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1. DISORDERS(INFECTIONS/INFLAMMATIONS) OF THE EYE by Shahla Arshad Lecturer INS-KMU

2. Anatomy of the Eye

3. Eyelids Each upper eyelid should cover the top quarter of the iris so the eyes look similar. Conjunctivae and sclera The conjunctivae should be clear and shiny. The sclera should be white . Pupils Each pupil should be round and equal in size . Retina The retina should have a uniform color and be free from scars and pigmentation Macula The part of the eye most sensitive to light. It appears as a darker structure, free from blood vessels

4. 5 EYE DISORDERS Refractive Errors Muscular Disorders Disorders Of The Eyelid Disorders Of The Globe Of The Eye

5. Refractive Errors of Eye Refractive error means that the shape of your eye does not bend light correctly, resulting in a blurred image. The main types of refractive errors are: Myopia (Nearsightedness) Hyperopia   (Farsightedness) Presbyopia   (loss of near vision with age) Astigmatism (causes blurred vision)

6. MUSCULAR DISORDERS Nystagmus : ( is a condition in which the eyes make repetitive, uncontrolled movements. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern) Strabismus (Crossed Eyes) DISORDERS OF THE EYE LID Hordeolum (Stye) Chalazion (Meibomian Cyst) Blepharitis

7. Entropion (The eyelid usually the lower lid folds inward) Ectropion (lower eyelid turns outward, away from your eye) Conjunctivitis (Pink Eye)

8. DISORDERS OF THE GLOBE OF THE EYE Keratitis (inflammation of the cornea of the eye) Corneal Abrasion Or Ulcer Scleritis (inflammation of sclera) Cataract Glaucoma

9. Macular Degeneration (Irreversible vision loss in people over age 60) Diabetic Retinopathy Retinal Detachment (Retina separates from the layer underneath)  Uveitis (  Is the inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and in iris, ciliary body, and choroid)

10. HORDEOLUM (STYE) Is a common disorder of the eyelid or Inflammatory infection of the hair follicle of the eye lid ETIOLOGY Staphylococcal infection Usually associated with Blepharitis SYMPTOMS AND SIGNS Occurs on the outside Pain/swelling/redness/pus patient feels something in the eye

11. DIAGNOSIS Visual exam Culture if needed TREATMENT Medical therapy for Hordeolum includes Eyelid hygiene (lid scrubs) Hot compress to alleviate pain Massages of the lesions for 10 minutes 4 times per day. Topical or systemic antibiotics

12. CHALAZION (MEIBOMIAN CYST) A chalazion is a benign, painless bump or nodule inside the upper or lower eyelid. These cyst-like nodules form around an oil gland (meibomian) within the eyelid, resulting in red, swollen eyelids. chalazion is Collection of fluid or soft mass cyst. ETIOLOGY Blockage of meibomian gland SYMPTOMS AND SIGNS Pea size cyst painless slow swelling of the inner part of eye lid Could become infected

13. DIAGNOSIS Visual Examination TREATMENT small ones usually disappear spontaneously after a month or two Warm compresses. Soak a clean washcloth in hot water and hold it to your eyelid for 10–15 minutes at a time, 3–5 times a day. Antibiotics large ones usually need surgical removal Do not squeeze or try to pop a stye or chalazion.

14. BLEPHARITIS Blepharitis is inflammation of the of the margins of the eyelids. Blepharitis usually involves the part of the eyelid where the eyelashes grow and affects both eyelids. it is commonly occurs when tiny oil glands located near the base of the eyelashes become clogged. ETIOLOGY Staphylococcus bacterial infection Allergies, smoke, dust, chemicals, seborrhea, stye, chalazions. SYMPTOMS AND SIGNS Persistent redness & crusting on eyelids Itching / burning sensation Feeling something in the eye Ulcers can cause eye lashes to fall out Scales can get into eye causing conjunctivitis

15. DIAGNOSIS visual examination TREATMENT Apply a warm compress over your closed eye for several minutes to loosen the crusty deposits on your eyelids. Immediately afterward, use a washcloth moistened with warm water and a few drops of diluted baby shampoo to wash away any oily debris or scales at the base of your eyelashes. Medications that fight against infection including eye drops, creams and ointments. If you don't respond to topical antibiotics, you may suggest an oral antibiotic. Steroid eye drops or ointments may help control inflammation. Blepharitis caused by seborrheic dermatitis, rosacea or other diseases may be controlled by treating the underlying disease.

16. BLEPHAROPTOSIS (PTOSIS) weakness of eye muscle. Blepharoptosis is an abnormal low-lying upper eyelid margin that raises eyelid (superior rectus, superior oblique) ETIOLOGY Caused by aging Trauma or any eye injury.  Diabetes mellitus Muscular dystrophy Myasthenia gravis Brain tumors Caused by more serious conditions, such as a stroke, brain tumor, or cancer of the nerves or muscles.  Side effect after certain eye surgery

17. SYMPTOMS AND SIGNS Drooping eye Blocks vision DIAGNOSIS Ophthalmic examination Blood test to rule out underlying disease TREATMENT Eye glasses with raised eyelid support Treat underlying disease Surgery (strengthen muscles)

18. CONJUNCTIVITIS (PINK EYE) An inflammation or swelling of the conjunctiva ETIOLOGY Viral / bacterial Irritants (allergies, chemicals, UV light) SYMPTOMS AND SIGNS Redness / swelling / itching Tearing when exposed to light Pus if infectious “Contagious” with contaminated hands.

19. DIAGNOSIS Ophthalmic examination Culture discharge TREATMENT Protect your eyes from dirt and other irritating substances. Avoid the use of makeup. Remove contact lenses if you wear them. Warm compress 3-4 times daily (10-15 min.) If bacterial (antibiotic eye drops or ointment ). Bacterial conjunctivitis may improve after three or four days of treatment, Eye drops may help relieve itching and burning from the irritating substances causing your pink eye. If viral- self limiting

20. Applying Eye Drop Medicine STEP : 1 Tilt your head back. Using your middle finger, gently press the corner of the eye by the side of the nose. STEP : 2 Use your index finger to pull down the lower lid. Then apply the eye drop medicine. STEP: 3 After applying the eye drop, let go of your lower lid. Close the eye and keep the middle finger in place for at least two minutes. If you’re applying more than one type of drop, wait at least 15 minutes for the next application. Use a tissue to wipe away excess drops on eyelids.

21. CATARACT A cataract is a clouding of the lens in the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. ETIOLOGY Old age Congenital Trauma Drug toxicity (high level of steroids) Diabetes mellitus

22. SYMPTOMS AND SIGNS Cloudy / white opaque area of the lens Reduce visual acuity Blurring of vision Photosensitivity Trouble seeing at night DIAGNOSIS Visual examination TREATMENT The symptoms of early cataract may be improved with new eyeglasses. Surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens .

23. Intra-capsular phacoemulsification (involves breakage of cataract then aspiration) Extra-capsular phacoemulsification: (artificial lens replacement)

24. GLAUCOMA Glaucoma is an eye disease that is often associated with elevated intraocular pressure, in which damage to the eye (optic) nerve can lead to loss of vision and even blindness. Glaucoma is the leading cause of irreversible blindness in the world. Chronic Open-Angle Glaucoma Increased intraocular pressure due to a malfunction in eyes aqueous humor drainage system - can lead to optic nerve damage ETIOLOGY Trauma Overuse of steroids

25. SYMPTOMS AND SIGNS Gradual loss of peripheral vision. If untreated - eventually complete vision loss DIAGNOSIS Ophthalmic examination Tonometry (pressure measure ) TREATMENT Medication that helps decrease aqueous humor production or opens drainage system Laser to open drainage Surgery (bypass)

26. Normal IOP 15 if IOP is 21 or 22 it means patient will develop Glaucoma

27. Acute Angle-Closure Glaucoma Complete blockage of aqueous humor drainage system ETIOLOGY Trauma

28. SYMPTOMS AND SIGNS Blurred vision Severe eye pain Redness of the eye Nausea & vomiting Photophobia Hazy cornea If untreated --> blindness DIAGNOSIS Goniolens (special lens to view the opening) TREATMENT LASER IRIDOTOMY (creation of a hole in the iris between the anterior and posterior chamber) Medications to reduce pressure