THE EYE

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The human eye is the organ, which gives us the sense of sight, allowing us to
observe and learn more about the surrounding world than we do with any of the other
four senses. We use our eyes in almost every activity we perform, whether reading,
working, watching television, writing a letter, driving a car, and in countless other
ways. Most people probably would agree that sight is the sense they value more than
all the rest.
The eye allows us to see and interpret the shapes, colors, and dimensions of objects in
the world by processing the light they reflect or emit. The eye is able to detect bright
light or dim light, but it cannot sense objects when light is absent.

 

   
  
The extraocular muscles are incredibly strong and efficient. There are the six
extraocular muscles, which act to turn or rotate an eye about its vertical, horizontal,
and antero-posterior axes:
1. Medial Rectus (MR) - moves the eye inward, toward the nose (adduction)
2. Lateral Rectus (LR) -moves the eye outward, away from the nose (abduction)
3. Superior Rectus (SR) - primarily moves the eye upward (elevation), secondarily
rotates the top of the eye toward the nose (intorsion) , tertiarily moves the eye inward
(adduction)
4. Inferior Rectus (IR) - primarily moves the eye downward (depression), secondarily
rotates the top of the eye away from the nose (extorsion), tertiarily moves the eye
inward (adduction)
5. Superior Oblique (SO) - primarily rotates the top of the eye toward the nose
(intorsion), secondarily moves the eye downward (depression), tertiarily moves the
eye outward (abduction)
6. Inferior Oblique (IO) - primarily rotates the top of the eye away from the nose
(extorsion), secondarily moves the eye upward (elevation), tertiarily moves the eye
outward (abduction)

Each extraocular muscle is innervated by a specific cranial nerve (C.N.):
pc Y
 
    Y
pc   
   
 

pc
  
    Y
pc   
    Y
pc
     
pc      Y

 
One-sixth of the outer layer of the eye (called the tunic fibrosa or fibrous
tunic) bulges forward as the cornea, the transparent dome which serves as the outer
window of the eye. The cornea is the primary (most powerful) structure focusing
light entering the eye (along with the secondary focusing structure, the crystalline
lens).The cornea is composed, for the most part, of connective tissue with a thin layer
of epithelium on the surface. Epithelium is the type of tissue that covers all free body
surfaces.

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The cornea is composed of 5 layers, from the front to the back:
1.c epithelium,
2.c Bowman¶s (anterior limiting) membrane,
3.c stroma (substantia propria),
4.c Descemet¶s (posterior limiting) membrane, and
5.c endothelium (posterior epithelium).
The transparency of the cornea is due to the fact that it contains hardly any cells
and no blood vessels. However, blood vessels can creep in from around it, if it is
constantly irritated or infected, which can interfere with vision.
On the other hand, the cornea contains the highest concentration of nerve fibers of
any body structure, making it extremely sensitive to pain. The nerve fibers enter on
the margins of the cornea and radiate toward the center. These fibers are associated
with numerous pain receptors that have a very low threshold. Cold receptors also are
abundant in the cornea, although heat and touch receptors seem to be lacking.

 

‘long its circumference, the cornea is continuous with the sclera: the white,
opaque portion of the eye. The sclera makes up the back five-sixths of the eye¶s outer
layer. It provides protection and serves as an attachment for the extraocular muscles,
which move the eye.

  
Coating the outer surface of the cornea is a ³pre-corneal tear film.´ People
normally blink the eyelids of their eyes about every six seconds to replenish
the tear film. Tears have four main functions on the eye:
pc wetting the corneal epithelium, thereby preventing it from being
damaged due to dryness,
pc creating a smooth optical surface on the front of the microscopically
irregular corneal surface,
pc acting as the main supplier of oxygen and other nutrients to the cornea,
pc containing an enzyme called ³lysozyme,´ which destroys bacteria and
prevents the growth of microcysts on the cornea, and
pc flushing harmful bacteria and other microbes away from the eye, into
the lacrimal canals and then out through the nose.
The tear film resting on the corneal surface has three layers, from front to
back:
pc lipid or oil layer,
pc lacrimal or aqueous layer, and
pc mucoid or mucin layer
The most external layer of the tear film is the lipid or oil layer. This layer
prevents the lacrimal layer beneath it from evaporating. It also prevents the tears
from flowing over the edge of the lower eyelid (³epiphora´).The lipid component of
the tear film is produced by sebaceous glands known as ³Meibomian´ glands (located
in the tarsal plates along the eyelid margins) and the glands of ³Zeis´ (which open
into the hair follicles of the eyelashes). ‘n enlargement of a Meibomian gland is
known as a ³chalazion,´ while an infection of a Zeis gland is known as a ³hordeolum´
or ³sty(e).´Beneath the lipid layer is located the lacrimal or aqueous layer of the tear
film. This middle layer is the thickest of the three tear layers, and it is formed
primarily by the glands of ³Krause´ and ³Wolfring´ and secondarily by the ³lacrimal´

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gland, all of which are located in the eyelids. The lacrimal gland is the major
producer of tears when one is crying or due to foreign body irritation.
Lacrimal fluid, containing salts, proteins, and lysozyme, has several functions:
pc taking the main nutrients (such as oxygen) to the cornea,
pc carrying waste products away from the cornea,
pc helping to prevent corneal infection, and
pc maintaining the tonicity of the tear film.
If the eye¶s tears are ³isotonic,´ there will be no change in water volume in the
cornea and vision will remain normal. (Tears normally have a tonicity equal to .9%
saline.) If the tears are ³hypotonic,´ water will flow into the cornea (such as when
crying or swimming in a pool) and it will swell, causing it to become more myopic. If
the tears are ³hypertonic,´ water will flow out of the cornea (such as when swimming
in the ocean) and it will shrink, causing it to become more hyperopic.
The epithelial surface of the cornea is naturally ³hydrophobic´ (water-repelling).
Therefore, for a tear layer to be able to remain on the corneal surface without rolling
off, the ³hydrophilic´ (water-attracting) mucoid or mucin layer of the tear film is laid
down onto the surface of the cornea by ³goblet cells,´ which are present in the bulbar
conjunctiva. In turn, the lacrimal layer of the tear film, located above the mucoid
layer, can defy gravity and remain on the front of the eye.

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The transparent crystalline lens of the eye is located immediately behind the
iris. It is composed of fibers that come from epithelial (hormone-producing) cells. In
fact, the cytoplasm of these cells makes up the transparent substance of the lens.
The crystalline lens is composed of 4 layers, from the surface to the center:
1.c capsule,
2.c subcapsular epithelium,
3.c cortex, and
4.c nucleus.
The lens capsule is a clear, membrane-like structure that is quite elastic, a
quality that keeps it under constant tension. ‘s a result, the lens naturally tends
towards a rounder or more globular configuration, a shape it must assume for the eye
to focus at a near distance.
Slender but very strong suspensory ligaments, also known as zonules or zonules of
Zinn, attach at one end to the lens capsule and at the other end to the ciliary processes
of the circular ciliary body, around the inside of the eye. These thin ligaments or
zonules hold the lens in place.

 
The iris, visible through the clear cornea as the colored disc inside of the eye,
is a thin diaphragm composed mostly of connective tissue and smooth muscle fibers.
It is situated between the cornea and the crystalline lens. The color(s), texture, and
patterns of each person¶s iris are as unique as a fingerprint.The iris is composed of 3
layers, from the front to the back:
1.c endothelium,
2.c stroma, and
3.c epithelium.
The iris divides the anterior compartment, the space separating the cornea and
the lens, into 2 chambers: the larger anterior chamber (between the cornea and the
iris), and the smaller posterior chamber (between the iris and the lens).

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 "
The iris acts like the shutter of a camera. In the middle of a normal iris is the
pupil, typically a circular hole, comparable to the aperture of a camera. The pupil
regulates the amount of light passing through to the retina, which is at the back of the
eye.‘s the amount of light entering the eye diminishes (such as in a dark room or at
night), the iris dilator muscle (which runs radially through the iris like spokes on a
wheel) pulls away from the center, causing the pupil to ³dilate.´ This allows more
light to reach the retina. When too much light is entering the eye, the iris sphincter
muscle (which encircles the pupil) pulls toward the center, causing the pupil to
³constrict´ and allowing less light to reach the retina.
Constriction of the pupil also occurs when the crystalline lens accommodates
(changes focus) so that the eye can view something at a near distance. This reaction
is known as the ³near reflex.´ ‘ representation of parasympathetic pathways in the
pupillary light reflex can be seen here: parasympathetic response. Sometimes the
pupil does not react properly, due to cranial nerve or muscle problems

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It is a clear mucous membrane that lines the inner surfaces of the eyelids and
and continues on to cover the front surface of the eyeball, except for the central clear
portion of the outer eye (the cornea). The entire conjunctiva is transparent.The
conjunctiva is composed of 3 sections:
1.c palpebral conjunctiva (covers the posterior surface of the eyelids),
2.c bulbar conjunctiva (coats the anterior portion of the eyeball), and
3.c fornix (the transition portion, forming the junction between the posterior
eyelid and the eyeball).
‘lthough the palpebral conjunctiva is moderately thick, the bulbar conjunctiva
is very thin. The latter also is very movable, easily sliding back and forth over the
front of the eyeball it covers. Since it is clear, blood vessels are easily visible
underneath it.Within the bulbar conjunctiva are ³goblet cells,´ which secrete
³mucin.´ This is an important component of the pre-corneal tear layer that protects
and nourishes the cornea.

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The macula lutea is the small, yellowish central portion of the retina. It is the
area providing the clearest, most distinct vision. When one looks directly at
something, the light from that object forms an image on one¶s macula. ‘ healthy
macula ordinarily is capable of achieving at least 20/20 (³normal´) vision or visual
acuity, even if this is with a correction in glasses or contact lenses.
Not uncommonly, an eye¶s best visual acuity is 20/15; in this case, that eye
can perceive the same detail at 20 feet that a 20/20 eye must move up to 15 feet to see
as distinctly. Some people are even capable of 20/10 acuity, which is twice as good
as 20/20. Vision this sharp may be due to there being more cones per square
millimeter of the macula than in the average eye, enabling that eye to distinguish
much greater detail than normal.

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The vitreous humor is a clear gel which occupies the posterior compartment of
the eye, located between the crystalline lens and the retina and occupying about 80%
of the volume of the eyeball. Light initially entering the eye through the cornea,
pupil, and lens, is transmitted through the vitreous to the retina.

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Vitreous humor has the following composition:
1.c water (99%),
2.c a network of collagen fibrils,
3.c large molecules of hyaluronic acid,
4.c peripheral cells (hyalocytes),
5.c inorganic salts,
6.c sugar, and
7.c ascorbic acid.

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The retina is the innermost layer of the eye (the tunica intima or internal tunic)
and is comparable to the film inside of a camera. It is composed of nerve tissue
which senses the light entering the eye.
This complex system of nerves sends impulses through the optic nerve back to
the brain, which translates these messages into images that we see. That is, we ³see´
with our brains; our eyes merely collect the information to do so.
The retina is composed of 10 layers, from the outside (nearest the blood vessel
enriched choroid) to the inside (nearest the gelatinous vitreous humor):
1.c pigmented epithelium,
2.c photoreceptors; bacillary layer (outer and inner segments of cone and rod
photoreceptors),
3.c external (outer) limiting membrane,
4.c outer nuclear (cell bodies of cones and rods),
5.c outer plexiform (cone and rod axons, horizontal cell dendrites, bipolar
dendrites),
6.c inner nuclear (nuclei of horizontal cells, bipolar cells, amacrine cells, and
Müller cells),
7.c inner plexiform (axons of bipolar cells and amacrine cells, dendrites of
ganglion cells),
8.c ganglion cells (nuclei of ganglion cells and displaced amacrine cells),
9.c nerve fiber layer (axons from ganglion cells traversing the retina to leave the
eye at the optic disc), and
10.cinternal limiting membrane (separates the retina from the vitreous).

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The " (also known as cranial nerve II) is a continuation of the axons
of the ganglion cells in the . There are approximately 1.1 million nerve cells in
each optic nerve. The optic nerve, which acts like a cable connecting the eye with the
brain, actually is more like brain tissue than it is nerve tissue.


 



I. Process of Vision
Light waves from an object enter the eye through the cornea, which is the
clear dome at the front of the eye. The light then progresses through the pupil, the
circular opening in the center of the colored iris.Fluctuations in incoming light change
the size of the eye¶s pupil. When the light entering the eye is bright enough, the pupil
will constrict , due to the pupillary light response.

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By the time one reaches age 65 or so, the crystalline lens is virtually incapable of
changing shape. Unless one is nearsighted, it is not possible to focus objects (such as
print on a page) clearly at even an arm¶s length distance.
Interestingly, the 
 symptom of presbyopia often is not blurred print or
eyestrain while reading. Rather, one may observe that objects across the room appear
momentarily blurry     !" from a near distance (that is, after reading,
writing, or viewing a computer screen for awhile). This is because the crystalline
lenses within the eyes have become less flexible than they used to be, resulting in
their being less able to accommodate (change focus) from near to far.
For some people with presbyopia, store-bought (non-prescription) reading
glasses may be an option. However, store-bought glasses have equal strengths in the
right and left lenses. Since most people¶s eyes have at least slightly unequal
refractive errors, the focusing between their two eyes will not be balanced when
wearing non-prescription readers. Thus, one or both eyes may experience eyestrain.
Headaches also may result.
The amount of presbyopia inevitably increases with age. Therefore, the additional
³plus power´ of the lens strength required to maintain a clear, unstrained focus at near
will need to be increased every few years to compensate for the irreversible effect of
the presbyopia.

II. Cataract
Normally, all the layers of the crystalline lens are clear, and light passes
through it unobstructed. However, with age or due to certain systemic diseases, as
well as with a cumulative absorption of ultraviolet radiation over many years, the lens
material can become cloudy, yellow, brown, and even opaque. ‘nything in the lens
which obstructs entering light is referred to as a ³cataract.´More than 50% of people
over the age of 60 have some form of a cataract. It has been said that if one lives long
enough, he/she will develop a cataract. Even some infants are born with a
³congenital´ cataract which, if left untreated, can cause permanent visual impairment
or blindness, even if the cataract is removed years later.
It is not possible to remove a Y" cataract without irreparably damaging
the crystalline lens within which the cataract is contained. ‘ laser  be used
successfully to remove a cataract, except as described later (in the case of a

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cataract). Therefore, cataract surgery involves removing Y
 or  of the lens of the
eye and replacing it with an artificial ³intraocular lens´ or ³lens implant,´ made of a
hard plastic (polymethyl methacrylate or PMM‘), silicone, acrylic, or hydrogel
material.
‘n ³extracapsular´ cataract extraction (ECCE) is the routine type of cataract
removal. In an ECCE procedure, an opening is made in the front of the lens capsule.
Through this opening, the lens nucleus is removed, either as a whole or by dissolving
it into tiny pieces and vacuuming out the pieces, a procedure called
³phacoemulsification.´ Next, the lens cortex also is sucked out, leaving the lens
capsule in place, and into the lens capsule is inserted the artificial lens implant.
Prior to the 1980¶s, the entire crystalline lens was removed in a cataract
surgery, called an ³intracapsular´ cataract extraction (ICCE). Usually, this was
performed using ³cryoextraction,´ where a cryoprobe froze the entire lens, permitting
its complete removal. Now, in the unusual case of an intracapsular lens extraction, or
ICCE, the implant lens is placed in front of the iris, rather than behind it, because
there is no lens capsule to hold the implant in place. Rarely is this procedure done
anymore.‘pproximately 1-2% of post-cataract extraction patients develop swelling in

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the area of the retina responsible for central vision (the macula). This swelling occurs
in cystoid spaces, and is referred to as cystoid macular edema. ‘fter an initial
improvement following surgery, these patients subsequently will describe blurred
vision. Cystoid macular edema can occur as early as days, or as late as several years,
following surgery. Treatment options include observation, topical therapy, periocular
injections, and surgery.

III. Iritis/Uveitis/Chorioretinitis
It is not uncommon for the iris, the entire uvea, and/or the choroid/retina
complex to become inflammed. Here are types of inflammation of the uveal tract:
pc : inflammation of the iris alone,
pc &: inflammation of the iris and ciliary body,
pc ': inflammation of the choroid alone,
pc ': inflammation of the choroid and retina, and
pc : inflammation of the entire uveal tract
‘lthough the exact cause of an iritis or uveitis often is unknown, in many
cases the inflammation is related to a disease or infection in another part of the body
(that is, a systemic problem). Sometimes these (and other) diseases can cause uveal
inflammation: arthritis, tuberculosis, syphilis, ankylosing spondylitis, Reiter¶s
syndrome, toxoplasmosis, histoplasmosis, cytomegalovirus (CMV), sarcoidosis, and
toxocariasis. Infection of some parts of the body (tonsils, sinus, kidney, gallbladder,
and teeth) also can cause inflammation of the iris or of the entire uveal tract.
The symptoms of iritis usually appear suddenly and develop rapidly over a
few hours or days. Iritis commonly causes pain, tearing, light sensitivity, and blurred
vision. ‘ red eye, usually with inflammed blood vessels around the limbus (the
junction of the cornea and sclera), often is present when there is an iritis. Some
people may see floaters, which appear as small specks or dots moving in the field of
vision. In addition, the pupil may become smaller in the eye affected by iritis.
Caught in the early stages, an iritis or uveitis usually is readily treated with
corticosteroids and/or antibiotics. However, without treatment, or with chronic
occurrences of the inflammation, there can be a permanent decrease in vision or, in
rare cases, even blindness.‘ case of iritis usually lasts 6 to 8 weeks. During this time,
a person should be observed carefully (by an optometrist or ophthalmologist) to
monitor potential side effects from medications and any complications which may
occur. Cataracts, glaucoma, corneal changes, and secondary inflammation of the
retina may develop as a result of iritis and/or the medications used to treat the
disorder.

IV. Conjunctivitis (red eye)

‘n infectious conjunctivitis is an inflammation of infected conjunctiva. ‘n
infection typically is caused by a bacterium or a virus. Less commonly, a fungus or
an amoeba can cause the infection.The same bacteria and viruses that cause colds, ear
infections, and sinus infections also can cause an infectious conjunctivitis. Even
bacteria that cause sexually transmitted diseases (STDs) such as chlamydia and
gonorrhea can cause an infectious conjunctivitis.
‘ ³noninfectious conjunctivitis´ is an inflammation of noninfected
conjunctiva. Unlike an infectious conjunctivitis, a noninfectious conjunctivitis cannot
be spread to someone else by hand-to-eye contact.

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One type of noninfectious conjunctivitis is ³irritant conjunctivitis.´ It is caused by
irritants to the eye, such as pollution particles in the air, chlorine in swimming pools,
or an acid or base accidentally dropped or rubbed onto the eye.
More frequently, a noninfectious conjunctivitis is caused by an allergic
reaction to something. It can produce conjunctival redness, extreme itching, and
excessive ocular mucous production. This reaction, called ³allergic conjunctivitis,´
commonly is caused by a seasonal allergy to pollen or plant bi-products, most often in
the spring and summer (³vernal conjunctivitis´). ‘n allergic conjunctivitis also can
be caused by an allergic reaction to preservatives in eye drops or solutions.
‘n allergic conjunctivitis also can result from a reaction to proteins or other
contaminants deposited on the surface of contact lenses, most commonly extended
wear soft lenses. The latter can result in ³giant papillary conjunctivitis´ (GPC),
mostly evidenced by the appearance of large ³papillae´ on the superior conjunctival
tarsal plate (underneath the upper eyelid). Each papilla is a collection of lymphocytes
and plasma cells.
Elimination of conjunctival papillae often is not easy. Obtaining new contact lenses,
with reduced wearing time and with regular enzymatic cleaning of the lenses, is
recommended. Sometimes it is best to be refit with disposable soft lenses or with
rigid gas permeable (RGP) lenses. With these lenses, protein build-up is not as much
of a problem as it is with extended wear lenses, though it still can occur.

V. Pinguecula
‘ pinguecula often is referred to as a fatty degeneration of the conjunctival
tissue. The fine, nearly transparent collagen fibers of the conjunctiva degenerate and
are replaced by thicker, yellowish, more durable fibers, sometimes containing calcium
crystals. This causes the elevated, yellow and sometimes glistening whitish area
located near the cornea.There is no effect on vision from a pinguecula, which can
appear after only a brief exposure to damaging irritation, such as excessive dryness or
sun (ultraviolet radiation). The tissue damage increases with continued exposure. It
might take only a day or two to notice a new pinguecula but weeks or months for it to
resolve.
Removing the source(s) of irritation and providing artificial lubricating drops
may shrink and eliminate pingueculae in their early stages. However, long-standing
pingueculae do not respond well to treatment and may be permanent.

VI. Pterygium
‘ pterygium, although produced by the same things which cause a pinguecula,
often has inflammed blood vessels infusing into it. ‘ pterygium does not emerge
from a pinguecula.Unlike a simple pinguecula, a pterygium often is progressive and
will involve the cornea, if left unchecked. It is triangular in shape, with the base of
the triangle located in the conjunctiva and the apex of the triangle encroaching onto
the cornea. ‘ pterygium virtually always is located on the nasal conjunctiva.
With corneal involvement, even if arrested surgically, a pterygium can affect
vision by warping the surface of the cornea and inducing astigmatism. In some cases,
the pterygium actually may grow all the over to the central cornea, in front of the
pupil, and obstruct the entering light.
Removing the source(s) of irritation and providing artificial lubricating drops
may slow down or halt the growth of pterygia. However, sometimes surgical
intervention is necessary to prevent a further decrease in vision.

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VII. Subconjunctival Hemorrhage
‘ somewhat common condition, caused by direct or indirect trauma to the
eye, is a ³subconjunctival hemorrhage.´ This manifestss as a spot or pool of blood
underneath the clear conjunctiva. It can be seen in distinct contrast to the sclera or
white part of the eye. The hemorrhage may be present on only one side or on both
sides of the cornea, and it almost always is on only one eye, unless the trauma has
affected both eyes.
The trauma causing the hemorrhage may be due to a blunt hit, hard coughing,
pushing, straining, heavy lifting, or even hypertension. ‘ny of these things can cause
a small blood vessel to break and to leak blood underneath the conjunctiva. ‘
subconjunctival hemorrhage is one of the worst looking things that is harmless and
will not affect vision. No treatment is necessary. The blood should reabsorb and
disappear in 1-2 weeks, depending on the extent of the bleeding.

VIII. Optic ‘trophy

‘trophy of the optic disc (visible to an eye doctor looking inside the eye) is
the result of degeneration of the nerve fibers of the optic nerve and optic tract. It can
be congenital (usually hereditary) or acquired.
If acquired, it can be due to vascular disturbances (occlusions of the central
retinal vein or artery or arteriosclerotic changes within the optic nerve itself), may be
secondary to degenerative retinal disease (e.g., optic neuritis or papilledema), may be
a result of pressure against the optic nerve, or may be related to metabolic diseases ,
trauma, glaucoma, or toxicity (to alcohol, tobacco, or other poisons).
Loss of vision is the only symptom. ‘ pale optic disc and loss of pupillary
reaction are usually proportional to the visual loss. Degeneration and atrophy of optic
nerve fibers is irreversible, although in some cases, intravenous steroid injections
have been seen to slow down the process.

IX. Posterior Vitreous Detachment (PVD)

With age, the vitreous humor changes from a gel to a liquid. ‘s it does so, the
vitreous mass gradually shrinks and collapses, separating and falling away from the
retina. This is called a ³posterior vitreous detachment´ (PVD) and is a normal
occurrence between ages 40 and 70.Commonly, a person having experienced a PVD
will report seeing flashing lights and/or floaters in his or her field of vision. The
flashes of light occur when the vitreous tugs on the sensory layer of the retina, as the
vitreous is detaching. The floaters²which are cells or debris released, when the
vitreous detaches²can appear as little dots, circles, lines, cobwebs, clouds, or a puff
of smoke.
Floaters can be apparent especially when looking at a bright background, as
the light entering the eye casts shadows of the floaters onto the retina. Sometimes a
large, single floater actually can obstruct print that is being read. The observance of
flashes and floaters can last two or more weeks. Episodes lasting even as long as six
months can occur.
It is said that the percent chance of having a vitreous detachment is at least the same
as one¶s age. However, a PVD may occur earlier than normal in moderately to
extremely nearsighted people, as well as in people who have had cataract surgery. ‘
dilated eye exam should be performed to make sure the symptoms are not due to a
retinal detachment, which is a much more serious and potentially sight-threatening
condition.

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X. Retinal Detachment (RD)
Normally, with age, the vitreous gel collapses and detaches from the retina²
an event known as a posterior vitreous detachment. Occasionally, however, the
vitreous membrane pulls on and creates a tear in the retina. Vitreous fluid can seep
into or beneath the retina, detaching it from the pigmented epithelium
underneath.When a retinal detachment occurs, a shower of floaters may be observed
by the person experiencing the detachment. These are thousands of blood cells being
liberated from a tiny blood vessel which has been broken due to the retinal tear or
detachment. Sometimes the floaters are described as being like a ³shower of pepper´
before the eyes.
Sudden flashes of light, as well as a ³web´ or ³veil´ in front or else in the
periphery of the eye, also may appear in conjunction with the onset of floaters. The
retinal tear and subsequent detachment must be repaired as soon as possible, usually
with one of these procedures:
pc sealing it using an argon laser (³photocoagulation´),
pc freezing it (³cryotherapy´ or ³cryopexy´),
pc securing it, after cryotherapy, with a tiny belt around the equator of the eye
(³scleral buckle´ surgery),
pc injecting a gas bubble into the eye (in conjunction with photocoagulation or
cryopexy) so that the bubble rests against the hole or tear (³pneumatic
retinopexy´), requiring the person to keep his/her head in the same position for
several days, or
pc removing the vitreous gel and filling the eye with a gas bubble or silicon oil
(³vitrectomy´).
If the tear and detachment are not repaired, permanent vision loss can result. The
worst vision loss occurs if the macula becomes detached.

Textbook of Clinical Ophthalmology: ‘ Practical Guide to Disorders of the Eyes and Their
Management

Publisher: World Scientific Publishing Company

‘uthor: R. Pitts Crick, Peng Khaw, Ronald P. Crick,
Edition Number: 3

 

  
(' ‘mer ‘cademy of Ophthalmology; 9 edition (Jan 1 2010)
Richard a. harper md

January 9, 2008

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