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DISORDERS OF RETINA
Nabina Paneru
Disorder of retina
Retinal Detachment
1. Retinal detachment
• Retinal detachment is a disorder of the eye in which
the retina peels away from its underlying layer of support
tissue.
• Without rapid treatment the entire retina may detach,
leading to vision loss and blindness.
• Permanent damage may occur, if the detachment is not
repaired within 24–72 hours.
Types:
a. Rhegmatogenous RD
b. Tractional RD
c. Exudative RD
a. Rhegmatogenous RD
 Occurs due to full thickness defect in the sensory retina
usually associated with a retinal hole or tear through
which subretinal fluid (SRF) seeps in and separate
sensory retina from retinal pigment epithelium (RPE).
b. Tractional RD
 Occurs when fibrous or fibrovascular tissue, caused by
an injury, inflammation or neovascularization, pulls the
sensory retina from the retinal pigment epithelium.
Rhegmatogenous RD
c. Exudative RD:
 Occurs due to inflammation, injury or vascular
abnormalities that results in fluid accumulating
underneath the retina without the presence of a hole,
tear, or break.
Disorder of  retina
Causes:
• Injury
• Advanced diabetes/Diabetic retinopathy
• An inflammatory eye disorder
• Glaucoma
• Cataract surgery
Contd.
• Eclampsia
• Family history of retinal detachment[
• Malignant hypertension
• Eye cancer (e.g.Retinoblastoma)
• Severe myopia
S/S:
• Flashes of light (photopsia).
• A ring of floaters or hairs just to the temporal (skull)
side of the central vision.
• A sudden dramatic increase in the number of floaters.
• A slight feeling of heaviness in the eye.
Contd.
• A dense shadow that starts in the peripheral
vision and slowly progresses towards the
central vision.
• Straight lines (scale, edge of the wall, road,
etc.) that suddenly appear curved.
• Central visual loss
Investigation:
• History taking
• Fluorescein angiography : Using special dye and
camera to look at blood flow in the retina
• Ophthalmoscopy : Examining the back part of the eye,
including the retina
• Tonometry: Check pressure inside the eye
Contd.
• Visual acuity test
• Checking color vision
• Slit lamp examination
• Ultrasound of the eye
Management:
 Bed rest until surgery is performed urgently.
 Eye bandaging.
 Avoid bumping, weight lifting, sudden head movement.
 Surgery:
 Lasers may be used to seal tears or holes in the retina before a
retinal detachment occurs.
Surgery Contd.
 Pneumatic retinopexy: in case of small detachment, the
doctor may place a gas bubble in the eye. It helps the retina
float back into place. The hole is sealed with a laser.
 Scleral buckle surgery to gently push the eye wall up
against the retina.
 Vitrectomy to remove gel or scar tissue pulling on the
retina, used for the largest tears and detachments.
2. Diabetic retinopathy
 Refers to the retinal changes that occurs in diabetic
mellitus.
 NPDR and PDR
Risk factors:
 Duration of diabetes
 Sex: Female: male (4:3)
 Heredity
 Pregnancy
 HTN
 Nephropathy
S/S:
• Often there are no symptoms in the early stages of the
disease, nor is there any pain.
• Don’t wait for symptoms.
• Be sure to have a comprehensive dilated eye exam at
least once a year.
Contd.
Decreased vision, blurred vision
Seeing spots or floaters in your field of vision
Having a dark or empty spot in the center of your
vision.
Difficulty seeing well at night
Haemorrhage
Contd..
 Leaking blood vessels.
 Pale, fatty deposits on the retina–signs of leaking
blood vessels.
 Retinal swelling (macular edema) and hard exudates
 Damaged nerve tissue.
Investigation:
 History taking
 Visual acuity test.
 Dilated eye exam.
 Tonometry
 Retinal photography or tomography to document current
status of the retina
 Fluorescein angiography to evaluate abnormal blood
vessel growth
Management:
• Blood and urine investigation
• Laser treatment (photocoagulation) is used to stop the
leakage of blood and fluid into the retina.
• Panretinal laser photocoagulation in proliferative diabetic
retinopathy and advanced diabetic eye diseases.
• Vitrectomy surgery in case of dense vitreous haemorrhage,
retinal detachment etc.
• Opthalmic examination periodically.
3. Hypertensive retinopathy
 Hypertensive retinopathy is damage to the retina and
retinal circulation due to high blood pressure
(i.e. hypertension).
Causes:
 Vasoconstriction
 Arteriosclerosis
S/S:
 Usually asymptomatic unless vision is decreased.
 Chronic, poorly controlled hypertension causes the
following:
 Permanent arterial narrowing
 Arteriovenous crossing abnormalities (arteriovenous
nicking)
 Arteriosclerosis with moderate vascular wall changes
 If acute disease is severe, the following can develop:
 Superficial flame-shaped hemorrhages
 Small, white, superficial foci of retinal ischemia (cotton-
wool spots)
 Yellow hard exudates
 Optic disk edema
Investigation:
History and fundoscopy
Management:
 Primarily treated by controlling hypertension.
 If vision loss occurs, treatment of the retinal edema with:
 Laser or
 Intravitreal injection of corticosteroids or
 Antivascular endothelial growth factor drugs (eg, ranibizumab,
pegaptanib, bevacizumab).
 Regular exercise and salt restricted diet to hypertensive patient.
 Periodiclly opthalmic check up.
Squint or strabismus
Introduction
 Commonly known as
“lazy eyes” or “crossed
eyes”
 Is a condition in
which the eyes aren’t
looking in same
direction.
Types
Paralytic type :
Also called as non-concomitant
type
Is due to the weakness or
paralysis of one or more extra-
ocular muscles
 There is limitation of
movement , false orientation of
field of vision, dizziness and
diplopia.
Non-paralytic type :
 Also called concomitant type.
Is due to the visual or ocular
defect of the deviating eye.
 Commoner variety
• Poorly developed binocular vision
• Far sighted with focusing problems
• Weakness of the extra ocular muscles
• Single visual axes are not parallel and brain
receives two images
Contd.
• Squint eyelids together or frowns
• Difficulty in focusing objects
• Inaccurate judgement in picking of objects
• Unable to see print or moving objects clearly
• Closes one eye to see
• Tilts head to one side
Disorder of  retina
Methods of testing for
squint
• A. Corneal light reflex
test
Is performed by shining a
small light on the patients
face and observing the
reflection.
B. Cover test
 Patient is asked to look at a distant object
 Alternatively each eye is occluded by turn
If no movement of any eye occurs, the eyes
alignment are normal.
When the fixating eye is occluded, the deviating
eye will move inward in case of divergent squint
and outward in case of convergent squint.
Treatment
Accurate
assessment
Occlusion therapy
Orthopedic
training
Surgery
i. Occlusion therapy
• Is recommended if the squinting eye is
amblyopic (poor vision in one eye) so
that the vision improves in the squinting
eye by continuous exercise.
• For this the normal eye has to be
occluded for 1-2 wks or longer at a time
for 6-8 wks
• Aim-to improve the vision of lazy eye.
ii. Orthopedic training
• Specially designed visual exercises are taken in
order to encourage the production of simultaneous
and binocular vision, elimination of false projection
and production of stereoscopic vision.
iii. Surgery
• Involves shortening, lengthening or reposition of extraocular
muscles
• Is usually performed between the age of 6 months and 4 yrs
• Is done under GA.
Disorder of  retina

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Disorder of retina

  • 4. 1. Retinal detachment • Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. • Without rapid treatment the entire retina may detach, leading to vision loss and blindness. • Permanent damage may occur, if the detachment is not repaired within 24–72 hours.
  • 5. Types: a. Rhegmatogenous RD b. Tractional RD c. Exudative RD
  • 6. a. Rhegmatogenous RD  Occurs due to full thickness defect in the sensory retina usually associated with a retinal hole or tear through which subretinal fluid (SRF) seeps in and separate sensory retina from retinal pigment epithelium (RPE). b. Tractional RD  Occurs when fibrous or fibrovascular tissue, caused by an injury, inflammation or neovascularization, pulls the sensory retina from the retinal pigment epithelium.
  • 8. c. Exudative RD:  Occurs due to inflammation, injury or vascular abnormalities that results in fluid accumulating underneath the retina without the presence of a hole, tear, or break.
  • 10. Causes: • Injury • Advanced diabetes/Diabetic retinopathy • An inflammatory eye disorder • Glaucoma • Cataract surgery
  • 11. Contd. • Eclampsia • Family history of retinal detachment[ • Malignant hypertension • Eye cancer (e.g.Retinoblastoma) • Severe myopia
  • 12. S/S: • Flashes of light (photopsia). • A ring of floaters or hairs just to the temporal (skull) side of the central vision. • A sudden dramatic increase in the number of floaters. • A slight feeling of heaviness in the eye.
  • 13. Contd. • A dense shadow that starts in the peripheral vision and slowly progresses towards the central vision. • Straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved. • Central visual loss
  • 14. Investigation: • History taking • Fluorescein angiography : Using special dye and camera to look at blood flow in the retina • Ophthalmoscopy : Examining the back part of the eye, including the retina • Tonometry: Check pressure inside the eye
  • 15. Contd. • Visual acuity test • Checking color vision • Slit lamp examination • Ultrasound of the eye
  • 16. Management:  Bed rest until surgery is performed urgently.  Eye bandaging.  Avoid bumping, weight lifting, sudden head movement.  Surgery:  Lasers may be used to seal tears or holes in the retina before a retinal detachment occurs.
  • 17. Surgery Contd.  Pneumatic retinopexy: in case of small detachment, the doctor may place a gas bubble in the eye. It helps the retina float back into place. The hole is sealed with a laser.  Scleral buckle surgery to gently push the eye wall up against the retina.  Vitrectomy to remove gel or scar tissue pulling on the retina, used for the largest tears and detachments.
  • 18. 2. Diabetic retinopathy  Refers to the retinal changes that occurs in diabetic mellitus.  NPDR and PDR Risk factors:  Duration of diabetes  Sex: Female: male (4:3)  Heredity  Pregnancy  HTN  Nephropathy
  • 19. S/S: • Often there are no symptoms in the early stages of the disease, nor is there any pain. • Don’t wait for symptoms. • Be sure to have a comprehensive dilated eye exam at least once a year.
  • 20. Contd. Decreased vision, blurred vision Seeing spots or floaters in your field of vision Having a dark or empty spot in the center of your vision. Difficulty seeing well at night Haemorrhage
  • 21. Contd..  Leaking blood vessels.  Pale, fatty deposits on the retina–signs of leaking blood vessels.  Retinal swelling (macular edema) and hard exudates  Damaged nerve tissue.
  • 22. Investigation:  History taking  Visual acuity test.  Dilated eye exam.  Tonometry  Retinal photography or tomography to document current status of the retina  Fluorescein angiography to evaluate abnormal blood vessel growth
  • 23. Management: • Blood and urine investigation • Laser treatment (photocoagulation) is used to stop the leakage of blood and fluid into the retina. • Panretinal laser photocoagulation in proliferative diabetic retinopathy and advanced diabetic eye diseases. • Vitrectomy surgery in case of dense vitreous haemorrhage, retinal detachment etc. • Opthalmic examination periodically.
  • 24. 3. Hypertensive retinopathy  Hypertensive retinopathy is damage to the retina and retinal circulation due to high blood pressure (i.e. hypertension). Causes:  Vasoconstriction  Arteriosclerosis
  • 25. S/S:  Usually asymptomatic unless vision is decreased.  Chronic, poorly controlled hypertension causes the following:  Permanent arterial narrowing  Arteriovenous crossing abnormalities (arteriovenous nicking)  Arteriosclerosis with moderate vascular wall changes
  • 26.  If acute disease is severe, the following can develop:  Superficial flame-shaped hemorrhages  Small, white, superficial foci of retinal ischemia (cotton- wool spots)  Yellow hard exudates  Optic disk edema
  • 28. Management:  Primarily treated by controlling hypertension.  If vision loss occurs, treatment of the retinal edema with:  Laser or  Intravitreal injection of corticosteroids or  Antivascular endothelial growth factor drugs (eg, ranibizumab, pegaptanib, bevacizumab).  Regular exercise and salt restricted diet to hypertensive patient.  Periodiclly opthalmic check up.
  • 30. Introduction  Commonly known as “lazy eyes” or “crossed eyes”  Is a condition in which the eyes aren’t looking in same direction.
  • 31. Types
  • 32. Paralytic type : Also called as non-concomitant type Is due to the weakness or paralysis of one or more extra- ocular muscles  There is limitation of movement , false orientation of field of vision, dizziness and diplopia. Non-paralytic type :  Also called concomitant type. Is due to the visual or ocular defect of the deviating eye.  Commoner variety
  • 33. • Poorly developed binocular vision • Far sighted with focusing problems • Weakness of the extra ocular muscles • Single visual axes are not parallel and brain receives two images
  • 35. • Squint eyelids together or frowns • Difficulty in focusing objects • Inaccurate judgement in picking of objects • Unable to see print or moving objects clearly • Closes one eye to see • Tilts head to one side
  • 37. Methods of testing for squint • A. Corneal light reflex test Is performed by shining a small light on the patients face and observing the reflection.
  • 38. B. Cover test  Patient is asked to look at a distant object  Alternatively each eye is occluded by turn If no movement of any eye occurs, the eyes alignment are normal. When the fixating eye is occluded, the deviating eye will move inward in case of divergent squint and outward in case of convergent squint.
  • 40. i. Occlusion therapy • Is recommended if the squinting eye is amblyopic (poor vision in one eye) so that the vision improves in the squinting eye by continuous exercise. • For this the normal eye has to be occluded for 1-2 wks or longer at a time for 6-8 wks • Aim-to improve the vision of lazy eye.
  • 41. ii. Orthopedic training • Specially designed visual exercises are taken in order to encourage the production of simultaneous and binocular vision, elimination of false projection and production of stereoscopic vision.
  • 42. iii. Surgery • Involves shortening, lengthening or reposition of extraocular muscles • Is usually performed between the age of 6 months and 4 yrs • Is done under GA.