Introduction to Eye Disease ( a Tafree3_ Will Be Done)
Transcript of Introduction to Eye Disease ( a Tafree3_ Will Be Done)
Introduction to Eye diseases
Hasan Mohidat MDVitreoretinal diseases and surgery,
JUST
Structures
• Eyelids• Lacrimal system• Conjunctiva• Cornea• Glaucoma• Lens• Retina• Strabismus• Trauma• Neuro ophthalmology
Upper lid
Lower lid “similer structure to upper eye lid but its shorter and less mobile”
Entropion“its interning of the eye lid toward the globe it will cause erosion in the corneal epithelium and if it left untreated
will form scars”
the cause is conjunctival scaring the scar will contract interning of the eye lid
must be corrected surgically otherwise blindness
Ectropion ”opposite to entropion the eye lid is hanging down happens in the lower lid more bcz of gravity effect most commonly due to senile changes in the eye lid tissues , or due to facial nerve palsy which will lead to loss of innervations in the orbicularis oculi muscle the complaining will be excessive lacrimation , and bcz of the closing of the eye lid is from temporal side to
the nasal side like a zipper then it will squeze the tears to the nasal side where we have lacrimal drainage system. surgical correction
Ptosis “it’s a congenital form which is the most common form”
Ptosis 3rd nerve
The right eye deviated not bcz of pathological reasons but bcz the right eye will receive Equal innervation to the left eye so when you ask the pt to look toward you using the left Eye the right eye will deviate
Hordeolum and Chalazion “infection of one of the glands in the eye lids one of them is meibomian gland”
Internal VS external
TT by topical antibiotics or surgical
Internal hordeolum bcz its infecting the Meibomian gland
When its infecting the eye lash follicles its called external hordeolum
Xanthelasma due to hyperlipidemia , or it can be just senile changes has no effects on the eye just cosmetic تجميلي so if the pt complains about it we just
excise it .
Malignancy, basal cell CA
Lacrimal system
Jones dye test
Stenosis
This represent the inferior nasal meatus
Positive test the die will go out through nose
Dacryocystogramits radio opaque technique
to assess the drainage to the inferior nasal meatus .
Probingfor tt and dx. The dr striating the eye lid by pulling laterally and upward bcz the canal is
going vertically first then lateraly
Dr said just lateraly
Acute dacryocystitis infection of the lacrimal sac due to occlusion of the nasolacrimal duct usually lower part infection which is painful and may cause fever tt with systeminc antibiotics , sometimes abscess will form
here you need to drain it once the infection subside then you have to solve the problem by a procedure called Dacryocystorhinostomy create a new opening to the lacrimal sac and the nose
The pt will present with excessive lacrimation
Congenital NLD “nasolacrimal duct” obstruction
Due to failure of canalization of the lacrimal duct the treatment is just by massage this area by the mother while feeding the baby squeezing down by the age of one year the canal will be opened
Conjunctiva
Chemosis edema of the conjunctiva most commonly due to allergic reactions
Bacterial conjunctivitis
Mild conjunctivitis tt by simple antibiotics drops “chloramphenicol” dose not affect the vision
Gonococcal conjunctivitis its STD so you have to treat the partner associated with keratitis. systemic Antibiotics usually 3rd Generation cephalosporin “ceftriaxone”
Tt by antibiotics.
Can cause blindness if left untt
Viral conjunctivitis
Conjunctivitis with subconj. hemorrhageCorneal involvement
*Usually bilateral , starts in one eye then in one or 2 days will move to the other eye , *tt is supportive , give artificial eye drops , anti-histamine , steroids to reduce the inflamation*The pt will complain from itching and watery discharge.
Chlamydial conjunctivitisTrachomaInclusion conjunctivitis
Cause : sterotypes D-K sterotypes A,B,C
mode of transmission : STD tick borne
tt: tetracycline for both , erythromycin for children
notes : most common cause of blindness worldwilde
Vernal catarrh “very common”
Moderate papillary reaction Giant papillae
Cause : allergy
treatment : steroids and antihistamine , symptomatic only
notes : also called الربيعي very common , causes PAPILLARY reaction in the , االلتهابeye
Degenerations Pterygium pinguiculum
Definition : fibrovasuclar growth
difference : apex toward the center , base is away from center vise versa
complications : cover the pupil and impair vision X (no growth on pupil)
treatment : surgical excition ( has high reoccurrence rate ) X ( no need to treat) t.t with micomycin C ( antimetabolite
notes : both may get inflamed every now and then , treat with anti-inflammatory drugs > Pterygium starts usually from the nasal side of the eye
The CorneaCornea :
> has 5 layers
> stromal layer makes 90% of the thickness
> endothelial layer :
one cell layer
functions to pump fluid from the cornea keeping it dehydrated and clear
never regenerate
number of cells per cm square :
> 3000 : starting number>1000 : risk for edema
we have critical number below which blindness happens
Myopia
Image fall in front of the retina
corrected by concave lens
hyperopia
Image fall behind the retina
corrected by convex lens
Fluorescein stain • A stain that is widely used in
ophalmology , it absorbs blue light and omits yellow and green light .
It stains :
1. water : found in the aqueous humor of the eye
2. Collagen : found in the connective tissue of the eye
> normal cornea is composed of epithelium , so no stain should appear on it
> cornea with erosions and defects allows the stain to reach the basement membrane , so it will be stained .
Corneal vascularization
May occur in :
recurrent irritationinfection intropium
Microbial keratitisEarly
Advanced
Definition : infection of the cornea
risk factor : contact lens
causes : bacterial fungal viral and protozoal
management : > scraping the eye for gram stain
> start the patient on 45 topical antibiotics
HSV(1) keratitis
Typical HSV presentation .
Typical findings in florescence stain :
> dendritic ulcer
management : acyclovir , triflordim
Arcus Senilis
Definition :
opacification on the peripheral coroners of the cornea
causes :
>Aging > hyperlipidemia
* affects the stroma
* doesn’t affect vision
KeratoconusDefinition : progressive thinning and bulging of the cornea due to weak collagen .
management :
> early in the disease ,
* collagen cross linking by riboflavin or UV light
* hard contact lenses
* Ring implantation
>late in the disease ,
* corneal graft .
Keratoplasty : قرنية زراعةNotes about the procedure :
> no need for tissue cross matching between donor and recipient .
> cornea must be tested for infections and “blood born malignances ! “
> implantation for parts “ layers” of the cornea instead of the whole cornea can be done .
LAser In situ Keratomiluesis ( LASIK)
Procedure :
> keratom is used to cut a superficial layer – flap - of the cornea , usually 100 micron layer ( thickness of the center of the cornea is 500 micron ) .
> laser is used to correct the refractive error by melting parts of the cornea
> flap is then sutured back .
Notes : for people with thin cornea we scrap the cornea directly without talking a flap away , this will cause pain for the patient and vision will be blurry for a weak . This method is called PRK (photo refractive keratectomy )
Wilson’s disease
The Lens
Phakia = natural lens
aphakia : absence of the lens
pseduphakia : presence of artificial lens
Subluxation
Cataract
Early
Advanced
Opacification of the lens that can be congenital or acquired .
Management :
* past : remove the lens and give large glasses
- glasses are called aphakik glasses .
*present : replace the lens with a thin artificial lens
- no suturing for the lens
Congenital Cataract
Phacoemulsification
Intraocular lens
Past and present
GlaucomaDefinition : progressive loss of optic neurons around the optic disc , mostly caused by increased IOP
normal IOP : 10 – 21
The Angle
Intraocular pressure
Optic nerve
Temporal retina
Horizontal raphe
Papillomacular bundle
Nasal retina
Optic nerve head
Normal Glaucomatous
In glaucoma , we have enlargement of the optic cup ( the center of the optic disc ) on the expense of the optic neurons present on the rim of the disc.
Progression of VF loss
Angle closure glaucoma
Can be caused by growth of blood vessels ! .
Neovascular glaucoma
Congenital glaucoma
Congenital glaucoma can cause Increase in the size of the eye , because the sclera is still stretchable , it can accommodate for the increased IOP , this results in what is called MEGALOCORNEA.
Treatment
• Drops: B- blockers, prostaglandin analogue, alpha2 agonists, Carbonic anhydrase inhibitors, Cholinergic agonists..
• Systemic: carbonic anhydrase inhibitors, Mannitol.
• Surgery: Trabeculectomy, Tube shunts..
Trabeculectomy
Tube shunt
Retina
Histology
vitreous
Retinal breaks
Definition : peripheral retinal pathology that is considered as a risk factor for retinal detachment .
Retinal detachment, rhegmatogenous
Definition : separation between the photoreceptors and the pigmented layer
Detachment, tractional
Fibrous tissue that grows on the retina most commonly caused by diabetic retinopathy leading to traction and detachment , tt by surgary
Vitrectomy surgery
Diabetic retinopathy
nonproliferative proliferative
No growth of new blood vessels , management is by better control of glucose levels
Growth and hemorrhage of blood vessels , management is by laser photocoagulation .
Risk factors :
> duration of diabetes ( most important)
> control of blood sugar
Laser photocoagulation
Retinal vein occlusion
Branch Central
Done by : shadi jraisat & hussam asslayem
good luck ^^