Jo ur nal of the Venu Eye Ins titut e & Resear ch Cent re
Volume 6 Issue 1
October to December 2014
Visual Fields
Pg. 3
Dry Eye
Pg. 6
Penetrating Keratoplasty
Pg. 11
Keep an Eye on Child’s Vision
Pg. 14
Binocular Single Vision
Pg. 16
Glaucoma Screening
Pg. 18
Systemic Disease that Affect Our Eyes
Pg. 20
From the editors desk
“Education is the most powerful weapon which
you can use to change the world.”
-Nelson Mandela
Dear friends
Greetings from the Venu family.
It gives us immense pleasure to reach to you every
time through the medium of our journal 'VERGE'.
Your kind patronage has made this publication one
of the most sought journal for optometrists & allied
cadre. In this issue we have hand picked articles
reflecting various aspects of optometry and allied
sciences relevant for an optometrist e.g. dry eye,
screening of glaucoma and visual field.
Being a totally asymptomatic disease most of the
time, Glaucoma is rightly said as “sneak thief of
sight”. Screening is the only way to detect this
disease at an early stage so that patient does not
reach a stage of irreversible blindness. Automated
Visual field testing is gold standard for diagnosis
and follow up of all glaucoma patients. Yet its use is
not limited to glaucoma as many neurological,
retinal and neuro ophthalmic cases need field
testing for their proper assessment. We have tried to
cover various methods of field testing and types of
possible defects we get on these tests.
Dry eye syndrome is a multifactorial disease
affecting usually older people but with use of
computer and digital gadgets, it is increasingly
more common in younger professionals also. Timely
diagnosis and its management is of paramount
importance to give the patient a comfortable vision
and avoid its serious complications.
Throughout the developing world, the problem of
corneal blindness is overshadowed by the backlog
of cataract blindness and most of the resources
have been earmarked for the alleviation of cataract
blindness. Ignorance and poverty have contributed
as much to the cataract blindness as to the corneal
blindness. In India, we have an estimated 4.6
million people with corneal blindness that is
curable through keratoplasty. We have discussed in
detail various indications, contraindications and
complications of penetrating keratoplasty. A case
of keratoconus with its detailed clinical findings is
also given with this chapter to give the readers a
glimpse of this condition and various management
options available.
There is a myth in people's mind that nothing
serious can happen in a child's eye. We need to
remove this misconception from people's mind. An
overview of common pediatric ocular problems and
warning clues for them gives a glimpse into this
matter.
The eye can be affected in a number of systemic
diseases. Problems in the eye may be a first
presentation of the systemic disease or patients
with known systemic problems may need to have
their eyes specifically checked for complications.
Awareness of these associations is the first step in
diagnosis and management of these often complex
patients. This is a very broad topic still we have
tried to compile a concise article on this matter
which can serve as a guide.
We would like to conclude by thanking you for your
encouragement. We look forward to your valuable
feedback.
Managing Editor
:
Ms. Tanuja Joshi
Editorial Team
:
:
:
:
:
:
:
Dr. Wangchuk Doma
Dr. Samiksha Chaudhary
Dr. O.P. Gupta
Dr. Bhumika Sharma
Dr. Shashi Sharma
Mr. Bhaskar Ghosh
Ms. Sheeba Qumar
Editorial Support
:
Mr. Satish Kumar
2 Verge Journal of the Venu Eye Institute & Research Centre
Visual Fields
Ms. Sukanya, Bsc IIIrd Year
Venu Eye Institute & Research Centre
The visual field refers to the total area in which
objects can be seen in the side (peripheral) vision
while we focus our eyes on a central point. In
optometry and ophthalmology a visual field test is
used to determine whether it is affected by
diseases
that cause
l o c a l
scotoma or
a more
extensive
loss of
vision or
e v e n a
reduction in
sensitivity
(threshold).
Normal limits : The normal human visual field
extends to approximately 60 degrees nasally
(toward the nose, or inward) from the vertical
meridian in each eye, to 100 degrees temporalily
(away from the nose, or outwards) from the
vertical meridian, and approximately 60 degrees
above and 75 below the horizontal meridian. The
macula corresponds to the central 13 degrees of
the visual field; the fovea to the central 3 degrees.
Aetiology
?
There are many causes of visual field loss.
Some more common ones are included here.
?
Central field loss occurs with:
?
Age-related macular degeneration.
?
Optic neuropathy.
?
Leber's optic atrophy.
?
Macular holes.
?
Cone dystrophies.
?
A number of rare conditions like Best's
disease, Stargardt's disease and
achromatopsia.
?
Peripheral field loss occurs with:
?
Glaucoma (angle-closure glaucoma and open
October - December 2014
angle glaucoma).
?
Retinal detachment.
?
Retinitis pigmentosa.
?
Chorioretinitis.
History
The following needs to be established:
?
Was the onset sudden, rapid or slow?
?
Where is the field loss? It is often helpful to
say to the patient, "If what you see is like a
television screen then where is the bit that is
missing?"
?
Does it affect one eye or both? If the patient
says that it affects only one eye, it is worth
asking them to close or cover the affected eye
and to note again if there is any visual loss. If
it is much more marked in one eye than the
other, the loss in the less affected eye may be
overlooked.
?
Does the visual defect look like a black spot, a
blur or does the picture look normal? If the
lesion is cortical, the patient may fail to notice
any defect. If the onset has been insidious, it
may also have gone unnoticed.
Looking for evidence of 'asymptomatic' visual
field loss
?
Does the patient tend to bump into people or
things?
?
Has there been any damage to the car
recently? Patients may continue to drive, as
they are oblivious of quite significant field
loss. This can cause failure to judge parking,
failure to negotiate obstacles or notice other
vehicles at road junctions. There may be
remarkable lack of insight despite numerous
claims on the insurance.
?
Are there any associated neurological or
ophthalmic symptoms?
Types of Visual Field Tests
Confrontation visual field testing typically is
used as a screening visual field test. One eye is
Verge Journal of the Venu Eye Institute & Research Centre 3
covered, while the other eye fixates on a target
object, such as the doctor's open eye, while the
doctor stands or
sits directly in
front of you.
The patient is
then are asked to
describe what
he sees on the
far edges or
periphery of
your field of
view.
A patient undergoes visual field testing with a
Humphrey Field Analyzer (HFA), which uses
automated perimetry to measure responses to
visual stimuli appearing in central and side
vision.
If an eye disease is suspected, patient may need to
undergo more comprehensive, formal types of
visual field testing to evaluate the quality of your
central and peripheral vision. Numerous tests for
measuring visual field loss exist, and can include:
Automated Perimetry: Various forms of
automated perimetry tests measure the responses
to the presence of objects in different areas of the
field of view.
doubling is based on an optical illusion produced
with vertical bars of contrasting colors (usually
black and white) appearing on a screen. These
bars appear to double in number when they
alternately flicker at higher frequencies, a
phenomenon thought to be due to the unique
response of specific light-sensitive cells
(photoreceptors) in the retina.
Inability to see vertical bars at certain
frequencies could indicate optic nerve or other
types of eye damage with accompanying loss of
vision in certain areas of the visual field.
Electroretinography: This test measures
electrical activity generated by the photoreceptor
cells in the retina when the eye is stimulated by a
special strobe light or a reversing checkerboard
pattern of light. The measurement is captured by
an electrode placed on the front surface of the eye
(cornea), and a graphic record called an
electroretinogram (ERG) is produced.
Electroretinography is useful in diagnosing
several hereditary and acquired disorders of the
retina, including retinitis pigmentosa, a detached
retina or functional changes in the retina caused
by arteriosclerosis (hardening of the arteries) or
diabetes
inability to see objects in an appropriate portion
of visual field indicates the vision loss in that area.
Examination
Visual acuity assessment indicates the eye's
greatest power of resolution whereas visual field
testing measures the peripheral sensitivity. Since
the image is projected on to the retina upside
down and inverted, a lesion of the top right of the
retina or in the pathway beyond will cause a
defect in the bottom left of the visual field.
Assessing for visual field defects can be via:
?
Screening tests (easily carried out in a
surgery) which include confrontational
visual field testing and use of an Amsler grid.
?
Quantitative measurements using manual or
automated
Frequency Doubling Perimetry: Frequency
Terms which may be encountered include:
While patient's head is held still, usually with a
chin rest inside a large bowl-like instrument,
staring at a source of light straight ahead. Random
lights of different intensities are flashed in your
peripheral field of vision.
Patient has to press a button or use other means to
indicate the response when he perceives the
computer-generated light suddenly appearing in
your field of view.
4 Verge Journal of the Venu Eye Institute & Research Centre
?
Visual field defect - a portion of the visual
field is missing. This may be central (eg, an
optic disc or nerve problem) or peripheral
(along the visual pathways from the optic
chiasm back).
?
Scotoma - this is a type of visual field defect. It
is a defect surrounded by normal visual field.
?
Relative scotoma - an area where objects of
low luminance cannot be seen but larger or
brighter ones can.
?
Absolute scotoma - nothing can be seen at all
within that area.
?
Hemianopia - a binocular visual defect in each
eye's hemifield.
?
Bitemporal hemianopia - the two halves lost
are on the outside of each eye's peripheral
vision, effectively creating a central visual
tunnel.
?
Homonymous hemianopia - the two halves
lost are on the corresponding area of the
visual field in both eyes, ie either the left or
the right half of the visual field.
?
Altitudinal hemianopia - refers to the dividing
line between loss and sight being horizontal
rather than vertical, with visual loss either
above or below the line.
?
Quadrantanopia - is an incomplete
hemianopia referring to a quarter of the
schematic 'pie' of visual field loss.
?
Sectoral defect - is also an incomplete
hemianopia.
Venu as seen with full visual fields
October - December 2014
Venu as seen
with bitemporal
hemianopsia
Venu as seen
with binasal
hemianopsia
Venu as seen
with left
homonymous
hemianopsia
Venu as seen
with right
homonymous
hemianopsia
What Abnormal Results Mean
Abnormal results may be due to diseases or
central nervous system disorders, such as tumors
that damage or press on (compress) the parts of
the brain that deal with vision.
Other diseases that may affect the visual field of
the eye include:
?
Diabetes
?
Glaucoma
?
High blood pressure
?
Macular degeneration
?
Multiple sclerosis
?
Overactive thyroid (hyperthyroidism)
?
Pituitary gland disorders
?
Retinal detachment
?
Stroke
?
Temporal arteritis
Verge Journal of the Venu Eye Institute & Research Centre 5
DRY EYE
Mr. Bhaskar Ghosh, Sr. Optometrist
Venu Eye Institute & Research Centre
INTRODUCTION
Dry eye disease is a very common multifactorial
disease of the lacrimal functional unit that results
in tear film instability, hyperosmolarity, chronic
irritation and inflammation of the ocular surface.
Diagnostic tools have been developing rapidly;
however, both classic dry eye tests (Schirmer I
test, floroscein in staining of the surface
epithelium and tear film break-up time) and noninvasive imaging techniques are essential for an
exact diagnosis. The management of dry eye
syndrome can be either conservative or invasive
based on the severity of the disease. The basic aim
of treatment is to improve quality of life and
reduce subjective complaints and objective
ocular surface alterations in dry eye patients. The
first line of treatment is tear substitution with
artificial tear drops, gels and ointments. In
moderate cases preservative-free tear
supplementation, topical anti-inflammatory
therapy and retinol treatment is recommended.
Temporary or permanent punctal plug occlusion,
therapeutic contact lenses or moisture chamber
constitute other options. In severe cases the
application of topical autologous serum, systemic
a n t i - i n f l a m m a t o r y t h e r a p y, a n d r o g e n
substitution, secretagogues and surgical
intervention can be effective. In the future,
noninvasive diagnostic tools and instruments
such as screening methods are likely to be
developed. In addition, causal therapy of the dry
eye will play a greater role, including
cyclosporine therapy, secretion stimulation,
growth factor-containing artificial tears, as well
as secratogogues, immunomodulants and
androgenic complexes for severe forms of the
disease.
Dry eye disease (also known as
keratoconjunctivitis sicca) is characterized by
precorneal tear film instability (reduced tear
break-up time [TBUT]) and damage of the
exposed surface epithelium (fluorescein or
Bengal rose staining of the corneal and
conjunctival epithelia), which cause chronic
6 Verge Journal of the Venu Eye Institute & Research Centre
irritation of the ocular surface. In most cases, dry
eye symptoms are associated with decreased
lacrimal gland secretion. However, the disease
can be related to quantitatively normal lacrimal
production and glandular hypersecretion.
Reduced tear volume is a common cause of
ocular manifestations; nevertheless, lacrimal
hyposecretion evaluated by the Schirmer test is
not essential in the diagnosis of dry eye disease.
ANATOMY
The tear film
covers the
normal ocular
surface. It is
generally
considered to
comprise the
following 3
intertwined
layers:
n
A superficial
thin lipid layer (0.11 µm) – This layer is
produced by the meibomian glands, and its
principal function is to retard tear evaporation
and to assist in uniform tear spreading[2]
n
A middle thick aqueous layer (7 µm) – This
layer is produced by the main lacrimal glands
(reflex tearing), as well as by the accessory
lacrimal glands of Krause and Wolf ring (basic
tearing)
n
An innermost hydrophilic mucin layer (0.020.05 µm) – This layer is produced by both the
conjunctiva goblet cells and the ocular surface
epithelium and associates itself with the ocular
surface via its loose attachments to the
glycocalyx of the microplicae of the
epithelium; it is the hydrophilic quality of the
mucin that allows the aqueous layer to spread
over the corneal epithelium.
Classifying dry eye disorders
Virtually all dry eye disorders are related to an
increase in tear film osmolarity above the normal
limit of 311 mOsm/L. Osmolarity increases when
water is lost from the tear film without an
accompanying decrease in solutes, such as
sodium and potassium. Increased osmolarity may
result from any condition that decreases tear
production or increases tear evaporation.
Everyone experiences a gradual decline in tear
function with age, usually secondary to an
associated decline in corneal sensation and
meibomian gland function. However, in most
people, physiologic reserve along with some
ptosis is adequate to prevent symptoms and
disease.
WHY DRY EYE
In most cases, dry eye problem can be diagnosed
on the basis of patient's history. Patients with dry
eye disorders complain of chronic sandy-gritty
irritation that worsens as the day progresses. The
eyelids form a watertight seal over the eyes during
sleep, giving the ocular surfaces a chance to
recover. However, once the patient opens his eyes
in the morning, evaporation begins and tear film's
osmolarity increases as the day progresses.
Patients with meibomitis (posterior blepharitis)
also complain of chronic sandy gritty eye
irritation, but in these patients, the symptoms are
worse upon awakening. Morning irritation occurs
because tear production decreases during sleep,
and eye closure brings the inflamed lids against
the eye where inflammatory mediators act on the
cornea. When these patients awaken, tear flow
October - December 2014
increases, the lids pull away from the cornea and
symptoms improve. Eventually, chronic
meibomian gland inflammation leads to
dysfunction.
Complaints
Depending on the severity of dry eye syndrome
(DES), or keratoconjunctivitis sicca (KCS), the
following are the most common patient
complaints:
u
Foreign-body sensation and ocular dryness
and grittiness
u
Hyperemia
u
Mucoid discharge
u
Ocular irritation
u
Excessive tearing (secondary to reflex
secretion)
u
Photophobia
u
Fluctuating or blurry vision
Investigations:Invasive Techniques:
1) TBUT
2) Schirmer test
3) Phenol red thread
Non-Invasive Techniques:
1) Tearscope
2) Hand-held keratoscope
3) Keratometer
Schirmer Test
Ÿ
Without Anesthesia (Schirmer1)
- Measures Reflex Tear Secretion (dry eye = <
6mm wetting)
Ÿ
With Anesthesia (Schirmer2)
- Measures Basal Tear Secretion (dry eye =<
3mm wetting)
Verge Journal of the Venu Eye Institute & Research Centre 7
Tear break up
time (TBUT):
Invasive TBUT
Stain the tears
with fluorescein
dye and measure
the interval
between a
complete blink
and the appearance of the first randomly
distributed dry spot or hole in the pre-corneal tear
film.The normal value is more than 10 seconds
Ÿ
Dry eyes can also be the result of inflammation
in the lacrimal glands. A vicious cycle follows
in that the eye irritated by dry eyes, can over
stimulate the nerve fibers of the lacrimal glands
which causes further lacrimal gland
inflammation due to its over stimulation and
thus reducing the tear formation.
ETIOLOGY
Ÿ
An evaporative state
Ÿ
An aqueous deficiency state
Etiology: Evaporative loss
Non-Invasive TBUT
Ÿ
Instillation of fluorescein is
not required
Ÿ
Done with the instrument
called “Xeroscope”
It consists of a hemispherical
bowl with a grid of white lines
inscribed onto its inner matte
black surface mounted a slit
lamp. A ring fluorescent tube
attached to the rim of the bowl
illuminates the grid. It is viewed on the cornea
through the slit lamp Normal – 30 sec
AIM &OBJECTIVE
Ÿ
Effective treatment of dry eyes requires a
careful examination to determine which factor
is causing the symptoms. The main aim of the
treatment is to keep the eyes moist. The initial
treatment is usually the use of lubricating
eyedrops. These lubricate the eyes, and relieve
the symptoms.
Ÿ
Hydroxypropyl methylcellulose is the most
commonly used medication followed by
Carboxy Methycellulose. Those with severe
dry eyes require more aggressive therapy with
lacrimal punctual occlusion plugs.
Ÿ
Dry eyes due to diseases of the meibomian
glands and blepharitis generally respond well to
treatment with an antibiotic eye ointment like
tetracycline, ciprofloxacin, chloramphenicol.
8 Verge Journal of the Venu Eye Institute & Research Centre
Causes of evaporative loss can be further
classified as intrinsic or extrinsic.
Intrinsic causes
Meibomian gland
disease (MGD)
may involve a
reduced number of
functioning
glands, as in
congenital
deficiency or
acquired MGD, or replacement, as in
distichiasis, lymphedema-distichiasis
syndrome, or metaplasia. MGD may be divided
into 3 sub-types as follows:
Ÿ
Hypersecretory - Meibomian seborrhea
Ÿ
Hyposecretory - Retinoid therapy
Ÿ
Obstructive – This may be simple, primary or
secondary to local disease (e.g., anterior
blepharitis), systemic disease (e.g., acne
rosacea, seborrheic dermatitis, atopy,
ichthyosis, or psoriasis), syndromes (e.g.,
anhidrotic ectodermal dysplasia, ectrodactyly
syndrome, or Turner syndrome), or systemic
toxicity (e.g. 13-cis retinoic acid or
polychlorinated biphenyls); or it may be
cicatricial, primary or secondary to local disease
(e.g., chemical burns, trachoma, pemphigoid,
erythema multiforme, acne rosacea, vernal
keratoconjunctivitis [VKC], or atopic
keratoconjunctivitis [AKC])
Evaporative loss may result from a low blink rate
caused by the following:
Ÿ
Physiologic phenomenon, such as may occur
during performance of tasks that require
concentration (eg. working at a computer or a
microscope)
Ÿ
Extrapyramidal disorder, such as Parkinson
disease (decreasing dopaminergic neuron pool)
Evaporative loss may result from the following
disorders of eyelid aperture and eyelid-globe
congruity:
Ÿ
Exposure (e.g. craniostenosis, proptosis,
exophthalmos, and high myopia)
Ÿ
Lid palsy
Ÿ
Ectropion
Ÿ
Lid coloboma
Extrinsic causes
Vitamin A deficiency may cause dry eye as a
consequence of the
following:
Ÿ
Developmental
disorder of goblet
cells.
Ÿ
Lacrimal acinar
damage
Other extrinsic causes are as follows:
Ÿ
Contact lens wear
Ÿ
Ocular surface disease (e.g., allergy)
Ÿ
Severity
October - December 2014
DEFICIENT AQUEOUS PRODUCTION
Causes of deficient aqueous production can be
further classified as related or unrelated to NonSjögren syndrome
Primary lacrimal gland deficiencies that may
impair aqueous production include the
following:
Ÿ
Idiopathic
Ÿ
Age-related dry eye
Ÿ
Congenital alacrima (eg, Riley-Day syndrome)
Ÿ
Familial dysautonomia
Secondary lacrimal gland deficiencies that may
impair aqueous production include the
following:
Ÿ
Lacrimal gland infiltration
Ÿ
Lymphoma
Ÿ
AIDS
Ÿ
Graft vs host disease
Ÿ
Amyloidosis
Ÿ
Hemochromatosis
Ÿ
Lacrimal gland infectious diseases
Ÿ
HIV diffuse infiltrative lymphadenopathy
syndrome
Ÿ
Trachoma
Ÿ
Systemic vitamin A deficiency
(xerophthalmia)Malnutrition, fat-free diets,
intestinal malabsorption from inflammatory
bowel disease, bowel resection, or chronic
alcoholism
Ÿ
Lacrimal gland ablation
Ÿ
Lacrimal gland denervation
Lacrimal obstructive diseases that may impair
aqueous production include the following:
Ÿ
Ocular cicatricial pemphigoid
Ÿ
Erythema multiforme and Stevens-Johnson
syndrome
Ÿ
Chemical and thermal burns
Ÿ
Endocrine imbalance
Ÿ
Trachoma
Medications that may impair aqueous
production include the following:
Ÿ
Antihistamines
Verge Journal of the Venu Eye Institute & Research Centre 9
Ÿ
Beta blockers
Ÿ
Atropine
Ÿ
Oral contraceptives
Ÿ
Chronic contact lens wear
Ÿ
CN VII damage
For classification of DES on the basis of
severity, the Delphi Panel Report was adopted
and modified as a third component of the DEWS
(see the Table below)
Other conditions that impair aqueous production
include the following:
Dry Eye Severity level
Variable
1
Discomfort (severity
and frequency)
Mild, episodic;
occurs under
environmental
stress
Visual symptoms
None or episodic
mild fatigue
Conjunctival
injection
Conjunctival
staining
Corneal
staining (severity
and location)
Corneal and tear
signs
Lid and meibomian
glands
Tear breakup time
Schirmer value
2
Moderate,
episodic or
chronic; occurs
with or without
stress
Annoying or
activity-limiting,
episodic
3
4 (must have signs
and symptoms)
Severe, frequent or
constant; occurs
without stress
Severe or disabling,
constant
Annoying, chronic or
Constant and possibly
constant, activitydisabling
limiting
None to mild
None to mild
+/–
+/++
None to mild
Variable
Moderate to marked
Marked
None to mild
Variable
Marked central
Severe punctate
erosions
Filamentary keratitis,
Filamentary keratitis,
mucus clumping,
mucus clumping,
None to mild
increased tear debris,
increased tear debris
ulceration
Trichiasis,
MGD variably
MGD variably
keratinization,
MGD frequent
present
present
symblepharon
Variable
= 10 s
=5s
Immediate
Variable
= 10 mm/5 min
= 5 mm/5 min
= 2 mm/5 min
MGD=meibomian gland dysfunction.
Mild debris,
decreased
meniscus
Ÿ
Increasing the tear secretion
SUMMARY:
Ÿ
Immune inhibition therapy
Ÿ
Eliminating the etiological factors
Ÿ
Re-establish the tear film
Ÿ
Tears replacement therapy
Ÿ
Other supporting treatment
Ÿ
Maintain moisture in the eyes
10 Verge Journal of the Venu Eye Institute & Research Centre
Penetrating Keratoplasty
Ms. Vamshu Bhat, B.Sc IIIrd Year
Venu Eye Institute & Research Centre
Penetrating Keratoplasty refers to the
replacement of the host cornea with a donor
cornea.It is used with success in patients with
decreased visual acuity secondary to corneal
opacity, in the
treatment of
corneal thinning
or perforation, for
the removal of
non responding
infectious foci
and for the relief
of pain.
?
Pre-existing conditions that limit visual
potential, including amblyopia, macular or
retinal disease and optic nerve damage
?
Multiple graft rejections
?
Stromal neovascularization
?
Poorly controlled glaucoma
?
Eyelid abnormality
?
Dry eye
Pros and cons of PK
Pros:
?
Established technique with good long-term
data
?
Potential for best corrected visual acuity
?
Less surgical skill required
Cons:
?
Greater risk for graft rejection
?
Greater post operative astigmatism
?
Greater loss of endothelial cells
Indications
?
Pseudophakic or aphakic corneal edema
?
Endothelial dystrophies: Fuchs and posterior
polymorphous corneal dystrophy
?
Regraft related to allograft rejection
?
Regraft unrelated to allograft rejection
?
Stromal dystrophies: lattice, granular, avellino,
?
Keratoconus and other ectasias
?
Viral/postviral keratitis/keratopathy
?
Microbial including Fungal and Bacterial
keratitis /post microbial keratitis/keratopathy
?
Non-infectious ulcerative keratitis or
perforation
?
Corneal degenerations and dystrophies
including Fuchs endothelial dystrophy
?
Chemical injuries
?
Mechanical trauma, non-surgical
?
Congenital opacity
?
Iridocorneal endothelial syndrome
?
Refractive indications
?
Other causes of corneal opacification or
distortion, including surgical trauma
Surgical Procedure
The initial step in
Penetrating
Keratoplasty should
be the preparation of
the donor tissue.
The use a corneal
button 0.250.50mm larger than
the diameter of the
host corneal
o p e n i n g i s
recommended as it can help to reduce excessive
postoperative corneal flattening, reduce the risk
of secondary glaucoma and enhance wound
closure.
Contraindications
?
Active uveitis
?
Active keratitis, except when necessary for
tectonic support or for removal of infectious
material in progressive microbial keratitis
?
Severe ocular surface disease
The host cornea is trephined, the anterior
chamber is filled with viscoelastic and the donor
tissue is placed endothellial side down on the
recipient's eye. The cornea is then sutured in
place with either interrupted or continuous
sutures. Interrupted sutures are preferred in
October - December 2014
Verge Journal of the Venu Eye Institute & Research Centre 11
vascularized, inflammed or thinned corneas as
well as in pediatric cases.
Penetrating keratoplasty may be combined with
cataract surgery, secondary intraocular lens
implantation,glaucoma surgery or retinal
surgery.
Follow-up care
A. Post-operative visit is advised to ensure
epithelial healing and control of IOP and
inflammation
B. Visits are indicated more frequently in the first
90 days
C. Essential components of the post-operative
exam include:
?
Interval history
?
Measurement of visual acuity
?
Slit-lamp biomicroscopy
?
IOP assessment
D. Topical corticosteroid and other ophthalmic
medications
E. Suture removal
Intraoperative Complications
?
Damage to the lens or iris
?
Damage to the donor tissue
?
Vitreous loss
?
Retained Descemet membrane
?
Poor graft centration
?
Irregular trephination and wound leak
?
Suturing problems
?
Problems reforming the anterior chamber,
Vitreous in the anterior chamber?
?
Hyphaema
?
Choroidal haemorrhage or effusion and supra
choroidal haemorrhage
?
Post-operative Complications
?
Wound leak
?
Flat chamber/iris incarceration
?
Elevated IOP
?
Endophthalmitis
?
Glaucoma
12 Verge Journal of the Venu Eye Institute & Research Centre
?
Severe inflammation including formation of
fibrin
?
Microbial or viral keratitis
?
Persistent epithelial defect
?
Primary endothelial failure
?
Recurrence of primary disease
?
Suture-related problems
?
Post-operative astigmatism
?
Allograft rejection
?
Anterior or Posterior synechiae
?
Pupillary block
?
Choroidal detachment
?
Corneal vascularisation
?
Epithelial ingrowth
?
Transmission of donor disease
?
Traumatic wound rupture
?
Graft failure
Corneal Graft Rejection
A Symptoms
?
Decreased vision
?
Pain
?
Redness
?
Photophobia after
corneal transplant
B Signs
?
Keratic precipitates or a white line on the
corneal endothelium
?
Stromal edema or infiltrates
?
Subepithelial or epithelial edema
?
Conjunctival injection
?
Anterior chamber cells or flare
?
Neovascularization
C Differential Diagnosis
?
Increased intraocular pressure
?
Uveitis
?
Suture abscess
?
Corneal infection
?
Recurrent disease in the graft (Herpetic or
corneal dystrophy)
D Treatment
?
A topical steroid is prescribed immediately,
such as prednisolone acetate 1% q 1hr
?
Cycloplegic agent
?
Systemic steroids (prednisone 40-80 mg daily)
should be considered in cases that do not
respond to topical steroids and in recurrent
rejection episodes
Is penetrating keratoplasty for corneal
endothelial disorders associated with donor
age or not???
Although most of the cases did not show a
significant difference in 10-year success rates
comparing donor ages 12 to 65 years and 66 to 75
years, there was evidence of donor age effect at
the extremes of the age range. Observation of a
fairly constant 10-year success rate for donors
aged 34 to 71 years, which account for
approximately 75% of corneas available for
transplant, the Cornea Donor Study results
indicate that donor age is not an important factor
in most penetrating keratoplasties for endothelial
disease.
CASE HISTORY:
A 22-year-old male with a history of progressive
keratoconus
Chief Complaint: Diminishing vision and
progressive corneal ectasia in a patient with
keratoconus.
History of Present Disease: A 22-year-old male
with keratoconus was referred for progressive
corneal ectasia and diminishing visual acuity.
Initial management included spectacle
correction, but progression of his disease
required correction with rigid gas permeable
contact lenses. Best corrected visual acuity was
20/100 OD, 20/50 OS and 20/50 OU. The patient
was unable to work because of poor vision.
Glasses did not provide adequate correction and
he was intolerant tocontact lenses, particularly in
the right eye in which the lens continued to pop
out despite the best possible fit. The patient was
referred
Past Ocular History: Progressive keratoconus
OD > OS as described above.
October - December 2014
Medical History: None.
Family History: Father has keratoconus.
Medications: None
Ocular Exam:
Visual Acuity - best corrected with contact lenses:
?
OD—20/100
?
OS—20/50
Anterior segment examination:
?
OD—clear cornea with central thinning
(central corneal thickness 419 microns,
thinnest 360), Fleischer ring, Vogt's striae,
Munson's sign
?
OS—clear cornea with central thinning
(central corneal thickness 467 microns,
thinnest 396)
Dilated fundus exam:
?
Normal OU
Figure1: Slit
lamp photo
OD showing
i r o n
deposition in
the corneal
b a s a l
epithelial cells
(Fleischer
ring).
Figure2: Slit
lamp photo
demonstrating
ectasia and
protrusion of
the cornea.
central corneal
thickness was
419 microns
Treatment:
The most common surgical options for
keratoconus include Deep Anterior Lamellar
Keratoplasty (DALK) and Penetrating
Keratoplasty (PK).
Verge Journal of the Venu Eye Institute & Research Centre 13
Keep an Eye on Child’s Vision
Ms. Garima Raghav, Optometrist Intern
Venu Eye Institute & Research Centre
In India, we have many prevailing myths
regarding vision, the common one's being that a
squint is lucky and that hours of TV or video
games can cause refractive errors.
But there is one more myth that is still prevailing
in the Indian minds, that in the worst case scenario
their child can get a pair of glasses. But times have
changed a lot. And with these advancements our
awareness towards the various eye diseases
should also increase which urges for a more
collaborative approach to combat causes of
childhood vision loss.
Now a days we have advanced techniques to treat
most of the eye problems. But problem arises with
the late diagnosis. And in cases of children a late
diagnosis can leave an impact on their whole life.
So let's have a look at the common eye problems
that we see in children:
1. Amblyopia or Lazy Eye
If there is a significant difference in the image
quality between both the eyes then there is a
mental preference to the better eye and
suppression of the other one. This suppression
gradually becomes permanent which leads to loss
of vision in the weak eye if not managed timely.
Reason for this could be many like refractive error,
squint, cataract etc. In such cases early detection is
important as they can be best treated only upto 6
years of age. Amblyopia is one of the major cause
of childhood blindness and needs to be detected
and managed at an early age.
2. Strabismus
More commonly known as squint, it is the
misalignment of the visual axis which is
commonly seen during childhood. It can be of
various types and can have various etiology.
Squint can cause amblyopia which needs an
effective management plan consisting of glasses,
14 Verge Journal of the Venu Eye Institute & Research Centre
patching and surgeries to combat the possible
side effects.
Their management is critical for maintaining a
good visual functioning of the child.
3. Refractive error
All infants are born hyperopic but as they grow
old their refractive status makes a shift towards
myopia to attain the state of emmetropia. But its
failure significantly hinders the childs visual
performance. In children this condition usually
goes un-diagnosed as they interpret this blurred
stimulus as the best possible image they can get
with their eyes.
It not only alters their ability to see but is also
capable of degrading their academic
performance, generate asthenopic symptoms and
might cause some serious effects like bilateral
amblyopia. They are quiet common and demands
an immediate action.
4. Vergence and Accommodative Anamolies
As far as numbers are concerned, these
conditions are found on massive scale. Though
the potential side effects when compared to other
conditions are not as severe but the asthenopic
symptoms that they are capable of generating are
quiet sufficient to cause a significant degradation
in academic performance. Most commonly
parents of such children report of lack of
concentration and which in most of the cases is
usually blamed upon the notorious behaviour of
the child, leaving the possible cause undiagnosed.
There are also some other conditions that are not
as common but need an immediate attention
when diagnosed, like:
Retinoblastoma, an intraocular tumour usually
seen in early childhood. It is vision threatening,
and needs immediate enucleation (removal of
eye ball) as in late stages the tumour can be life
threatening also.
Congenital/Developmental cataracts are the
media opacities seen in the lens during childhood
and can cause form deprivation amblyopia which
among all types of amblyopia is most dangerous
and most difficult to treat. Early surgery is the
only key to good vision.
In many cases it is usually present with a family
history so patient education often plays an
important role. There are other eye conditions
like keratoconous, congenital glaucoma etc
which are often seen with many syndromes and
needed to be tackled accordingly.
Ophthalmologist are medical doctors who
provide comprehensive eye care with medicine
and surgery.
Peadiatric ophthalmologist are doctors who
have additional special training to treat childhood
eye problems.
Optometrists provide services that may be similar
to ophthalmologists, they examine, diagnose,
monitor, refer and manage to some extent, but
they don't perform surgery. Some optometrists
specialize in childhood eye problems.
We are talking about keeping an eye on child's
vision. But unlike adults a child is not going to
come to an optometrist and say "hey I'm not able
to see clearly. I need glasses."
In children there are certain signs that often
indicate a particular condition. Some of them are:
?
Constant eye rubbing - From a common
allergic conjunctivitis to early keratoconus this
feature is common and can be present in
various conditions hence it is needed to be
taken seriously.
?
Extreme light sensitivity
?
Poor focusing is often seen in the child having
significant accommodatative or vergence
anamoly. These deficits adversely affects the
child's academic performance.
?
Poor visual tracking (following an object)
?
Abnormal alignment or movement of the
eyes (after 6 months of age). Till six months
eyes learn to work in co-ordination. But any
ocular misalignment or abnormal eye
movement after this age should be viewed with
suspicion.
?
Chronic redness of the eyes
?
Chronic tearing of the eyes
?
A white pupillary reflex (leucocoria) instead
of black - can be a cataract or in rare cases it can
be a retinoblastoma
In school going children, other signs to watch for
include:
?
Being unable to see objects at a distance
?
Having trouble reading the blackboard (such
children usually squeeze their eyes to see the
blackboard or copy from his or her bench
mate's notebook)
?
Squinting
?
Difficulty in reading
?
Sitting too close to the television (most
common!)
Watch your child for signs of poor vision or
squinting eyes. If you notice any eye problems,
have your child examined right away so that the
problem doesn't become permanent. If caught
early, eye conditions can often be treated
efectively.
Now we have a next question standing in front of
us.
When to take the child to the doctor?
In our country, eye check-ups are usually
preceded by a referral from a teacher or more
rarely from a school screening camp.
But the point is a regular eye examination is
equally important like a regular health check up.
Cont. on Page No. 19
October - December 2014
Verge Journal of the Venu Eye Institute & Research Centre 15
Binocular Single Vision
Ms. Radhika, B.Sc IIIrd Year
Venu Eye Institute & Research Centre
Binocular Single Vision may be defined as the
state of simultaneous vision, which is achieved
by the coordinated use of both eyes, so that
separate and slightly dissimilar images arising in
each eye are appreciated as a single image by the
process of fusion. Thus binocular vision implies
fusion, the blending of sight from the two eyes to
form a single percept.
Binocular Single Vision can be:
1. Normal – Binocular Single vision can be
classified as normal when it is bifoveal and
there is no manifest deviation.
2. Anomalous - Binocular Single vision is
anomalous when the images of the fixated
object are projected on the fovea of one eye
and an extrafoveal area of the other eye i.e.
when the visual direction of the retinal
elements has changed. A small manifest
strabismus is therefore always present in
anomalous Binocular Single vision.
Normal Binocular Single vision requires:
1. Clear Visual Axis leading to a reasonably clear
vision in both eyes
2. The ability of the retino-cortical elements to
function in association with each other to
promote the fusion of two slightly dissimilar
images i.e. Sensory fusion.
3. The precise co-ordination of the two eyes for
all direction of gazes, so that corresponding
retino-cortical element are placed in a position
to deal with two images i.e. Motor fusion.
The advantages of a Binocular vision are:
1. The first and the foremost advantage of a
binocular vision is single vision
2. In addition to single vision it results in
stereopsis – the most precise kind of depth
perception
3. Enlargement of the field of vision
4. Compensation for blind spot
GRADES OF BINOCULAR SINGLE
VISION:
16 Verge Journal of the Venu Eye Institute & Research Centre
Worth classified binocular single vision to be of
three grades?
Simultaneous Macular Perception
?
Fusion
?
Stereopsis
Simultaneous Macular Perception
Simultaneous perception exists when signals
transmitted from the two eyes to the visual cortex
are perceived at the same time. It consists of the
ability to see two dissimilar objects
simultaneously.
FUSION
Fusion is the cortical unification of visual objects
into a single percept that is made possible by the
simultaneous stimulation of corresponding
retinal areas.
Slides for simultaneous macular perception
Fusion Slides
Sensory Fusion – It is based on the innate orderly
topographic relationship between the retina and
the visual cortex, whereby corresponding retinal
points, project to the same cortical locus, and
corresponding adjacent retinal points have
adjacent cortical representation.
Motor Fusion - It is the ability to align the eyes in
such a manner that sensory fusion can be
maintained. The stimulus for these fusional eye
movements is retinal disparity outside panum's
area and the eyes moving in opposite direction
(vergence). Unlike sensory fusion, motor fusion
is the exclusive function of the extrafoveal retinal
periphery.
STEREOPSIS
Stereopsis allows subjective ordering of visual
objects in depth; or three-dimension. It is the
highest form of binocular co-operation and it
adds a new quality of vision.
Central and Peripheral Suppression
?
Images formed on the fovea of the deviating
eye are prevented from reaching consciousness
in order to avoid confusion. This is called
central suppression.
?
The image similar to the one falling on the
fovea of the fixing eye falls on the peripheral
retina of the deviating eye. Suppression of this
image is called peripheral suppression.
Monocular and Alternate Suppression
?
If the image from one eye alone is suppressed, it
is called monocular suppression. This leads to
amblyopia in that eye.
?
If the images from the two eyes are suppressed
alternately, it is called alternate suppression.
This occurs in alternating squints and usually
both eyes have fairly good visual acuity.
ANOMALIES OF SMP
Confusion
When squinting occurs the two fovea view two
different objects that are physically separated in
objective space, and send two different images to
a single cortical perceptual area. This leads to
confusion. But, confusion is not common as the
cortex immediately settles for one image with its
inherent strong cortical or retinal rivalry.
Diplopia
When squinting occurs an object in space is
perceived by the fovea of one eye and some other
extra-foveal point of the other eye, which has a
different projection or localization value in space.
Thus an object would be localized twice in space
causing diplopia. Diplopia usually results from
an acquired misalignment of the visual axis.
Suppression
The image formed in one eye is prevented from
reaching consciousness. This is called
suppression. It occurs when there is strabismic
misalignment of the visual axis. It is an adaptation
to avoid diplopia and/or confusion.
There are various types of suppression:
October - December 2014
Facultative and Obligatory Suppression
?
Suppression is called facultative when it is
present only when the eyes are in the deviated
state and absent in all other states.
?
Obligatory Suppression is present at all times
irrespective of whether the eyes are aligned or
misaligned.
Retinal Correspondence,
Abnormal (ARC)
It is type of retinal
correspondence in which the
fovea of one eye is
associated with an
extrafoveal area of the other
eye to give rise to a
perception of a single object.
This phenomenon is
common in strabismus, but
may also occur as a result of a macular lesion.
Amblyopia
Amblyopia, also called lazy eye, is a disorder of
sight. It involves decreased vision in an eye that
otherwise appears normal, or out of proportion to
associated structural problems of the eye.
Verge Journal of the Venu Eye Institute & Research Centre 17
Glaucoma Screening
Ms. Arti Gupta, B.Sc IIIrd Year
Venu Eye Institute & Research Centre
Glaucoma is a condition that causes damage to
the optic nerve and gets worse over time. It's often
associated with a buildup of pressure inside the
eye. Glaucoma tends to be inherited and may not
show up until later in life.
Normally, this fluid, called aqueous humor,
flows out of the eye through a mesh-like channel.
If this channel becomes blocked, fluid builds up,
causing glaucoma. The direct cause of this
blockage is unknown, but it can be inherited.
Less common causes of glaucoma include a blunt
or chemical injury to the eye, severe eye
infection, blockage of blood vessels in the eye,
inflammatory conditions of the eye, and
occasionally eye surgery to correct another
condition. Glaucoma usually occurs in both eyes,
but it may involve each eye to a different extent.
The increased pressure, called intraocular
pressure, can damage the optic nerve, which
transmits images to the brain. If damage to the
optic nerve from high eye pressure continues,
glaucoma will cause permanent loss of vision.
Without treatment, glaucoma can cause total
permanent blindness within a few years.
Because most people with glaucoma have no
early symptoms or pain from this increased
pressure, it is important to get the eyes checked
regularly so that glaucoma can be diagnosed and
treated before long-term visual loss occurs.
RISK FACTORS:?
Age more than 40.
?
Family history of glaucoma
?
High eye pressure(IOP)
?
Farsightedness
?
High blood pressure
?
Diabetes
?
Patients taking corticosteroid medicines
?
Eye injury
Diagnosis of Glaucoma
If patient is over age 40 and have a family history
of glaucoma, a complete eye checkup is necessary
at least once in a year. Patients with some health
problems such as diabetes or a family history of
glaucoma or are at risk for other eye diseases.
Why Does Pressure Rise in the Eye to Cause
Glaucoma?
Glaucoma usually occurs
when pressure in your
eye increases. This can
happen when eye fluid
isn't circulating normally
in the front part of the
eye.
18 Verge Journal of the Venu Eye Institute & Research Centre
Individuals at high risk for glaucoma should have
a dilated pupil eye examination at least every one
to two years. Eye doctors use
several tests to detect
glaucoma; these tests include:
?
Tonometry measures the
pressure inside the eye
?
Field testing measures the
entire area
seen by the
forwardlooking eye to
document
straighta h e a d
(central)
and/or side
(peripheral)
vision.
?
A visual acuity test measures sight at various
distances. While seated 20 feet from an eye
chart, the patient is asked to read standardized
visual charts with each eye, with and without
corrective lenses.
?
Pachymetry uses an ultrasonic wave instrument
to help determine the thickness of the cornea
and better evaluate eye pressure.
?
Ophthalmoscopy allows the doctor to examine
the interior of the eye by looking through the
pupil with a
special
instrument.
This can
help detect
damage to
the optic
n e r v e
caused by
glaucoma.
?
Gonioscopy
allows the doctor to view the front part of the
eye (anterior chamber)
to
determine if the iris is closer than normal to the
back of the
cornea.
This test
can help
diagnose
closeda n g l e
glaucoma.
?
O p t i c
n e r v e
October - December 2014
imaging helps document optic nerve changes
over time. Nerve imaging techniques include
stereo optic nerve photographs, scanning laser
polarimetry (GDx), confocal scanning laser
ophthalmoscopy (Heidelberg Retinal
Tomograph or HRT) and optical coherence
tomography (OCT). It is very important to have
regular eye examination particularly if patient
has any of the risk factors associated with
glaucoma. However, if diagnose early
glaucoma is treatable. If detected early, disease
prognosis can be delayed by monitoring and
controlling the eye pressure.
C o n t d . f r o m P a g e No.15
Here is a rough guideline for when to get it done:
?
Newborns should be checked for general eye
health by a pediatrician or family physician in
the hospital nursery
?
High-risk newborns (including premature
infants), those with a family history of eye
problems, and those with obvious eye
irregularities should be examined by an eye
doctor
?
In the first year of life, all infants should be
routinely screened for eye health during
checkups with their pediatrician or family
doctor
?
Around the age of 3½ years, children should
have eye health screenings and visual acuity
tests (tests that measure sharpness of vision)
with their pediatrician or family doctor.
?
Around the age of 5 years, children should
have their vision and eye alignment checked by
their pediatrician or family doctor. Those who
fail either test should be examined by an eye
doctor.
?
After the age of 5 years, routine screenings
should be done at school and the doctor's clinic
Verge Journal of the Venu Eye Institute & Research Centre 19
Systemic Disease that affect our Eyes
Ms. Neha, B.Sc IIIrd Year
Venu Eye Institute & Research Centre
Systemic diseases are the diseases that occur in
any part of our body. They can happen to any
person at any age. Ocular involvement in
systemic disorders is quite frequent. It is
important for the ophthalmologist as well as
general physician to pay necessary attention
towards it. Many-a time, the ocular manifestation
may be the presenting signs and the
ophthalmologist should refer the patient to the
related specialist for further treatment &
diagnosis. Sometimes, patient suffering from
high blood pressure and diabetes does not know
that they are suffering from it unless the disease
affects their eyes. So, systemic diseases are very
important to be considered in case of eyes.
HOW EYES ARE RELATED WITH
SYSTEMIC DISEASES?
The eyes are linked
with the other part
of body by many
means, such as its
blood supply, nerve
supply & meninges
with the brain. So,
it is obvious that
we can expect that
eye would reflect changes within the body,
especially vascular changes.
COMMON SYSTEMIC DISEASES THAT
EFFECT OUR EYES are as follows:
?
Ocular disorder due to nutritional deficiencies
like XEROPHTHALMIA.
?
Ocular problem due to immunological disorder
like
* RHEUMATOID ARTHIRITIS
* SYSTEMIC LUPUS ERYTHEMATOSUS
* SARCOIDOSIS
* REITER SYNDROME
?
Ocular problem related with some
haematological disease like- SICKLE CELL
ANAEMIA
?
Ocular problem related with some infectious
20 Verge Journal of the Venu Eye Institute & Research Centre
systemic disorder like
AIDS,
TUBERCULOSIS
?
Ocular disorder due to some endocrine
disorder or circulatory disorder like
* DIABETES MELLITUS
* HYPERTHYROIDISM
* HYPERTENSION
?
Ocular disorder related to muscular disorder
like MYASTHENIA GRAVIS
HOW DO SYSTEMIC DISEASE EFFECT
OUR EYES
?
XEROPHTHALMIA –It is a common
nutritional deficiency disorder of eye. It occurs
due to dietary deficiency of vitamin A or its
defective absorption from gut. It can cause
night blindness, conjunctival xerosis, corneal
xerosis,
corneal ulcer
& scar.
?
A U T O
IMMUNE
DISORDERO c u l a r
involvement
occur as a
component
of various auto immune disorder, but the eye
can also be involved secondarily, due to post
inflammatory effect of disease or side effect of
medication. common disease like
RHEUMATOID ARTHIRITIS, SYSTEMIC
L U P U S E RY T H E M AT O S U S ,
SARCOIDOSIS can cause inflammation in the
eye. A common example of hypertensive
retinopathy is seen in systemic lupus
Scleritis
Uveitis
limbic keratitis, disc oedema.
?
HYPERTENSION- It is the most common
systemic disease. Every person of age 40 may be
suffering from it. It can cause macular edema,
cotton wool spots, retinal detachment,sub
conjunctival haemorrhages etc.
?
MYASTHENIA GRAVIS - It is a muscular
disorder. It can
affect the extra
ocular muscle of
eye. The extra
ocular muscle
differs from
skeletal muscle
elsewhere in the
body in the
nerve to motor
end plate ratio and tonicity of the muscle. It can
cause ptosis & diplopia.
erythematosus. Besides this, dry eye, scleriti,
uveitis enlargement of lacrimal glands are also
some ocular feature of these disease.
?
SICKLE CELL ANAEMIA- It is a
haematological disease. The ocular
manifestation may be the initial reason for
presentation to an ophthalmologist or physician
in some cases. It can cause dilated conjunctival
vessels, retinal capillary
o c c l u s i o n ,
neovascularization,
chorioretinal scar.
?
AIDS- It is an infectious
disease with the HIV
virus, an RNA virus of
the human retrovirus
family. The disease is characterized by a
deficiency of T-helper lymphocytes. Ocular
lesion is a common feature of AIDS. The ocular
manifestations of HIV infection itself are
microangiopathy
affecting mainly the
conjunctiva and
retina and Kaposi
sarcoma of the lids
& conjunctiva. It
can cause HIV
retinopathy. Ocular
features include
cotton wool spots
on retina, superficial & deep hemorrhages,
microaneurysmes, retinal detachment etc.
?
TUBERCULOSIS- is also a bacterial infectious
disease. It causes a whole spectrum of
involvement from lids to the ocular coats.
?
DIABETES MELLITUS – It is a metabolic
disorder. Blood sugar is raised due to defective
insulin secretion/resistance to its action. In long
standing cases of diabetes, ocular complication
are found, they may even lead to visual loss. It
can cause subconjunctival haemorrhages,
refraction changes, premature formation of
senile cataract, glaucoma etc.
?
HYPERTHYRODISM - It can cause
exophthalmos, lid retraction, lid lag, superior
Systemic diseases are diseases that can happen to
any person. We can't do anything to stop them but
we can reduce the effect or treat the disease when
it is diagnosed.
For this a regular
health checkup is
advised to every
person. A regular
eye checkup can
reveal any
systemic disease
at its early
stages. So, we
can treat them. If the eyes are involved then the
ophthalmologist can do the treatment and
depending upon the condition of disease, if
systemic treatment is needed then the patients is
referred to the related specialist for further
management. Ocular treatment include therapy,
inflammatory drugs, laser therapy, surgery etc. By
following all the parameters we can prevent all
eye problems related to systemic diseases
October - December 2014
Verge Journal of the Venu Eye Institute & Research Centre 21
HOW CAN WE PREVENT THE EFFECT OF
SYSTEMIC DISEASES ON BODY?
VERGE
October-December 2014
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