1.Define refractive error.What are the different tyres of refractive errors? 2.What is ametropia?

What are the different types of ametropia?discuss

briefly the treatment. 3. What are the different types of ametropia?out line the management of each one of them.enumerate the complication of
ametropia.
>Refractive error is a condition of refraction where the parallel rays of light coming from infinity are focused either in front of behind the ssensitive
layer of retina in noe or both meridians. Types are Myopia, Hypermetropia, Astigmatism
1 .What is hypermetropia?classify hypermetropia.briefly describe treatment of hypermetropia. 2. Describe briefly the caused of hypermetropia
Hypermetropia (long-sightedness) is a common eye condition where nearby objects appear blurred, but your vision is clearer when looking at things
further away.If you feel your eyes are often tired and you have problems focusing on objects close to your eyes, you may have hypermetropia.
Classification:
1. Etiological classification:
I. Axial hypermetropia
 Commonest type
 Normal refractive power
 Axial shortening of eye ball
 Imm shortening = 3D hypermetropia
II. Curvatural hypermetropia
 Curvature of cornea or lense or both is flatter than normal
 Imm increase in radius = 6D of hypermetropia
III. Index hypermetropia
 Due to decrease in refractive index of lens. Eg. Juvenile diabetes, senile cortical sclerosis

IV. Positional hypermetropia

 Posteriorly placed crystalline lens
V. Aphakia
 A condition of high hypermetropia
a) Congenital
b) Acquired: due to surgical removal or posterior dislocation of lens
2. Clinicall classification
I. Simple/Development hypermetropia
 May be due to developmental variation
 Commonest type
II. Pathological hypermetropia
 Index: due to acquired senile cortical scleriosis
 Positional: due to posterior subluxation of lens,aphakia
 Consecutive due to surgically over corrected Myopia
III. Functional hypermetropia
 Due to paralysis of accommodation
 E.g 3rd nerve paralysis, internal opthalmoplegia, etc.
Treatments for hypermetropia
If you think you may be longsighted, let your optician know. They will be able to diagnose this in an eye examination and provide you with a
prescription if you need one.
If you have been diagnosed with hypermetropia by an optician, there are three solutions :
Glasses
If you have long-sighted vision, it can be corrected by wearing plus powered lenses. This helps focus light entering the eye on the correct area of the
retina, making your vision clearer.
Contact Lenses
Contact lenses are another alternative, although you will still need a pair of glasses as backup in case you are unable to wear your lenses . Again, they
will be plus powered to refract the light to the retina. The prescription is likely to differ from a glasses prescription. There are different types of
contact lenses available, including daily or monthly disposables. Talk to your optician about the best option to suit your lifestyle.
Laser Surgery
Laser surgery provides the opportunity to correct your vision. Although it corrects existing visual impairments, it does not
prevent further changes to eyesight afterwards.
1What is myopia?classify clinical types of myopia.describe surgical treatment of myopia. 2. Briefly describe myopia under types
>Myopia is the inability to see things clearly unless they're relatively close to your eyes. Also called nearsightedness or shortsightedness, myopia is
the most common refractive error among children and young adults.
Myopia occurs when the eye grows too long from front to back, causing light to come to a focus in front of the retina instead of directly on it.
Other contributing factors include a cornea that is too curved for the length of the eyeball or a lens inside the eye that is too thick.
Classification
A. Etiological types
I. Axial Myopia due to increase in length of eyeball
II. Curvatural myopia ed curvature of cornea or lens
III. Positional myopia. Anterior ed refractive index of lens associated with nuclear sclerosis
 IV. Index myopia. Ed refractive index of lens associated with nuclear sclerosis
V. Myopia due to excessive accommodation
B. Clinical types
I. Congenital myopia:present since birth
 Diagnosed by age of 2-3 yrs
 Usually unilateral
 Manifest as anisometropia
 Error about 8-10D, remains constant
II. simple myopia:Developmental Myopia
 commonest variety
 is a physiological error, not associated with any disease of eye
III. Pathological of degenerative myopia
IV. Acquired myopia which may be
 Post traumatic
 Post keratitic
 Drug induced
 Pseudomyopia: due to spasm of ciliary muscles
 Consecutive myopia: due to surgical over correction of hypermetropia
i) Simple myopia
Simple Myopia is not progresive beyond the amount included within normal development; is associated with good vision and
requires no treatment except optical correction.
symptoms:
 Poor vision for distance
 Asthenopic symptoms in pts with small degree of myopia
 Half shutting of the eyes- for greater clarity of stenopaeic
Signs:
 Prominent
 Anterior chamber is slightly deeper than normal
 Pupil: somewhat large & a bit sluggishly reacting
 Funds:normal
 Usually doesnot exceed 6-D

ii) pathological myopia

Pathological Myopia on the other hand is a degenerative myopia accompanied by changes in the posterior segment of the eyeball
with lengthening of AP axis of the globe. Besides, the axial pathological myopia,there are other types of myopia due to defects in the
curvature of cornea and lens and due to drauma. Today, I will confine my remarks only to pathological axial Myopia.

Symptoms:
 defective vision
 muscae voliantes:floating black opacitiesdue to degenerative liquefied vitreous
 nmight blindness: complained by very high mmyopes having degenerative changes
signs
 prominent eyeballs
 large coenea
 deep anterior chamber
 pupil-slightly large & react sluggishly to light
 ERG- subnormal due to chorioretinal
Treatment of myopia
A. optical treatment
principle: using appropriate concave lens so that the ray are diverted & the image forms on retina
Modes of optical treatment:
 glasses: simple myopia
 contact lens: esp in high myopia
 intraocular lens
B. Surgical treatment
Indications:
 Pt. who doesnot wish to use spectacles
 Intolerance to contact lens
 Age>20yrs
 After error has established
S.N. Surgery Range of myopia
1. Methods of induce flattening of central cornea
a. Radial Keratotomy 1-6D
b. intracorneal rings (icr) 1-6D
c. Excimer laser- PRK 1-4D
d. Excimer laser-LASIK 2-12D
2. Methods to reduce overall refractive power of eye
a. clear lens extraction >15D
b.Intraocular contact lens or phakic intraocular lens 12D
C. General measures
D. low vision aids
E. Prophylaxis
1. What is astigmatism? Classify astigmatism. 2 define the treatment of astigmatism.3 define astigmatism. What is regular & irregular astigmatism?
What is with the rule & aginst the rule?4 what are the clinical features investigation & treatment of astigmatism?

It’s a big word, but it simply means your eye isn’t completely round. Almost all of us have it to some degree.
A normal eyeball is shaped like a perfectly round ball. Light comes into it and bends evenly, which gives you a clear view. But if your eye is shaped
more like a football or the back of a spoon, light gets bent more in one direction than another. That means only part of an object is in focus. Objects
at a distance may look blurry and wavy. It’s fairly easy for an eye doctor to fix with glasses, contacts, or surgery.
Classification:
A. Regular astigmatism
B. Irrehular astigmatism
A. Regular astigmatism: it occurs when the refractive power changes uniformly from one meridian to another
I.Depending on the axis & the angle between two principal meridian:
a) With the rule astigmatism
 2 principal meridian curvature
 Vertical meridian exists normally,due to pressure of eyelids
b) Against the rule astigmatism
 2 principal meridian at right angles
 Horizontal meridiancurvaturegreater than vertical
c) Oblique astigmatism
 2 principal meridian are not horizontal or vertical
 But are at right angles
d) Bi-oblique astigmatism
 2 principal meridian are not at 30 degree & other at 100 degree
II. Depending upon refrattion
a. Simple astigmatism
 In one meridian-rays focused on retina
 In other meridian- rays focused either
b. Compound astigmatism
 Rays in both meridian focused either
 In front of retina
 Behind the retina
c. Mixed astigmatism
 Rays in one meridian focused in front of retina
 Rays in other meridianficused behind the retina
B. Irregular astigmatism
 Occurs when the refractive power changes irregular from one meridian t another
Types:
I. Curvatural
II. Index
Symptoms:
I. Defective vision
II. Blurring of objects
III. Elongated objects based on type & degree os astigmatism
IV. Asthenopic symptoms,marked esp. in small amount of astigmatism
V. Polyopia in irregular astigmatism
Sings:
I. Different power of two meridian on retinoscopy or autorefractometry
II. Oval & tilted optic disc may be seen in ophthamoscopy in patients with high degree of astigmatism
III. Half closure of eyelids- to achieve greater clarity of asthenopic vision
IV. Inirregular astigmatism, signs of causative factor
Investigation:
For regular astigmatism:
I. Retinoscopy-reveals different powers in two different axis
II. Keratometry to measure corneal curvature
III. Jaksons cross cylinder & astigmatism fan test
IV. Placid’s disc distortes corcle
V. Astigmatic dial for irregular circle
Treatment
A. Regular astigmatism
I. optical treatment
 spectacles : full cylindrical correction with perfect axis should be used for distant & near vision
  cpntact lens: rigid lens 2-3D
II.Surgery
 astigmatism keratotomy by giving cuts in the direction of more curved axis
 removal of suture in astigmatism following cataract surgery or kerato[lasty.
 LAISK-can correct upto 5D
III.Laser-excimer laser is useful to resharpen the cornea in particular meridian
B. Irregular astigmatism
 Best treatment by contact lens
 Surgical t/t: penetrating keratoplasty in extensive corneal scarring
1. What is accommodation? Write abiout range & amplitude of accommodation & theories of accommodation . 2. Mechanism of
accommodation. 3 how does accommodation affect the vision?
>Adjustment of the eye for various distances whereby it is able to focus the image of an object on the sensitive layer of retina is called
accommodation.
This is achieved by various adjustments made in the eye.
 Convergence f eye balls.
 Constriction of pupil
 Incresse the anterior curvature of lens
Range of accommodation
 The distance between near point & far poin is called ROA
 Near point nearesr pont at which small object can be seen clearly
 Far point farthest point at which eye can see clearly
Amplitude of accommodation
 The difference between the diopetric power needed to focus at near point & far point is called amplitude accommodation
Theories of accommodation:
a. Young Helmholtz theory describes how the anterior curvature of lens increase during accommodation
b. Besides increase in the anterior curvature of the lens, two more adjustments are made in the eyeball during accommodation for
nearvision.
Effects of accommodation in vision:
 Accommodation helps to see the near objects bby focusing the diverging light rays coming from the sensitive part of retina which
mainly brought upon by accommodation reflex.
Accommodation reflex
I. When the eye is at rest, the ciliary ring is large & keeps the zonule tense.
II. In accommodation
 Contraction of ciliary muscles
 Shortening of ciliary ring
 Suspensoryligamentrelaxes
 Constriction of sphincter papillae
 Contraction of medial revtus
Anomalies of accommodation:
Results in various problems which are:
 Presbyopia:- difficulty innear vision in old age. Asthenopic symptoms due to fatigue of ciliary muscles
 Insufficiency of accommodation
 Paralysis of accommodation
 Spasm of accommodation
1. What is presbyopia? What sre its symptoms? How will you manage it ? 2. describe briefly the t/t of presbyopia 3. Pathophysiology of Presbyopia
>
Presbyopia is the gradual loss of your eyes' ability to focus on nearby objects. It's a natural, often annoying part of aging. Presbyopia usually becomes
noticeable in your early to mid-40s and continues to worsen until around age 65.
You may become aware of presbyopia when you start holding books and newspapers at arm's length to be able to read them. A basic eye exam can
confirm presbyopia. You can correct the condition with eyeglasses or contact lenses. You might also consider surgery.
Pathophysiology
There is diminutionof accommodative power of eye with age.the causativefactors are.
 Lens capsule is lenselastic
 Progressive increase in the size of lens
 Weakening of ciliary muscles
Symptoms
Presbyopia develops gradually. You may first notice these signs and symptoms after age 40:
 A tendency to hold reading material farther away to make the letters clearer
 Blurred vision at normal reading distance
 Eyestrain or headaches after reading or doing close-up work
Treatment
The goal of treatment is to compensate for the inability of your eyes to focus on nearby objects. Treatment options include wearing corrective
eyeglasses (spectacle lenses) or contact lenses, undergoing refractive surgery, or getting lens implants for presbyopia.
I. Eyeglasses
Eyeglasses are a simple, safe way to correct vision problems caused by presbyopia. You may be able to use over-the-counter (nonprescription)
reading glasses if you had good, uncorrected vision before developing presbyopia. Ask your eye doctor if nonprescription glasses are OK for you.
Most nonprescription reading glasses range in power from +1.00 diopter (D) to +3.00 D. When selecting reading glasses:
 Try different powers until you find the magnification that allows you to read comfortably, starting with the lower powers
 Test each pair on reading material held at a comfortable distance
Basic principles for presbyopic correction
 Always find out refractive error for distance & first correct it
 Near point should be fixed by taking consideration for profession of the patient
II. Surgival treatment
 Monovision LASIK
 Monovision conductive keratoplasty
 Sclera expansion procedures
 Monovision with IOL
 Bifocal
1. Describe opthalmia neonatorum under a. etiology & causative agents b. investigations c. clinical picture d. treatment 2. Describe the management
of ophthalmia neonatorum. 3 S>N on ophthalmia neonatorum.
>ophthalmia neonatourm is defined as the bilateral inflammation of the conjunctiva occurring in an infant in the first mont of life characterized by
mucoid, mucopurulent or purulent discharge from one or both eyes