

2) OPHTHALMIA NEONATORUM

Description

A) Commonly known as "conjunctivitis in the newborn". This infection is picked.up from

the mother by the newborn during birth. The cause is usually gonorrhea or staphylococcus.

Pus
-.;;...."

\1

Figure lO·A
Conjunctivitis in the newborn
(ophthalmia neonatorum)

Figure JO·B

Signs and Symptoms

A) Red swollen eyelids.

B) Much pus. (The pus may "shoot" out when you open the bahy's eyes).

Action

A) Wash the eyes carefully.

30
 B) Apply penicillin eye drops (dosage equal to 10,000 units per ml.).(RHU only)

1) One drop in each eye every ten minutes for one hour.

2) Then one drop every hour for 6 hours.

3) Theil one drop for every two or three hours for three days.

C) Also, inject 150,000 units of crystalline (benzyl ) penicillin I.M. twice a day for 3 days. (RHU only)

D) If gonorrhea, treat both parents too.

E) If staphylococcus infection, treat mother (probably urmary tract" infection).

Prevention

A) Antihiotic eye ointment in the eyes of all predisposed newborns at birth.

B) Proper pre-natal care and advice to parents to prevent infections in their bodies.

3) JAUNDICE

Description

A) The sclera appears yellow because of hepatitis, malaria and anemia.

Conjunctiva

Figure 11

31
 Signs and Symptoms

A) Both eyes are affected.

B) The skin may appear yellow.

C) There may be general illness.

Action

A) Measure the vision of each eye and record.

B) Treat the hepatitis, malaria or anemia.

Prevention

A) Good hygiene and sanitation practice to prevent hepatitis.

B) Chloroquine prophylaxis in endemic malaria areas.

4.) BITOT'S SPOT

Description

A) Whitish grey patches on the surface of the nasal and!or temporal conjunctiva. These
patches appear as "foamy" bubbles. They are usually a sign of Vitamin A deficiency.

Grey Foamy bubbles

Figure 12

32
Signs and S)'mptoms

A) Whitish grey patches on the surface of the nasal and!or temporal conjunctiva.

E) Usually affects both eyes.

C) The patient may he malnourished.

Action

A) Measure the vISIOn of each eye and record.

E) Give 200,000 LU. Vitamin A capsule and record.

C) Ask the patient to return in one week. If the eyes are not well, give another 200,000
LU. Vitamin A capsule and record.

D) Nutrition education.

E) If the patient also has a corneal ulcer, then this is more serious condition. Give anti-
biotic eye ointment four times a day and reexamine after two days. If there is no improve-
ment, refer to the RHU or eye specialist in the hospital.

Prevention

A) Nutrition Education - this will include telling the patients and his family about foods
rich in Vitamin A. Everyone should eat one of these foods everyday to prevent blindness.

I) Dark, green and leafy vegetables

Gabi leaves

Saluyot leaves

Kamoteng-kahoy tops

Ampalaya leaves

Kamote tops

Kangkong leaves

Malunggay

.'13
VITAMIN A RICH FOODS

'C())c5b
"""1

~ '~.'
.~~
..

_""'<t.~

~9

Figure e
 2) Yellow fruits and yellow vegetables

Carrots

Tomatoes

Kamote

Squash

Pumpkin

Papaya

Mango

Tiesa

3) Animal Sources
Breast milk for children under one year old.

Milk

Eggs

Liver oil

5) NEVUS
Description

A) A pigmented growth (mole) on the con junctiva.

Figure 13

Signs and Symptoms

A) A pigmented growth anywhere on the conjunctiva.

35
•

Action

A) Measure the vision of each eye and record.

B) No treatment is necessary.

C) Ask the patient to return and tell you if there IS any change in the SIZe of the neVUS.

Prevention

A) There is no known prevention for a conjunctival nevus.

6) SCLERAL NODULE

Description

A) There crac numher of conditions which will cause d lump on the sclera or conjunctiva.

They can be caused by allergic, infectious or inflammatory conditions and most are sympto-

matic and harmless. However, if you find a localized nodule in one eye with associated

redness and pain, this is a serious condition, It should be managed by an eye specialist.

A round elevated structure

Figure 14
 Signs and Symptoms

A) There is a circumscribed nodule on the white part of the eye.

B) The nodule is red.

C) There is pain.

Action

A) Measure the vision of each eye and record.

B) Refer to the RHU or EENT physician at the hospital for treatment.

Prevention

A) There is no known prevention for the scleral nodule.

7) FOREIGN BODY

Description

A) Any piece of dirt or material (insects, rice husks, eyelash, dust) that goes into the eyes.

Forei~n body
Figure 15

37
 Signs and Symptoms

A) Scratching and irritation when blinking.

B) Tearing of eyes due to irritation.

C) The patient may complain of pain.

Action

A) Measure the vision of each eye and record.

B) Try to remove the foreign body with a damp cloth.

C) If you removed the foreign body, apply antibiotic eye ointment once.

D) If you cannot remove the foreign body, apply antibiotic eye ointment and a pressure

patch.

E) Refer to the RHU or EENT physician at the hospital for treatment.

Prevention

A) Safety education in the home, school and industry.

8) SUBCONJUNCTlVAL HEMORRHAGJ£

Description

A) Broken blood vessels under the conjune tiva appearing as a blood clot. In an adult, this

is often due to untreated high blood pressure. In a child, this is usually due to whooping

cough.

Blood

Figure 16

38
Signs and Symptoms

A) Bleeding under the conjunctiva, appear mg as a blood clot on the white part of the eye.

R) There is no pain.

C) The vision is not affected.

Action

A) Measure the vISIOn of each eye and record.

B) Ask about the injury to the eye.

C) 1£ there has been an injury, check for hyphema and treat hyphema if it is also present.

D) If an adult with no history of injury:

1) Measure blood pressure.

2) Treat if blood pressure is high.

E) T£ a c~i1d with no history of injury:

1) Check for whooping cough.

2) Treat cough if present.

F) If there is no history of injury, high blood pressure or whooping cough:

1) Reassure the patient that it is like a bruise and will go away in two weeks.

2) No treatment is necessary. You may give Vitamin C (ascorbic acid 500 mg.) daily

for one week.

Prevention

A) Safety education to prevent injury.

B) Treatment of high blood pressure.

C) Vaccination against whooping cough.

39
9) LACERATION

Description

A) A cut through the conjunctiva and sclera caused by a sharp object.

Cut

Figure 17

Signs and Srmptoms

A) A laceration through the conjunctiva which may have cut the sclera too.

E) You may see fluid leaking from the wound.

C) The vision is blurred if the sclera has been cut.

Action

A) DO NOT PRESS ON THE EYE.

B) If the sharp object is still in the eye, DO NOT REMOVE IT.

C) Try to measure the vision of each eye and record.

D) DO NOT APPLY OINTMENT. Use eyedrops instead.

F) Do not apply pressure patch.

F) You can apply a protective shield.

G) Refer to the EENT physician at the hospital immediately.

Prevention

A) Safety education to prevent injury.

 CONDITIONS AFFECTING THE CORNEA
1) CORNEAL ULCER

Description

A) An ulcer is a crater that forms in the cornea. It can be caused by any or a co~pination of the

following:

1) Malnutrition

2) Infection, especially measles.

3) Injury.

An ulcer can destroy the cornea In 24·48 hour•.

Ulcer due to Vitamin A deficiency.

Figure 18·A Ulcer dne to infection

or injury
Signs and Symptoms Figure 18·B

A) The cornea is not clear especially where the ulcer IS located.

B) There may be pain.
C) Poor vision.
D) Redness and/or discharge.

Action

A) If possible, measure the vision of both eyes and record.

It) Clean the eye carefulIy and examine the cornea and conjunctiva again. If there is red-
ness and discharge, increase the dosage of antibiotic ointment and examine the patient daily
for two days. If after two days the cornea looks worse (no sign of clearing up) refer to the
EENT physician at the hospital for evaluation.

41
C) If the patient is a malnourished child, gIve one 200,000 LU. Vitamin A capsule and refer

to MSSD for evaluation and supplementary feeding. If the patient has received Vitamin A

from the BHA, refer to MSSD for evaluation and for supplementary feeding.

D) If the patient has measles and doesn't want to open his eyes, give Vitamin A as In (C) and

try to open the eyes to put medicines into it. Eyedrops may be more soothing than ointment

and easier to administer. It has to be dropped every ~0-60 minutes.

Prevention

A) Nutrition Education - discuss with the pa tient and his family about foods ri~h in Vitamin

A. Everyone should eat one or more of these foods everyday.

1) Dark, green and leafy vegetables

Gabi leaves

Saluyot leaves

Kamoteng Kahoy tops

Ampalaya leaves

Kamote tops

Kangkong leaves

2) Yellow fruits and yellow vegetables

Carrots

Tomatoes

Squash

Kamote

Pumpkin

Papaya

Mango

Tiesa

42
3) Animal Sources

Breast milk for children under one year old

Milk
Eggs (Balut too!!)

Liver

4) Seafoods

Fish (especially fish liver)

Tahong and other sheII£ish

Cod liver oil

.43
2) PTERYGIUM

Description

A) A pterygium is a fleshy triangular growth that starts temporally or nasally on the conjunc-

tiva and grows across the cornea. It can appear in one or both eyes..

Pterygium

Figure 19

Signs and Symptoms

A) The cornea is not clear where the pterygium has grown.

B) The vision will be poor if the pterygium covers the pupil.

C) The eye looks red and irritated.

Action

A) Measure the VISIOn of eaeh eye and record.

B) Refer to the RHU or EENT physician at tile hospital for evaluation.

Prevention

A) There is no known prevention fer pterygium.

44
3) CORNEAL SCAR

Description

A) A painless, whitish spot covering part or all of the cornea. A scar forms after healing of a

corneal ulcer caused by infection, foreign body, injury or Vitamin A deficiency.

Scar
Figure 20

Signs and Symptoms

A) There is an opacity on the cornea.

B) The vision is poor, if the scar is dense and if it IS located at or near the center of the

cornea.

Action

A) Measure the VISIOn of each eye and record.

B) If the scar is in one eye only and the other eye IS healthy with good vision, comfort

the patient. Nothing needs to be done, discuss safety education to protect his good eye.

e) If the patient has scars in both eyes, refer to the RHU EENT physician at the hospital for

evaluation.

Prevention

A) Early treatment for infection. or injury.

B) Safety education to prevent injuries.

1,1

45
4) CORN,EAL FOREIGN BODY

A) Any piece of foreign matter (insects, rice husks, eyelash, metal, dust) that enters the

eyes and lodges on the cornea.

Foreign body

Figure 21

Signs and Symptoms

A) There is a foreign body on the cornea.

B) Scratching and irritation when blinking.

C) Watering/tearing from the affected eye due to irritation.

D) The patient complains of pain.

E) Redness and/or discharge may be present

Action

A) Measure the V1SlOn of each eye and record.

B) Try to remove the foreign body by wash ing.

C) Try to remove with a damp cloth.

D) If you removed the foreign body:

1) Apply antibiotic eye ointment.

2) Apply pressure patch.

3) Ask the patient to come and see you next day 10 remove the patch and check the eye.
 E) If yOIl cannot remove the foreign body, or if pain and tearing persist:

1) Apply antibiotic eye ointment.

2) Apply pressure patch.

3) Refer to the EENT physician at the hospital for evaluation.

Prevention

A) Safety education in the home, school and industry.

5) CHEMICAL BURN

Description

A) A burn on the cornea and conjunctiva from acids or alkalis such as hleach or lye.

Figure 22
Signs and Symptom.!

A) Burning and stinging in one or both eyes.

B) Watering from the eyes.

e) The patient complains of pain.

D) Poor vision.

47
-.r;
 Action

A) DO NOT WASTE TIME with questions and examinations.

B) IMMEDIATELY irrigate the affected eyes for 15 minutes straight, if the burn was due to-

acid, and for a longer time if the burn is due to alkali. Here are three ways to irrigate the

eyes:

1) Hold the patient's head under a slow- running tap or water pump. Be sure the eyelids

are open.

2) Put the patient's head back and open the eyelids. Pour water into the eyes using a

cup or bottle.

3) Ask the patient to bend his head into a bucket of water and blink his eyes many times.

C) When the patient is comfortable, measure the vision of each eye and record. Ask the

patient what chemicals went into his eyes and record;

D) After irrigation, apply antibiotic eye ointment in affected eyes and patch lightly, or

you can leave them unpatched to let tears continue to wash the eyes.

E) Give analgesic if there is pain.

F) Ask the patient to return the next day to remove the patch and check the eyes.

G) If the patient is not well and comfortable the next day, refer to the RHU or E'ENT physi-

cian at the hospital for evaluation.

6) HYPHEMA

Description

A) Blood behind the cornea. After a blunt injury, the small vessels in the iris bleed and

the blood collects in the space between the cornea and iris.

48
 Hyphema

Figure 23

Signs and Symptoms

A) Blood b'ehind the cornea.

B) There may be pain.

C) There may he poor vision.

Actwn

A) Measure the vision of each eye and record.

B) If there is pain and poor vision, refer to the EENT physician at the hospital immediately.

C) l.f there is no pain and if the vision is good, ask the patient to rest in bed for four days.

Advise to patch both eyes and rest them completely.

D) Examine the patient after four days. If the hyphema is receding or gone, and if there is

still no pain and the vision is good, the eye is healing. Advise the patient not to strain

for at least one week more.

E) But, if there is pain, and the vision, IS poor, refer to the EENT physician at the hospital

immediately.

Prevention

A) Safety education to prevent injury.

49
7) LACERATION OF THE CORNEA

Description

A) A cut through the cornea caused by injury with a sharp object.

Figure 24
Signs and Symptoms

A) Pain.

B) A cut in the cornea.

C) Fluid may be leaking from the laceration.

D) A piece of iris tissue may have plugged the hole In the cornea. The pupil becomes oval

in such c1 case.

Action

A) DO NOT PRESS on the eye.

R) CardulJ} measure the vision of each eye and record.

C\ Do not apply ophthalmic ointment. Instead, use antibiotic eye drops.

. D ) You can apply a protective eye shield.

F.) If there IS iris tissue on the cornea, do not touch it.

F) Patch the eye gently and refer to the EENT physician at the hospital Immediately for

suturing.

Prevention

A) Safety education to prevent Injury.

50
 CONDITIONS AFFECTING THE PUPIL

1) CATARAC,T
Description

A) The lens inside the eyeball has become cloudy.

Cataract

Figure 25

Signs and Symptoms

A) Poor vision.

B) The pupil is not Black. When you shine your lit;ht into the eye, the pupil will appear grey

or white.

Action

A) Measure the vision of each eye and record.

B) Refer to the RHU.

Prevention

A) There is no known prevention for a cataract.

51
2) TUMOR

Description

A) A growth inside the eyeball of babies and young children. This IS called retinoblastoma.

Hetinoblastoma is a cancer.

Possible sign of Tumor

Figure 26

Signs and Symptoms

A) The pupil appears white or grey.

B) The eye may be turned and not straight.

Action,

A) If the child is old enough, measure the vision of each eye and record.

B) REFER TO THE RHU IMMEDIATELY.

NOTE: It is sometimes difficult to tell the difference between a cataract and a tumor.
That is why a child must be referred immediately. If it is a cataract, you will save
the child's sight. If it is a tumor, you will save the child's life.

Prevention

A) There is no known prevention for retinoblastoma.

52
3) UNEVEN OR IRRF:GULAR PUPILS

Description
A) A difference in the size of the two pupil. or, none or Loth pupils are not round.
.
/ Normal

Irregular'
Figure 27

Irregular
Figure 28
Signs and Symptoms

A) \Vhen you shine your light in the eyes, you see a difference in the size of the two pupils.
tl) 1 hey may not open and close equauy,
C) They may nol be round.

Action
-
A) Measure the vision of each eye and record.
B) Refer to the RHU immediately for evaluation.

Prevention

A) Safety education to prevent injury.

B) Safety education about medicines that affect the eye.

53
 OTHER EYE CONDITIONS THAT MAY BE RECOGNIZED

1) THE EYE APPEARS NORMAL BUT THE VISION IS POOR

Description

A) The external examination is normal. But the patient cannot read helow line 3 in one or

Loth eyes. The patient may need glasses or may have something wrong with the Lack part

of his eyes.

Normal eyes

Figure 29

Signs and Symptoms

A) Poor vision.

Action

A) Measure the vision of each eye and record.

B) Hefer to the EENT physician at the hospital for evaluation.

Prevention

A) There is no way to prevent a need for glasses.

54
2) TIlE EYE APPEARS NORMAL, AND THE VISION IS GOOD.

Description

A) The external examination is normal. Also. the patient can read at least line (4) or (5) in
both eyes. If the patient complains of pain, he probably has eye strain. If he has headache.
and dizziness, he may need eyeglasses.

Normal eyes

Figure 30

Signs and Symptoms

A) Tired eyes.

B) The patient may complain of headaches.

Action

A) Measure the vision of each eye and record.

B) Instructions for good reading habits.

C) For recurrent complaints, refer to optometrist for refraction and to the 'EENT specialist
for evaluation.

Prevention

:\) Instructions for good reading habits:

1) Use good light on the reading materials.

2) Hold the reading materials about 14" (33 cm.) from your eyes.

3) Rest your eyes for five minutes after each half hour reading.

55
3) BLOCKED TEAR DUCT

Description

A) A blocked tear duct causes tears to back up and run down the cheek. This creates a good
home for bacteria to grow, causing infection. This condition is usually found in babies.
Tears run down their cheeks even when they are not crying.

Red swollen lump

Figure 31

Signs and S)'mptoms

A) Tears running down the cheek from the affected eyes.

B) There may be discharge or pus.

Action

A) If the patient is a baby, ask the mother to massage the nasal corner of the lower eyelid
4 times a day.

B) If there is discharge, apply antibiotic eye ointment 4 times a week.

C) If the baby is not well after one week, or if the patient is an adult, refer to the RHU
or EENT physician at the hospital for evaluation.

Prevention

A) There is no known prevention for a blocked tear duct.

56
4) ENDOPHTlJALMITlS

Description

A) This is an extremely serious extra-ocular infection. The eye is full of pus and it is blind.
Endophthalmitis can he caused hy infection or injury.

Figure 32

Signs and Symptoms

A) Very red swollen eyes.

B) Pus is seen between the cornea and the Ins.

e) The vision is poor.

D) The eye is very painful.

Action

A) Give analgesic tablets

B) Refer to ophthalmologist. IMMEDIATE LY try to save the eye.

Prevention

A) Safety education against injury.

57
 In summary. you should be able to recognize the following eye eonditions that can lead to
blindness if not recognized early:

I) Infecnons of the Cornea

2) Injury to tbe Eyeball

3) Uncorrected Need for Eyeglasses especially III Children

4) Cataract

5) Blinding Malnutrition (Nighthlindness, Drying of the Eye)

6) Glaucoma

7) Iritis

8) Retinoblastoma
 SAFETY AWARENESS
Common injuries to the eyes are those caused
by:

lighting

stone
stick

chemicals

.-
rice husks

Figure f
 SAFETY AWARENESS

Many people become needlessly blind because of eye injuries. It is common for someone to

suffer from an eye injury and delay going for treatment, By the time he finally goes to the BHA,

RHM or RHU, there are complications to the injury such as infection. Because of the delay,

the health worker has a more difficult job trying to manage the problem.

Also, most eye injuries can be prevented, if individuals and the community have know-

ledge about safety measures. Eye safety should be practiced everywhere; in the home; in the

school and in industry.

Examples of causes of eye injuries are:

I) Fighting

2) Thlrowing sticks, stones and other objects at people

3) Chemicals in the eyes such as bleach, acid and lye

4) Burns of the face and eyes

5) Stone and metal working (grinding wheels and stone hammers)

6) Welding

7) Rice husks

To prevent injuries, we must always be on the look out for dangerous situations, and avoid

them before someone is injured.

60
Some blindness prevention measures are:

1) People should wear protective goggles when working with grinding wheels, stone ham-
mers, and heavy tools.

2) People working near fire and welding tools must wear protective shields.

3) Keep dangerous chemicals and fluids away from the reach of children.

4) Educate children about the dangers of throwing sticks, stones and other objects at
each other.

5) Educate the children about dangers of fire.

6) Educate individuals and the commu nity about eye safety and the serIOUS results of
eye injuries.

7) Be aware that rice husks can get into your eyes and cause irritation.

61
 HOW TO MAKE AND APPLY AN
EYE PATCH

You will need:

eye patch pattern

bottom

(2) Use your eye patch patternprovided in your Primary Eye

Care Kit for cutting pads.

(3) Be carefull not to contaminate the eye pad by touching

it all over.

(4) Apply pads using two strips of plaster tape as shown on

Figure I.

Figure 6
 HOW TO MAKE AN EYE SHIELD

cut a circle from used

x-ray film, heavy paper
or card

cut this shape

make a cone

tape paper outside

tape paper insi de

tape over patient's

injured eye

~\\Io""

Figure H

I
 INJURIES TO THE EYE

PUTTING OINTMENT IN THE EYE

tetracyc line
eye ointment

Figure I
 FORMS AND REPORTING

As you know, records are extremely important for monitoring the program and for properly

referring and following up patients.

REFERRAL FORMS

The BHA's have been instructed to fill out a referral form (yellow) for each patient they

refer on to the RHU. These forms are to be kept at the RHU. Periodically, these will be collected

and reviewed for follow-up on the referral activities of the BHA'S.

The RHM's and RHU's are also provided with referral forms for patients that you wish to

refer to the (RHU or) EENT physician. The RHM referral forms can be seen in previous

page. (Page 13)

The RHUs already have their referral forms. The RHM's will receive their forms during the

PEe trainings.

MONTHLY LIST OF PA.TIENTS SEEN

All health personnel are kindly asked to submit to the PHO a completed list of All Eye

Patients Seen in their clinic at the end of each month along with their other forms. From these

lists we will he able to get an idea of the eye problems being seen at the different levels, how

many patients are being treated and how they are being referred.

When filling out the monthly eye forms, please include the patient's age and sex, so we

can better understand which groupings are being seen.

65
 REHABILITATION OF THE BLIND

Some of the eye patients we may find cannot be helped by treatment. These patients are In

need of rehabilitation which is available through the MSSD Rehabilitation of the Rural Blind

(RRB) Program.

RRB workers are found at the Municipal level and are responsible for blind clients within

one or more municipalities. The RRB workers go to the homes of their blind clients and teach

them four major rehabilitation areas:

1) Orientation and Mobility

How to use a sighted guide

How to use a cane

How to be socially involved in the community

2) Daily Living Skills

- Cleaning the house and yard

- Washing clothes

- Working in the garden

- Fetching water

3) Manual Dexterity Exercises

- Handicrafts

4) Vocational Trainings

The purpose of the RRB workers work is to help the blind to become a contributing part of

the community and gain respect from their com munity members as well as self-respect which is

a basic need of all people.

Contact the RRB worker closest to you by getting In touch with your municipal MSSD

worker.

66
 GLOSSARY

Anterior Chamber space between the back of the cornea and the front of the iris and lens.

Amblyopia decreased V1SlOn due to non-development of vision ("lazy eye").

Aphakia without lens

A'lueous humor clear, watery fluid that fills the front part of the eyeball.

Astigmatism non-spherical corneal or lens surface causing light rays to focus at

two different points in the eyeball

Bitoi's spot silvery-grey plaques appearing as foamy material on the temporal, bul-

bar conjunctiva. Superficial and can be wiped away. Seen in the pa·

tients with Vitamin A malnutrition.

Blepharitis inflammation causmg swelling of the eyelids.

Blindness according to the ninth (1975) revision from the International Classifi-

cation of Dise~ses by the World Health Organization - 3/60 (Finger,

Counting at 3 meters) or 20/400 or 1120 (0.50) or worse.

Bulbar pertaining to the eyeball

Canthus the angle between the eyelids at each side of each eye.

Caruncle pink tissue located at the media I canthus

67
Cataract any opacity in the lens

Chalazion a clogged, hard mass in the Meibomian gland (lipogranuloma)

Choroid blood vessel layer of the eyeball between the retina and sclera

Conjunctiva clear membrane that lines the inside of the eyelids and covers the

anterior portion of the sclera.

Conjunctivitis inflammation of the conjunctiva causing redness

Cornea clear, front window of the eyeball

Dacryo referring to the tear (lacrimal) system

Dendrite branching ulcer on "the cornea seen in herpes simplex

Ectropion turning outward of the eyelid

Endophthalmitis inflammation of the internal tissues of the eyeball

Entropion turning inward of the eyelid

Enucleation removal of the entire eyeball from the orbit

Far-sightedness inability to see clearly at near (hyperopia)

Focus activity of the lens to make images fall clearly on the retina

Fornix the back of the inside of the eyeball

Glaucoma elevated pressure within the eyeball causing damage to the nerves of

the retina and permanent loss of vision

68
Globe the eyeball

Herpes simplex a viral infection that causes viral conjunctivitis and dendritic ulcers

on the cornea 0

Herpes Zoster when affecting the eye, causes an inflammation affecting the eyelid

skin and eye structures

Hordeolum (stye) infected lash follicle or sebaceous of the eyelid

Hyperopia far-sightedness, the inability to see clearly at near

Hyphema any blood on the anterior chamber

Intra-ocular pressure - pressure within the eyeball

Iridectomy removal of iris tissue

Iris the colored part of the eye surrounding the pupil

Keratitis inflammation of the cornea

Kerato Prefix referring to the cornea

Keratomalacia softening and "melting" of the cornea seen in nutritional eye disease

Lacrimal referring to the tear system

Lens clear structure suspended behind the iris in the pupil that focuses light

into the retina

Leuko describing anything that appears white as an opacity

Leukocoria a white pupil

Leukoma an opacity on/in the cornea

69
Light perception the ability of retina to perceIve light

Limbus circular junction of the cornea and conjunctiva - border of the cornea

M
c

Macula central area of the retina concerned with color perception and has the

sharpest vision.

Meibomia n gland sebaceous gland In the eyel id (sight of chalazion)

Microphthalmos abnormally small eyeball

Myopia short-sightedness, inability to see clearly at a distance

Nearsightedness inability to see clearly at a distance

Night blindness difficulty seeing well in poor light and at night due to poor rod Iunc-

tion; seen in nutritional eye disease.

Occipital lobe area in the back of the hrain that interprets visual messages sent from

the eyes; visual cortex

Occular referring to the eye

Opacity meaning whiteness

Ophthalmia
neonatorum conjunctivitis in the newborn

Ophthalmologist a medical doctor speciallv trained In ophthalmology; usually for four

years after medical school.

Ophthalmology the study of the eye

70
•
Ophthalmoscope an instrument with a light used to view the inner structures of the

eyeball

Optic nerve nerve leading from the back of the eyeball that carries visual messages

from the eyeball to the brain.

Optometrist a non-medical person trained to prescribe glasses only and not to

diagnose or treat any diseases. Also, known as dispencing optician.

Orbit the bony structure that houses the eyeball and extra-ocular muscles

Palpebral pertaining to the eyelid

Pannus clouding of the cornea bv invasion of blood vessels

PERRLA abbreviation meaning - Pupils, Equal, Round and Reactive to Light

and Accomodation
•
Pingueculum henign, thickened area of conjunctiva nasal and/or temporal to th-

Iimuus

Posterior chamber space between the iris and lens

Posterior segment hack part of the eyeball from behind the lens to the retina

Presbyopia inability to focus clearly at near due to aging of the lens

Proptosis protrud i ng outward of the eyeball

Prosthesis a false eye worn after enucleation

Pterygium benign, triangular fold of conjunctiva that can grow over the cornea

and impair vision

Ptosis a drooping of the upper evel.d

Pupil the black opening in the iri-,

..
71
 "I
R •

Refraction the bending of light rays to focus on the retina

•

Refractive error defect in the eye that prevent light rays from being focused on the

retina.

Retina a light-sensitive membrane of nerves in the back of the eyeball

Retinal detachment a "peeling" ofi of the retina from the outer layers of the eyeball

Retinoblastoma a malignant, white tumor of the eyeball seen In young children

s
Sclera the tough, white outer layer of the eyeball

Short-sightedness inahility to see clearly at a distance (myopia)

Slit lamp instrument with a special microsoope used by the specialist to view the

external structures of the eye

Snellen's chart a cuart used Ior testing visual acuity especially measured to be used

at 3 meters or 10 feet

Staphyloma a bulging of the contents of the eyeball through the cornea or sclera

Stye mfected lash follicle or sehaceous gland In the eyelid (hordeolum)

Tears clear fluid of water and oil that bathes the cornea and conjunctiva

Tension referring to the intra-ocular pressure

e.

..
72
f
• Tonometer instrument used by the ophthalmic specialist to measure intra ocular

pressure

Trachoma chlamydial infection affecting the conjunctiva and cornea whose com-

plications can lead to blindness

Trichiasis turning inward of the lashes causing them to scratch the cornea

u
Uvea the entire vascular coat of the eyeball of the Ins, ciliary body and

choroid

Uveal tract another way of referring to the uvea

Uveitis painful inflammation of the parts of the uvea

v
Visual acuity the clearest VISIOn obtained by the eye when tested

Visual field the entire area that can be seen withont shifting the eye

Vision the ability of the eye to see

Vitreous body clear, gelatinous fluid that fills the back of the eyeball

, x
Xerosis drying of the cornea and conjunctiva, seen 1Il Vitamin A deficiency

73
 -. -, :os _

XEROPHTHALMIA
TREATMENT AND PREVENTION SCHEDULE

1. CHILDREN· WITH XEROPHTHALMIA OR GENERAL ILLNESS OR MALNUTRITION

IMMEDIATELY - 200000 IU vitamin A orally or

100000 IU vitamin A intramuscularly
FOLLOWING DAY - 200000 IU vitamin A orally
1·2 WEEKS LATER - 200 000 IU vitamin A orally
Note: Water miscible vitamin A must be used
>-
0:: for the intramuscular injection
«
~

~ 2. ALL CHILDREN·
~
oct
....
~

%
EVERY 4-6 MONTHS - 200 000 IU vitamin A orally

±3.
u.J

o
MOTHERSATBIRTHOFCHILDORWITHINONEMONTHAFTERDELIVERY
o 200 000 IU vitamin A orally

·FOR CHILDREN LESS THAN 1 YEAR OF AGE

REDUCE ALL DOSES BY ONE·HALF
,"
REMEM8ER: Vitamin A Rich Foods are best.

IHI~I High Potency vitamin A capsules are

only for children with signs of
vitamin A deficiency.
RECOMMENDED BY WORLD HEALTH ORGANIZATION
Revised 1981
[;)[?@W@[]l)1J lIDOoou@]ou@@@
through primary eye care

~- -----~

Department ofHeaKh

111111111
D435 GVs
H13.4S P93/ prtmaryeye care

,.'
HELEN KELLER INTERNATIONAL
INCORPORATEO