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DISORDERS AND CONDITIONS OF

THE EYE

Claudette Anne T. Cormary

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Eyes• Anatomy of Eye

– Housed in a cone of fatty tissueEyeball– Three layers– External fibrous layer – Middle vascular layer – Inner layer of nerve tissue

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Anatomy of the Eye

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External Fibrous Layer

• Sclera– “white of eye’

• Protective & supportive outer layer

• Cornea– Dense fibrous connective tissue

• Must be transparent to allow light

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Middle Vascular Layer

• Heavily pigmented

• Blood vessels

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Inner Layer

• Retina– Continuous with optical nerve in rear– Ora serrata in front– Two parts

• Outer part-pigmented-attached to choroid layer

• Inner part is nerve tissue

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• Eyelids– Tarsal glands secrete oil to lubricate

• Lacrimal glands – outer edge of eye socket– Secretes tears to clean & protect

• Aqueous humor – between cornea & lens– Salty clear fluid

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Retina• Thin membrane lining rear of eye

• Contains light sensitive cells

• Rods & cones– Rods are sensitive to light

• 120 million rods

– Cones are sensitive to colors• 6 million cones

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Eye Disorders

• CATARACT• GLAUCOMA• CORNEAL ABRASION OR ULCER• RETINAL DETACHMENTE• EYE INFECTIONS/INF;LAMMATORY

DETACHMENTS• REFRACTIVE ERRORS• EYE TRAUMA/EMERGENCIES

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CATARACT• MECHANISM

– * Gradual deterioration of lens

• ETIOLOGY– * familial – * old age

* congenital – * trauma

* drug toxicity (high level of steroids)* diabetes mellitus

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• SYMPTOMS AND SIGNS

• Cataracts usually form slowly and cause few symptoms until they noticeably block light. When symptoms are present, they can include:

• Vision that is cloudy, blurry, foggy, or filmy• Progressive nearsightedness in older people often called

"second sight" because although their distance vision is deteriorating, they may no longer need reading glasses.

• Changes in the way you see color because the discolored lens acts as a filter.

• Problems driving at night such as glare from oncoming headlights.

• Problems with glare during the day.• Double vision while looking through the eye with a cataract

(like a superimposed image).• Sudden changes in glasses prescription.

• DIAGNOSIS– * Visual examination

* pen light of slit lamp confers the presence of a cataract

• TREATMENT• Types of Cataract Surgery• There are two types of cataract surgery. In the more common type, called

phacoemulsification (phaco), the doctor makes a tiny incision in the eye and breaks up the lens using ultrasound waves. The lens is removed, and an intraocular lens (IOL) is put in its place. In most modern cataract surgeries the IOL eliminates the need for thick glasses or a contact lens after surgery.

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Cataract Surgery InnovationsRecent developments in cataract surgery can correct both near and distance vision. They minimize or eliminate the need for reading glasses after surgery. Conventional "monofocal" lenses only correct for distance vision, meaning reading glasses are still needed after surgery. "Toric" implants are available to correct astigmatism.

• What to Expect After Surgery• itchy and sensitive to light. • You may be prescribed drops to aid healing and asked to wear an eye shield or glasses for

protection. I• t'll take about eight weeks for your eye to heal completely, though your vision should begin to

improve soon after surgery. You may still need glasses, at least occasionally, for distance or reading -- as well as a new prescription after healing is complete.

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Cataract Surgery Risks• rare• The most common risks are bleeding, infection, and changes in eye pressure,

which are all treatable when caught early. • Surgery slightly raises the risk of retinal detachment, which requires

emergency treatment. Sometimes, lens tissue left after surgery and used to support the IOL can become cloudy, even years after surgery. This "after-cataract" is easily and permanently corrected with a laser.

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• Tips to Prevent Cataracts• Things you can do that may lower your risk of

developing cataracts:• Don't smoke.• Always wear a hat or sunglasses in the sun.• Keep diabetes well controlled.• Limit alcohol consumption.

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GLAUCOMA

What happens?

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Glaucoma: what is happening

Either:the drain blocks here

Or poor blood supply here

Damages the optic nerve..looks ‘caved in’, called ‘cupped’

Characteristic pattern to loss of visual field

Rim of optic nerve becomes thinner as

disc caves in and becomes more cupped

Types of glaucoma

• Congenital• Secondary• Juvenile• open angle*• Angle-closure*• Many different

types

Who gets glaucoma?

• You are at an increased risk of glaucoma if you:• Are of African-American, Irish, Russian, Japanese, Hispanic, Inuit, or

Scandinavian descent• Are over age 40• Have a family history of glaucoma• Have poor vision• Have diabetes• Take certain steroid medications, such as prednisone• Have had trauma to the eye or eyes

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S/Sx

• "sneak thief of vision.“• If you have any of the following symptoms, seek immediate medical care:• Seeing halos around lights• Vision loss• Redness in the eye• Eye that looks hazy (particularly in infants)• Nausea or vomiting• Pain in the eye• Narrowing of vision (tunnel vision)

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Dx/Treatment

• Glaucoma can be treated with eye drops, pills, laser surgery, traditional surgery or a combination of these methods. The goal of any treatment is to prevent loss of vision, as vision loss from glaucoma is irreversible. The good news is that glaucoma can be managed if detected early, and that with medical and/or surgical treatment, most people with glaucoma will not lose their sight.

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Corneal Abrasion

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• A corneal abrasion is a scratch on the eye's cornea.

Causes of Corneal Abrasion?• Many situations can cause a corneal

abrasion, including:• Being poked in the eye, for instance by

a fingernail, plant, or makeupbrush• Dirt, sand, sawdust, ash, or some

other foreign matter blowing into your eye and getting caught under the eyelid

• Chemical burns

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• Aggressively rubbing your eye• Poor fitting or dirty contact lenses• Certain types of eye infections• Not protecting the eyes during

surgery while under general anesthesia; if your eyes are not closed during surgery, the cornea can dry out, making it more prone to corneal abrasion.

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•Feeling like you have sand or grit in your eyeEye pain, especially when opening or closing your eyeTearing and rednessSensitivity to lightBlurred vision or loss of vision

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Symptoms of Corneal Abrasion

Corneal Abrasion Treatment

• Antibiotic eye drops or ointment

•  Painmedication

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Retinal Detachment

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What happens?• The retinal pigment epithelium (RPE) is a

layer of support cells that lines the back of the eye. It is normally attached to the sensory retina layer.

• In retinal detachment caused by a retinal tear, the sensory retina is pulled away from the RPE because fluid builds up between the two layers. Part or all of the retina comes off (detaches from) the back of the eye.

• Blurred and lost vision can occur.32

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Retinal detachment means that the retina—a thin layer of nerve tissue at the back of your eye—has detached, or pulled away. This can lead to vision loss and blindness, but surgery can often restore good vision.A retina can detach as a result of aging, an eye injury, inflammation, or some diseases such as diabetes. But many times there is no obvious cause.

Retinal Detachment - Cause• Tears or holes in the retina. 

• Traction on the retinaTraction on the retina.

• Fluid buildup under the retina.

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Retinal Detachment - What Increases Your Risk

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• A family history of retinal detachment.

• Previous retinal detachment in the other eye.

• Lattice degeneration, an inherited condition in which parts of the retina become very thin and are easily torn.

• Age older than 50.

• Nearsightedness (myopia). 

• Surgery for cataracts.

• Blunt injury or blow to the head.

• Injury to the eye.

• Diabetes, which can lead to proliferative diabetic retinopathy.

• Other eye disorders or eye tumors.

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Retinal Detachment - When To Call a Doctor

• Flashes of lights/ floaters• Migraine headaches

• Exams/test:•  routine eye exams 

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Treatment

• Surgery:• Almost all retinal detachments can be

repaired with scleral buckle surgery, pneumatic retinopexy, or vitrectomy.

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Eye Health and Uveitis• What Are the Symptoms of

Uveitis?• Eye redness and irritation

• Blurred vision

• Eye pain

• Increased sensitivity to light

• Floating spots before the eyes

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• What Causes Uveitis?• There are four types of uveitis:

• Iritis • Cyclitis• Retinitis• Choroiditis

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• How Is Uveitis Treated?

• For uveitis not caused by an infection, your eye specialist may prescribe eye drops containing steroids to reduce swelling and drugs to relieve pain. Antibiotics are used in patients with infectious uveitis. Dark glasses will help with light sensitivity.

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• Complications of uveitis may include glaucoma, cataracts, abnormal growth of blood vessels in the eyes that interfere with vision, fluid within the retina, and vision loss. Early diagnosis and treatment by an eye specialist is critical.

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Iritis• Iritis Causes:• Iritis may be a consequence of trauma

(traumatic iritis) or nontraumatic causes:• Blunt trauma to the eye can cause traumatic

inflammation of the iris.

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• Nontraumatic iritis is frequently associated with certain diseases, such as ankylosing spondylitis, Reiter syndrome, sarcoidosis,inflammatory bowel disease, and psoriasis.

• Infectious causes may include Lyme disease, tuberculosis,toxoplasmosis, syphilis, and herpes simplex and herpes zosterviruses.

• In a large number of cases, no cause for iritis is found.

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• Iritis Symptoms:

• Pain in the eye or brow region• Worsened eye pain when exposed to bright

light• Reddened eye, especially adjacent to the iris• Small or funny shaped pupil• Blurred vision• Headache

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When to Seek Medical Care for Iritis

Eye pain, including pain associated with bright light

• Blurred vision

• Redness in the eye, especially near the iris

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• Iritis Exams and Tests• Iritis Treatment at Home• Drugs to Treat Iritis

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Allergy Conjunctivitis (Pink Eye)

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What Are the Symptoms of Allergic Pink Eye?• Symptoms of allergic pink eye include:• Redness in the white of the eye or inner

eyelid• Increased amount of tears• Itchy eyes• Blurred vision• Swelling of the eyelid• Crusty eyes

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How Is Allergic Pink Eye Treated?

•  Ocular (topical) decongestants

• Ocular (topical) antihistamines

• Ocular (topical) steroids

• Ocular (topical) mast cell stabilizers (such as Cromolyn)

• Immunotherapy

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Other Tips for Allergic Pink Eye• Don't touch or rub the affected eye(s).• Wash your hands often with soap and warm water.• Wash your bed linens, pillowcases, and towels in hot

water and detergent to reduce allergens.• Avoid wearing eye makeup.• Don't share eye makeup with anyone else.• Never wear another person's contact lens.

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• Wear glasses instead of contact lenses to reduce irritation.

• Wash your hands before applying the eye drops or ointment to your eye or your child's eye.

• Do not use eye drops that were used in an infected eye in a non-infected eye.

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Blepharitis

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Blepharitis is the medical term for inflammation of the eyelids. The word "blepharitis" is derived from the Greek word blepharos, which means "eyelid," 

Symptoms of Blepharitis• Feeling like something is in your eye

• Burning of the eye

• Sensitivity to light

• Red and swollen eyes or eyelids

• Blurry vision

• Dry eyes

• Crusting of the eyelashes

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Treatment• good eyelid hygiene and a regular

cleaning routine can control blepharitis.

• frequent scalp and face washing, using warm compresses to soak the eyelids, and doing eyelid scrubs.

• The single most important treatment principle is a daily routine of lid margin hygiene.

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• The following is a typical lid margin hygiene routine:

• Soften lid margin debris and oils: Apply a warm wet compress to the lids, such as a washcloth with hot water, for five to 10 minutes two to four times a day. To keep the compresses warm for a longer period of time, you may place a small hot water bottle over the compress. Using a clean washcloth for each cleansing is important.

• Mechanically remove lid margin debris: After using the compresses, clean the eyelids with a cotton applicator stick soaked in a 4 to 1 mixture of water and baby shampoo or an over-the-counter lid-cleansing product. Gently and repeatedly rub along the lid margins while the eyes are closed. Be careful to avoid rubbing or scratching your eyes.

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• Limit or stop using eye makeup, as its use will make lid hygiene more difficult.

• If you wear contact lenses, you may have to temporarily discontinue wearing them during treatment.

• Other treatment depends on the specific type of blepharitis. The key to treating most types of blepharitis is keeping the lids clean and free of crusts.

• Dandruff shampoo is a standard recommendation.• Antibiotics such

as doxycycline, tetracycline, azithromycin or erythromycinmay be prescribed topically or systemically.

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STY• A sty (also spelled stye) is an infection

of the oil gland at the base of an eyelash. It appears as a red, raised pimple on the edge of the eyelid. Symptoms of a sty are pain, tenderness, redness, and swelling with a small pustule. The eyeball itself may feel irritated or as if something is scratching it due to the swelling of the eyelid.

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• Treatment for a sty includes warm compresses applied to the affected area for 10 minutes, up to six times daily. If the sty comes to a head and releases pus, it should be cleaned gently with soap and water. This rupture usually leads to the sty going away. If the sty is very large, painful, or affects your vision, see your doctor.

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• There are two distinct types of styes: hordeolum and chalazion. Each has different causes and treatments.

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1. A hordeolum is a blockage of one of the sweat glands found in the skin of the lid and base of the eyelashes, or one of the small sebaceous glands found at the base of the eyelashes. Sebaceous glands secrete sebum, a waxy, oily material.

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• Treatment of hordeolum:

• A noninfected hordeolum will resolve on its own.

• Warm compresses may help soften the material in the gland, easing the drainage of the gland's contents. Squeezing or cutting the hordeolum can cause the skin to become scarred.

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2. A chalazion is a blockage of a meibomian gland, which is a special sebaceous gland unique to the eyelids. These glands form a single row in each lid, with the body of the gland located inside the eyelid, and the opening located at the rim of the lid, posterior to the lashes. They secrete an oily material onto the surface of the eye, preventing the water layer of tears from evaporating too rapidly from the eye's surface between blinks. Therefore, poorly functioning meibomian glands can lead to dry eye symptoms.

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• Treatment:

• A noninfected chalazion similarly will resolve on its own, though over a much longer period of time.

• The most conservative treatment is application of frequent warm compresses.

• Steroids• the chalazion can be incised and drained. 

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