This document provides information about common eye conditions like cataract, refractive errors, and conjunctivitis. It discusses the risk factors, clinical features, investigations, management, and referral pathways for each condition. For cataract, it describes screening, treatment by surgery, and the role of the CHO in management and follow-up care. For refractive errors, it discusses screening, testing visual acuity, and managing patients through referrals and follow-up. For conjunctivitis, it describes the types, clinical features for diagnosis, treatment with antibiotics or anti-allergics, and the CHO's role in identification, referral, and follow-up.

1. CHO Module on Eye Care
Chapter 5 – Chapter 12
Page Number: 16-27
Common Eye related Conditions

2. Learning Objectives
 Understand about some of the common eye
conditions which you are expected to experience
at SC-HWC.
 To know about the risk factors, clinical features
and management of each of this condition, along
with the referral care pathway

3. Cataract
 Refers to the opacification of crystalline lens,
which impedes the passage of light reaching the
retina leading to impaired vision.
 Affects- adults more than 50 years.
 People who are in 20 years and 30 years of age
may also develop cataract.

4. Cataract...
Clinical Features
Symptoms:
 Gradual painless progressive diminution of vision in one or
both eyes
 Excessive glare
 Monocular diplopia (double vision in only one eye) or Polyopia
(seeing of multiple images on focusing on one object)
 Coloured halos /bright circles around lights
 Diurnal variation in vision
Signs:
 Greyish white or whitish lenticular opacity on torch light
examinations.

5. Cataract...
Investigations:
 Visual Acuity, Intra Ocular Pressure (IOP)
 Blood Pressure, Random Blood sugar
 Prior to Surgery: ECG, Urine routine, A-scan, Xylocaine
sensitivity test.
Management:
a) Screening for Cataract
b) Treatment for Cataract
c) Role of CHO in management of Cataract

6. Cataract...
a) Screening for Cataract
 Examine the eye of the patient with the help of a torch.
 In normal cases, the pupils get constricted and appear jet
black.
 In patients suffering from cataract, due to the opacity of the
lens, light gets reflected and the pupil appears to be white.
b) Treatment for Cataract
 No medicines.
 Surgery is the primary method of treatment.
 Hence, all suspected cases of cataract should be referred to
eye camps (organized under National Programme for Control
of Blindness)/ eye surgeons for further evaluation and
management.

7. Cataract...
c) Role of CHO in management of Cataract:
 Screening all individuals (even younger age group)
 Maintain a list of all facilities where Eye Surgeon/Eye
Specialist is available, for identification of operable cataract
and surgery nearest to your service area.
 Linking patients with suspected cataracts to these facilities for
treatment (PHC-MO to be informed regarding the referral).
 Inform the individuals that under the National Programme,
cataract surgeries with Intra Ocular Lens (IOL) insertion would
be done free of cost at all government institutions.

8. Cataract...
 Follow up all post – operative cases to ensure that they
follow proper eye care post cataract surgery and do not
develop any complications.
 Long term follow- up of all cataract cases for vision acuity.
 Supervise the primary healthcare team members for
conducting health promotion activities and ensure screening
of individuals for eye disorders and blindness. (special
attention to those with diabetes and hypertension).
 Maintenance of records and registers. ANM/MPW will assist
you in maintaining the records and reports, as required.

9. Referral care pathway for Cataract
Patient presents with complaints of:
diminution of vision, opacity in front of the eyes, coloured
halos around light sources, excessive glare
Ask for:
Onset and progression of vision
loss
whether asssociated with pain
Uni / bilateral loss of vision
Known case of DM/HTN
Any other medicine use
Previous eye surgery
Assess for:
Age of the patient
General examination: BP, RBS
Ophthalmic examination:
i. Check for any uncorrected
refractive errors
ii. Torch examination to look for
opacity of lens
Probable case of cataract if:(1) Gradual painless loss of vision (2) Bilateral
(although one may be more affected than the other) (3) Age of patient above 30
years (4) Known case of DM/HTN (5) Opacity of lens observed during torch
examination

10. Referral care pathway for Cataract
Refer to DH/ or to a facility with eye surgeon/eye specialist/ any near-by eye camp
After treatment at the referral centre (surgery in cases of cataract), patient is
referred back to AB-SHC-HWC for follow-up
Follow-up care through AB-SHC-HWC:
-Instilling antibiotic eye drops as prescribed by the surgeon
- Check for post-operative complication such as watering from the eyes, continued redness and pain in the eye
- Counsel about: (1) Importance of follow-up visits to surgeon after 24 hours/ as advised by surgeon. (2) Need
for using protective eye wear such as dark glasses during day time (3) Procedure of cleaning the eyes and
instillation of eye drops (4) Avoid splashing water into the operated eye during face wash/bathing. Head bath
can be resumed only after a period of 3-4 weeks. (5) Lifting heavy objects/ exercises should be avoided for 4-6
weeks (6) Avoid applying kajal/mascara for at least 4 weeks (7) Warning Symptoms such as increasing
redness, pain or decreased vision, needing re-referral to the surgeon
Follow-up at community level through ASHA/ANM/MPW:
-Visit the patient on Day 1, Day 3 and Day 7 after surgery
- Check if the patient is able to use the eye drops correctly and has understood the dosage of his medicines.
- Re-enforce the post-operative care and pre-cautions to be undertaken.
- Ask if the patient is suffering from any of the warning symptoms such as increasing redness, pain or
decreased vision, needing URGENT referral to the eye surgeon.

11. Loss of Vision
 Loss of vision can be due to many reasons.
 The flow chart below will guide you how to check
anybody who complains of loss of vision.

12. Loss of
Vision
CANNOT SEE
CLEARLY
Cannot see things close by or read
clearly
NEAR VISION LOST
MEASURE DISTANT
VISION
BOTH EYES
ARE NORMAL
CHECK NEAR
VISION
NEAR VISION
NORMAL
REASSURE
NEAR VISION
ABNORMAL
REFER FOR
FURTHER TESTING
AND POSSIBLE
GLASSES
Cannot see things far away , things are blurred
DISTANT VISION LOST
MEASURE
DISTANT
VISION
VISION
NORMAL IN
BOTH EYES
REASSURE
VISION
ABNORMAL IN
ONE/ BOTH
EYES
SUDDEN OR
GRADUAL LOSS?
SUDDEN LOSS IN
ONE/BOTH EYES
URGENT
REFERRAL TO
EYE SPECIALIST
GRADUAL
LOSS
REFER FOR
FURTHER
TESTING

13. Loss of Vision...
 AB-HWC-SHC will be responsible for making all referrals
required to the appropriate health facility.
 ANM/MPW will assist you in arranging for referral.
 Inform the PHC-MO regarding all referrals.
 CHO along with the ANM/MPW and ASHA will help in
providing follow-up care for ensuring adherence to
treatment as advised and for developing any
complications.

14. Refractive Errors
 Normally, the rays of light entering the eye are
brought to a precise focus on the retina.
 When such a focus is not achieved, a refractive
error results and vision is not clear.
 In India, it is estimated to be the second largest
cause of treatable blindness, next only to
cataract.

15. Refractive Errors...
 Ametropia includes myopia- when light rays focus at a point in front of
retina.
 Hypermetropia- when light rays focus at a point behind the retina.
 Astigmatism- when light rays focus at different points on the retina.
 Presbyopia- common type of vision disorder that occurs due to
ageing where the eye is not able to focus light from near objects
directly onto the retina due to the hardening of the zonular ligaments
of the natural lens.

16. Refractive Errors...

17. Refractive Errors...
Clinical Features
Symptoms:
 Myopia, hypermyopia
 Headache
 Tiredness and watering from eyes
 Constant itching of the eyes
 Frequently blinking/squeezing eyelids
 Lid swelling
 Some children many have squint (cross-eyes)

18. Refractive Errors...
Management:
a. Screening for Refractive Errors/
Testing of Visual Acuity
 Done using certain vision charts.
 CHO and the MPW/ANM will be
responsible for screening for blindness
and refractive errors using Snellen’s
chart and near vision card/chart.
 ASHA will undertake screening for Visual
Impairment for all adults at community
level using 6/18 Vision Chart (E chart).

19. Refractive Errors...
Management:
b. How to Measure Near Vision using Near Vision card/chart
Steps for testing Near Vision
1. Make the individual sit upright in a well illuminated room.
2. Place the near vision card/chart at a distance of 35 cms from
the individual.
3. Ask the individual to close one eye and start reading the
alphabets from the top line moving downwards. The lowermost
readable line is the vision of the patient.
 The individuals who cannot read N 12 line in the chart will be
referred.
 Refer them to the ophthalmic assistantat the PHC/Vision
Centre for further assessment (PHC-MO to be informed
regarding the referral).

20. Refractive Errors...
Role of CHO:
 Annual screening of all the community members aged 30 years
and above.
 Opportunistic screening at AB-HWC-SHC for the remaining
population (18-29 years).
 Support the RBSK in undertaking eye screening of children
and adolescents 0-18 years of age.
 Making a list of all Vision Centres/ higher health facilities
having OA and Eye Specialist.

21. Refractive Errors...
Role of CHO:
 Linking patients with any suspected refractive errors to the
PHC/nearest Vision Centre.
 Inform the patients that free spectacles may be available free
in all Government Health Institutions.
 Follow- up with all individuals.
 Supervise the primary healthcare team members for
conducting health promotion activities.
 Maintenance of records and registers.

22. Referral care pathway for Refractive Errors
ASHA identifies a case using the 6/18 chart and refers to AB-HWC-SHC
OR the Patient himself presents at AB-HWC-SHC with complains of
inability to read/see distant / near objects clearly
Ask whether, the diminution in vision is:
- Painless, Gradual and Bilateral
- More for distant / near by objects
- Not associated with features such
excessive watering / redness of eye
Yes
Screen for
refractive errors
Visual Acuity >
6/18 Visual acuity
<6/18
No
Refer to Vision centre/ specialist for
further evaluation and management
Check if:
- There are no obvious sign of
trauma, local opthalmic infections
- Patient is stable

23. Referral care pathway for Refractive Errors
Follow-up care @ AB-HWC-SHC through CHO (ANM/MPW can also provide support):
(1) Check if there is improvement in the vision of the patient using the prescribed glasses.
(2) Counsel the patient about:
- Ask if the patient is having any difficulty in using the glasses and encourage constant, regular use of eye glasses.
- To report back to the AB-HWC-SHC in case of symptoms such as continued redness, watering, eye fatigue,
diminished vision following the use of spectacles
- Vit. A rich food items
- Simple eye exercises to reduce eyestrain (20-20-20 rule): Every 20 minutes, look away about 20 feet in front of
you for 20 seconds
- Limiting the use to light of television /computer and other gadgets as much as possible
Follow-up care @ AB-HWC-SHC through CHO (ANM/MPW can also provide support):
(1) Check if there is improvement in the vision of the patient using the prescribed glasses.
(2) Counsel the patient about:
- Ask if the patient is having any difficulty in using the glasses and encourage constant, regular use of eye
glasses.
- To report back to the AB-HWC-SHC in case of symptoms such as continued redness, watering, eye fatigue,
diminished vision following the use of spectacles
- Vit. A rich food items
- Simple eye exercises to reduce eyestrain (20-20-20 rule): Every 20 minutes, look away about 20 feet in front of
you for 20 seconds
- Limiting the use to light of television /computer and other gadgets as much as possible

24. Conjunctivitis
 Inflammation of conjunctiva is called as conjunctivitis.
 It is one of the most common reasons for an acute episode of
red eye.
Classification:
a. Infective:
i. Bacterial Conjunctivitis: Staphylococci, Streptococci,
Pneumococci, Gonococci
ii. Viral Conjunctivitis: Herpes simplex, Herpes Zoster,
Adenovirus, etc
b. Allergic conjunctivitis (more common):
Allergic reactions to dust, pollen, etc.

25. Conjunctivitis...
Clinical Features
Symptoms:
 Acute redness of eyes
 Foreign body sensation in eyes
 Watering from eyes
 Photophobia (intolerance to light)
Signs:
 Purulent discharge with matting of eye lashes due to discharge
with photophobia: Probable case of Bacterial Conjunctivitis.
 Watery discharge with pre-auricular lymphadenopathy and
swollen lids: Probable case of Viral conjunctivitis.
 Slightly muco-purulent discharge, recurrent episodes without
much photophobia: Probable case of Allergic conjunctivitis.

26. Conjunctivitis...
 Common Differential diagnosis of painful-red eyes
.
Conditions Features
Foreign body in
eye (e.g. dust,
pollen, etc.)
Usually affects one eye only; redness and pain
variable
Burns or
harmful liquids
One or both eyes; redness and pain variable
Conjunctivitis/
Hay Fever/
Trachoma
Usually affects both eyes
(may start/ be worse in
one eye).
Usually more red at the
outer edge.

27. Conjunctivitis...
 Common Differential diagnosis of painful-red eyes
.
Conditions Features
Acute
Glaucoma/
Iritis/
Corneal ulcer
Usually one eye only; reddest next to thecornea.
Often causes severe pain

28. Conjunctivitis...
Management:
a. Early identification and referral:
 Diagnosis of conjunctivitis is often simple and is based on
the basis of typical presenting signs and symptoms of the
patient.
 Few other conditions may appear to mimic the symptoms
and hence its best to refer the case to appropriate centre
for further care.

29. Conjunctivitis...
Management:
b. Treatment at the referral centre:
 Treatment depends on the probable underlying aetiology.
 Antibiotic containing eye drops (Ciprofloxacin/
chloramphenicol) are usually needed only in cases of
Bacterial conjunctivitis.
 Allergic conjunctivitis can be treated using topical anti-
allergic (anti-histaminic) containing drugs such as 2%
Sodium Cromoglycate.
 Supportive treatment for pain relief should also be given.
 Dispense the medicines as prescribed by the PHC-
MO/Eye Specialist.

30. Conjunctivitis...
Role of CHO in Management of Conjunctivitis
 Identification and diagnosis
 Referral of all suspect cases to the PHC-MO or closest referral
centre/Vision Centre for confirmation and treatment (PHC-MO
to be informed regarding the referral).
 Follow-up care and regular follow up of all treated cases.
 Supervise the primary healthcare team members
 Maintenance of records and registers.
 ANM/MPW will assist you in maintaining the records and
reports, as required

31. Approach to a patient with Red Eye (new)
ASHA identifies a case and refers to AB-HWC-SHC / Patient presents
with a primary complain of redness in eye to the AB-HWC-SHC
Ask for:
Onset, duration and
progression of disease
Uni/bi-lateral
Painful/ painless
Discharge
Diminution of vision/ loss of
vision
Any h/o trauma, foreign body
Look for:
Size of the Pupil
Pupillary light
response
discharge, redness,
tenderness in eye
Insidious onset with slow
progression
Copious amount of
discharge
No diminution of vision
Mild to moderate pain
Normal pupil size, pupillary
response and intro-ocular
pressure
Probable case of
conjuctivitis
Refer to PHC MO/
Vision Centre for
further evaluation
and management
Relief obtained Relief not
obtained
Rapid progression
No discharge
Blurring of vision
Moderate to severe pain
Abnormal pupil size, pupillary
response and intra-ocular pressure
Refer to DH/ specialist further
evaluation and management

32. Approach to a patient with Red Eye (new)
Follow-up care services @ AB-SHC-HWC through CHO:
(1) Ensuring compliance to the treatment and f/u visit advised
(2) Counsel about
-Importance of hand washing after touching the eyes
-Avoiding sharing of handkerchief, towels, napkins, pillows etc.
-Avoid use of steroids (both topical and systemic) / indigenous medicines
-Seeking prompt treatment for other similar cases in family/ neighbourhood
-Re-visit the specialist if the symptoms are not resolving/worsening within a period of 3 days
Follow-up care services @ Community through ASHA/ANM/MPW:
1. Contact the patient after 3-5 days of treatment and check if the patient is compliant to the treatment advised
and whether symptoms are improving. Encourage the patient to re-visit the specialist in case of no
improvement
2. Screen others in the family, especially children, for similar complaints
3. Counsel for maintenance of hand hygiene and avoiding sharing of towels, handkerchiefs, etc.

33. Stye
 A stye is like a pimple on the eyelid as the result of a
blocked gland.
 There are two types of swellings on the eyelid:
a) stye (hordeolum externum) and
b) chalazion.

34. Stye...
 A hordeolum externum (Stye) is an acute inflammation
of the sweat glands found in the skin of the lid and base of
the eyelashes.
 It is a painful condition.
Causes of Stye
 Styes occur when a gland in the base the eyelash
becomes inflamed due to blockage.
 This can happen due to poor hygiene or dust particles
blocking the opening of the gland.

35. Stye...
Symptoms and Signs of formation of Stye:
 Feeling of a foreign body sensation in the eye (particularly
with blinking)
 Pressure on the eye
 Painful red bump
 May also be blurred vision if thick sebum or pus from
within the stye spreads over the eye's surface
 Presence of a lump (like a pimple) on the edge of the
eyelid
 Redness and swelling of the skin
 May be thick discharge or crusting on the lids and lashes
 Tears can also be produced in response to irritation

36. Stye...
Prevention of Stye:
 The most effective method of prevention is to keep the
eyelids and eyelashes clean.
 Daily warm compress at the first sign of irritation in the
eyelid can prevent it from getting worse.
 Following general eye health measures and consuming a
balanced diet with all four food groups and in adequate
amounts.

37. Stye...
 A chalazion is a blockage of a
meibomian gland, which is a special
oil gland (sebaceous) unique to the
eyelids.
Treatment for Chalazion:
• If it is a chalazion, it has to be incised and drained by an
Eye Surgeon.

38. Stye...
Treatment for Stye /Chalazion:
 Conservative treatment- application of frequent warm (not
too hot) compresses several times a day.
 Plucking of the involved cilium (Eye lash).
 A simple pain reliever can also be given.
 If there is severe burning, discharge and redness that
interferes with vision, you will refer to the Medical Officer
at PHC for further care.
 Antibiotic eye drops may be required for styes that have
become infected.

39. Xerophthalmia
 Xerophthalmia is a condition of early vitamin A deficiency
in which cornea keratinises, become opaque and forms
dry, scaly layers of cells.
 The conjunctiva may keratinise and develop plaques
known as Bitot’s spots.

40. Xerophthalmia...
Clinical Features
Symptoms
 Delayed dark adaptation (an early symptom)
 Night blindness or nyctalopia (seen in more advanced cases).
 Photophobia (sensitivity to light).
 Diminution of vision.
 Dry and scaly cornea (Xerophthalmia).
 Conjunctival plaques (Bitot’s spot)
 Besides eye lesion, child with vitamin A deficiency may have
systemic features such as growth retardation, susceptibility to
infections, anaemia, diarrhoea, mental retardation, apathy,
increased intracranial pressure, and wide separation of the
cranial bone at the sutures.

41. Xerophthalmia...
Management
a. Screening and early diagnosis of Xerophthalmia:
 Clinically the presence of Bitot’s spot and history of night
blindness is often sufficient for referring the individual for
further evaluation and management.
b. Treatment:
 Children below 5 years, receive 2 lakh IU of Vitamin A orally
every 6 months under the Universal Immunization Programme
(1 lakh IU below age of 1 year).
 This helps to prevent children from getting blindness due to
Vitamin A deficiency.
 Severe cases of Xerophthalmia are treated using 2 lakh IU of
vitamin A by mouth on the first day.
 Repeat the same dose on the second day and again after 14
days.

42. Xerophthalmia...
Role of CHO in Management of Xerophthalmia
 Early detection of night blindness in children and treatment with
Vitamin A prophylaxis.
 Early identification of Vitamin A deficiency and Bitot’s spots.
 Assure Vitamin A prophylaxis as in children between 9 months
to 5 years of age per National Immunization Schedule.
 Referral of all cases with Bitot’s spots, corneal xerosis and
blindness to PHC-MO or Vision Centre (PHC-MO to be
informed regarding the referral).

43. Xerophthalmia...
Role of CHO in Management of Xerophthalmia
 Follow up of all treated cases with regular eye check-up and
Vitamin A prophylaxis.
 Health education on importance of Vitamin A Prophylaxis and
Vitamin A rich diet.
 Regular screening of all children in Anganwadis and schools
for early signs of Vitamin A Deficiency with support of RBSK
team.
 Maintenance of records and registers. ANM/MPW will assist
you in maintaining the records and reports, as required.

44. Glaucoma
 Glaucoma is a group of related eye disorders that cause
damage to the optic nerve that carries information from
the eye to the brain.
 In most cases, glaucoma is associated with higher-than-
normal pressure inside the eye — a condition called
ocular hypertension.
 Can occur when intraocular pressure (IOP) is normal.
 If untreated or uncontrolled, glaucoma first causes
peripheral vision loss and eventually can lead to
blindness.

45. Glaucoma...
Types of Glaucoma:
a. Open-Angle Glaucoma:
 Common form of the diseases.
 It happens gradually; where the eye does not drain fluid
as well as it should (like a clogged drain). As a result, eye
pressure builds and starts to damage the optic nerve.
b. Angle-closure Glaucoma:
 This happens when the drainage angle gets narrowed or
completely blocked, resulting in rapid rise in the eye
pressure.
 This leads to acute severe pain in the eye and should be
treated as an eye emergency.

46. Glaucoma...
Clinical Features
 In Open Angle Glaucoma, the patient is mostly asymptomatic,
at least in the initial stages.
 Patients are left with only a tunnel vision in the advanced
stages.
Features of Angle closure Glaucoma include:
 Sudden diminution of vision
 Severe eye pain
 Sudden redness of the eye
 Constitutional symptoms such as headache, nausea, vomiting.
 Coloured halos/ bright circles around source of light.

47. Glaucoma...
Clinical Features
 The first picture is what a person with normal vision can see.
 The other two are from patients with glaucoma.
 In early stages, only the side vision or peripheral vision gets
damaged.
 If left without treatment, this becomes worse and finally the
person can see only the middle part of the picture.

48. Glaucoma...
Management:
a. Screening for Glaucoma:
 The visual field of a patient suffering from Glaucoma becomes
narrow.
 This fact is used for the screening of chronic cases of
glaucoma.
 The steps are as illustrated in the image below:

49. Glaucoma...
Management:
b. Treatment:
 Glaucoma is usually controlled with eyedrop medicine.
 Used every day, these eye drops lower eye pressure.
 Some do this by reducing the amount of aqueous fluid the
eye makes (e.g. brinzolamide eye drops).
 Others reduce pressure by helping fluid flow better
through the drainage angle (e.g. timolol eye drops).
 Few cases of glaucoma may also need surgery.

50. Glaucoma...
Role of CHO in Management of Glaucoma
 Screening all individuals aged 30 years and above for
hypertension and diabetes symptoms of glaucoma such as eye
pain and patchy vision.
 Making a list of all vision centres/ Eye Surgeons in the area.
 Referral of all suspect cases of glaucoma to PHC-MO or Vision
Centre for eye pressure test and confirmation and initiation of
treatment (PHC-MO to be informed regarding the referral).

51. Glaucoma...
Role of CHO in Management of Glaucoma
 Follow up all patients confirmed with glaucoma –dispensing
eye drops, monitoring blood pressure and side effects of
medications.
 Regular screening of all hypertension and diabetic cases for
any eye symptoms
 Heath promotion activities for proper eye care and prevention
of glaucoma.
 Maintenance of records and registers. ANM/MPW will assist
you in maintaining the records and reports, as required.

52. Eye Injuries
 Eye injuries are a leading cause of blindness in young people
(less than 25 years of age).
Type of Eye Injuries
 Injuries can be due to-
 Mechanical trauma:
 Blunt trauma (most common) –some object hitting the eye
 Penetrating trauma
 Chemical injuries
 Radiation / Heat injuries

53. Eye Injuries...
Clinical Features of Eye Injuries
 Acute pain in the eye, may be associated with redness,
cuts
 Diminished vision
 Photophobia
 Watering from eyes
 Injury to eyelids
 Other injuries on face and neck region

54. Eye Injuries...
Management:
 Brief history- noting the cause of injury, severity and
duration of symptoms and any change in vision.
 Do a rapid examination to check for pupillary responses,
extraocular movements, integrity of orbital rim (eye
socket).
 Initiate the First Aid for foreign body and eye injuries.

55. Eye Injuries...
Management:
For penetrating injuries, treatment before referral:
 To avoid secondary eye injury/ damage by preventing any
increase in intraocular pressure (IOP).
 Penetrating and chemical injuries would need specialized care
and hence should be referred only to such centres where an
eye surgeon is available (PHC-MO to be informed regarding
the referral).
For chemical burns, treatment before referral:
 Do immediate and copious irrigation of the eye to dilute and
remove as much of the chemical as possible.

56. Eye Injuries...
Role of CHO in Management of Eye Injuries:
 Take brief history of incident and cause of eye injury.
 Examine eye to note extent and depth of injury.
 Call for an ambulance to refer the patient to an Eye Specialist
(PHC-MO to be informed regarding the referral).
 Give first aid for foreign body, eye injuries, provide stabilization
and then referral.
 Follow up all individuals – after they have completed treatment
to see if they require any further treatment.
 Heath promotion activities for proper eye care.

57. Eye Injuries...
Role of CHO in Management of Eye Injuries:
 Maintain required records and registers.
 ANM/MPW will assist you in maintaining the records and
reports, as required.
 If you suspect any foul play and probable medico-legal case in
any patient with eye injury, inform the PHC- Medical Officer
immediately.
 Maintenance of records and registers. ANM/MPW will assist
you in maintaining the records and reports, as required. .

58. Eye Injuries...
Management of foreign body in eye:
 Foreign bodies such as dust, sand, small stones, etc.
commonly get lodged in the eye.
Steps for removal of superficial foreign bodies:
 Ask the person to close the eyes and look to the left, the right,
up and down.
 Then while you hold her eye open, have her look up and then
down.
 This will make the eye produce more tears and the dirt often
comes out by itself.
 Or you can try to remove the bit of dirt or sand by flooding the
eye with clean water or by using the corner of a clean cloth or
some moist cotton.

59. Trachoma
 An infection of the eye with Chlamydia Trachomatis which
normally occurs in childhood (below 10 years of age).
 Main mode of spread of trachoma infection is a case of
trachoma with infected eye secretions.
The most common routes of transmission are-
 Close physical contact for e.g., mothers of affected
children
 Sharing of towels, handkerchiefs, etc.
 Houseflies
 Coughing and sneezing

60. Trachoma...
Signs and symptoms of Trachoma:
 Active Trachoma infection in children is associated with-
1. Irritation of the eye with scratchiness
2. Pain and redness in eye
3. Foreign body sensation in inner eyelid
4. Mucus and pus-filled discharge
5. Swelling of upper eyelid
6. Continuous tears from the eye

61. Trachoma...
What is Trachiasis?
 The progress of infection of trachoma causes the
eyelashes of upper eyelid to turn inwards so that the
lashes rub against the globe.
 Sometimes whole lid margin may turn inwards.
Complications of Trachoma
 Constant rubbing of the eyelashes on the corneal surface
lead to the formation of corneal ulcers, corneal scarring
and eventually corneal opacities.

62. Trachoma...
Risk factors which spread Trachoma
 Overcrowding
 Poor personal/ environmental hygiene
 Shortage of water
 Inadequate latrines and sanitation facilities
What is the treatment of Trachoma?
 Promote hand and facial hygiene practices among individuals.
 CHO will refer patients to MO at Primary Health Centre/ Vision
Centre/Eye specialist as appropriate (PHC-MO to be informed
regarding the referral).
 Providing follow- up care
 Ensure adherence to treatment by the patient as advised by
the doctor.

63. Trachoma...
Role of CHO in Managing Trachoma :
 Early detection and referral of suspected cases.
 Follow- up care of those diagnosed by referral centre.
 Health promotion for good eye hygiene and clean water.
 Regular follow up of all treated cases.
 Health education to children to maintain good personal
hygiene and to report immediately for any symptoms.
 Maintenance of records and registers.
 ANM/MPW will assist you in maintaining the records and
reports, as required.

64. THANK YOU