BINOCULAR ABNORMALITY

( refractive errors 2 )

Z A L D I Z

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA
MEDAN
2021
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 BINOCULAR
ABNORMALITY
1. ADULT ANISOMETROPIA
2. AMBLYOPIA
3. BINOCULAR DIPLOPIA
4. NIGHT BLINDNESS
5. SCOTOMA
6. FIELD DISTURBANCES

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 ANISOMETROPIA

• Anisometropia is the condition in which the two

eyes have unequal refractive power.

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 ANISOMETROPIA

In certain types of anisometropia, the visual cortex of

the brain will not use both eyes together (binocular
vision), and will instead suppress the central vision of
one of the eyes.

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 ANISOMETROPIA

• If this occurs often enough during the first 10 years

of life while the visual cortex is developing, it can
result in amblyopia, a condition where even when
correcting the refractive error properly, the person
is still not correctable to 20/20 ( 6/6 )

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ANISOMETROPIA CLASSIFICATION

• Simple anisometropia.
• Compound anisometropia.
• Mixed anisometropia.
• Simple anisometropia astigmatism.
• Compound anisometropia astigmatism.

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 AMBLYOPIA

• Amblyopia, by definition, refers to a partial

reversible loss of vision in one or both eyes, for
which no cause can be found by physical
examination of the eye, i.e., there is absence of
any organic disease of ocular media, retina and
visual pathway.

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 PATHOGENESIS
AMBLYOPIA
• Amblyopia is produced by certain amblyogenic
factors operating during the critical period of visual
development (birth to 6-7 years of age). During this
period, the visual pathway continues to develop
and brain learns to interpret the signals that come
from the eye.

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 AMBLYOGENIC FACTORS

• Visual (form sense) deprivation

anisometropia

• Light deprivation
congenital cataract

• Abnormal binocular interaction

strabismus
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 BINOCULAR DIPLOPIA

• Occurs due to formation of image on dissimilar

points of the two retinae

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ETIOLOGY OF BINOCULAR DIPLOPIA

■ Paralysis or paresis of the extraocular muscles

■ Displacement of one eyeball as occurs in space occupying lesion
in the orbit, and fractures of the orbital wall,
■ Mechanical restriction of ocular movements as caused by thick
pterygium, symblepharon and thyroid ophthalmopathy
■ Deviation of ray of light in one eye as caused by decentred
spectacles
■ Anisometropia i.e., disparity of image size between two eyes as
occurs in acquired high anisometropia (e.g., uniocular aphakia with
spectacle correction).
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 NIGHT BLINDNESS ( NYCTALOPIA )

• Night blindness may occur in patients with rod

dysfunction and also in patients having media
opacities and advanced POAG.

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 ROD DYSFUNCTION

Night (scotopic) vision is a function of rods. Therefore, the

conditions in which functioning of these nerve endings is deranged
will result in night blindness.

These include:
• Vitamin A deficiency, retinitis pigmentosa
• Congenital high myopia,
• Familial congenital night blindness, and
• Oguchi’s disease.
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 NYCTALOPIA
Media opacities
• Night blindness may also develop in conditions of the ocular media
interfering with the light rays in dim light (i.e., with dilated pupils).
• Corneal opacities.

Advanced POAG
• In advanced cases of primary open angle glaucoma, dark adaptation
may be so much delayed that patient gives history of night
blindness.

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 SCOTOMA

• a spot in the visual field in which vision is absent

or deficient
• Symptoms may be mild and temporary, or leave
some viewers with blind spots called scotomas.

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 TYPES OF SCOTOMA
• Color scotoma an isolated area of depressed or defective vision for color in
the visual field.
• Hemianopic scotoma depressed or lost vision affecting half of the central
visual field; see also hemianopia.
• Peripheral scotoma an area of depressed vision toward the periphery of
the visual field.
• Physiologic scotoma that area of the visual field corresponding with the
optic disk, in which the photosensitive receptors are absent.
• Positive scotoma one which appears as a dark spot in the visual field.
• Negative scotoma a scotoma appearing as a blank spot in the visual field;
the patient is unaware of it, and it is detected only by examination.
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 FIELD DISTURBANCES

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 Visual Field of Human with Frontal Eyes

Monocular Field = 145 degrees

Total Visual field = 180+
Binocular Visual Field = 130+ degrees

Note: if the total horizontal

visual field is >180
degrees, this means that
you can see behind you. Humans have frontal eyes and are blind
How is this possible? to more than half of the world. This loss
ZALD I Z
must have come with some
REFRACTIVE ERRORS 2
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 VISUAL PATHWAY
Lesions of the visual pathways at the
level of:

1. optic nerve;
2. proximal part of optic nerve;
3. central chiasma;
4. lateral chiasma (both sides);
5. optic tract;
6. geniculate body;
7. part of optic radiations in temporal lobe;
8. part of optic radiations in parietal lobe;
9. optic radiations;
10. visual cortex sparing the macula
11. visual cortex, only macula;
12. bilateral visual cortex only macula
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 REFERENCES
• Khurana A. K, Comprehensive Ophthalmology, 7th
Edition, New Age Internasional (p) Limited
Publisher, New Delhi , 2019.
• Vaughan D.G, Asbury T, Riordan P, General
Ophthalmology , 19 edition , New York , 2018.
• Pengurus Besar Ikatan Dokter Indonesia , Panduan
Keterampilan Klinis Bagi Dokter di Fasilitas
Kesehatan Primer , Edisi 1 , Jakarta , 2017
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08/22/2021
Segala puji bagi Allah, Tuhan semesta alam.

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