2. The word hypermetropia is derived from the
words
Hyper- excess
Met-measure
Opia –of the eye
The hypermetropia is also known as hyperopia
And long-sightdness.
3. Defination
•When the parallel rays of light coming from infinity
are focused behind the retina with accommodation
being at rest
4. ETIOLOGY
1) AXIAL
Most common
Axial length is short
1mm shorting of AP dia 3 D of HM
At birth +2.5 – 3 D of HM (physiologically)
Phyiologically more than 6D HM are uncommon
5. 2) CURVATURAL
Flattening of cornea, lens or both
1mm increase in Radius of curvature 6D of HM
Never exceed 6D HM physiologically
Congenitally flattened is c/a cornea plana
Result (trauma and disease )
3) INDEX
Change in refractive index with age
Physiologically in old age
Pathologically in diabetics under treatment
6. 4)POSITIONAL
Posteriorly placed crystalline lens
Occurs as congenital anomaly
Result of trauma or disease
5)ABSENCE OF LENS
Seen in aphakia
8. SIMPLE HYPERMETROPIA
Commonest form
Results from normal biological variations in the
development of eyeball
Include axial and curvatural HM
May be hereditary
9. PATHOLOGICAL HYPERMETROPIA
Results due to either congenital or acquired conditions
of the eyeball which are outside the normal biological
variations of the development.
• There are two types of pathological hypermetropia
1 congenital hypermetropia
2 acquired hypermetropia
10. Congenital
pathological
•Is seen in following conditions
•Microphthalmos,
•Microcornea,
•Congenital posterior subluxation of the lens and
•Congenital aphakia
11. Acquired
pathological
1 senile hypermetropia or frequently designated as
acquired hypermetropia , occurs in old age due to
two causes
•Curvatural hypermetropia
•Index hypermetropia
2 poistional hypermetropia may occur due to
acquired posterior subluxation of the lens
3 aphakia due to acquired absence of lens
12. 4 consecutive hypermetropia due to surgically
overcorrected myopia or pseudophakia with
undercorrection
5 retrobulbar orbital tumors may sometime
manifest as hypermetropia by anteriorly pushing
the posterior wall of the eyeball
13. FUNCTIONAL HYPERMETROPIA
Results from paralysis of accommodation
Seen in patients with 3rd nerve paralysis & internal
ophthalmoplegia
15. TOTAL HYPERMETROPIA
It is the total amount of refractive error,estimated
after complete cycloplegia with atropine
Divided into latent & manifest
16. LATENT HYPERMETROPIA (Hl)
Amount of hyeropia corrected by inherent tone of
ciliary muscle (Usually about 1D)
Degree of Hl High in children
Decreases with age
Revealed after abolishing tone of ciliary muscle
with atropine
17. MANIFEST HYPERMETROPIA
Remaining part of total hypermetropia
Correct by accommodation and convex lens
Consists of facultative & absolute
FACULTATIVEHYPERMETROPIA
Corrected by patients accommodative effort
ABSOLUTE HYPERMETROPIA
Residual part not corrected by patients
accommodative effort
19. SYMPTOMS
Principal symptom is blurring of vision for close
work
Symptoms vary depending upon age of patient &
degree of refractive error
1.ASYMPTOMATIC
small error produces no symptoms
Corrected by accommodation of patient
20. 2.ASTHENOPIA
Refractive error are fully corrected by
accommodative effort
Thus vision is normal
SYMPTOMS
Tiredness
Frontal or fronto temporal headache
Watering
Mild photophobia
21. 3.DEFECTIVE VISION WITH ASTHENOPIA
Not fully corrected by accommodation
Defective vision for near more than distance
4.DEFECTIVE VISION ONLY
Refractive vision more than 4D
Adults who usually do not accommodate
Marked defective vision for near and distance
22. 5. The effect of aging on vision :
Progressive loss of accomodative power with
ageing progressive loss of vision.
6. Intermittent sudden blurring of vision:
May occur due to spasm of accomodation inducing
pseudomyopia
Cycloplagic refraction reveals the underlying
hyperopia
23. SIGNS
VISUAL ACUITY : Defective
EYEBALL: small or normal in size
CORNEA : may be smaller than normal.
ANTERIOR CHAMBER : may beshallow
LENS: could be dislocated backwards
A Scan ultrasonography (biometry) reveal short
axial length
24. FUNDUS:
A) DISC: which may look small and more reddish
in colour with ill-defined margins and even
simulate papillitis.
B) MACULA: foveal reflects may be situated at
greater distance from the disc margins.
C) BLOOD VESSELS: Show undue tortuosity &
abnormal branchings
D) BACKGROUND: SHOT- SILK RETINA (shiney)
26. BASIS FOR TREATMENT
No Treatment
Error is small
Asymptomatic
Visual acuity normal
No muscular imbalance
TREATMENT
27. Young children(<6 or 7yrs)
Children younger than 4 years who require
hypermetropic correction can usually accept the full
cycloplegic measurement
Once a child reaches school age, consider reducing the
plus for the refractive prescription by about one-third
but the child is not required to accommodate more
than 2.5 continually for the distance
28. Adults
The older children may not accept full cycloplegic
refraction because of blur distance .
So always first undercorrect and prescribe the glasses
that the child accepts comfortably.
Gradually increase the spherical correction at 6-
month interval till the patient accepts ,manifest
hypermetropia
Exophoria hyperopia should be under correct by 1 to
2D
29. In the presence of accommodative convergent
squint, full correction should be given at the first
sitting.
If there is associated amblyopia, full correction
with occlusion therapy should be started.
It is important to remember that hypermetropia
may diminish with the growth of the child. So,
refraction should be carried out every 6 months,
and if necessary the correction should be
reduced.
31. SPECTACLES
Basic principle
Prescribe convex lenses (Plus lenses) so that
rays are brought to focus on the retina
Advantages
Comfortable
Easier method
Less expensive
Safe
34. VISUAL HYGIENE
While reading or doing intensive near work take
a break about every 30 min
When reading maintain proper distance that is
the book should be at least as far from your eyes
as your elbow when you make a fist and hold it
against your nose
Sufficient Illumination
Place a limit spent watching television &
watching videogames
Sit 5-6 feet away from the television
35. Appropriate optical correction almost always leads
to clear and comfortable single binocular vision
Younger children who have significant hyperopia
associated with amblyopia, strabismus,or
anisometropia require treatment, starting as early
as 3-6 months of age