Debre Brehan University

School of Health Science

Program of Nursing
Medical-Surgical Nursing II
Eye Disorder
Prepared by Tesfa D.
(B.Sc. in Nursing)

1
 Review of Anatomy &
Physiology of the eye
 The eye is the organ of vision which is located in a
cone shaped cavity known as the orbit.
 It is highly specialized & complex structure.
 It receives & sends visual data to the cerebral cortex
for interpreting visual images.
 Seven cranial nerves have connections to the eyes.
These are;
 For vision – CN II.
 Eye movement – CN III, IV & VI.
 Papillary reaction – CN III.
 Eyelid elevation – CN III.
 Eyelid closure – CN VII.

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 Brain stem connections permit coordinated eye
movement.
 The eye ball is situated in the bony socket or orbit.
 The eye ball is protected by: -
 Orbit.
 Eyelids (Upper & lower).
 Nerves & blood vessels that supply nutrients &
transmit impulses to the brain are also present with in
the orbit.
 Organized bands of muscles are attached to the
external eye ball.

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 External Structures of the eye

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 Grey line;
Where the skin joins palpebral conjunctivas.
 Glands: -
Meibomian gland;
It is found with in the tarsal plate, their
ducts opening through the palpebral
conjunctiva just behind the lashes.
Produce sebaceous substance which creates
the oily layer of the tear film.

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 Cont…d

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Glands of moll – These are sweat glands producing
sebum.
 Muscles:-There are three muscles supplying the
eyelid.
a. Orbicularis: Oculi
 Origin:– Lacrimal bone.
 Insertion:- Deep in the facia around the lacrimal.
 Function:- to close the eye lid & to screw up the eyes & facilitate
tear drainage.
 Nerve supply:- Facial nerve (CN-VII).
 Its paralysis cause lag-ophthalmas (Failure to close
eye).

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b. Levator palpebral superioris
Origin:– around apex of orbit.
Insertion:– skin of upper lid & tarsal plate.
Function:– to lift the upper lid.
Nerve supply:– Oculomotor (CN-III).
Its paralysis cause ptosis (dropping of
eye lid).

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c. Muller’s muscle
 This is smooth muscle.
 Origin:– Levator palpebral superiors.
 Insertion:– Tarsal plate.
 Function:– provide extra elevation to
the upper lid.
 Nerve supply:– Sympathetic nervous
system.

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 Cont….d

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 The junction of the upper & lower eyelid is called
canthus/commisure.
 The outer, Lateral Canthus is on the lateral temporal
aspect of the eye.
 The inner, Medial Canthus contains the Puncta,
openings that allow tears to drain into the upper portion
of the lacrimal system.
 The elliptical space between open eye lid is called
palpebral fissure.
 Vertical palpebral fissure = 8-11mm (More wide in
female).
 Horizontal palpebral fissure = 27 – 30 mm.
 Upper eye lid is more mobile than lower eyelid.

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 Cont…d
 Skin
It is the thinnest of the body.
It is freely movable.
Meibomian gland orifice in a single row.
The anterior border of lid margin gives rise to the eye
lashes.
Eye lashes:-hairs-like filament (cilia)
2 to 3 irregular row.
With 100 lashes on upper lid.
With 50 lashes on lower lid (thin & short).
It is important to trap dust particles.

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Subcutaneous connective tissue
o Loose & doesn’t contain fat.
o This cause rapid accumulation of fluid (Oedema)
 Tarsus
o It is called skeleton of the eyelid.
 Conjunctiva
o It is a mucous membrane.
o Its zones are: -
 Palpebral conjunctiva:– forms inner layer of eyelid & reflects over
eye ball.
 Bulbar conjunctiva;
 It is extremely thin & transparent so that vessels are easily seen.
 It is freely movable.
 Covers the eye ball except the cornea.
 Fornices:– formed where bulbar & palpebral conjunctiva fold back over
each other.

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 Cont…d
Eyelids;
It is skin without subcutaneous fat.
It has 4 basic layers.
From anterior to posterior the layers are;
Skin & subcutaneous connective
tissue.
Muscle.
Tarsus .
Conjunctiva.

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 Cont…d
 Functions of eye lids;
Protect eye ball (globe).
Lubricate anterior surface of globe (By
blinking the tear film spread over anterior
surface).
 Blood supply to the lid;
 Lacrimal artery & vein.
 Supra – orbital artery & vein (upper lid).
 Superior & inferior medial palpebral artery &
vein.

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 Lacrimal glands & Excretory System
 Lacrimal glands
 Location – Superiorly in a shallow depression of frontal
bone.
 It has 2 parts: -
 Orbital (lacrimal gland proper).
 Numerous Excretory ducts emptying secretion to conjunctiva.
 Mechanism of tear secretion is by: -
Reflex – due to stimulation of trigeminal nerve.
Psychogenic – central mechanism.

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 Accessory glands
Krause’s gland located in the eye lid.
Meibomian gland
Basal tear secretion is constant & under sympathetic
nervous system control.

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Lacrimal excretory system
Punctum (on posterior edge of lid margin) upper & lower

Upper & Lower canaliculi (Common Canaliculi)

Lacrimal sac (tear Sac)

Naso-lacrimal duct

Nose

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 Cont…d
.

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Function of tear
Refraction:– to provide an optically smooth surface to the
cornea.
Lubrication of the front of eye ball.
Cleansing action by washing away dust particles from the
eye.
Protection from infection by secreting the enzyme
lysozyme, immuno-proteins & antimicrobial agents.
 Flow of tear is affected by;
Blinking.
Capillary attraction into the puncta.
Lacrimal pump by contraction of muscle.
Gravity.

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 Internal Structure of eye

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 Eye Ball;
 It is lined by 3 layers,
1. Outer protective layer
 It is fibrous layer.
 It consists;
A. Sclera
 It is the white part of the eye.
 Form outermost tissue of posterior & lateral (4/5)th aspects of eye
ball.
 It is continuous anteriorly with cornea.
 Maintains the shape of the eye & gives attachment to extra ocular
muscle of eye.
B. Cornea
 It is the anterior continuation of sclera.
 It is clear transparent & allow passage of light rays.
 It is convex anteriorly & is involved in refraction or bending light
rays to focus them on retina.
 It is highly sensitive.

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2. Middle layer
 It is Vascular organ.
 It Consists;
A. Choroid
Lines the posterior (5/6)th of inner surface of
sclera.
Highly vascularized.
Light enters the eye through the pupil,
stimulate the nerve endings in the retina then
is absorbed by the choroid.
Deep chocolate brown in colour.

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B. Ciliary body
 It is anterior continuation of the choroid &
consists ciliary muscle & secretary cells
(producing aqueous humor).
 It gives attachment to suspensary ligament
which, at its other end, is attached to the lens.
 The ciliary muscle controls the shape of lens
for focusing.

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C. Iris
It is the visible coloured part of the eye &
extends anteriorly from the ciliary body, lying
behind the cornea in front of the lens.
It divides the anterior segment of the eye into
anterior & posterior chambers which contain
aqueous fluid secreted by ciliary body.
In the center is an aperture, the pupil.
The pupil varies in size depending upon the
intensity of light.
During bright light the pupil constrict, whereas
dilate during dim light .

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D. Lens
It is a highly elastic circular biconvex transparent
body, lying immediately behind the pupil.
It is suspended from the ciliary body by the
suspensory ligament & enclosed with in a
transparent capsule.
Its thickness is controlled by the ciliary muscle
through suspensary ligament.
It bends light rays reflected by an object in front
of eye.

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3. Inner layer
A. Retina
 It is nervous tissue layer.
 Retina is especially adapted to be stimulated by light rays.
 Composed of several layers of nerve cell bodies.
 Rods & cones are layer highly sensitive to light.
 Macula
 It is an area of the retina situated to the temporal side of the optic disc.
 It contains a high concentration of cones.
 In its centre is the fovea centralis, a slight depression where only cones
are present.
B. Optic disc
 Contains no nerve cells, so the vision cannot take place here.
 This is known as the “blind spot”.

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 Cont…d
Structures inside the eye ball are
Aqueous humour (fluid).
Vitreous body.
 The anterior segment of the eye, i.e. the space between the cornea &
the Lens, is incompletely divided into anterior & posterior chambers
by iris. Both chambers contain a clear aqueous fluid.
 Aqueous fluid
It is secreted by ciliary gland.
It passes in front of the lens, through the pupil into
anterior chamber & returns to the venous
circulation in the angle between iris & cornea.
Produced continuously & drained but the IOP
remains fairly constant b/n 10 to 20 mm hg.
An increase in pressure cause glaucoma.

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Vitreous body
It is found behind the lens & filling the cavity
of the eye ball.
Soft, colourless, transparent, jelly like
substance composed of 99% water.
It maintains sufficient IOP to support
the retina against the choroids & prevent
the wall of eye ball from collapsing.
The eye keeps its shape because of IOP
exerted by vitreous & aqueous fluid.

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 Cont…d
 Optic nerves
The fibers of optic nerve originate in the
retina of the eye.
All the fibers converge to form the optic
nerve about 0.5cm to the nasal side.
It pierces the choroid & sclera to pass
backwards & medially through the orbital
cavity.
Passes through optic foramen of sphenoid
bone, backwards & medially to meet the
nerve from the other eye at the optic chiasma.

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Optic chiasma
It is situated immediately in front of &
above the pituitary gland in the
sphenoid bone.
In the optic chiasma the nerve fibers
of the optic nerve from the nasal side
of each retina cross over to the
opposite side.
The fibers from temporal side do not
cross.

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 Cont…d
Physiology of Sight
Light reflects into the eyes by objects within
the field of vision.
A specific colour is perceived when only one
wave length is reflected by the object & all
the others are absorbed.
E.g. an object appears red when only the red
wave length is reflected.
Objects appear white when all wavelengths
are reflected & black when they are all
absorbed.

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 Cont…d
In order to achieve clear vision light
reflected from objects with in the visual field
is focused on the retina of both eyes.
The processes involved in producing a clear
image are refraction of the light rays,
changing the size of pupils & accommodation
of the eyes.

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 Cont…d
Refraction of the light rays
When light rays pass from a medium of one
density to a medium of a different density
they are refracted or bent.
Helps to focus light on retina.

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 Cont…d
Lens: - is the only structure in the eye that changes
its refractive power.
 Light from distant objects needs least refraction &
as the objects come closer, the amount needed is
increased (i.e. ciliary muscle contract).
 Size of the pupils: - control the amount of light entering
to the eye.
 If the pupils were dilated in a bright right, too much
light would enter eye & damage retina.
 The two muscles of iris, circular muscle fiber
constriction causes pupil to constrict but constriction of
radiating muscle fiber dilate pupil.

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 Cont…d
Accommodation of the eyes to light
Close Vision
 In order to focus on near object i.e. with in
6 meters, the eye must make the following
adjustments.
 Constriction of the pupils.
 Convergence of the eye balls
(Movement).
 If convergence is not complete there is
double vision (diplopia).
 Changing the power of lens – the lens
is thicker.
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 Cont…d
 Distant Vision
 Objects more than 6 meters away from the eyes are
focused on the retina without adjustment of the lens or
convergence of the eyes.
 With aging, the ability of the eye to accommodate
gradually decreases because of increased rigidity of the
lens (Presbyopia).
 The lens is tense able to change shape in response to
visual challenge of focusing on near objects.

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 Summary of eye structure

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 Passage way of light rays
Light Cornea Pupil Iris
Lense

AH VH Retina Optic
Nerve

Cerebral Cortex.

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 Ocular Assessment
1. Assisting the patient in measurement of
visual acuity
The measurement of visual acuity records
the acuteness of central vision for distance,
and near or reading vision.
Visual acuity: - is the most important
function of eye and it should be performed
first, so that vision is assessed before
actually touching the eye.
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 Cont…d
Distance Vision
 It is tested at 6m as rays of light from this
distance are nearly parallel.
 If the patient wears glasses constantly, vision
may be recorded with & without glasses, but
this must be noted on the record.
 Each eye is tested and recorded separately, the
other being covered with a card held by the
examiner.
 Visual acuity is tested with an eye chart called
snellen’s chart.

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 Cont…d
Snellen’s Chart test type
 Heavy black letters, numbers or symbols printed in
black on a white background, are arranged on a chart
in grows of graded size, diminishing from above
downwards. The top letter can be read by the normal
eye at a distance of 60m, and the following rows should
be read at 36, 24, 18, 12, 9, 6, 5, 4m respectively.
 The patient is seated 6m from the chart, which must be
adequately lit, & asked to read down to the smallest
letter he can distinguish, using one eye at a time.
 Visual acuity is expressed as a fraction & abbreviated
as VA.
 The numerator is the distance in meters at which a
person (pt)can read a given line of letters.

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 Cont…d
 The denominator is the distance at which a
person with a normal average vision can read
the same line.
Example: - If the 7th line is read at a distance of
6m this is VA 6/6. If same letters in the line are
read but not all, it is expressed as, for example,
VA 6/6 -2, or VA 6/9+2.
 For vision less than 6/60 the distance between
the patient & the chart is reduced a meter at a
time & the vision is recorded accordingly as, for
example, 5/60, 4/60, 2/60, 1/60.

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 Cont…d
 If the patient cannot read the top letter at
a distance of 1 meter, the examiner’s hand
is held at 0.9m, 0.6m or 0.3m a way against
a dark background & the patient is asked
to count the number of fingers held up.
 If he answers correctly, record VA= CF
(Count Fingers). For less visions the hand
is moved in front of the eye at 0.3m, record
VA = HM (Hand movement).
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 Cont…d
 In the case of less vision, test for projection of light
by shining a torch into the eye from different
directions to see if the patient can tell from which
direction it comes if he sees the light from which
direction, it is noted as VA = PL(Perception of light).
This test is performed in the dark room. If no light
is seen, record NO PL, which is total blindness.
 A pinhole disk is used if the VA is less than 6/6,
which may improve VA. If considerable increase in
vision is obtained, it may usually be assumed that
there is no gross abnormality, but a refractive error.

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 Cont…d
2. Assisting on ophthalmoscope Examination
 The internal eye is called the fundus &
comprises the retina, optic disc, macula, &
retinal vessels.
 It can be visualized through an
ophthalmoscope.
Def: - Ophthalmoscope is a hand-held
instrument that projects light through a
prism & bends the light at 90 degrees,
allowing the observer to view the retina.

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 Cont…d
 The direct ophthalmoscope has several
lenses arranged on a wheel. A lens may be
chosen by rotating the wheel with the
index finger with out interrupting the
inspection.
 To a void a confrontation of noses, the
right eye of the patient is examined with
the right eye of examiner
 The room is darkened to enhance
papillary dilation.
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 Cont…d
 Instruct the patient to hold the eyes still & focus
on a real or imagined distant object.
 Grip the ophthalmoscope firmly in the hand,
with the index finger resting on the lens wheel.
 The head of the ophthalmoscope is braced with
in the angle made by the eye brow & the nose.
 The lens chosen for initial inspection should be
the one labelled zero unless the examiner is
knowingly correcting his own defect in visual a
acuity.

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 Cont…d
 An examiner who wears corrective lenses should
become proficient in ophthalmoscopy while
wearing the lens.
 Lenses lobe led with a red numerals are for
hyperopic (far sighted) patients & those with a
black numerals are for myopic (nearsighted)
patients.
 The examiner stands approximately 37.5cm away
& about 15 degrees to the side of the patient’s gaze.
 When the light is focused on the pupil, the retina
glows red (or orange) through dilated pupil
opening. This is called the red reflex.

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 Cont…d
 The examiner then moves closer to the patient.
Placing a hand on the patient’s forehead, the
examiner rests his or her forehead on the hand &
focuses through the ophthalmoscope.
 Examining the fundus includes evaluating: -
 The optic disc
 Retinal blood vessels
 Retinal characteristics
 Macular area
 Vitreous hum

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 Cont…d
 The disc for: -
Its physiologic cup & Proportional size
 The blood vessels for:-
Size
Distribution
Crossings & colour reflection
 Retinal fundus for: -
General Colour
Hemorrhagic
Fluid
Attachment

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 Cont…d
 Macula & fovea centralis for: -
Colour (darker red)
Central reflection 
 The vitreous humor for: -
Colour
Foreign bodies

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 Cont…d
3. Assisting in measurements of intraocular pressure
 Tonometry is a technique for measuring intra-ocular
pressure (IOP) indirectly by measuring the force
necessary to flatten a 3.06mm diameter portion of the
corneal surface. The higher the IOP, the greater the
force required.
 Methods of measuring IOP:-
 Digital.
 Golmann applanation tonometer.
 Schiotz (perkins applanation) tonometer.
 Pneumotonometer.
 Tonopen.

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 Cont…d
Schiotz tonometry
Requires using a metal, hand held instrument (the
tormenter) that rest on the anesthetized cornea. The result
can be variable but are a good estimate of IOP.
Goldmann applanation tonometry
it is attached to a slit lamp to measure IOP.
It is the most accurate form of measuring IOP. 

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 Cont…d
Procedure
 Identity the patient.
 Check if the patient is wearing contact lenses, if so then
remove them before commencing the procedure.
 Administer topical anaesthesia into both eyes.
 Instil fluorescein stain for accurate reading.
 Instruct the patient to look straight a head with both eyes
wide open- if necessary, the patient’s eyelids should be held
apart by the examiner with out pressure being applied to the
eyeball.
 The ton meter is brought into contact with the center of the
cornea .
 The IOP (in mm Hg) is found by multiplying the drum
reading by ten.

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 Cont…d
 Non contact tonometer (pneumotonometer)
 It is employed by optometrists, use a puff of air blown
against the eye.
 It is useful when contact with the cornea is not desired.
 Digital
 A general determination of IOP can be made by applying
gentle finger pressure over the sclera of the closed eye.
 The tips of both fore fingers are placed on the closed
upper lid. One finger gently presses inward while the
adjacent finger senses the amount of pressure exerted
against it.

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 Cont…d
 The examiners then compare the tension felt or
perceived in the patient’s eye with the pressure in their
own. This requires practice.
 The patient looks down wards, closing the eye.
 palpate the eye ball to assess the degree of hardness.
 No accurate measurement can be taken but on eye with
raised pressure will feel harder than one with normal
pressure.
 It is a useful initial method of assessment, especially if
none of the specialized equipment needed for measuring
IOP is available.

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 Cont…d
 Tonopen
Are small pen like instruments that measure
pressure in a similar fashion to the applanation
method.
NB: - IOP = normal value is 10-20mmHg. Increased
IOP is the cardinal sign of glaucoma
4. Assisting the patient in measurement of refractive
errors
 Refraction
 Determination of refractive errors.

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 Cont…d
 Corneal Reflections
 Method: - A pen torch is held at 1/3m directly in front of
both eyes. The position of the reflection on each eye is
then compared.
 Results: - The results may be: -
 Normal Corneal reflections – symmetrical.
 Asymmetrical Corneal reflections.

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 Cont…d
 Cover Test:-It is carried out to detect the presence of a
squint, & should be used in conjunction with
observation of the corneal reflections.
 Method: - A penlight is held at ~ 1/3m from the child.
The child must be looking at the height whilst the cover
test is carried out.
 It is important to repeat the cover test using a detailed
target, e.g. a small picture on a tongue depressor, because
same squints are only present when looking at detailed
objects. The caver test should also be carried out at 6m
where possible because other squints are only present
when looking into the distance, i.e. intermittent squints.

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 Cont…d
 Cover one eye, watch for any movement of the
uncovered eye, remove the cover & repeat covering
the other eye & watching for any movement of
uncovered eye.
 The results may be: -
No manifest squint.
Manifest squint – right convergent squint (Fig
13.6)
Manifest squint – right divergent squint (Fig
13.7)

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 Cont…d
 Ocular Movements
The examiner sits in front of the patient & using
a pen torch, observes both eyes moving in all
eight positions of gaze.
 This will include up, down, both sides & in all four
corners, always returning to the straight a head or
primary position. The patient’s head must be held still.
Any muscle imbalance, over action & under actions are
then noted.

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 Refractive errors
 RE is a pathological condition where
parallel rays of light are not brought to
focus on retina, b/c of defect in the
refractive media that is cornea and lens.
 Refraction is the ability of the eye to bend
light rays, so that they fall on the retina.

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 Cont…d
 In normal eye, parallel light rays are focused
through the lens in to a sharp image on retina,
this condition termed as Emmetropia.
 Emmetropia means the light is exactly focused
on the retina, not infront of it or behind it.

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 Cont…d
 When the light is does not focus properly, it is
called a refractive error.
Refractive errors include;
1. Myopia (Short sightedness).
2. Hyperopia or hypermetropia (Long
sightedness).
3. Astigmatism (asymmetric focus).
4. Presbyopia.
5. Aphakia.
66
 1. Myopia or short sightedness
 A short – sighted person has a long
eyeball and the eye have excessive
refracting power (cornea and lens).
 The light rays therefore come to a focus
in front of the retina.
 Can see near objects clearly.
 Objects at a distance are blurred.

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 Cont…d
 C/F = decreased distant vision.
 Can be corrected by concave lens (minus), so that
objects seen in the distance are focused clearly on
the retina. It bends light ray out ward.

68
 2. Hyperopia or long sightedness
The eye has insufficient refractive power to
focus light on the retina.
The rays of light entering the eye are focused
behind the retina.
The individual can see distant object clearly,
but close objects are blurred (C/M-
Impairment of near vision).

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 Cont…d
Can be corrected by convex lens (plus) which
bends light ray inward.

70
 3. Astigmatism
 It is a refractive error in which the light rays are
spread over a diffuse area rather than sharply
focused on the retina.
 It results from unequal curvature of the cornea,
causing horizontal and vertical rays to be focused
at two d/t pts on the retina, so that there is no point
of focus of the light rays on the retina.
 C/F: - blurred vision, eye discomfort.
 It can be hyperopic or myopic in relation to where
the image falls.

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 4. Presbyopia
 It is a form of hyperopia that occurs as a
normal process of aging usually around
the age of about 45 years.
 As the lens ages and becomes less elastic ,
it loses its refractive power and the eye no
longer has the ability to accommodate for
near vision.
 The light rays therefore fall behind the
retina before coming to a focus.
 Can be corrected by convex lens.

72
 5. Aphakia
 It is the absence of crystalline lens.
The lens may be absent congenitally,
cataract surgery, trauma.
 Eye loses about 30% of its refractive
power and no near vision.
Can be corrected by implanting
intraocular lens.

73
 External Ocular diseases
1. Hordeolum (Sty)
A Sty is an acute suppurative infection of
superficial eye lid sebaceous glands.
Cause: - Staphylococcus aureus.
C/F: - Sub acute pain, redness, & swelling
(edematous) of a localized area of the lid
that may rapture.
- Stys are localized to the lid margins.
- small collection of pus in the form of
an abscess.

74
 Cont…d

75
 Cont….d

76
 Cont…d
Mx
Worm, moist compresses for 10 to 15
minutes, three to four times a day,
hastens the healing process.
If the condition doesn't begin to resolve
with in 48 hours, incision & drainage may
be indicated.
Application of topical antibiotics.
Analgesics.

77
 2. Chalazion
 Defn: - Chalazion is a swelling of one of the
meibomian/tarsal glands due to blockage of its
duct.
 It is chronic condition.
 It is some times called internal hordeolum.
Cause: - Staphylococci are common causes if infected.
C/F: -Localized, firm, painless swelling that develops
over period of weeks.
-Palpation usually indicates small, painless
nodule in the eye lid some distance from the lid
margin.

78
 Cont…d

79
 Cont….d

80
 Cont…d
Mx
 Worm, moist compresses for 10 to 15 minutes,
three to four times a day especially in the early
stage.
 Massage & expression of the glandular secretions.
 Antibiotic therapy (Chloramphenicol;- apply 3-4
x/d for 7-10 day, after the eye has been steamed).
 Corticosteroid drops/injection in to the chalazion
lesion.
 Incision is indicated if the chalazion grows larger
enough to distort vision.

81
 Cont…d
Nursing Care:
- Instruct the patient to apply steam to the
eye.
- Instruct how to use drugs.
- Instruct the pt. to clean eye lids by using
worm water.

82
 3. Blepharitis
 It can be a cute or chronic inflammation of both
eyelid margins.
 It is usually bilateral.
 It can take the form of;
1. Staphylococcal blepharitis:- It is usually
ulcerative and more serous due to
involvement of the base of hair follicle.
Permanent scaring can result. Caused by
staphylococcal chronic infection.

83
 Cont…d
2. Seborrehic blepharitis:- It is chronic and
usually resistant to Rx, but the milder case
can respond to lid hygiene. Caused by
Seborrhoea (excessive secretion of lipid from
meibomian glands).
 It may be associated with dandruff, poor
hygiene, eczema.

84
 Cont…d

85
 Cont…d

86
 Cont…d
C/M
 Irritation of eye lids margins and red
rimmed eyes with many scales or crusts
on the lid margin and eye lashes.
 Burning.
 Itching.
 Photophobia.
 Conjunctivitis may occur simultaneously.

87
 Cont…d
Mx
o Daily meticulous cleaning of the lid margins
using cotton tipped applicator, with dilute baby
shampoo: 2x/day.
o Worm Compresses.
o Application of antibiotic ointment 2-3x/d.
o Dandruff RX.
o Stop using make up or change the brand used.
o Improve hygiene.

88
 Cont…d
Complication
Conjunctivitis.
Trichiasis.
Entropion or ectropion of lower
lid.
Corneal Ulcer.

89
 4. Trichiasis
 It is a condition in which the eye lashes
grow in words & rub on the cornea.
Cause: - blepheritis
- Trauma or surgery to the lids.
Rx: - Epilation
Complication: - Corneal abrasions
- Corneal ulceration
- Corneal Opacity
- Vascularisation of cornea
90
 Cont…d

91
 Cont…d

92
 5. Entropion
Turing inward of eyelids, usually
lower eye lids.
Cause: - Contraction of the palpebral
conjunctiva following trauma or
disease to the eye lid or conjunctiva.
Rx: - Transverse lid surgery and
suture.

93
 6. Ectropion
 It is turning outwards of the eye
lids, usually the lower lids.
Cause: - Scaring of the lid or
conjunctiva
- Paralysis of facial nerve.
Rx:- Surgery

94
 7. Ptosis
 It is dropping of the upper eyelid.
Cause: - congenital.
- Oedema, tumor & scarring of eye
lid
- Myasthenia gravis (Levator
palpebral superioris).
- Paralysis of nerves supplying the
upper lid.
Rx: - Treat underlying cause.
95
 Disease of conjunctiva
1. Conjunctivitis
 Conjunctivitis an inflammation of
the conjunctiva.
 It is the most common ocular disease
world wide.
 It is characterized by a pink
appearance (hence the common term
“pink eye”) b/c of subcutaneous
blood vessel haemorrhages.
96
 Cont…d

97
 Cont…d

98
 Cont…d
Cause
1.Infections;
1. Bacteria (Haemophilus influenza,
staph aureus).
2. Virus (Adeno virus, HSV).
3. Chlamydial.
4. Fungal.
5. Parasitic.
99
 Cont…d
2. Immunologic (allergy);
environmental allergens (e.g.
pollens).
3. Irritant/toxic (Chemical, thermal,
electrical).
4. Associated with systemic disorder.
 Most conjunctivitis is bilateral;
unilateral involvement suggests a
toxic or chemical origin.
100
 1.1. Bacterial Conjunctivitis
 It can be acute or chronic
Causative agents: - Streptococcus
- Staph. auerus
- Pneumococcus
C/M
 Conjunctival injection, especially in the
fornices where the blood supply is rich.
 Hyperemia/redness.
 Purulent discharge.
 Pain.

101
 Cont…d
Rx & Nursing Care
Take swab from affected eye for
culture & sensitivity if severe.
Clean the eye using cooled, boiled
water.
Chloramphenicol or tetracycline
eye drop or paint 3x/d for 3-5days.

102
 1.2. Neonatal Conjunctivitis
Severe conjunctivitis occurring in a baby
less than 28 days old is notifiable disease.
Cause: - Gonococcus
- Streptococcus
- Chlamydia
C/M: - Severe discharge
- Red, swollen eye lids
- Chemosis (edema of the
conjunctiva)
- Unilateral or bilateral infection.
103
 Cont…d
Rx: - Clean the eye.
- Gentamycin eye drop TID.
- Oral antibiotics.
Complication: - Conjunctival Scarring.
- Chronic blepheritis.
- Conjunctival ulceration
& perforation.
- Marginal corneal ulcer.
104
 Cont…d

105
 1.3. Viral Conjunctivitis
Cause: - Measles
- Herpes Simplex
- Varicella
C/M
 Red eye.
 Chemosis, if severe.
 Follicle may be present on the palpebral conjunctiva.
 Keratitis .
 Watery discharge & photophobia.
Rx: - Self limiting (with in 7-10days).
- Steroid Rx.

106
 Cont…d
Mx summary for bacterial and viral conjunctivitis
(highly contagious)
 Hand washing.
 Avoid sharing hand towels, face clothes, eye, drops.
 Tissue paper should be directly discarded in to a
trash can after use.
 Using new tissue paper every time you wipe the
discharge.
 All forms of tonometry must be avoided unless
medically indicated.

107
 1.4. Allergic Conjunctivitis
Causes: - Hay fever, Eczema
C/F: - Severe chemosis
- Red eye
- Watery eye
- Sinusitis may present
- Burning sensation & severe itching
- Photophobia
Rx: - Betamethasone or hydrocortisone
drop.
-Wearing dark glass.
108
 2. Trachoma
Trachoma is a highly contagious
infectious eye disease (Chlamydia
Conjunctivitis) that affects more than
500 million people world wide and
which may result in blindness.
It is the world's leading cause of
preventable blindness & primarily
affects people in Africa.
109
 Cont…d

110
 Cont…d
Pathophysiology
Scaring of the inside of the eye lid.
The eye lid turned inward and the
lash rubs the eye ball.
Scaring of the cornea.
Irreversible corneal opacities and
blindness.

111
 Cont…d
Cause: - Chlamydia trachomatis
Mode of transmission:-
Direct Contact (with eye, nose, throat
secretion from the affected individual.
Fomites (towel, hand kerchiefs,
fingers, wash clothes).
Insect Vector (flies).

112
 Cont…d
C/M
 Mild itching & irritation is principal symptom.
 Red eye.
 Discharge (slightly purulent).
 Follicles & papillae an upper palpebral connective.
 Keratitis.
 Entropion and trichiasis of the upper eyelid.
 Chemosis of bulbar conjunctiva.
 Blurring of vision.
 Photophobia.
 Pannus blood vessels on the upper part of cornea.
 Corneal scaring.

113
 Cont…d
Complications
Scarring of eye lids.
Entropion.
Trichiasis.
Corneal trauma & ulceration.
Mx: - Good personal hygiene
- Tetracycline eye

114
 Cont…d
Management
SAFE strategy;
Surgery:- trichiasis and entropion.
 Antibiotic:- TTC (ointment apply TID for 3-4weeks.),
sulphonamides, erythromycin.
 Facial cleanness:- good hand and face washing
practice.
 Environmental changes:-address water shortage,
eradicate flies, avoid crowded, e.t.c.

115
 Disease of cornea
1. Keratitis
 Keratitis is an inflammation of the cornea.
 Cornea is susceptible to infection and injury because of its
anterior location and degree of exposure.
Cause
 Exposure (exophtalmos, lagophtalmos) keratitis as a result of
drying of the cornea because of eye lids can not protect it
adequately.
 Infections;
 Bacteria (staph.. aureus, strep.. pneumonia, pseudomonas
aergunosa).
 Virus (herpes simplex, varicella zoster virus).
 Fungus (Candidia, aspergillus, cephalosporium).
 Parasitic organism.
Most of infections of cornea occur as a result of trauma or
compromised systemic or local defense mechanism.

116
 Cont…d

117
 Cont…d

118
 Cont…d
C/M
 Sensation of foreign baby in the eye.
 Marked inflammation of glade (open space).
 Muco-purulent discharge with the eyelids stuck
together on awakening.
 Ulceration.
 Hypoyon (Pus in the anterior chamber).
 Photophobia.
 Blurred vision.
 In advanced disease;
 Perforation of cornea.
 Extrusion of the iris.
 End-ophthalmitis.

119
 Cont…d
Dx
 Identifying the ulcer by slit - lamp examination
after instilling fluorescein drops to demonstrate the
shape & size of the ulcer under special light.
Mgx
 Patients with severe corneal infections are usually
hospitalized to allow frequent administration
(every 30 minutes) of antimicrobial drops &
regular examination.

120
 Cont…d
 Keep the lid clean.
 Cool compresses.
 Monitor for sign of increased IOP.
 Acetaminophen 500mg 2tabs PRN.
 Cycloplegic & mydriatics to relieve pain &
inflammation.
Complication
 Corneal Scar.
 Revascularization (new blood vessels formation) in the
cornea.

121
 2. Pterygium
 Pterygium is a triangular fibro-vascular connective tissue
over the growth of the intra-palpebral conjunctiva with
extension to the cornea.
 Usually occurring on the nasal side, but it can be temporal.
 It is thought to be an irritative and degenerative
phenomenon caused by ultraviolet light.
Cause – unknown.
Predisposing factors: - people who live in hot, dry climates
or who work in the open air.
Rx
 Surgical removal if pterygium encroaches on the visual
axis or causes significant discomfort.
 In 30-50% of cases it reoccurs after surgery.

122
 Cont…d

123
 Cont…d

124
 3. Corneal ulcer
 It is ulceration of cornea.
Etiology
 Bacteria;
 Staph.. aureus, strep.. pneumonia, pseudomonas aergunosa.
 Fungus
 Candidia, aspergillus.
C/M
 Pain.
 Blurred vision.
 Photophobia.
 The ciliary vessel around the cornea will be dilated.

125
 Cont…d

126
 Cont…d

127
 Cont…d
Dx
 Hx.
 P/E.
 Culture and sensitivity.
 Microscopic exam.
Mgx
 Treat urgently.
 Antibacterial;
 Gentamycin and ciprofloxacilin eye drops.
 Antifungal;
 Natamycin and econazole eye drops.

128
 Intraocular disease
/disorder of the Lens/
1. Cataract
 It is clouding or opacity of crystalline lens the impairs vision.
 The lens is a delicate structure & any insult on it causes
absorption of water, resulting in the lens becoming opaque.
 According to WHO, cataract is the leading cause of blindness in
the world (2002).
Cause
 From birth (congenital).
 Age (senile).
 Eye injury (traumatic).
 Secondary to existing eye disease (e.g. uveitis).
 Drug like corticosteroids.
 Cataract associated with systemic disease (DM,
Hyperparathyroidism).
 UV light exposure.
 High dose of radiation therapy.

129
 Cont…d

130
 Cont…d

131
 Cont…d
Degree of Cataract
 Immature cataract – part of the lens is opaque.
 Mature cataract – the whole lens is opaque & may be swollen.
Congenital Cataract
Cause
Abnormal development of the eye.
Metabolic disturbance.
Rubella or malnutrition in first trimester of pregnancy.
C/M
Unable to see.
white pupil (Unilateral or bilateral).
Rx: - Removing the cataract

132
 Cont…d
Senile Cataract
Occur in patients over the age of 60 years.
They result from sclerosis of the lens due to a
degenerative process.
Usually bilateral.
It is either;
 Nuclear:-
 affects the central lens & takes on a brown color.
 The patient sees better in dim light when pupil is dilated.
 Cortical:-
 Affects the periphery of the lens & looks white.
 Vision is usually better in bright light when the pupil is
constricts.

133
 Cont…d
General C/M
 Gradual, progressive, and painless loss of vision.
 Double vision/blurred vision/
 Reduced light transmission.
 Rainbow/haloes/
 Previous dark pupil appear milky or white.
Dx
 Hx.
 P/E.
 Ophtalmoscopic exam.
 Slit lamp examination.

134
 Slit lamp examination.

135
 Cont…d
Mgx
 Surgery;
 surgical removal of the lens usually done under local
anesthesia.
 IOL (intraocular lens) are usually implanted at the time of
cataract extraction.
Nursing intervention
 Preparing the pt for surgery.
 Orient pt and explain the procedure and plan of care to
decrease anxiety.
 Instruct the pt not to touch to decrease contamination.
 Administer preoperative eye drops.

136
 Cont…d
Postoperative care;
Administer medication as prescribed.
Teach the pt to report sudden pain and restlessness
with increased pulse.
Caution pt against coughing, sneezing, rapid
movement, bending.
Encourage pt to wear shield at night to protect
operated eye fro injury while sleeping.

137
 Diseases of sclera
1. Scleritis
It is an inflammation and swelling of sclera.
Etiology
 Associated with connective tissue disorder like rheumatoid
arthritis.
C/M
 Severe pain.
 The white part of the eye may appear red, swollen and a
nodule which is painful in touch.
Mgx
 Heavy immune suppression.
 Systemic corticosteroid and eye drops.
 Systemic NSAID’s and treating the underlying cause.

138
 Cont…d

139
 Cont…d

140
 Disease of uveal tract
1. Unveitis
 Uveal tract comprises the middle vascular pigmented
layer of the eye.
 It is composed of three areas: -
 The choroid.
 The ciliary body.
 The iris.
Def: - Uveitis is the inflammation of one or all structures of
the uveal tract.
 Because the uvea contains many of the blood vessels
that nourish the eye and because it borders many other
parts of the eye, inflammation of this layer may threaten
vision.
141
 Cont…d
Cause
Bacteria ( TB).
Virus (CMV, syphilis, herpes zoster and
simplex).
Fungi (toxoplasmosis, histoplasmosis, ocular
candidiasis).
Chemical
Trauma
Allergy

142
 Cont…d
1) Acute anterior uveitis (iritis)
Is the most common type.
Is characterized by a history of pain, photophobia, blurring of
vision, & red eye.
Rx
 Dilating drops (mydriasis) are instituted immediately to
prevent scar formation & adhesion to the lens (Synechiae),
which may cause glaucoma by impending aqueous outflow.
 Local corticosteroids are used to decrease the inflammation.
 Wearing sunglasses.
 Analgesics.

143
 Cont…d
2) Intermediate uveitis (Chronic cyclitis)
 It is characterized by “Floating spots” in the field of vision.

Rx: - Topical or injectable corticosteroids are used in

severe cases.
3) Posterior uveitis (Inflammation affecting the
choroid or retina)
 Is usually associated with some form of systemic disease, such as
AIDS, herpes simplex or zoster, tuberculosis.
C/M
 Decreased or distorted vision.
 eye redness & pain.
Rx – Systemic corticosteroid.

144
 Cont…d
Uveitis generally categorized into two. These are;
1. Non-granulomatous
2. Granulomatous
C/M for NGU;
 Have acute onset.
 Pain.
 Photophobia.
 Conjectival ejection (congestion of blood vessel), especially
around the cornea.
 Pupil will be small or irregular.
 Vision will be blurred.
 Hypopyon in severe case.
 Anterior synechia (peripheral iris adheres to cornea and
impeds out flow of aqueshumour).
 Posterior synechia (adherence of the iris and lens).

145
 Cont…d
C/M for GU;
 Insidious onset.
 Vision is markedly and adversely affected.
 Conjuctival injection is diffuse.
 Vitreous clouding.
 Photophobia pain is minimal.

146
 2. Sympathetic Ophthalmia
It is a rare but devastating bilateral uveitis .
Occurs after a latent period of days to years after a
penetrating injury to the uveal tract.
Cause – Unknown
Predisposing factor: - Allergy
C/M
 Inflammation of injured eye, followed by
inflammation of the unaffected (Sympathetic) eye.

147
 Cont…d
MX
 Enucleation of the sightless eye within 10 days of
injury is usually recommended to reduce the risk of
sympathetic disease in the other eye.
Indication for enucleation
Blindness after penetrating injury.
Painful blind eyes that is unresponsive to the
medical treatment.
Tumor of the eye.

148
 Disease of the inner ear
1. Panophthalmitis
It is an inflammation of all tissue of the eye ball.
Etiology
 Bacteria.
 Virus.
 Fungus.
 E.t.c…
 Hx of recent intraocular operation.
 Penetrating trauma.
 Common in immune compromised pts, such as
HIV/AIDS and diabetes.

149
 Cont…d
C/M
 Severe pain.
 Loss of vision.
 Redness of conjunctiva and underlying episclera.
Mgx
 Medication (antimicrobial plus steroids)
 Topical.
 Subconjuctival.
 Intravitreally.
 Systemically, or in combination form.
 Surgery
 Enucleation.

150
 Injuries to the eye
1. Trauma to the eye
A. Blunt contusion
 It is bruising of the periorbital soft tissue.
C/M
 Swelling and discoloration of the tissue.
 Bleeding in to the tissue and structure of the eye.
 Pain.
Mgx
 Reducing swelling and pain by applying cold and
warm compress.
 Refer for ophthalmologist ass’t.

151
 Cont…d
B. Hyphema
 It is the presence of blood in the anterior chamber.
C/M
 Pain.
 Blood in the anterior chamber.
 Increase IOP.
Mgx
 Usually spontaneously recovers.
 If sever bed rest, and eye shield application.

152
 Cont…d
C. Orbital fracture
 It is fracture and dislocation of the wall of the orbit,
orbital margin or both.
Cause:- Injury on the cranial area.
C/M
 Rhinorrhea.
 Contusion.
 Diplopia.
Mgx
 May heal by itself, if no displacement or infringement on
the other structure.
 Surgery:- repair of the orbital floor.

153
 Cont…d
D. Foreign body
 It is the presence of foreign material on the cornea or
conjunctiva.
C/M
 Severe pain with lacrimation.
 Foreign body sensation.
 Photophobia.
 Redness.
 Swelling.
Mgx
 Consider a medical emergency.
 Removal of foreign body through irrigation, cotton tipped
applicator.
 Surgical removal.

154
 Cont…d
E. Laceration/Perforation.
 It is cutting or penetration of soft tissue.
C/M
 Pain
 Bleeding
 Lacrimation
 Photophobia
Mgx
 Consider as medical emergency.
 Surgical repair- method of repair depends on the severity
of injury.
 Antibiotics.

155
 Cont…d
F. Ruptured globe
 It is concussive injury to globe with tears in the ocular coat, usually the
globe.
C/M
• Pain
• Altered IOP
• Limitation of gaze in field of rupture
• Hyphema
• hemorrhage
Mgx
 Consider as medical emergency.
 Surgical repair
 Antibiotics
 Steroids
 Enucleation

156
 2.Burn of the eye
 It is the destruction of the eye tissue by chemical, thermal, and
ultraviolet ray.
A. Burn of chemical agent that is caused by alkali or acids.
C/M
 Pain
 Burning
 Lacrimation
 Photophobia
Mgx
 Consider as medical emergency.
 Copious irrigation until PH is 7.
 Keratoplasty for severe scaring.
 Antibiotics.

157
 Cont…d
B. Burns of thermal sources
C/M
 Pain
 Burned skin
 Blisters
Mgx
 First aid-apply sterile dressing.
 Pain control.
 Leave fluid blebs intact.
 Suture eyelid together to protect eye if perforation is possible.
 Skin grafting with severe second and third degree burns.

158
 Cont…d
C. Burn of UV source
C/M
 Pain
 Foreign body sensation
 Lacrimation
 Photophobia
Mgx
 Pain relief.
 Bilateral patching with antibiotic ointment and
cycloplegics.
159
 Other eye condition
1. Glaucoma (Disorder of an aqueous
Humor Circulation)
Glaucoma is a pathological rise in the intra ocular
pressure that causes damage to the various structure of
the eye, especially the optic nerve.
It is the cause of blindness.
There are four types of glaucoma. These are;
1. Congenital .
2. Closed angle (acute).
3. Open angle (chronic)
4. Secondary.

160
 Cont…d
1. Congenital glaucoma.
 It is a rare condition that occurs in infant and neonates
C/M
 The diameter of the cornea increase in size.
 The cornea becomes edematous
Dx
 Tonometry exam-increase IOP.
Mgx
 Medical-Pilocarpine drops, Acetazolamide tablet.
 Surgical-Goniotomy-to incise the mesodermal
membrane in the angle of anterior chamber.

161
 Cont…d
2. Closed angle glaucoma
 It accounts for 10% of the primary glaucoma.
Etiology
 Mechanical blockage of the anterior chamber angle.
C/M
 A sudden severe pain in and around the eye.
 Nausea and vomiting
 Pupil mid-dilated and fixed.
 Hazy appearing cornea due to corneal edema.
 A sudden elevation of IOP
Dx
 Slit lamp exam nation.
 Tonometry examination.

162
 Cont….d
Mgx
 Medical
• Lower the IOP as quick as possible by medical means.
Miotics- Used to constrict the pupil and contract the
ciliary muscle, thus the iris is drawn away from cornea;
aqueous humor may drain through lymph spaces
(meshwork) ion to canal of schlemm.
E.g. Pilocarpine drops 2-4% every 5 minute fro an hour,
and then every hour for 12 hour topically.
Carbonic anhydrase inhibitor-restricts action of the
enzyme that is necessary to produce aqueshumor.
E.g. Acetazolamide (diamox)250mg QID.

163
 Cont…d
Hyperosmotic agents-reduce IOP by promoting
diuresis.
E.g. Mannitol IV.
Surgical
Iridecomy- excision of a small portion of the iris where
by AH can bypass. This prevents the periphery of the iris
blocking the angle of the anterior chamber.
Trabeculectomy-partial thickness sclera, resection with
small part of trabecular meshwork and iridectomy.
Laser iridotomy-multiple tiny laser incision to create
openings for AH flow.

164
 Cont…d
3. Open angle glaucoma
 Makes up 90% of primary glaucoma cases.
 Its incidences is increased with age.
Etiology
 Degenerative changes occur in the trabecular meshwork
and canal of schelmm.
Risk factors
 AGE.
 Familial history of glaucoma.
 Diabetes
 Hypertension

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 Cont…d
C/M
 Mild, bilateral discomfort (tired feeling in the eyes,
foggy vision).
 Slowly developing impairment of peripheral vision with
dilated pupil.
 Progressive loss of visual field.
 No pain or inflammation.
Dx
 Paleness of the optic disk.
 Optic nerve atrophy.
 Rise in IOP.

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 Cont…d
Mgx
Medical
 Reduce the IOP by medication- the medication should be
continued for the rest of the patient life
 Pilocarpine drops 2-4% QID.
 Adrenaline drops 1% BID.
 Timolol/Timoptol/ drops ).25-0.5% BID.
Surgical
 Iridencleisis- an opening is created b/n anterior chamber
and space beneath the conjunctiva; this by pass the blocked
meshwork, and AH is absorbed into conjunctival tissues.
 Cyclodiathermy/Cylocryotherapy-destruction of ciliary
body with a high frequency electrical current or
supercooled probe.

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 Cont…d
4. Secondary glaucoma.
It is a type of glaucoma caused by a specific causes or
pathologies.
Etiology
Hemorrhage.
Corticosteroid use.
Uveitis.
Mgx
Treat the cause.

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 2. Strabismus/Squint
It is the situation where by the two eyes are looking in
different directions.
Etiology
Disorder of vision.
Disorder of the eye movement secondary in the
abnormality on the muscle that controls the movement.
Effects of squint
In adults
 Double vision/diplopia/.
 Abnormal head posture.
In children
 Ambylopia/lazy eye/.

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 Cont…d
C/M
 The corneal light reflex.
This is the best and simplest test of squint.
If the two eyes are straight, then the two corneal light
reflexes are central and symmetrical, but if one eye
squints, then the reflex deviates from the center of the
cornea.
 Testing the ocular movements.
There are six extra ocular muscle, and each one produces
most of the movement in the particular direction.

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Mgx
In children
Try to correct any refractive errors and ambylopia
before straightening the squint surgically.
Patching the good eye.
Surgical correction by either weakening, straightening
or realigning the extra ocular muscles
In adults
Cosmetic surgery is the only treatment.

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 3. Diabetic Retinopathy
 Is a frequent complication of DM.
 Occur after 20years of having DM.
 Caused by damage to or occlusion of the blood vessels
those nourish the retina. Weakened blood vessels become
hyper-permeable & leak, causing micro-hemorrhages,
retinal swelling, or exuadative deposits.
 Progressive retinal ischemia stimulates the formation of
new blood vessels (neovascularization).
 These new vessels are fragile & may rapture, causing sub
retinal hemorrhage or bleeding. The vitreous body also,
they may form fibro vascular bands that contract, resulting
in traction & subsequent retinal detachment.
 There are five stages of diabetic retinopathy.

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Background retinopathy
 Occurs in most diabetics about 20years after the onset
of the disease.
 Has no symptom until macula is involved.
C/M: - The fundus has dots (Micro - Aneurysms), blots
(Small hemorrhage), & hard waxy exudates (leakages
of lipids from the hemorrhaging blood vessels.
 Maculopathy
 It is main cause of visual impairment in non insulin
dependent DM.

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Pre – Proliferative retinopathy
 Occurs in eyes with background retinopathy only.
C/M: - The retina is ischemic which causes;
Cotton wool spot
Dilation, beading, looping of blood vessels
Arteriole narrowing
Large dark blot hemorrhage
Proliferative retinopathy
 Is the main cause of visual impairment in IDDM.
Advanced retinopathy
 It is the end result of uncontrolled proliferative retinopathy
& results in blindness.

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Generally C/M of Diabetic retinopathy is;
 If fluid collects at the macula, the patient notices blurred
central vision.
 Vitreous hemorrhage in cloudy or hazy vision of sudden
onset.
Mgx
 Laser photocoagulation surgery is useful. An intense
beam of laser light is used to seal of leaking blood
vessels & destroy abnormal new ones.
 Control DM.

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 4. Retinal detachment
Retinal detachment occurs when there is a separation
of the neuro-sensory retina from the underlying
pigment epithelium layer of the retina.
Neurosensery retina contains: - rods & cones.

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Causes: - The neural retina can be either pulled, pushes
or floated off the underlying epithelial layer
Pulled off: - by vitreous traction, which occurs when
new blood vessels have grow in to the vitreous.
 This condition con be caused by;
 DM.
 Retinal hemorrhage .
 Vitreous hemorrhage.
 Pushed off: - A lesion behind the retina . such as choroidal
tumors, hemorrhage, choroiditis & retinopathies
 Floated off :- If a tear or hole appears in the retina, subretinal
fluid or vitreous fluid enters the hole, floating the neural layer
off the epithelial layer. Rhegmatagenaus ( tear – induced )
detachment - is most common type.

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In general the causes can be;
congenital malformation
Metabolic disorders
Vascular disease
 Neoplasm
trauma
Degenerative changes

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C/F: - History of floating or flashing lights or both. The
floaters are perceived as tiny dark spots or cobwebs.
 Spreading shadow or curtain moving across the field
of vision, resulting in blurred vision & loss of visual
field as the retina separates
 Decreased central acuity or lass or central vision
 Flashing lights (photopia).

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 The End
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