Refractive errors (eye condions) - 20240519_203406.pdf
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About This Presentation
Refractive errors of eye
Slide Content
SUBMITTED TO:
Mrs. Mamta Toppo
Associate Professor,
College of nursing
RIMS, Ranchi
SUBMITTED BY:
Prerna Tirkey
Roll no — 19
Basic B.Sc. Nursing
3" year (2017- 2021)
RIMS, Ranchi
Mrs. Mamta Toppo
Associate Professor,
College of nursing
RIMS, Ranchi
SUBMITTED BY:
Prerna Tirkey
Roll no — 19
Basic B.Sc. Nursing
3" year (2017- 2021)
RIMS, Ranchi
CA O eee hae Keone
Introduction
Definition
Emmetropia
Ametropia
Types of refractive error
Myopia
Eetiology
Pathophysiology
types
Clinical manifestation
Management
Surgical management
Hyperopia
Etiology and types
Clinical manifestation
Management
Surgical management
CONTENT
O
¡+ Astigmatism
H Etiology and types
. Management
po Surgical management
+ Presbyopia
. Etiology
. Clinical features
. Management
6. Diagnostic evaluation
7. Pharmacological management
8
9.
Nursing management
Recent research
10. Summery
u. Reference
2. Bibliography
Introduction
Definition
Emmetropia
Ametropia
Types of refractive error
Myopia
Eetiology
Pathophysiology
types
Clinical manifestation
Management
Surgical management
Hyperopia
Etiology and types
Clinical manifestation
Management
Surgical management
CONTENT
O
¡+ Astigmatism
H Etiology and types
. Management
po Surgical management
+ Presbyopia
. Etiology
. Clinical features
. Management
6. Diagnostic evaluation
7. Pharmacological management
8
9.
Nursing management
Recent research
10. Summery
u. Reference
2. Bibliography
INTRODUCTION
O
e Refractive disorders are abnormalities of
refraction that occur in the eye. Refraction
results in the focusing of image on the retina
of the eye, permitting vision. In refractive
errors, vision is impaired because a
shortened or elongated eyeball prevents
light rays from focusing sharply on the retina.
Blurred vision from refractive errors can be
correctly with eyeglasses or contact lenses.
O
e Refractive disorders are abnormalities of
refraction that occur in the eye. Refraction
results in the focusing of image on the retina
of the eye, permitting vision. In refractive
errors, vision is impaired because a
shortened or elongated eyeball prevents
light rays from focusing sharply on the retina.
Blurred vision from refractive errors can be
correctly with eyeglasses or contact lenses.
DEFINITION
O
+ Arefractive error is a very common eye
disorder. It occurs when the eye cannot
clearly focus the image from the outside
world. The result of refractive error is blurred
vision which is sometimes so severe that it
causes visual impairment.
e Refractive error also known as refraction
error is a problem with focusing light
accurately on the retina due to the shape of
O
+ Arefractive error is a very common eye
disorder. It occurs when the eye cannot
clearly focus the image from the outside
world. The result of refractive error is blurred
vision which is sometimes so severe that it
causes visual impairment.
e Refractive error also known as refraction
error is a problem with focusing light
accurately on the retina due to the shape of
EMMETROPIA
O
« Emmetropia ( optically normal eye) can be
defined as a state of refraction, when the
parallel rays of light coming from infinity are
focusing at the sensitive layer of retina with
the accommodation being at rest.
O
« Emmetropia ( optically normal eye) can be
defined as a state of refraction, when the
parallel rays of light coming from infinity are
focusing at the sensitive layer of retina with
the accommodation being at rest.
AMETROPIA
O
e Ametropia ( a condition of refractive error), is
defined as a state of refraction, when the
parallel rays of light coming from infinity,
(with accommodation at rest), are focussed
either in front or behind the sensitive layer of
retina.
O
e Ametropia ( a condition of refractive error), is
defined as a state of refraction, when the
parallel rays of light coming from infinity,
(with accommodation at rest), are focussed
either in front or behind the sensitive layer of
retina.
TYPES OF REFRACTIVE
ERROR
The types of refractive errors are:
+ Myopia
« Hyperopia
« Astigmatism
« Presbyopia
ERROR
The types of refractive errors are:
+ Myopia
« Hyperopia
« Astigmatism
« Presbyopia
MYOPIA
O
e It is near sightedness also known as short
sightedness.
+ It is a type of refractive error in which parallel rays of
light coming from infinity are focussed in front of the
retina when accommodation is at rest.
e Myopia is a condition of the eye where light focuses
in front of the retina instead of on the retina this
causes distant objects to be blurred while close
objects appear normal.
O
e It is near sightedness also known as short
sightedness.
+ It is a type of refractive error in which parallel rays of
light coming from infinity are focussed in front of the
retina when accommodation is at rest.
e Myopia is a condition of the eye where light focuses
in front of the retina instead of on the retina this
causes distant objects to be blurred while close
objects appear normal.
Nearsighted Eye
Normal vision
Normal vision
ETIOLOGY OF MYOPIA
O
e Axial myopia results from increase in the antero-
posterior length of the eyeball.
+ Curvatural myopia occurs due to increased
curvature of the cornea, lens or both.
+ Index myopia results from increase in the
refractive index of the crystalline lens associated
with nuclear sclerosis.
O
e Axial myopia results from increase in the antero-
posterior length of the eyeball.
+ Curvatural myopia occurs due to increased
curvature of the cornea, lens or both.
+ Index myopia results from increase in the
refractive index of the crystalline lens associated
with nuclear sclerosis.
PATHOPHYSIOLOGY
O
Due to =p factor
degenerative changes causes by gradual loss of
elasticity of lens L
Which leads to decreased ability to accommodate
Then lead to refractive error
O
Due to =p factor
degenerative changes causes by gradual loss of
elasticity of lens L
Which leads to decreased ability to accommodate
Then lead to refractive error
TYPES OF MYOPIA
CONGENITAL MYOPIA
O
e Congenital myopia is present since birth. Usually the
error is of about -8 to -10 diopters, which mostly
remains constant . It may be associated with other
ocular congenital anomalies. Ex: cataract,
megalocornea, aniridia and microphthalmos.
O
e Congenital myopia is present since birth. Usually the
error is of about -8 to -10 diopters, which mostly
remains constant . It may be associated with other
ocular congenital anomalies. Ex: cataract,
megalocornea, aniridia and microphthalmos.
SIMPLE MYOPIA
O
e It is the commonest variety, which results from
normal is starts biological variation in the
development of eye. Simple myopia starts at school
age and very slowly progresses till adult age. Usually
the error does not exceed -6 to -8 diopters.
O
e It is the commonest variety, which results from
normal is starts biological variation in the
development of eye. Simple myopia starts at school
age and very slowly progresses till adult age. Usually
the error does not exceed -6 to -8 diopters.
DEGENERATIVE MYOPIA
O
e Pathological myopia or degenerative myopia is a
rapidly progressive error resulting in high myopia of
-20 D or more. It is strongly linked with heredity.
O
e Pathological myopia or degenerative myopia is a
rapidly progressive error resulting in high myopia of
-20 D or more. It is strongly linked with heredity.
CLINICAL MANIFESTATION
O
e There is reduced visual acuity for the distance of but near
objects are seen clearly. Usually there is no headache.
» In pathological myopia, the patient may complain of
seeing black spots floating in front of the eye, due to
vitreous opacities.
+ Ophthalmoscopically, the typical changes seen in the
high myopia are: myopic crescent either on the temporal
side of the optic disc or surrounding the disc and chorio-
retinal myopic degeneration or atrophy at the periphery.
e In vary high myopia the eye are prominent
(pseudoproptosis), the pupils are large and vision may be
very poor even with optical correction.
O
e There is reduced visual acuity for the distance of but near
objects are seen clearly. Usually there is no headache.
» In pathological myopia, the patient may complain of
seeing black spots floating in front of the eye, due to
vitreous opacities.
+ Ophthalmoscopically, the typical changes seen in the
high myopia are: myopic crescent either on the temporal
side of the optic disc or surrounding the disc and chorio-
retinal myopic degeneration or atrophy at the periphery.
e In vary high myopia the eye are prominent
(pseudoproptosis), the pupils are large and vision may be
very poor even with optical correction.
MANAGEMENT
O
» Concave lenses in the form of glasses or contact
lenses.
O
» Concave lenses in the form of glasses or contact
lenses.
SURGICAL MANAGEMENT
O
e Radial keratotomy: Multiple radial incisions are
given in the periphery of cornea in order to flatten
the curvature of cornea.
RK incisions
O
e Radial keratotomy: Multiple radial incisions are
given in the periphery of cornea in order to flatten
the curvature of cornea.
RK incisions
+ Lasik laser: Laser assisted in situ the preferred
surgical technique for correcting myopia of up to
-12 D. The midstromal tissue is ablated with
excimer laser after raising a 130-160 micron
thick flap of anterior corneal tissue.
Removal of clear crystalline lens: Removal
of lens extra capsular cataract extraction
(phacoemulsification) with IOL implantation of
appropriate power is being recommended.
Orthokeratology : A non surgical reversible
method pf molding the cornea with overnight
wear unique rigid gas permeable contact
lenses.
surgical technique for correcting myopia of up to
-12 D. The midstromal tissue is ablated with
excimer laser after raising a 130-160 micron
thick flap of anterior corneal tissue.
Removal of clear crystalline lens: Removal
of lens extra capsular cataract extraction
(phacoemulsification) with IOL implantation of
appropriate power is being recommended.
Orthokeratology : A non surgical reversible
method pf molding the cornea with overnight
wear unique rigid gas permeable contact
lenses.
HYPEROPIA
O
e Hypermetropia (hyperopia) or long sightedness is
the refractive state of the eye where in parallel rays of
light coming from infinity are focussed behind the
retina with accommodation being at rest. Thus the
posterior focal point is behind the retina, which
therefore receives a blurred image.
Proce, ate
I point is, blurry
© www.medindia.net behind Retina
O
e Hypermetropia (hyperopia) or long sightedness is
the refractive state of the eye where in parallel rays of
light coming from infinity are focussed behind the
retina with accommodation being at rest. Thus the
posterior focal point is behind the retina, which
therefore receives a blurred image.
Proce, ate
I point is, blurry
© www.medindia.net behind Retina
ETIOLOGY
O
e Axial hyoermretropia is by far the commenest
form. It occurs due to short axial length of the
eyeball.
e Curvatural hypermetropia occurs due to
comparatively flatter curvature of the cornea or lens
or both.
e Index hypermetropia results due to change in the
refractive index of the lens.
e Absence of the lens (aphakia) either congenital or
acquired (following surgical removal of the lens)
leads to high hypermetropia.
O
e Axial hyoermretropia is by far the commenest
form. It occurs due to short axial length of the
eyeball.
e Curvatural hypermetropia occurs due to
comparatively flatter curvature of the cornea or lens
or both.
e Index hypermetropia results due to change in the
refractive index of the lens.
e Absence of the lens (aphakia) either congenital or
acquired (following surgical removal of the lens)
leads to high hypermetropia.
CLINICAL FEATURES
O
+ Tiredness of eyes
e Frontal or frontotemporal headache
e Watering
+ Mild photophobia
O
+ Tiredness of eyes
e Frontal or frontotemporal headache
e Watering
+ Mild photophobia
MANAGEMENT
e Appropriate convex lenses in the form of spectacles
or contact lenses.
object image
of object
e Appropriate convex lenses in the form of spectacles
or contact lenses.
object image
of object
SURGICAL MANAGEMENT
O
» Refractive corneal surgery
O
» Refractive corneal surgery
ASTIGMATISM
O
e Astigmatism is a type of refractive error where in the
refraction varies in the different meridia of the eye
consequently, the ray of light entering in the eye
cannot converge to a point focus but form focal lines.
A ©
O
e Astigmatism is a type of refractive error where in the
refraction varies in the different meridia of the eye
consequently, the ray of light entering in the eye
cannot converge to a point focus but form focal lines.
A ©
ETIOLOGY
O
e Usually occurs due to unequal curvature of cornea.
e Rarely it may occur due to subluxation abnormalities
of the curvature of the lens.
<p
Es
O
e Usually occurs due to unequal curvature of cornea.
e Rarely it may occur due to subluxation abnormalities
of the curvature of the lens.
<p
Es
SIGN AND SYMPTOMS
O
e Blurred vision
e Eye strain and eye fatigue
e Headache
» Dizziness
e Vomiting
O
e Blurred vision
e Eye strain and eye fatigue
e Headache
» Dizziness
e Vomiting
TYPES OF ASTIGMATISM
REGULAR IRREGULAR
ASTIGMATISM ASTIGMATISM
REGULAR IRREGULAR
ASTIGMATISM ASTIGMATISM
MANAGEMENT
O
e Cylindrical lenses in the form of spectacles or contact
lenses.
O
e Cylindrical lenses in the form of spectacles or contact
lenses.
SURGICAL MANAGEMENT
e Keratoplasty
OFF
e Keratoplasty
OFF
PRESBYOPIA
O
» Presbyopia (eyesight of old age ) is not an error of
refraction, but a condition of physiological
insufficiency of accommodation, leading to failing
vision for near.
e It is usually occurs after 40 years of age.
Normal Less flexible Focal point
lens lens ug
\
—&
O
» Presbyopia (eyesight of old age ) is not an error of
refraction, but a condition of physiological
insufficiency of accommodation, leading to failing
vision for near.
e It is usually occurs after 40 years of age.
Normal Less flexible Focal point
lens lens ug
\
—&
ETIOLOGY
O
» Decrease in the accommodation power of crystalline lens
with increasing age, leading to presbyopia occur due to:
e Decrease in the elasticity and plasticity of the crystalline
lenses.
e Age related decrease in the power of ciliary muscle.
> Causes of premature presbyopia:-
+ Hypermetropia
- Primary open- angle glaucoma
+ Premature sclerosis of the lens
» Excessive close work
O
» Decrease in the accommodation power of crystalline lens
with increasing age, leading to presbyopia occur due to:
e Decrease in the elasticity and plasticity of the crystalline
lenses.
e Age related decrease in the power of ciliary muscle.
> Causes of premature presbyopia:-
+ Hypermetropia
- Primary open- angle glaucoma
+ Premature sclerosis of the lens
» Excessive close work
SIGN AND SYMPTOMS
O
e A tendency to hold reading material farther away to
make the letter clearer.
+ Blurred vision at normal reading distance.
e Eye strain or headache after reading or doing close
up work .
O
e A tendency to hold reading material farther away to
make the letter clearer.
+ Blurred vision at normal reading distance.
e Eye strain or headache after reading or doing close
up work .
MANAGEMENT
O
+ Convex glasses of an appropriate power:
= At the age of 40 years — reading correction is + 1D.
= At the age of 45 years - reading correction is +1.5D.
» At the age of 50 years - reading correction is +2D.
= At the age of 55 years - reading correction is +2.5 D.
O
+ Convex glasses of an appropriate power:
= At the age of 40 years — reading correction is + 1D.
= At the age of 45 years - reading correction is +1.5D.
» At the age of 50 years - reading correction is +2D.
= At the age of 55 years - reading correction is +2.5 D.
DIAGNOSTIC EVALUTION
O
« History collection
« Physical examination
* Snellens
chart
+ ophthalmoscopy
O
« History collection
« Physical examination
* Snellens
chart
+ ophthalmoscopy
* retinoscopy * autorefractometry
PHARMACOLOGICAL MANAGEMENT
O
e Cycloplegia drugs are used to refraction ( to paralyze
the ciliary muscle in order to determine the true
refractive error of eye)
e Cholinergics (Miotics): Pilocarpine, carbachol
- It increases aqueous fluid outflow by contracting
the ciliary muscles.
e Beta blockers : Betaxolol, Timolol
Decrease aqueous humor production.
O
e Cycloplegia drugs are used to refraction ( to paralyze
the ciliary muscle in order to determine the true
refractive error of eye)
e Cholinergics (Miotics): Pilocarpine, carbachol
- It increases aqueous fluid outflow by contracting
the ciliary muscles.
e Beta blockers : Betaxolol, Timolol
Decrease aqueous humor production.
NURSING MANAGEMENT
O
« Assess the patient for any previous allergy to medicine,
fruits etc.
+ When we administer any new medicine we have to
observe the side effect of it.
e We must have the knowledge about the sign and
symptoms of shock.
» Observe the response to the treatment.
O
« Assess the patient for any previous allergy to medicine,
fruits etc.
+ When we administer any new medicine we have to
observe the side effect of it.
e We must have the knowledge about the sign and
symptoms of shock.
» Observe the response to the treatment.
- Safe administration of the prescribed fluid .
* Right documentation.
* Monitor the hemodynamic pressure, vital
sign, arterial blood gas .
* Right documentation.
* Monitor the hemodynamic pressure, vital
sign, arterial blood gas .
NURSING RESEARCH
Prevalence of Refractive Errors and
Number Needed to Screen among
Rural High School Children in Southern
India: A Cross-sectional Study
nara beter
DEEPIKA DOROTHY JOHN’, PADMA PAUL", EVON SELINA KUJUA?, SARADA DAVID",
SMITHA JASPER®, JAYAPRAKASH MULIYIL*
ABSTRACT
Introduction: Avoidable blindness is mainiy due to uncorrected
refractive errors (URE). School Eye Screening (SES) can be used
as an initiative to address this issue.
Aim: To determine prevalence of URE and Number Needed to
Screen (NNS) to find one child with tow vision or blindness from
URE among rural school children.
Materials and Methods: A cross-sectional study was
performed in 22 government schools with sixth to ninth grades
in Kaniyambadi block of Vellore District of Tamil Nadu, India.
There were 4739 children on the rolls. Among children present,
all those identified to have a visual deficit in either eye. using
a single line 20/40 Snellen's optotype E chart at 6 m. were
referred to the hospital for confirmatory evaluation. Blindness
(uncorrected) was defined as inability to see 20/200 in the better
Prevalence of Refractive Errors and
Number Needed to Screen among
Rural High School Children in Southern
India: A Cross-sectional Study
nara beter
DEEPIKA DOROTHY JOHN’, PADMA PAUL", EVON SELINA KUJUA?, SARADA DAVID",
SMITHA JASPER®, JAYAPRAKASH MULIYIL*
ABSTRACT
Introduction: Avoidable blindness is mainiy due to uncorrected
refractive errors (URE). School Eye Screening (SES) can be used
as an initiative to address this issue.
Aim: To determine prevalence of URE and Number Needed to
Screen (NNS) to find one child with tow vision or blindness from
URE among rural school children.
Materials and Methods: A cross-sectional study was
performed in 22 government schools with sixth to ninth grades
in Kaniyambadi block of Vellore District of Tamil Nadu, India.
There were 4739 children on the rolls. Among children present,
all those identified to have a visual deficit in either eye. using
a single line 20/40 Snellen's optotype E chart at 6 m. were
referred to the hospital for confirmatory evaluation. Blindness
(uncorrected) was defined as inability to see 20/200 in the better
eye. In two of these schools, visual deficits were validated
through a second school based examination by a clinician.
Results: Of the 4739 children on rolls, 601 were absent; all
4138 (87.3%) who were present underwent screening; 2.3% (98)
{95% Confidence Interval (Cl) 1.8 to 2.8} failed the screening test
in at least one eye and were referred for examination. Only 28
(28.6%) of 98 children who were referred came for examination
to the hospital. In the 2 of the 22 schools where the visual deficit
was validated, there were no false positives. The prevalence of
refractive error in these two schools was 2.2% (95% CI 1.7 -
2.7). NNS to detect one child with low vision or blindness from
URE was 147.
Conclusion: Magnitude of refractive error, low NNS, low
response to referral necessitates complete care at school and
hence a relook at the current SES program.
through a second school based examination by a clinician.
Results: Of the 4739 children on rolls, 601 were absent; all
4138 (87.3%) who were present underwent screening; 2.3% (98)
{95% Confidence Interval (Cl) 1.8 to 2.8} failed the screening test
in at least one eye and were referred for examination. Only 28
(28.6%) of 98 children who were referred came for examination
to the hospital. In the 2 of the 22 schools where the visual deficit
was validated, there were no false positives. The prevalence of
refractive error in these two schools was 2.2% (95% CI 1.7 -
2.7). NNS to detect one child with low vision or blindness from
URE was 147.
Conclusion: Magnitude of refractive error, low NNS, low
response to referral necessitates complete care at school and
hence a relook at the current SES program.
er
Rah JS, Sipath S, Gilbert CE. Foster À Criicthood blindness in india: causes in
1318 bind school students in nine states. Eye (Londi. 1995;MPt 5):546-60.
[2] Got ©, Foster A, Negmi AD, Thylofors Chikihoad bindness: a new
forn for recording causes of Malal loss in chikdrert. Bull Word Health Organ
1293,71(5);485-89
BI Visyaleetmi PM Extent and impact of eye disease in chñaren of Indie ana the
status of paediatric service delrery Community Eye Heath Journal, 201023
S127- Se.
141 Jase A, Sachdea S_ School eye screening and the National Program for Control
ot Bingness. Incian Pediatr 2009;463/-205-08.
15] Saxena A, Vashet PR. Tandon R, Pancey AM. Bnardawes A, Menon Y Acouracy of
visual assesernent by school teachers a school eye screening program m Dotti,
Incáan Journal of Community Medicine. 2015;40/1)39-42.
FINANCIAL OR OTHER COMPETING INTERESTS: None. aa
Rah JS, Sipath S, Gilbert CE. Foster À Criicthood blindness in india: causes in
1318 bind school students in nine states. Eye (Londi. 1995;MPt 5):546-60.
[2] Got ©, Foster A, Negmi AD, Thylofors Chikihoad bindness: a new
forn for recording causes of Malal loss in chikdrert. Bull Word Health Organ
1293,71(5);485-89
BI Visyaleetmi PM Extent and impact of eye disease in chñaren of Indie ana the
status of paediatric service delrery Community Eye Heath Journal, 201023
S127- Se.
141 Jase A, Sachdea S_ School eye screening and the National Program for Control
ot Bingness. Incian Pediatr 2009;463/-205-08.
15] Saxena A, Vashet PR. Tandon R, Pancey AM. Bnardawes A, Menon Y Acouracy of
visual assesernent by school teachers a school eye screening program m Dotti,
Incáan Journal of Community Medicine. 2015;40/1)39-42.
FINANCIAL OR OTHER COMPETING INTERESTS: None. aa
SUMMERY
O
e Refractive error are disorders, not disease.
e Arefractive error means that the shape of eye doesn't
bend light correctly, resulting in a blurred image.
+ Types of refractive error are:
Myopia : near sightedness
Hyperopia :far sightedness
Presbyopia : Age related loss of lens flexibility,
causing reduced near vision.
4. Astigmatism :Irregularly shaped cornea, causing
blurred vision.
w DE
O
e Refractive error are disorders, not disease.
e Arefractive error means that the shape of eye doesn't
bend light correctly, resulting in a blurred image.
+ Types of refractive error are:
Myopia : near sightedness
Hyperopia :far sightedness
Presbyopia : Age related loss of lens flexibility,
causing reduced near vision.
4. Astigmatism :Irregularly shaped cornea, causing
blurred vision.
w DE
REFERENCE
O
e Book
e Magazine
e Internet
+ Discussion with the teacher
O
e Book
e Magazine
e Internet
+ Discussion with the teacher
BIBLIOGRAPHY
O
o Ansari javed, a text book of medical surgical
nursing-ll, pv publications, page no.-164-170
o Brunner and suddarth,s textbook of medical surgical
nursing vol-ll, south asian edition, wolters
kluwer,page no- 255-262
> Www.wikipedia.com
O
o Ansari javed, a text book of medical surgical
nursing-ll, pv publications, page no.-164-170
o Brunner and suddarth,s textbook of medical surgical
nursing vol-ll, south asian edition, wolters
kluwer,page no- 255-262
> Www.wikipedia.com
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