Visual Disorders

By:
Bryan Mae H. Degorio
Corrective Refractive Disorders

Astigmatism
-characterized by an irregular curvature of the
cornea. This type of disorder is also known as
a refractive error.
-is a common eye condition that's easily
corrected by eyeglasses, contact lenses or
surgery.
Causes:
1. Astigmatism can be hereditary and is often
present at birth.
2. It can also result from pressure from the eyelids
on the cornea, incorrect posture or an
increased use of the eyes for close work.
3. It may accompany farsightedness or
nearsightedness.
4. Usually it is caused by an irregularly shaped
cornea (called corneal astigmatism).
5. But sometimes it is the result of an irregularly
shaped lens, which is located behind the
cornea; this is called lenticular astigmatism.
Signs and Symptoms:
1. People with undetected astigmatism often
experience headaches, fatigue, eyestrain and
blurred vision at all distances.
2. While these symptoms may not necessarily be
the result of astigmatism, you should
schedule an eye exam if you are experiencing
one or more symptoms.
Treatment:
1. Almost all degrees of astigmatism can be
corrected with properly prescribed eyeglasses or
contact lenses.

a. Corrective lenses (eyeglasses or

contact lenses).
- For astigmatism, special corrective
lenses called toric lenses are
prescribed. Toric lenses have greater
light bending power in one
direction than the other.
b. Refractive surgery.
- Another method for correcting
astigmatism is by changing the
shape of the cornea through refractive
or laser eye surgery.
-Refractive surgeries require healthy
eyes that are free from retinal
problems, corneal scars and any eye
disease.
Hyperopia
-Farsightedness
-parallel rays of light focus behind the retina
-corrected with convex lens
Miopia
-nearsightedness
-parallel rays of light is focus in front of the
retina
-corrected with concave lens
- Radial Keratotomy(RK Surgery)
Presbyopia
-”old sight”
-lessening of the effective powers of
accommodation as a result of
hardening of the lens due to aging
process
-Blurring of the near objects or visual fatigue
when doing close eye work
-convex reading glasses is recommended
Extraoccular Disorders
Hordeulom
-pustular infection of the of the eyelash
follicles or sebaceous gland on an eyelid
margin
-there is painful red swelling on eyelid margin
-commonly associated with staphylococcus
Chalazion
-internal eye
-inflammation of the meibomian gland
-painless, slow-growing, hard non-tender rpund
mass in the eyelid
Conjunctivitis
-inflammation which results from bacterial
infection and viral infection
-characterized by redness, swelling, lacrimation,
pain, itching and dischrges from the eyes
Strabismus (squint, tropia, heterotropia)
1. Eye deviation
a. esotropia- inward convergent
deviation of the eye
b. exotropia- outward/divergent
deviation from eyes
c. hypertropia- upward deviation of the
eyes
d. hypotropia- downward deviation of
the eyes
 1. Management:
a. corrective eyeglasses
b. Surgery:
-advancement, resection and tucking
-tenotomy recession
Keratitis
- corneal inflammation that might lead to
corneal ulceration
-Assessment:
a. Pain
b. photopobia
 c. lacrimation
d. blepharospam
e. decreased vission
-treatment:
1. Trifulridine, idoxuridine
2. mechanical and chemical
debridement
Corneal Ulceration
-is a medical emergency that may lead to
corneal perforation, scarring and intraoccular
infection and permanent vission loss.
 Causes:
-trauma, exposure to allergy,
vitamin deficiency, lowered
resistance and infection
Corneal Opacity
-lack of corneal transparency due to
inflammation, ulceration or injury
Intraoccular Disorders
Cataract
-A cataract is a clouding of the eye's natural
lens, which lies behind the iris and the pupil
leading to blurry of vision, and eventual loss
on sight
Causes:
1. degenerative changes in the eye protein
2. ultraviolet exposure
3. injury and intraocular infection
4. presence of other disease such as DM
Manifestations:
1. You may notice that your vision is blurred a
little, like looking through a cloudy piece of
glass or viewing an impressionist painting.
2. light from the sun or a lamp seem too bright or
glaring.
Classification of Cataract:
 nuclear cataract (senile)

- This cataract forms in the nucleus, the center of the

lens, and is due to natural aging changes.
 cortical cataract

- which forms in the lens cortex, gradually extends

its spokes from the outside of the lens to the
center
- Many diabetics develop cortical cataracts.
 subcapsular cataract

- begins at the back of the lens.

-People with diabetes, high farsightedness,
retinitpigmentosa or those taking high doses of
steroids may develop a subcapsular cataract.
Management:
2. Intracapsular technique
-removal of cataractwithn its capsule
2. Extracapsular technique
-an opening is made in the capsule and the
lens is lifted without disturbing the membrane
3. Cryoextraction
-the cataracts lifted from the eye by a small
probe that has been cooled to a temperature
below zero and edheres to the wet surface of
the cataract
4. Iredectomy
-is done proceeding cataract extraction to
create an opening for the flow of the aqueous
humor which may become blocked postop.
5. Phacoembolism
-a method of cataract extraction which
breaks up the lens and fluhes it out into tiny
pieces
6. Intraocular lens implantation
- implanted in the eye in place of the patient's
clouded natural lens.
- the lens material is yellow because it filters out
blue light, which may be harmful to eyes.
Post-op Care:
l Cover the with a dressing to prevent injury
l Patient is allowed to be out of bed the day
following surgery
l Daily change of dressing is done and after 7
days all dressings are usually removed
l 1st month-protect the eye with eye shield
during night
l Note: temporary glasses may be prescribed 1-
4 weeks. Permanent glasses or contact lens is
given after 6-12 weeks if healing is already
sufficient
5. Cataract glasses magnify so that everything
appear one fourth closer than it is. It takes time
to judge distance.
Glaucoma
- is an eye condition that develops when too
much fluid pressure builds up inside of the
eye
-eye disorders often associated with a
dangerous build up of internal eye pressure (
intraocular pressure or IOP), which can
damage the eye's optic nerve that transmits
visual information to the brain.
Types of Glaucoma:

l Open-angle glaucoma.
-Also called wide-angle glaucoma, this is the
most common type of glaucoma.
-The structures of the eye appear normal,
but fluid in the eye does not flow properly
through the drain of the eye, called the
trabecular meshwork.
l Angle-closure glaucoma.
-Also called acute or chronic angle-
closure or narrow-angle glaucoma, this type of
glaucoma is less common, but can cause a
sudden buildup of pressure in the eye.
-Drainage may be poor because the
angle between the iris and the cornea (where a
drainage channel for the eye is located) is too
narrow. Or, the pupil opens too wide,
narrowing the angle and blocking the flow of
the fluid through that channel.
Causes:
 Glaucoma most often occurs in adults over age
40, but it can also occur in young adults,
children, and even infants. In African-Americans,
glaucoma occurs more frequently and at an
earlier age and with greater loss of vision.
 Are of African-American, Irish, Russian,
Japanese, Hispanic, Inuit, or Scandinavian
descent.
 Have a family history of glaucoma.
 Have poor vision.
 Have diabetes.
 Take systemic corticosteroid medications, such
as prednisone
Manifestations:

 Seeing halos around lights

 Narrowing of vision (tunnel vision)
 Vision loss
 Redness in the eye
 Eye that looks hazy
 Nausea or vomiting
 Pain in the eye
Diagnostic Procedure:

4. Tonometry
- to check for eye pressure
6. Visual field test
-to determine if there is loss of
peripheral vision.
Management:
Glaucoma treatment may include prescription
eye drops, laser, or microsurgery.
 Eye drops for glaucoma. These either reduce
the formation of fluid in the front of the eye or
increase its outflow.

a. Miotics-used to constrict the pupil and to

draw the smooth muscle of the iris away
from the canal of schlemm permiting the
acqueous humur to drain out
b. Acetazolamide
-tend to reduce the formation of
aqueous humor and commonly use for
chronic glaucoma
-glycerol-osmotic drugs that
reduce the intraoccular
pressure
c. Avoid the Atropine and Mydriatrics
-these drugs are use to dilate the
pupil
-the iris are brought closer to the angle
of outflow
 Laser surgery for glaucoma
-Laser surgery for glaucoma slightly
increases the outflow of the fluid from the
eye in open-angle glaucoma or eliminates
fluid blockage in angle-closure glaucoma.
-Types of laser
a. Trabeculoplasty- laser is used to pull
open the trabecular meshwork
drainage area
b. Iridotomy- in which a tiny hole is made in
the iris, allowing the fluid to flow more
freely
c. cyclophotocoagulation- a laser beam
treats areas of the ciliary body,
reducing the production of fluid.
 Microsurgery for glaucoma
a. Trabeculectomy
-a new channel is created to
drain the fluid, thereby reducing intraocular
pressure that causes glaucoma.
Retinal Detachment
-is a very serious condition that occurs when
the retina pulls away from its supporting
tissues.
-the retina can't work properly under these
conditions, permanent vision loss may occur
if a detachment is not repaired within 24 to
72 hours
Causes:

 Nearsighted adults
 People who have had an eye injury or post-
cataract extraction surgery
 People with a family history of retinal
detachment .
MANIFESTATIONS:

 Flashes of light
-the light that enters is not absorbed by the
detached melanin epithelial pigment
 Showering effect of floaters (small flecks or
threads) in the visual field.
- These are blood and retinal cell thatare
freed at the time of the tear and cast
shadows on the retina as they seem to rift
about the eye
 Darkening of the peripheral visual field.
 Progressive constriction of vision in one area
-when detached is extensive and occur
quickly , there is sensation that a curtain has
been drawn before the eyes as if looking gin a
fence
MANAGEMANT:
 Laser (thermal) or freezing (cryopexy).
-Both of these approaches can repair a
detached retina if it is diagnosed early
enough.
 Pneumatic retinopexy.
-This procedure can be used to treat
retinal detachment if the tear is small and
easy to close. A small gas bubble is injected
into the vitreous where it then rises and
presses against the retina, closing the tear. A
laser or cryopexy can then be used to seal
the tear. This procedure is 85% successful.
 Scleral buckle.
-This treatment for retinal detachment
involves placing a silicone band
(buckle)around the eye to hold the retina in
place. This band is not visible and remains
permanently attached. Thermal treatment may
then be necessary to close the tear. This
procedure is effective as high as 95% of the
time.
 Vitrectomy.

-This procedure for retinal detachment

is used for large tears. During a vitrectomy
the vitreous is removed from the eye and
replaced with a saline solution. It has similar
success rates to the scleral buckle.