Naga College Foundation

College of Health and Sciences

2019-2020

Health Assessment
(Eyes)

Submitted by:
Mikka Gacer Baal
BSN1C
Submitted to:
Mrs. Ava Marie Claro

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Eyes
 transmits visual stimuli to the brain for interpretation
Eyeball
 Is located in the eye orbit, a round, bony hollow formed by several different bones of the
skull.

External Structures of the Eye

Eyelids (upper and lower)
 Are two movable structures
composed of skin and two types of
muscle: striated and smooth.
 Their purpose is to protect the eye
from foreign bodies and limit the
amount of light entering the eye.
The eyelids join:
 Lateral (outer) canthus
 Medial (inner) canthus.
The medial canthus contains the
puncta, two small openings that allow
drainage of tears into the lacrimal
system, and the caruncle, a small,
fleshy mass that contains sebaceous
glands.
Caruncle
 A small, fleshy mass that contains
sebaceous glands.
Palpebral Fissure
 The white space between open eyelids.
Eyelashes
 Are projections of stiff hair curving outward along the margins of the eyelids that filter
dust and dirt from air entering the eye.
Conjunctiva
 Is a thin, transparent, continuous membrane.

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  Divided into two portions: a palpebral and a bulbar portion.
 The palpebral conjunctiva lines the inside of the eyelids, and the bulbar conjunctiva
covers most of the anterior eye, merging with the cornea at the limbus.
 The point at which the palpebral and bulbar conjunctivae meet creates a folded recess that
allows movement of the eyeball.
 This transparent membrane allows for inspection of underlying tissue and serves to
protect the eye from foreign bodies.
Lacrimal apparatus
 Consists of glands and ducts that
serve to lubricate the eye
 Lacrimal gland, located in the upper
outer corner of the orbital cavity just
above the eye, produces tears.
 As the lid blinks, tears wash across
the eye then drain into the puncta,
which are visible on the upper and
lower lids at the inner canthus.
 Tears empty into the lacrimal canals
and are then channeled into the
nasolacrimal sac through the
nasolacrimal duct. They drain into
the nasal meatus.
Extra ocular muscles
 Are the six muscles attached to the
outer surface of each eyeball.
 These muscles control six different
directions of eye movement.
 Four rectus muscles are responsible
for straight movement, and two
oblique muscles are responsible for
diagonal movement.
 Each muscle coordinates with a
muscle in the opposite eye.
 This allows for parallel movement
of the eyes and thus the binocular
vision characteristic of humans.
 Innervation for these muscles is
supplied by three cranial nerves: the
oculomotor (III) trochlear (IV),
and abducens (VI).

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Internal Structures of the Eye

The eyeball is composed of three separate coats or layers.

1. External Layer
 Sclera
- Is a dense, protective, white covering that physically supports the internal structures
of the eye. It is continuous anteriorly with the transparent cornea (the “window of
the eye”).

 Cornea
- Permits the entrance of light, which passes through the lens to the retina. It is well
supplied with nerve endings, making it responsive to pain and touch.

2. Middle Layer
 Ciliary body
- Consists of muscle tissue that controls the thickness of the lens, which must be
adapted to focus on objects near and far away.

 Iris
- Is a circular disc of muscle containing pigments that determine eye color.

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 Pupil
- Is the central aperture of the iris. Muscles in the iris adjust to control the pupil’s size,
which controls the amount of light entering the eye.
- The muscle fibers of the iris also decrease the size of the pupil to accommodate for
near vision and dilate the pupil when far vision is needed.

 Lens
- Is a biconvex, transparent, avascular, encapsulated structure located immediately
posterior to the iris.
- Suspensory ligaments attached to the ciliary body support the position of the lens.
The lens functions to refract (bend) light rays onto the retina.
- Adjustments must be made in refraction depending on the distance of the object being
viewed. Refractive ability of the lens can be changed by a change in shape of the lens
(which is controlled by the ciliary body).
- The lens bulges to focus on close objects and flattens to focus on far objects.

 Chorioid layer
- Contains the vascularity necessary to provide nourishment to the inner aspect of the
eye and prevents light from reflecting internally. Anteriorly, it is continuous with the
ciliary body and the iris.

3. Innermost Layer
 Retina
- Extends only to the ciliary body
anteriorly.
- It receives visual stimuli and
sends it to the brain.
- Consists of numerous layers of
nerve cells, including the cells
commonly called rods and
cones.
- These specialized nerve cells are
often referred to as
“photoreceptors” because they
are responsive to light.
- Rods are highly sensitive to
light, regulate black and white
vision, and function in dim light.
- Cones function in bright light
and are sensitive to color.

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 Optic disc
- Is a cream-colored, circular area located on the retina toward the medial or nasal side of
the eye. It is where the optic nerve enters the eyeball.
- Can be seen with the use of an ophthalmoscope and is normally round or oval in shape,
with distinct margins.
- A smaller circular area that appears slightly depressed is referred to as the physiologic
cup.
- This area is approximately one-third the size of the entire optic disc and appears
somewhat lighter/whiter than the disc borders.

 Retinal vessels
- Can be readily viewed with the aid of an ophthalmoscope.
- Four sets of arterioles and venules travel through the optic disc, bifurcate, and extend to
the periphery of the fundus.
- Vessels are dark red and grow progressively narrower as they extend out to the peripheral
areas.
- Arterioles carry oxygenated blood and appear brighter red and narrower than the veins.
The general background, or fundus varies in color, depending on skin color.
- A retinal depression known as the fovea centralis is located adjacent to the optic disc in
the temporal section of the fundus.
- This area is surrounded by the macula, which appears darker than the rest of the fundus.
- The fovea centralis and macular area are highly concentrated with cones and form the
area of highest visual resolution and color vision.

 Eyeball
- Contains several chambers that serve to maintain structure, protect against injury, and
transmit light rays.

 Anterior chamber
- Is located between the cornea and iris.

 Posterior chamber
- Is the area between the iris and the lens.
- These chambers are filled with aqueous humor, a clear liquid substance produced by the
ciliary body.
-
 Aqueous humor
- Helps to cleanse and nourish the cornea and lens as well as maintain intraocular pressure.
- The aqueous humor filters out of the eye from the posterior to the anterior chamber then
into the canal of Schlemm through a filtering site called the trabecular meshwork.

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  Vitreous chamber
- Is located in the area behind the lens to the retina. It is the largest of the chambers and is
filled with a vitreous humor that’s clear and gelatinous.

Vision
VISUAL FIELDS AND VISUAL PATHWAYS
Visual Field
- Refers to what a person sees with
one eye.
- The visual field of each eye can be
divided into four quadrants: upper
temporal, lower temporal, upper
nasal, and lower nasal.
- The temporal quadrants of each
visual field extend farther than the
nasal quadrants. Thus, each eye
sees a slightly different view but
their visual fields overlap quite a
bit.
- As a result of this, humans have
binocular vision (“two-eyed”
vision) in which the visual cortex
fuses the two slightly different
images and provides depth
perception or three-dimensional
vision.

Visual Perception
- Occurs as light rays strike the
retina, where they are transformed
into nerve impulses, conducted to
the brain through the optic nerve,
and interpreted.
- In the eye, light must pass through
transparent media (cornea,
aqueous humor, lens, and
vitreous body) before reaching the
retina.
- The cornea and lens are the main eye components that refract (bend) light rays on the
retina.

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 - The image projected on the retina is upside down and reversed right to left from the
actual image.

VISUAL REFLEXES
Pupillary light reflex
- Causes pupils immediately to constrict
when exposed to bright light.
- This can be seen as a direct reflex, in
which constriction occurs in the eye
exposed to the light, or as an indirect or
consensual reflex, in which exposure to
light in one eye results in constriction of
the pupil in the opposite eye.
- These protective reflexes, mediated by
the oculomotor nerve, prevent damage to
the delicate photoreceptors by excessive
light.

Accommodation
- Is a functional reflex allowing the eyes to
focus on near objects.
- This is accomplished through movement
of the ciliary muscles causing an increase
in the curvature of the lens.
- This change in shape of the lens is not
visible.

Physical Examination Purpose:

The purpose of the eye and vision examination is to identify any changes in vision or
signs of eye disorders in an effort to initiate early treatment or corrective procedures. Collected
objective data should include assessment of eye function through specific vision tests, inspection
of the external eye, and inspection of the internal eye using an ophthalmoscope.
For the most part, inspection and palpation of the external eye are straightforward and
simple to perform. The vision tests and use of the ophthalmoscope require a great deal of skill,
and thus practice, for the examiner to be capable and confident during the examination. It is a
good idea for the beginning examiner to practice on friends, family, or classmates to gain
experience and to become comfortable performing the examinations.

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Assessment Procedure:
 Perform hand hygiene
 Gather all the necessary materials needed
 Provide privacy
 Collect Subject data: (History of present heath concern, Personal health history, Family
history, and Lifestyle and health practices)
 Collect Objective data: Physical Examination
 Explain the procedure to the client

Equipment:
 Snellen or E chart
 Hand-held Snellen card or near vision screener
 Penlight
 Opaque cards
 Ophthalmoscope
 Disposable gloves (wear as needed to prevent spreading infection or coming in contact
with exudate)

Physical Assessment

EVALUATING VISION

• TEST DISTANT VISUAL ACUITY. Position the client 20 feet from the Snellen or E
chart and ask her to read each line until she cannot decipher the letters or their direction.
Document the results.
Normal Findings:
- Normal distant visual acuity is 20/20 with or without corrective lenses.
This means the client can distinguish what the person with normal vision
can distinguish from 20 feet away.

Abnormal Findings:
- Myopia (impaired far vision) is present when the second number in the
test result is larger than the first (20/40). The higher the second number,
the poorer the vision. A client is considered legally blind when vision in
the better eye with corrective lenses is 20/200 or less. Any client with
vision worse than 20/30 should be referred for further evaluation.

 TEST NEAR VISUAL ACUITY. Use this test for middle-aged clients and others who
complain of difficulty reading.
Give the client a hand-held vision chart (e.g., Jaeger reading card, Snellen card, or
comparable chart) to hold 14 inches from the eyes. Have the client cover one eye with an
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 opaque card before reading from top (largest print) to bottom (smallest print). Repeat test
for other eye.
Normal Findings:
- Normal near visual acuity is 14/14 (with or without corrective lenses).
This means the client can read what the normal eye can read from a
distance of 14 inches

Abnormal Findings:
- Presbyopia (impaired near vision) is indicated when the client moves the
chart away from the eyes to focus on the print. It is caused by decreased
accommodation.

 TEST VISUAL FIELDS FOR GROSS PERIPHERAL VISION. To perform the

confrontation test, position yourself approximately 2 feet away from the client at eye
level. Have the client cover his left eye while you cover your right eye. Look directly at
each other with your uncovered eyes. Next fully extend your left arm at midline and
slowly move one finger (or a pencil) upward from below until the client sees your finger
(or pencil). Test the remaining three visual fields of the client’s right eye (i.e., superior,
temporal, and nasal). Repeat the test for the opposite eye.
Normal Findings:
- With normal peripheral vision, the client should see the examiner’s finger
at the same time the examiner sees it. Normal visual field degrees are
approximately as follows:
- Inferior: 70 degrees
- Superior: 50 degrees
- Temporal: 90 degrees
- Nasal: 60 degrees

Abnormal Findings:
- A delayed or absent perception of the examiner’s finger indicates reduced
peripheral vision (Abnormal Findings 15-1). The client should be referred
for further evaluation.

TESTING EXTRAOCULAR MUSCLE FUNCTION

 PERFORM CORNEAL LIGHT REFLEX TEST. This test assesses parallel alignment
of the eyes. Hold a penlight approximately 12 inches from the client’s face. Shine the
light toward the bridge of the nose while the client stares straight ahead. Note the light
reflected on the corneas.

Normal Findings:
- The reflection of light on the corneas should be in the exact same spot on
each eye, which indicates parallel alignment.

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 Abnormal Findings:
- Asymmetric position of the light reflex indicates deviated alignment of the
eyes. This may be due to muscle weakness or paralysis.

 PERFORM COVER TEST. The cover test detects deviation in alignment or strength and
slight deviations in eye movement by interrupting the fusion reflex that normally keeps
the eyes parallel. Ask the client to stare straight ahead and focus on a distant object.
Cover one of the client’s eyes with an opaque card (Fig. 15-10). As you cover the eye,
observe the uncovered eye for movement. Now remove the opaque card and observe the
previously covered eye for any movement. Repeat test on the opposite eye.

Ask the client to stare straight ahead and focus on a distant object. Cover one of the
client’s eyes with an opaque card (Fig. 15-10). As you cover the eye, observe the
uncovered eye for movement. Now remove the opaque card and observe the previously
covered eye for any movement. Repeat test on the opposite eye.
Normal Findings:
- The uncovered eye should remain fixed straight ahead. The covered eye
should remain fixed straight ahead after being uncovered.

Abormal Findings:
- The uncovered eye will move to establish focus when the opposite eye is
covered. When the covered eye is uncovered, movement to reestablish
focus occurs. Either of these findings indicates a deviation in alignment of
the eyes and muscle weakness.
- Phoria is a term used to describe misalignment that occurs only when
fusion reflex is blocked. Strabismus is constant malalignment of the eyes.
- Tropia is a specific type of misalignment: esotropia is an inward turn of
the eye, and exotropia is an outward turn of the eye.

 PERFORM THE POSITIONS TEST ASSESSES EYE MUSCLE STRENGTH AND

CRANIAL NERVE FUNCTION. Instruct the client to focus on an object you are
holding (approximately 12 inches from the client’s face). Move the object through the six
cardinal positions of gaze in a clockwise direction, and observe the client’s eye
movements
Normal Findings:
- Eye movement should be smooth and symmetric throughout all six
directions.

Abnormal Findings:
- Failure of eyes to follow movement symmetrically in any or all directions
indicates a weakness in one or more extraocular muscles or dysfunction of
the cranial nerve that innervates the particular muscle

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 - Nystagmus, an oscillating (shaking) movement of the eye may be
associated with an inner ear disorder, multiple sclerosis, brain lesions, or
narcotics use.

EXTERNAL EYE STRUCTURES

Inspection and Palpation:

 INSPECT THE EYELIDS AND EYELASHES:
Note width and position of palpebral fissures.
Normal Findings:
- The upper lid margin should be between the upper margin of the iris and
the upper margin of the pupil. The lower lid margin rests on the lower
border of the iris. No white sclera is seen above or below the iris.
Palpebral fissures may be horizontal.

Abnormal Findings:
- Drooping of the upper lid, called ptosis, may be attributed to oculomotor
nerve damage, myasthenia gravis, weakened muscle or tissue, or a
congenital disorder. Retracted lid margins, which allow for viewing of the
sclera when the eyes are open, suggest hyperthyroidism.
Assess ability of eyelids to close.
Normal Findings:
- The upper and lower lids close easily and meet completely when closed.

Abnormal Findings:
- Failure of lids to close completely puts client at risk for corneal damage.
Note the position of the eyelids in comparison with the eyeballs. Also note any unusual
Turnings, Color, Swelling, Lesions, Discharge
Normal Findings:
- The lower eyelid is upright with no inward or outward turning. Eyelashes
are evenly distributed and curve outward along the lid margins.
Xanthelasma, raised yellow plaques located most often near the inner
canthus, are a normal variation associated with increasing age and high
lipid levels.

Abnormal Findings:
- An inverted lower lid is a condition called an entropion, which may cause
pain and injure the cornea as the eyelash brushes against the conjunctiva
and cornea.

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 - Ectropion, an everted lower eyelid, results in exposure and drying of the
conjunctiva. Both conditions interfere with normal tear drainage.
Observe for redness, swelling, discharge, or lesions.
Normal Findings:
- Skin on both eyelids is without redness, swelling, or lesions

Abnormal Findings:
- Redness and crusting along the lid margins suggest seborrhea or
blepharitis, an infection caused by Staphylococcus aureus. Hordeolum
(stye), a hair follicle infection, causes local redness, swelling, and pain. A
chalazion, an infection of the meibomian gland (located in the eyelid),
may produce extreme swelling of the lid, moderate redness, but minimal
pain.

 OBSERVE THE POSITION AND ALIGNMENT OF THE EYEBALL IN THE EYE

SOCKET.
Normal Findings:
- Eyeballs are symmetrically aligned in sockets without protruding or
sinking.

Abnormal Findings:
- Protrusion of the eyeballs accompanied by retracted eyelid margins is
termed exophthalmos and is characteristic of Graves’ disease (a type of
hyperthyroidism). A sunken appearance of the eyes may be seen with
severe dehydration or chronic wasting illnesses.

 INSPECT THE BULBAR CONJUNCTIVA AND SCLERA. Have the client keep her
head straight while looking from side to side then up toward the ceiling. Observe clarity,
color, and texture.
Normal Findings:
- Bulbar conjunctiva is clear, moist, and smooth. Underlying structures are
clearly visible. Sclera is white.

Abnormal Findings:
- Generalized redness of the conjunctiva suggests conjunctivitis (pink eye).
- Areas of dryness are associated with allergies or trauma.
- Episcleritis is a local, noninfectious inflammation of the sclera. The
condition is usually characterized by either a nodular appearance or by
redness with dilated vessels.

 INSPECT THE PALPEBRAL CONJUNCTIVA. Put on gloves for this assessment

procedure. First inspect the palpebral conjunctiva of the lower eyelid by placing your

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 thumbs bilaterally at the level of the lower bony orbital rim and gently pulling down to
expose the palpebral conjunctiva. Avoid pressuring the eye. Ask the client to look up as
you observe the exposed areas.
Normal Findings:
- The lower and upper palpebral conjunctivae are clear and free of swelling
or lesions.

Abnormal Findings:
- Cyanosis of the lower lid suggests a heart or lung disorder.

Evert the upper eyelid. Ask the client to look down with his or her eyes slightly open.
Gently grasp the client’s upper eyelashes and pull the lid downward. Place a cotton-
tipped applicator approximately 1 cm above the eyelid margin and push down with the
applicator while still holding the eyelashes. Hold the eyelashes against the upper ridge of
the bony orbit just below the eyebrow, to maintain the everted position of the eyelid.
Examine the palpebral conjunctiva for swelling, foreign bodies, or trauma. Return the
eyelid to normal by moving the lashes forward and asking the client to look up and blink.
The eyelid should return to normal.
Normal Findings:
- Palpebral conjunctiva is free of swelling, foreign bodies, or trauma.

Abnormal Findings:
- A foreign body or lesion may cause irritation, burning, pain and/or
swelling of the upper eyelid.

 INSPECT THE LACRIMAL APPARATUS. Assess the areas over the lacrimal glands
(lateral aspect of upper eyelid) and the puncta (medial aspect of lower eyelid).
Normal Findings:
- No swelling or redness should appear over areas of the lacrimal gland. The
puncta is visible without swelling or redness and is turned slightly toward
the eye.

Abnormal Findings:
- Swelling of the lacrimal gland may be visible in the lateral aspect of the
upper eyelid. This may be caused by blockage, infection, or an
inflammatory condition. Redness or swelling around the puncta may
indicate an infectious or inflammatory condition. Excessive tearing may
indicate a nasolacrimal sac obstruction.

 PALPATE THE LACRIMAL APPARATUS. Put on disposable gloves to palpate the

nasolacrimal duct to assess for blockage. Use one finger and palpate just inside the lower
orbital rim.

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 Normal Findings:
- No drainage should be noted from the puncta when palpating the
nasolacrimal duct.

Abnormal Findings:
- Expressed drainage from the puncta on palpation occurs with duct
blockage.

 INSPECT THE CORNEA AND LENS. Shine a light from the side of the eye for an
oblique view. Look through the pupil to inspect the lens.
Normal Findings:
- The cornea is transparent with no opacities. The oblique view shows a
smooth and overall moist surface; the lens is free of opacities.

Abnormal Findings:
- Areas of roughness or dryness on the cornea are often associated with
injury or allergic responses. Opacities of the lens are seen with cataracts

 INSPECT THE IRIS AND PUPIL. Inspect shape and color of iris and size and shape of
pupil. Measure pupils against a gauge if they appear larger or smaller than normal or if
they appear to be two different sizes.

Normal Findings:
- The iris is typically round, flat, and evenly colored. The pupil, round with
a regular border, is centered in the iris. Pupils are normally equal in size (3
to 5 mm). An inequality in pupil size of less than 0.5 mm occurs in 20% of
clients. This condition, called anisocoria, is normal.

Abnormal Findings:
- Typical abnormal findings include irregularly shaped irises, miosis,
mydriasis, and anisocoria.
- If the difference in pupil size changes throughout pupillary response tests,
the inequality of size is abnormal.

 TEST PUPILLARY REACTION TO LIGHT. Test for direct response by darkening the
room and asking the client to focus on a distant object. To test direct pupil reaction, shine
a light obliquely into one eye and observe the pupillary reaction. Shining the light
obliquely into the pupil and asking the client to focus on an object in the distance ensures
that pupillary constriction is a reaction to light and not a near reaction.

Normal Findings:
- The normal direct pupillary response is constriction.

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 Abnormal Findings:
- Monocular blindness can be detected when light directed to the blind eye
results in no response in either pupil. When light is directed into the
unaffected eye, both pupils constrict.

Assess consensual response at the same time as direct response by shining a light
obliquely into one eye and observing the pupillary reaction in the opposite eye.
Normal Findings:
- The normal consensual pupillary response is constriction.

Abnormal Findings:
- Pupils do not react at all to direct and consensual pupillary testing.

 TEST ACCOMMODATION OF PUPILS. Accommodation occurs when the client

moves his focus of vision from a distant point to a near object, causing the pupils to
constrict. Hold your finger or a pencil about 12 to 15 inches from the client. Ask the
client to focus on your finger or pencil and to remain focused on it as you move it closer
in toward the eyes
Normal Findings:
- The normal pupillary response is constriction of the pupils and
convergence of the eyes when focusing on a near object (accommodation
and convergence).

Abnormal Findings:
- Pupils do not constrict; eyes do not converge.

Internal Eye Structures

 INSPECT THE INTERNAL EYE. To observe the red reflex, set the diopter at zero and
stand 10 to 15 inches from the client’s right side at a 15-degree angle. Place your free
hand on the client’s head, which helps limit head movement. Shine the light beam toward
the client’s pupil.
Normal Findings:
- The red reflex should be easily visible through the ophthalmoscope. The
red area should appear round with regular borders.

Abnormal Findings:
- Abnormalities of the red reflex most often result from cataracts. These
usually appear as black spots against the background of the red light
reflex. Two types of age-related cataracts are nuclear cataracts and
peripheral cataracts
 INSPECT THE OPTIC DISC. Keep the light beam focused on the pupil and move
closer to the client from a 15-degree angle. You should be very close to the client’s eye

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 (about 3 to 5 cm), almost touching the eyelashes. Rotate the diopter setting to bring the
retinal structures into sharp focus. The diopter should be zero if neither the examiner nor
the client has refractive errors. Note shape, color, size, and physiologic cup.
Normal Findings:
- The optic disc should be round to oval with sharp, well-defined borders.
- The nasal edge of the optic disc may be blurred. The disc is normally
creamy, yellow-orange to pink, and approximately 1.5 mm wide.
- The physiologic cup, the point at which the optic nerve enters the eyeball,
appears on the optic disc as slightly depressed and a lighter color than the
disc. The cup occupies less than half of the disc’s diameter. The disc’s
border may be surrounded by rings and crescents, consisting of white
sclera or black retinal pigment. These normal variations are not considered
in the optic disc’s diameter.

Abnormal Findings:
- Papilledema, or swelling of the optic disc, appears as a swollen disc with
blurred margins, a hyperemic (bloodfilled) appearance, more visible and
more numerous disc vessels, and lack of visible physiologic cup. The
condition may result from hypertension or increased intracranial pressure.
- The intraocular pressure associated with glaucoma interferes with the
blood supply to optic structures and results in the following
characteristics: an enlarged physiologic cup that occupies more than half
of the disc’s diameter, pale base of enlarged physiologic cup, and
obscured or displaced retinal vessels.
- Optic atrophy is evidenced by the disc being white in color and a lack of
disc vessels. This condition is caused by the death of optic nerve fibers.

 INSPECT THE RETINAL VESSELS. Remain in the same position as described

previously. Inspect the sets of retinal vessels by following them out to the periphery of
each section of the eye. Note the number of sets of arterioles and venules.
Normal Findings:
- Four sets of arterioles and venules should pass through the optic disc.

Abnormal Findings:
- Changes in the blood supply to the retina may be observed in constricted
arterioles, dilated veins, or absence of major vessels
Also note color and diameter of the arterioles.
Normal Findings:
- Arterioles are bright red and progressively narrow as they move away
from the optic disc. Arterioles have a light reflex that appears as a thin,
white line in the center of the arteriole. Venules are darker red and larger

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 than arterioles. They also progressively narrow as they move away from
the optic disc.

Abnormal Findings:
- Initially hypertension may cause a widening of the arterioles’ light reflex
and the arterioles take on a copper color. With long-standing hypertension,
arteriole walls thicken and appear opaque or silver.
Observe the arteriovenous (AV) ratio.
Normal Findings:
- The ratio of arteriole diameter to vein diameter (AV ratio) is 2:3 or 4:5.
Look at AV crossings.
Normal Findings:
- In a normal AV crossing, the vein passing underneath the arteriole is seen
right up to the column of blood on either side of the arteriole (the arteriole
wall itself is normally transparent).

Abnormal Findings:
- Arterial nicking, tapering, and banking are abnormal AV crossings caused
by hypertension or arteriosclerosis
 INSPECT RETINAL BACKGROUND. Remain in the same position described
previously and search the retinal background from the disc to the macula, noting the color
and the presence of any lesions.
Normal Findings:
- General background appears consistent in texture. The red-orange color of
the background is lighter near the optic disc.

Abnormal Findings:
- Cotton-wool patches (soft exudates) and hard exudates from diabetes and
hypertension appear as light-colored spots on the retinal background.
Hemorrhages and microaneurysms appear as red spots and streaks on the
retinal background.

 INSPECT FOVEA (SHARPEST AREA OF VISION) AND MACULA. Remain in the

same position described previously. Shine the light beam toward the side of the eye or
ask the client to look directly into the light. Observe the fovea and the macula that
surrounds it.
Normal Findings:
- The macula is the darker area, one disc diameter in size, located to the
temporal side of the optic disc. Within this area is a starlike light reflex
called the fovea.

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 Abnormal Findings:
- Excessive clumped pigment appears with detached retinas or retinal
injuries. Macular degeneration may be due to hemorrhages, exudates, or
cysts.

 INSPECT ANTERIOR CHAMBER. Remain in the same position and rotate the lens
wheel slowly to +10, +12, or higher to inspect the anterior chamber of the eye.
Normal Findings:
- The anterior chamber is transparent.

Abnormal Findings:
- Hyphemia occurs when injury causes red blood cells to collect in the lower
half of the anterior chamber.
- Hypopyon usually results from an inflammatory response in which white
blood cells accumulate in the anterior chamber and produce cloudiness in
front of the iris

Diseases: Sign and Symptoms

Macular Degeneration

Macular degeneration is the name given to the damage to the central portion of retina, known
as the macula. With its ability to focus central vision in the eye, macula helps us read, view
objects in detail, recognize colors and faces, drive a car and get a detailed image of an object.

Signs and Symptoms

No definite signs and symptoms exist through earlier stages of macular degeneration other
than gradual or sudden change in the quality of your vision followed by appearance of straight
lines as distorted. Some other symptoms in the later stages include:
 Blurriness of central vision
 Partial vision loss marked by formation of blind spots (scotomas)
 Problem seeing in dim light
Objects appearing smaller than their actual size, as viewed with one eye and then the other

Treatment Options
To this date, there is no single cure capable of completely treating macular degeneration.
There are some prescription medications helpful in preventing the growth of abnormal blood
vessels within the eye – Anti VEGF medicines, administered by injecting into the eye cavity.
Photodynamic therapy or laser therapy is also an option in destroying abnormal blood vessels.
Dietary supplements enriched in certain vitamins and minerals may also be prescribed to
counteract vision loss. Low vision aids also help people make the most of their receding vision.

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 Cataracts

Cataracts happen to be another of the most widely existing eye problems. The formation of
cloudy areas in the eye lens is referred as the cataracts. Light passes through a clear eye lens to
your retina (just like a camera), where images are processed. With cataracts affecting your eye
lens, light cannot pass through to the retina smoothly enough.
As a result, you are unable to see as clearly as people without cataracts and may also notice a
halo or glare around lights at night.

Signs and Symptoms

Most of the times, the formation of cataracts is a slow process, lacking typical symptoms like
pain, tearing or redness of eyes. Some other symptoms include:
 Blurred, clouded or dim vision
 Problem seeing at night
 Problem seeing through light and glare
 Seeing ‘halos’ around lights
 Frequently changing contact lens prescription or eyeglasses
 Faded view of colors

Treatment Options
Through early stages of cataracts, new eyeglasses, antiglare sunglasses, magnifying
lenses and brighter lighting can help. If not, surgery turns out to be the only effective treatment,
which involves removal and replacement of cloudy lens with an artificial one.

Glaucoma

Glaucoma is an eye condition where eye’s optic nerve is damaged, getting worse over time.
Mostly, it results in pressure buildup within the fluid in your eye, which can potentially damage
the optic nerve responsible for transmitting images to your brain.
This increased pressure, also referred as intraocular pressure, might also lead to permanent
vision loss if it continues for a longer period of time. If left untreated, glaucoma can result in
permanent blindness in a matter of few years.

Types of Glaucoma
Glaucoma is segregated into two basic types:
1: Open-angle Glaucoma: The most common type, also referred as ‘wide-angle glaucoma’ is an
eye condition where the trabecular meshwork (the drain structure of the eye) looks normal, but
the flow of fluid within it is not the way it should be.

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2: Angle-closure Glaucoma: Westerners suffer less from this type of glaucoma than Asians. It is
also known as acute or chronic angle-closure or narrow-angle glaucoma. This affects the
drainage of your eyes because the angle between your cornea and iris gets too narrow, thus
building up excessive pressure in your eye. This condition is also linked with farsightedness and
cataracts.

Signs and Symptoms

Signs and symptoms of both types of glaucoma vary significantly.
1: Symptoms of Open-Angle Glaucoma

 No definite symptoms initially, the later ones include:

 Tunnel vision
 Peripheral vision loss, gradually affecting both eyes in most cases
2: Symptoms of Angle-Closure Glaucoma
Angle-closure glaucoma needs immediate treatment or it can result in blindness in a day or two.
Some of its symptoms include:
 Severe pain in eyes accompanied by nausea and vomiting in most cases
 Sudden visual disturbance in low light conditions
 Halos around lights
 Blurred vision
 Redness of the eyes

Treatment Options
From eye drops to pills, traditional surgery and laser surgery, or even a combination of
these methods, an experienced eye doctor would recommend any treatment as long as it is
focused on preventing vision loss, because once eyesight is damaged due to glaucoma, vision
loss is irreversible.

Diabetic Retinopathy

Diabetic retinopathy is basically a diabetes complication, which affects eyes by causing

damage to the blood vessels spread throughout the light sensitive tissues of the retina (the back
of the eye).
Anyone having type 1 or type 2 diabetes can develop this eye condition, especially those who
have diabetes for a long time with fluctuating blood sugar levels. Usually, both eyes get affected
by diabetic retinopathy.

Signs and Symptoms

There might not be any noticeable symptoms through the early stages of this eye condition.
When it progresses to later stages, following symptoms might appear eventually:

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  Dark spots or strings floating through your vision (floaters)
 Impaired color recognition
 Fluctuating vision
 Blurred vision
 Vision loss

Treatment Options
There is no reliable way to cure retinopathy once it has progressed to advanced stages.
However, photocoagulation (laser treatment for retinopathy) comes really handy in preventing
vision loss if chosen before retina being severely damaged.
Another treatment option for diabetic retinopathy in its earlier stages is vitrectomy, a
process through which vitreous gel is surgically removed while retina has not been severely
damaged.

Dry Eyes Syndrome

One of the functions of tears is to keep your eyes lubricated, and when they fail to provide
adequate lubrication for the eyes, you are being affected by dry eye syndrome. From your body
being unable to produce enough tears to production of low quality tears, there can be a host of
reasons behind inadequate lubrication for your eyes.
You can experience stinging or burning sensation when you have dry eyes, which can be
experienced under certain situations, such as in an air-conditioned room, while traveling on an
airplane or looking at a computer screen for a long time without any breaks.

Signs and Symptoms

 A burning, scratchy or stinging sensation in eyes
 Eye redness
 Sensitivity to light
 Mucus production in or around the eyes
 Blurred vision
 Eye fatigue
 Issues in wearing contact lenses

Treatment Options
Different treatment options can be used for dry eyes syndrome depending upon the
reason behind the eye problem. Some most commonly used treatment options include:
OTC (Over-the-counter) topical medications: These can be used when your dry eyes
syndrome is mild in nature. Artificial tears, gels and ointments can be some of the commonly
used OTC medications to treat mild dry eyes.

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Prescription Medications: FDA approves only ‘Lifitegrast’ and ‘Cyclosporine’ as prescription
dry eye medications. To deal with eye inflammation, ‘Corticosteroid’ eye drops may also be
prescribed as short-term treatment.
Devices: There are also some FDA-approve devices that serve to temporarily relieve you from
dry eyes by stimulation of nerves and glands responsible for tear production.
Surgical Options: Your eye care professional may resort to insertion of silicone-based punctal
plugs to partially or completely plug tear ducts through the inner corners of your eyes to ensure
tears aren’t draining from the eye.
Lifestyle Changes: Lifestyle based enhancements also prove helpful in dealing with dry eyes
syndrome. Taking periodic breaks or cutting your screen exposure can be really helpful.
Avoiding warmer temperatures also helps in doing so.

Conjunctivitis (Pinkeye)

Conjunctivitis, also known to many as pinkeye is a condition that inflames the tissues lining
the back of your eyelids and covering your sclera (conjunctiva). As a result of this, your eyes can
turn itchy, red, blurry, teary and discharging, sometimes also giving you a feeling that something
is in your eyes. It is also one of the most commonly prevailing eye problems.
Though it is highly contagious (readily affecting children), but rarely serious, quite unlikely
to damage your vision, more so when identified and treated early.

Types of Conjunctivitis
Conjunctivitis is categorized into three main types:
1: Allergic Conjunctivitis
Allergic Conjunctivitis: Mostly affects people already suffering from seasonal allergies, when
they contact with something that triggers an allergic reaction within their eyes.
Giant Papillary Conjunctivitis: Caused due to long term presence of a foreign body in an eye,
affecting people wearing hard or rigid contact lenses or the soft ones not being replaced
frequently.
2. Infectious Conjunctivitis
Bacterial Conjunctivitis: This is the type of eye infection caused mostly by streptococcal or
staphylococcal bacteria that’s transferred to your eyes via your own respiratory system or skin.
Viral Conjunctivitis: Contagious viruses thriving in common cold are mostly responsible for
spread of this type of conjunctivitis, thus affecting people by exposure to the sneezing or
coughing of someone suffering from an upper respiratory tract infection.

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Ophthalmia Neonatorum: One of the most severe forms of bacterial conjunctivitis specifically
affecting newborn babies, also capable of causing permanent eye damage if not treated
immediately.
3: Chemical Conjunctivitis
This spreads as a result of exposure to noxious chemicals, chlorine in swimming pools or even
air pollution.

Signs and Symptoms

 Redness appearing in the eyelid or through the white of the eye
 Swelling in the conjunctiva
 Excessive tearing
 Thick yellowish discharge, mostly covering whole eyelashes, especially after sleep
 Itching and burning eyes
 Blurred vision
 Extra sensitivity to light

Treatment Options
Appropriate treatment options for conjunctivitis vary depending upon the cause of this
eye condition.
Allergic Conjunctivitis: It must start with avoiding exposure to the irritant(s). Artificial tears and
cool compresses suffice in case of mild intensity of the disease. Antihistamines or non-steroidal
anti-inflammatory drugs may be prescribed in case of severe allergic conjunctivitis. And for
people with persistent allergic conjunctivitis, topical steroid eye drops may be the appropriate
option.
Bacterial Conjunctivitis: Antibiotic eye drops or ointments work well for this type of
conjunctivitis, mostly requiring 3 to 4 days of treatment for reasonable recovery. However, it’s
highly recommended that patients complete the entire course of antibiotics to totally avoid
recurrence.
Viral Conjunctivitis: Viral conjunctivitis cannot be treated with drops, ointments or some
antibiotics until the virus runs its course like common cold. This may take up to about 2-3 weeks.
Chemical Conjunctivitis: The standard treatment for chemical conjunctivitis includes thorough
flushing of the eyes using saline water. In some cases, people might need to go for topical
steroids.

Retinal Detachment

When the retina is separated or detached from its underlying tissues holding it in its place
within the eye, the instance is referred as the retinal detachment. Sometimes, it all begins with
small areas of the retina being torn (attributed as retinal tears or retinal breaks), eventually

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leading to retinal detachment. The longer you take in treatment of retinal detachment, the greater
your chances of total vision loss in the affected eye are.

Types of Retinal
Retinal detachment is segregated into three basic types:
Rhegmatogenous: These are the most common of all retinal detachments whereby a small break
or tear appears within the retina, resulting in flow of the fluid underneath the retina, eventually
separating it from the retinal pigment epithelium (RPE), which is pigmented cell layer
responsible for nourishment of the retina.
Tractional: In this type, the retina detaches due to the contraction of the scar tissue on surface of
retina, resulting in its separation from the PRE. Tractional detachment is not so common.
Exudative: This sort of detachment takes place due to eye injury/trauma, inflammatory disorders
and other such retinal diseases. In exudative detachments, the retina suffers no tears or breaks
despite the fluid leaking underneath it.

Signs and Symptoms

 Though you don’t suffer any pain through the retinal detachment, but it is almost always
followed by certain warning signs, such as:
 Sudden appearance of floaters (tiny specks drifting through your field of vision) in the
affected eye
 Sudden appearance of light flashes in one or both eyes
 Blurred vision
 Steadily receding peripheral or side vision
 Presence of a curtain-like shadow through your field of vision

Treatment Options
Cryopexy (a freeze treatment) or laser surgery is used by an ophthalmologist to treat
small holes and tears. Tiny burns are made around the damaged area to “weld” the retina back
into place, whereas “cryopexy” is used to freeze the area around the weld, helping reattach the
retina.
Vitrectomy may also be performed in some cases, during which a tiny incision is made in
the white of the eye (the sclera). Sometimes, it also involves removing vitreous (a gel-like
substance filled in the center of the eye) by means of a specialized instrument, and injecting gas
into the eye to push retina back to its appropriate position.

Uveitis

This is the name collectively given to a group of eye diseases causing inflammation in the
uvea, eye’s middle layer containing the most blood vessels. Uveitis may also result in destruction
of eye tissue, leading to the loss of eye in some cases.

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Signs and Symptoms
The symptoms of uveitis may vanish quickly or last a long time. People affected with
AIDS, rheumatoid arthritis, ulcerative colitis and other such immune system conditions are
highly likely to suffer from uveitis. Some major symptoms include:
 Blurred vision
 Pain in the eye
 Light sensitivity
 Redness of the eye

Types of Uveitis
Uveitis is mostly described by the part of the eye it affects.
Anterior Uveitis: Affecting the front of the eyes, this is the most widely existing type of uveitis
found commonly in young and middle-aged people.
Intermediate Uveitis: Commonly found in young adults, intermediate uveitis often hits the
virteous. It is also linked to a host of disorders like sarcoidosis and multiple sclerosis.
Posterior Uveitis: Least common of all, posterior uveitis primarily affects the back of the eye,
mostly involving the retina as well as the choroid. That is why it is also referred sometimes as
choroditis or chorioretinitis.
Pan-Uveitis: This refers to the instance when inflammation occurs in all three major parts of the
eye. One of the most famed forms of pan-uveitis is the Behcet’s disease, severely damaging the
retina.

Treatment Options
Uveitis treatment is dependent on the underlying cause and the area of the eye that’s
affected, reducing nflammation in your eye being the primary objective here. Several treatment
options are available:
1: Medications
Inflammation Reducing Drugs: Your eye doctor may resort to some anti-inflammatory
medication based eye drops, such as corticosteroid. If it is unable to resolve the issue, a
corticosteroid pill or injection can be the next options.
Bacteria/Virus Fighting Drugs: if some sort of infection is the underlying cause of your uveitis,
your ophthalmologist can prescribe antibiotics or antiviral medications to control the infection,
with or without corticosteroids.
Immunosuppressive Drugs: Immunosuppressive and cytotoxic drugs are used to treat uveitis if it
has affected both eyes, because at this stage, it doesn’t respond well to corticosteroids and can
potentially threaten your vision.2: Surgical and Other Options.

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2: Surgical and Other Options
Vitrectomy: A surgical procedure used for removal of excessive vitreous in your eye can be the
only way out in some cases.
Device Implanting Eye Surgery for Slow and Sustained Medication: Posterior uveitis, which is
very difficult to treat otherwise, may be treated by implanting a device in eye. The device is
introduced in the eye for slowly releasing corticosteroid medications for about two to three years.
Recurrence is also a possibility with uveitis. Consult your eye doctor immediately in case of
experiencing any of the associated symptoms.

Eyestrain

Another of the most commonly existing eye problems, eyestrain refers to a common
condition in which your eyes get tiresome and fatigued due to intense use; for instance, after
looking at a computer screen (or other digital screens) for prolonged time period and driving
long distances.
Eyestrain can be quite irritating sometimes, but still not capable of seriously inflicting your
eyes or vision. It normally fades out after you rest your eyes and follow other ways to sooth your
eyes.

Signs and Symptoms of Eyestrain

In some instances, signs and symptoms of eyestrain point out towards other underlying
eye condition(s) needing treatment. Some common symptoms of eyestrain include:
 Soreness, tiredness, burning or itching in eyes
 Watery or dry eyes
 Headache
 Blurred or double vision
 High light sensitivity
 Difficulty in keeping your eyes open

Treatment Options
Some methods commonly used by eye doctors to treat eyestrain symptoms include:
 Taking frequent breaks from digital screens and reading activities.
 Improving your home environment, lifestyle and work habits, thus inculcating more
breaks for your eyes.
 In case of dry eyes and blinking problem, your doctor might recommend artificial tears.
 Natural treatments like a yoga program, visual cleansing exercises and relaxation routines
to lessen stress within your eyes and head.

Night Blindness (Nyctalopia)

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 ‘Nyctalopia’ or night blindness is a kind of vision impairment in which people are unable to
see rightly at night or in other dimly lit environments. Unlike commonly perceived, night
blindness doesn’t totally prevent you from seeing at night. You might only feel increased
difficulty in seeing or driving in places not adequately lit.
Night blindness is not considered to be a disease itself; it’s more like a symptom of some
other eye problem like untreated nearsightedness.

Signs and Symptoms

The only symptom associated with night blindness is increased difficulty seeing things in
dark. It seems to be effecting more when your eyes undergo a transition from a properly lit
environment to a lowly lit environment.
Similarly, you’ll have problems driving at night due to sporadic nature of vehicle’s
headlights and streetlights on roads.

Treatment Options
Your eye doctor will be able to diagnose night blindness after thoroughly examining your
eyes. Some types of blindness have got a treatment, while others don’t. Once your doctor has
determined the underlying cause of your blindness, you can start taking appropriate treatment.
Night blindness caused due to cataracts, nearsightedness or vitamin A deficiency can be
treated with corrective lenses like contacts or eyeglasses.
Color Blindness
Color blindness, also known as color deficiency is an eye condition when the pigments found
in eye cones have some problem and you cannot see the colors in the normal manner.
Red-green colorblindness, the most common form of color blindness, is a type of vision
impairment where a person is unable to differentiate between red and green colors.
Similarly, there is blue-yellow color blindness as well and people suffering from it almost
always have red-green color blindness as well.
In rare cases, the cones lack any color pigments at all, so the eyes can’t see any color at all,
the worst form of color blindness, also known as ‘achromatopsia’.
Color blindness is basically a genetic condition, which seems to be lenient with women than
with men, affecting 1 out of every 10 men to some degree.

Signs and Symptoms

 Trouble distinguishing between different colors
 Failure in seeing differing tones or shades of the same color

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Treatment Options
Unfortunately, color blindness still lacks a reliable cure, though glasses and contact
lenses with filters are available to assist color deficiencies whenever needed. Luckily, most color
blind people enjoy normal vision in all aspects but one, and all they require is certain adaptation
methods.

Eye Floaters

Strings, black/gray specks or cobwebs drifting around with the movement of your eyes and
darting away when trying to look through them, eye floaters are basically spots in your vision.
These are mostly produced due to age-related changes taking place through the jelly-like
substance (vitreous) within your eyes, turning into more and more liquid. This vitreous contains
microscopic fibers, which tend to cast tiny shadows on your retina when vitreous clump away.
These shadows are what floaters are all about.

Signs and Symptoms

Some common symptoms associated with eye floaters include:
 Appearance of dark specks or transparent strings floating around within your vision
 Movement of the spots in correspondence with the movement of your eyes, quickly
moving out of your visual field when looked upon
 High visibility of the spots when looked at against a plain bright background like a white
wall or blue sky

Treatment Options
Rarely, the density and frequency of floaters gets to the point that they start significantly
affecting your vision, thus needing vitrectomy. This surgical procedure is used to remove the
vitreous gel, also removing the floating debris contained within it and relieving your eye.

Nearsightedness (Myopia)

When you can view the objects close to you clearly enough, while getting a blurry vision of
the objects far away, this eye condition is referred as myopia or nearsightedness. This happens
because of irregular bending of light (refraction) due to the shape of your eye. The resultant
images are focused in front of your retina rather than being focused right on it.
Near sightedness seems to be running in families, developing either gradually or rapidly,
getting severe mostly during childhood and adolescence.

Signs and Symptoms

Major symptoms may include:

29
  Vision getting blurry when looking at distant objects
 Requiring squinting or partial closing of the eyelids to get a clear vision of something
 Eyestrain leading to headaches
 Difficulty viewing objects while driving a vehicle, particularly at night (night myopia)

Treatment Options
Different options are available as myopia treatment, such as corrective glasses, contact
lenses or refractive surgery. You might need to wear your glasses all day long or just when you
want to have a sharp distant vision (watching a movie, driving, etc.), depending upon the
intensity of your myopia.

Farsightedness (Hypermetropia)

Unlike myopia, hypermetropia or farsightedness refers to an eye condition when you have a
clear vision looking at far placed things, while getting a blurry vision of nearby objects.
If you feel tiredness in your eyes quite often, coupled with problems focusing on close by
objects, you might be suffering from hypermetropia.

Signs and Symptoms

 Vision getting blurry for objects close by
 Need to squint for getting a better vision
 Headache hitting after tasks needing your focus on close by objects

Treatment Options
Corrective glasses and contact lenses are some of the most common ways of treating
hypermetropia. Other treatments like LASIK surgery is also advisable for adults suffering from
mild to moderate levels of farsightedness.
Astigmatism
When your vision gets out of focus due to the abnormally curved cornea (the clear tissue
lining the front of the eye), this eye disorder is referred as ‘astigmatism’ or ‘keratoconus’.
People having a family history of acute astigmatism are highly susceptible to this eye
problem. Moreover, people using power tools without wearing safety glasses are also prone to
the injuries resulting in acquired astigmatism.

Signs and Symptoms

While astigmatism may exhibit different symptoms for different persons, some might not have
any symptoms at all. Some of the symptoms associated with astigmatism include:
 Distorted and blurry vision at close range as well as at a distance
 Difficulty in seeing things at night

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  Eyestrain
 Headaches
 Squinting
 Eye irritation

Treatment Options
Astigmatism can be treated in a host of ways including corrective contact lenses,
eyeglasses, laser surgery as well as other refractive surgery procedures. LASIK (Laser in Situ
Keratomileusis) or PRK (photorefractive keratectomy) are also used to treat astigmatism.

Presbyopia

Human eyes’ inability to focus on nearby objects due to gradual loss of vision is referred as
“Presbyopia”, an eye disease normally associated with aging. Mostly, it remains unnoticeable
until early to mid 40s and continues progression until 65 years of age or so.
Most people become aware of presbyopia only when they feel compelled to hold books,
newspapers and other reading materials at arm’s length to be able to read something on them. It
can be detected with the help of a basic eye exam.

Signs and Symptoms

 Presbyopia progresses really slowly, first significant symptoms surfacing after 40 years
of age and some of them are:
 Blurry vision and inability to read at normal reading distance
 Eyestrain (mostly accompanied with headaches) as a result of activities requiring close-
up vision

Treatment Options
Treatments for presbyopia aim at assisting your eyes in focusing nearby objects.
Corrective eyeglasses, contact lenses, refractive surgery or lens implantation for presbyopia are
some of the mostly sought after treatment options for this eye disease.

Proptosis

The phenomenon of protrusion of the eyeball is referred as “Proptosis”, also termed as

“Exophthalmos” when such protrusion is caused by the “Graves’ disease”. Orbital mass or
inflammation, thrombosis of cavernous sinus, fistulas and expansion of orbital bones are some of
the common reasons behind this abnormal protrusion of eyeballs.

Signs and Symptoms

 Eye pain and irritation
 Light sensitivity
 Eye secretions (lacrimation)

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  Blurry vision
 Diplopia (double vision resulting from weakened eye muscles)

Treatment Options
In severe cases of proptosis, an ophthalmologist mostly suggests lubrication for corneal
protection. When lubrication fails to work, experts resort to surgery, which results in improved
coverage of the exposed eye surface. Orbital congestion due to inflammatory orbital
pseudotumor or thyroid eye disease is treated with specific systemic corticosteroids. And for
cavernous sinus caused by arteriovenous fistulas, selective embolization works best.

Strabismus (Crossed Eyes)

Strabismus (or “Crossed Eyes”) represents misaligned eyes pointing in different directions
and this misalignment can either be intermittent or constant. Strabismus exists in four common
forms, i.e. “esotropia” and “exotropia”, “hypotropia” and “hypertropia”.
Esotropia is when one eye fixates on an object/point of interest, while the other eye turns in;
whereas exotropia is when it turns out. Similarly, turning down of the other eye while one fixes
at a point is hypotropia and hypertropia is when it turns up.
Strabismus usually occurs because the muscles controlling the movements of the eye and the
eyelid, the extraocular muscles, fail to do so in a coordinative manner. Moreover, a disorder in
the brain affecting the coordination of the extraocular muscles can also become the cause of
strabismus. It can affect children as well as adults and about 4 percent of US population is
believed to be suffering from this eye disease.

Signs and Symptoms

 Double vision
 Eyes’ inability to focus on a particular point at the same time
 Uncoordinated eye movements
 Loss of depth perception

Treatment Options
Strabismus is treated differently in kids and adults.
a. Strabismus Treatment Options for Kids
Strabismus in kids is treated preferably with eye patching, eye glasses, and/or atropine
drops. If none of these prove effective, then an eye muscle surgery might be advised by your eye
doctor, which involves tightening or loosening of the muscles causing the eye to wander. In most
cases, kids can go home the same day after receiving surgical treatment.
b. Strabismus Treatment Options for Adults

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 Adults are treated differently for strabismus depending upon its severity, relying on
various options ranging from observation to surgery. For treating minor to mild cases of
strabismus, optical approaches including prism correction are preferred. If all such options run
out, only then an ophthalmologist would advise for surgery after considering a host of factors
and variants.

Macular Edema

Macula is the central region of the retina (constituted by the light sensitive tissues located at
the back of the eye, wherein macula within the retina serves for sharp, straight-ahead vision) and
unwanted buildup of fluids there is referred as the “Macular Edema”. Any accumulation of fluids
inside the macula results in swelling and thickening of the macula, which leads to distorted
vision.
Since the retina is richly populated with blood vessels, abnormal leakage of blood from
damaged blood vessels there can result in fluid accumulation within the macula. Diabetic
Retinopathy (DR – an eye disease mostly affecting diabetic people) is considered as one of the
most common causes of macular edema. In fact, any eye disease damaging retinal blood vessels
can lead to macular edema, such as age-related macular degeneration, an inflammatory disease
sometimes, or even a wrongly performed eye surgery.

Signs and Symptoms

Wavy or blurry vision in or around your central field of vision is considered as the very
first symptom of macular edema in most cases. Some people also complain of colors appearing
faded or washed. In fact, macular edema symptoms vary anywhere between slightly blurry vision
to significant vision loss. If this disease attacks only one of your eyes, you may not even notice
blurriness in your vision until the condition is already in advanced stage.

Treatment Options
Treatment options for macular edema also vary according to the underlying cause of the
disease and consequential fluid leakage and retinal swelling. Some of them include:
Eye-drops Medication: This serves best in treating cystoid macular edema, a type of macular
edema that can potentially damage the macula after cataract surgery and comprises of non-
steroidal anti-inflammatory (NSAID) eye-drops. Such treatment can last for a few months.
Steroid Treatment: When inflammation is the reason behind macular edema, your eye doctor may
recommend steroid treatment, which can be administered in form of pills, eye-drops or
injections.
Laser Treatment: As the name suggests, this surgery is about applying numerous tiny laser pulses
to the regions of fluid leakage around the affected macula, so that leaking blood vessels can be
sealed and vision can be stabilized.

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Anti-VEGF Medication: This treatment is based on anti-VEGF drugs, which are administered to
the damaged eye through a very slender needle. Anti-VEGF (anti vascular endothelial growth
factor) drugs are meant to curb the growth of abnormal blood vessels in your retina, thus helping
prevent unwanted fluid leakage.
Vitrectomy Surgery: Sometimes, macula undergoes vitreous pulling, which results in macular
edema (vitreous is the jelly like substance filling the back of the eye). Under such circumstances,
seasoned eye doctors resort to “Vitrectomy”, a procedure in which vitreous is removed from the
eye using tiny instruments, also peeling off scar tissues damaging the macula due to traction.

REFERENCES:
http://downloads.lww.com/wolterskluwer_vitalstream_com/sample-
content/9780781781602_Weber/samples/Chapter015.pdf?fbclid=IwAR2efynZs9BwTlOUEQ_G_duNOjM
BO-9mliXxQBR1qooyMVtDy_tVS20jxGo

https://irisvision.com/most-common-eye-problems-signs-symptoms-and-treatment/

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