Common Eye Disorders

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Common Eye Disorders

• Mohammed Al-Naqeeb
• Umm Al-Qura university

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Chalazion
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Chalazion

• Inflammation of a meibomian gland
• Also called an internal hordeolum
• Usually requires no treatment, although if
  persistent may require surgical excision
• Hot compresses may be tried to help unblock
  meibomian gland

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Blepharitis

• A common, chronic, inflammatory condition of the
  eyelid margins
• Signs
• waxy, shiny lid margins
• oily/debris in tear film
• itchy, irritated eyes
• most common cause of dry eye

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Blepharitis

• Treatment
• Eyelid hygiene is the mainstay of treatment. This
  helps to remove crusts/scales and helps unplug
  blocked meibomian glands
• Warm compresses and eyelid massage
• Natural tears give some relief, dont cure
  problem
• Occasionally ABs for staphylococcal blepharitis

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Conjunctivitis
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Conjunctivitis

• Inflammation of the conjunctiva
• Signs
• redness
• swelling
• discharge
• grittiness

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Conjunctivitis

• Often viral infection
• Treatment is dependant on the cause. May be
• viral
• bacterial
• allergic
• follicular
• others

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Abrasion
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Abrasion
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Corneal Abrasion

• Scraped area of corneal surface, accompanied by
  loss of epithelium.
• Abrasions of the epithelium heal within 72 hours
  and do not leave a scar. Deeper lesions,
  involving Bowmans layer and below, heal with
  permanent opaque scarring.

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Corneal Abrasion

• Treatment may be with artificial tears for a
  minor abrasion or patching/bandage contact lens
  (BCL) application for more severe abrasions

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Keratoconus
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Keratoconus

• Degenerative corneal disease
• Characterized by generalized thinning and
  cone-shaped protusion of the central cornea
• Typically bilateral
• Usually diagnosed in the second decade

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Keratoconus

• Causes increase in myopia, astigmatism and
  surface irregularity
• In early stages, glasses or soft contact lenses
  may be used
• As disease progresses, need to use hard contacts
  to provide smooth refractive surface.
• Advanced cases may require penetrating
  keratoplasty

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Foreign Body
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Corneal Graft
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Corneal Graft(Penetrating Keratoplasty)

• Replacement of a scarred or diseased cornea with
  clear corneal tissue from a donor.
• Usually reserved for severe cases, where there is
  a good chance of vision improving after surgery

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Cataract
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Cortical Cataract
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Cataract

• Any lens opacity
• May be classified by age (congenital to senile),
  stage (early to hypermature), or type (NS, cort,
  PSC, etc)
• Some systemic diseases/conditions predispose to
  cataract (DM, RA, hypothyroid, smoking,
  corticosteroid use, etc)

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Cataract

• Treatment
• always the same regardless of what type or stage
  of cataract.
• CE with placement of either a AC or PC IOL. The
  power of the lens used is determined by the
  length of the eye (A-scan measurement)
• Phacoemulsification is used (US) to break up the
  cataract and remove it from the eye. Uses much
  smaller incision then removal of whole lens.
  Shorter healing time, less chance of infection,
  etc.

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ACIOL
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PCIOL
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PCO
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Post Cataract Surgery

• Posterior capsule opacification (PCO)
• a membrane that forms behind the IOL causing a
  decrease in vision.
• may see Elschnig pearls on retroillumination
• treatment is with a capsulotomy

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YAG Capsulotomy
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ON cupping
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Acute Angle Closure Glaucoma
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Glaucoma

• An optic neuropathy with characteristic optic
  nerve head changes
• Diagnosis is determined by ON evaluation, IOP
  measurements, and visual field findings.

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Glaucoma

• Normal findings
• ON cup to disc ratio (c/d) of 0.4 or less
• IOP 10-21 mm Hg for average corneal thickness
• VF full field (no paracentral scotomas, diffuse
  depression, nasal steps or arcuate scotomas)

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Glaucoma

• Treatment
• topical or oral medication (many different types)
• laser surgery
• incisional surgery

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Bleb
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Iritis

• Inflammation of the iris
• Signs
• red eye
• pain
• tearing
• blurred vision
• miosis (small pupil)

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Iritis

• Cause is unknown
• Iritis is graded at the slit lamp based on the
  presence of cells and flare in the AC
• Associated with systemic inflammatory conditions
  (RA, SLE, etc)
• Treatment is with dilating drops and topical
  steroids to reduce inflammation
• Often have recurrent flare-ups

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Anterior Uveitis
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Posterior Uveitis
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Uveitis

• Inflammation of the uvea (iris, ciliary body,
  choroid)
• Anterior uveitis (iridocyclitis) - iris or
  ciliary body
• Posterior uveitis - choroid

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Uveitis

• Signs
• photophobia
• decreased vision
• small pupil (meiosis)
• red eye (usually most prominent at limbus)
• normal IOP

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Uveitis

• Treatment is with topical steroids
• Steroids help to prevent secondary problems
  (cataract, uveitic glaucoma, adhesions of iris to
  lens)
• In severe cases, systemic steroids may be
  required
• Recurrence is common

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Posterior Vitreous Detachment (PVD)

• Separation of the vitreous gel from the retinal
  surface
• Tends to occur with aging as the vitreous
  liquifies
• May also occur in the presence of high myopia and
  diabetes

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Posterior Vitreous Detachment (PVD)

• No treatment is required in most cases
• Floaters tend to become less bothersome over time
• Treatment is required if there are retinal tears
  associated with the PVD which may lead to retinal
  detachment

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Diabetic Retinopathy
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Diabetic Retinopathy (DR)

• Spectrum of retinal changes that accompany
  long-standing diabetes mellitus
• Early stage is non-proliferative (dot and blot
  hemmorhages, hard exudates, microaneurysms)
• May advance to proliferative (neovascularization
  and fibrous tissue) if blood sugars not controlled

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Diabetic Retinopathy (DR)

• Treatment of proliferative disease is with
  panretinal laser photocoagulation (PRP)
• Concept of treatment is that areas that are
  scarred require less oxygen, therefore, this
  should promote regression of new blood vessels
  (neovascularization)

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Total Retinal Detachment
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Retinal Detachment (RD)

• Separation of sensory retina from underlying
  pigment epithelium
• May be caused by a retinal tear or by fibrous
  tissue traction
• Symptoms are flashing lights, streaks of lights,
  curtain coming across the eye, loss of vision

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Retinal Detachment (RD)

• Treatment is surgical and is usually done
  immediately
• A scleral buckle may be used in some cases

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Age-related Macular Degeneration
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ARMD
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Age-Related Macular Degeneration (ARMD/AMD)

• Deterioration of the macula resulting in loss of
  clear central vision
• Peripheral vision is maintained
• Two major types are dry and wet
• Dry - aging spots in the macula, exudate
• Wet - abnormal new blood vessels grow under the
  macula and leak blood and fluid

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Age-Related Macular Degeneration (ARMD/AMD)

• Treatment
• Dry no treatment at present. Different types of
  supplements have been tried but nothing has been
  proven to work
• Wet Visudyne (dye and laser) is used to halt
  blood vessel growth and preserve vision

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Retinitis Pigmentosa
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Retinitis Pigmentosa

• Disease of the retina, often leading to
  functional blindness
• Usually presents by 20 years of age
• Characterized by night blindness and constriction
  of visual fields
• There is no treatment to cure this disease, only
  slow its progression

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Strabismus
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Strabismus

• Eye misalignment caused by extraocular muscle
  imbalance
• Deviation may be horizontal (eso or exo) or
  vertical (hypo or hyper)
• Tropia - present at all times
• Phoria - present only after fusion has been broken

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Strabismus

• Treatment is dependant on the cause of the eye
  turn
• Eyes may be straightened with patching, glasses,
  or surgery
• Visual maturity is reached at about 8 years of
  age
• Individuals with strabismus will never have fine
  stereoscopic vision