2. 2
1. Xerophthalmia
• This condition is common cause of blindness in
children.
• It is associated with inadequate vitamin A.
• Diet should contain dark green leafy vegetables,
kontomire, yellow fruits and vegetables, palm oil, milk,
eggs
Causes
• Vitamin A deficiency resulting from (Protein Calorie
Malnutrition, Measles, Malabsorption states.
3. 3
1. Xerophthalmia
Symptoms
• Poor night vision (in the early stages)
Signs
• Dry conjunctiva
• Grey saliva
• Conjunctival folding (wrinkling)
• Keratomalacia (cloudy cornea, soft & easy ulceration)
Investigations
• Nil
4. 4
1. Xerophthalmia
Treatment (objectives)
• To recognize and correct vitamin A deficiency
• To prevent complications e.g. blindness
Non - Pharmacological treatment
• High vitamin containing foods should be encouraged
5. 5
1. Xerophthalmia
Pharmacological Treatment
• Give vitamin A to children as soon as the illness is
diagnosed and also in patients with measles and
malnutrition
Vitamin A, oral
• Children: 6 – 11 months; 100,000 units stat, repeat
after 24 hours, then 100,000 units after 1 week.
• Children:1- 6 years; 200,000 units stat, repeat after
24 hours, then 200,000 units after 1 week
6. 6
2. Foreign body in eye
• Foreign bodies refer to specks of dust, small insects or
other tiny objects that get into the eyes.
• The foreign body may be either in the conjunctival sac,
on the cornea or inside the eyeball (intraocular)
• Careful inspection of the cornea or conjunctival sac
with adequate lighting.
Causes
• Specks of dust
• Small insects
• Ferrous metallic specs (in metal grinders)
• Other tiny objects
7. 7
2. Foreign body in eye
Symptoms
• Feeling of something in the eye which may be irritating
• Sudden discomfort or severe pain, Watering of the eye
• Red eyes, inability to open the eyes, Photophobia
Signs
• Evidence of foreign body, conjunctivitis, photophobia
• Tearing of the eyes, sub-conjunctival hemorrhage
Investigations
• X-ray of the orbit
8. 8
2. Foreign body in eye
Treatment (objectives)
• Remove superficial foreign bodies
• Treat associated injury
• Prevent complications
Non - Pharmacological treatment
• Where the foreign body is under the upper eyelid,
evert the eyelid and remove the foreign body.
• If the foreign body cannot be removed, apply topical
antibiotic, pad the eye and REFER to eye specialist.
9. 9
2. Foreign body in eye
Pharmacological Treatment
A. Foreign body identification
Tetracycline hydrochloride, 0.5% eye drop, instill one or
two drops prior to evaluation
B. For eye irrigation
Normal saline, 0.9%
C. Prevention of infection
Chloramphenicol eye ointment, 1% topical, (after
removal of foreign body)
D. Pain control
Paracetamol 500mg-1,00 mg qid
10. 10
3. Red eye
• Is either the result of inflammation of ocular tissue or
bleeding into the sub conjunctival space.
• The pattern of the redness, nature of discharge,
associated pain and intensity, vision loss and
appearance of the cornea are helpful in characterizing
the red eye
Causes
• Conjunctivitis, Episcleritis, scleritis
• Acute angle closure of glaucoma
• Corneal ulcer or keratitis
• Subconjunctival hemorrhage
11. Characteristics of Acute red eye
diagnosis Predomina
nt pattern
of redness
Nature of
discharge
Vision
loss
Corneal
appearance
Associat
ed pain
Conjunctivitis Peripheral
(inner lining
of eyeball)
watery,
mucoid,
purulent or
muco-purulent
Nil, except
when
cornea is
involved
Clear usually Nil to mild
pain
Corneal ulcer Around the
cornea
Watery or
muco-purulent
Variable Grey or greyish
white patch
when bacteria
Severe
pain
Acute
anterior
uveitis
Around the
cornea
Watery Variable Clear to hazy Moderatel
y severe
Acute angle
closure
glaucoma
Around the
cornea
Watery profound i=uniformly
hazy
Vety
severe
Scleritis sectorial Nil or watery Nil except
if assoc.
with uveitis
Clear Very
severe
11
12. Common types of conjunctivitis and their
mode of treatment
Age,
background
of patient
Type of
doschsrge
Type of
ocular
discomfort
Duration Treatment
Bacterial All ages Purulent Nil to mild
itching or
pain
1-2
weeks
Antibiotic eye
drops
Viral All ages Watery to
muco-
purulent
Nil to mild
itching or
pain
1-8
weeks
symptomatic
Allergic Children and
Adolescents
mucoid itching Chronic,
intermitte
nt
Mast cell
stabilizing
agent, Sodium
chromoglycate
Trachoma All ages,
associated
with dry,
dusty, dirty
and poor
environment
mucopurule
nt
Nil to mild
itching or
pain
1 month
to 1 year
or more
Tetracycline
eye ointment
and
Azithromycin
tablets (oral)
12
14. 14
3. Red eye
Treatment (objectives)
• Treat the infection in the case of of acute
conjunctivitis
• To relieve pain and refer immediately to specialist for
urgent management to prevent blindness on ulcers
Non - Pharmacological treatment
• Wipe discharges with tissue, discard it and wash
hands after each wipe
• Don’t share towels with others.
• Avoid close contact with others e.g from school,
work, swimming, camping etc
15. 15
3. Red eye
Pharmacological Treatment
A. Or treatment of acute conjunctivitia
Tetracycline, 1% ointment, apply at night for 7 days
AND
Chloramphenicol 0.5% eye drops; 1 drop 2 hourly for
48 hours, then 1 drop 6-8 hourly for 7 days
OR
Ciprofloxacin, 0.3% eye drops, 1-2 drops, 6-12 hourly
REFER CORNEAL ULCERS, ACUTE ANTERIOR
UVEITIS, ACUTE ANGLE CLOSURE GLAUCOMA,
EPISCLERITIS AND SCLERITIS TO EYE SPECIALIST
IMMEDIATELY
16. 16
4. Glaucoma
• Is an optic neuropathy usually bit not always
associated with raised intraocular pressure.
• it is the 2nd leading cause of preventable blindness in
the world.
• Chronic glaucoma may produce severe loss of vision
and blindness without prior- warning symptoms,
therefore screen all people above 40 years
• Acute glaucoma is however associated with very high
intraocular pressure and very severe pain and
inflammation of the eye and can lead to blindness
quickly if not treated.
17. 17
4. Glaucoma
Causes
• Acute closure of the drainage angle (due to pupil block
in primary angle closure glaucoma)
• Inadequate drainage of aqueous from the anterior
chamber (despite open drainage angles in chronic
open angle glaucoma
• Neovascular membrane in the drainage angle in
ischemic eye diseases such as proliferative diabetic
retinopathy
• Displaced lens in secondary angle closure glaucoma
• Malformation of the drainage angle in congenital
glaucoma
18. Characteristics of the various
types of Glaucoma
Congenital Acute Angle
closure
Chronic open
angle
Onset Infants and toddlers Elderly Usually 40 years
and above
Symptoms Photophobia,
watering
Sudden visual loss,
Severe eye pain,
watery discharge,
headache and
vomiting sometimes
Nil till late then
progressive visual
loss
Intraocular pressure High Very high Usually high, may
be normal
Cornea Enlarged and hazy
with linear breaks
Hazy Normal 18
19. 19
4. Glaucoma
Investigations
Visual field analysis
Optic disc photography
Treatment (objectives)
• Prevent progression of the disease and halt further
deterioration of vision
• Normalize intraocular pressure
20. 20
4. Glaucoma
Non - Pharmacological treatment
• Glaucoma drainage surgery, Laser surgery
Pharmacological Treatment
Treatment is with one medication from one or more of the following groups:
• Latanoprost, eye drops, 50 microgram/mll
• Travoprost, eye drops, 40 microgram/ml
AND/OR
• Timolol 0.5% eye drops
• Betaxolol 0.5% eye drops
AND/OR
• Brimornidine, 1 mg/ml or 1.5 mg/ml
AND/OR
• Acetazolamide, oral 250mg
• Dorzolamide, eye drops, 20mg/ml
AND/OR
• Pilocarpine 1-4%, eye drops
21. 21
5. Cataract
• Is the opacity of the crystalline lens of the eye
• It is the leading cause of blindness worldwide
Causes
• Old age
• Trauma to the eye
• Inflammation within the eye
• Metabolic conditions such as diabetes mellitus
• Congenital
22. 22
5. Cataract
Symptoms
• Feeling of drying of the eye
• Foreign body sensation in the eye
• Photophobia
• Blurring of vision
Signs
• Infrequent blink
• Corneal ulceration
• Corneal perforation
• Lagophthalmos (inability to close the eye)
23. 23
5. Cataract
Treatment objectives
• To moisten the cornea artificially
• To prevent the complications of dry eyes
Non-pharmacological treatment
• Taping the eyelids closed in the comatose patient
• Education of patients with Parkinson’s or Thyroid eye
disease to blink frequently voluntarily rather than rely
on reflex blink
• Partial tarsorrhaphy
24. 24
5. Cataract
Pharmacological treatment
1st line
• Hydroxymethyl cellulose, 0.3% eye drops, 1-2 hourly
during waking time
2nd line
• Polyvinyl alcohol, 1.4-2.0% eye drops, 1-2 hourly
during waking time
AND
• Chloramphenicol, 1% eye ointment, nocte
• OR
• Tetracycline, 1% eye ointment, at bedtime
25. 25
6. Strabismus (squint)
• Is misalignment usually of one eye preventing
simultaneous viewing of an object by both eyes.
• Onset in children under 7 years interferes with the
development of the visual system of the deviating eye
in the brain leading to amblyopia
• Acute onset at an older age causes double vision
Causes
• Congenital misalignment
• Acquired deviation
• Paralysis of cranial nerve III, IV or VI
• Myasthenia gravis
26. 26
6. Strabismus (squint)
Symptoms
• Malalignment of the eye
• Impaired judgement of depth of distance
• Diplopia or double vision
Signs
• Deviation of the corneal light reflex in one eye from a
central position
• Limitation of eye movements
27. 27
6. Strabismus (squint)
Treatment objectives
• Identify and correct any significant refractive error
• Treat any amblyopia (lazy eye), diplopia and
• Correct misalignment
Non- pharmacological treatment
• Spectacle correction of any refractive error
• Treatment of amblyopia in the deviating eye by
patching the non deviating eye
• Patching of the deviating eye to relieve diplopia in
older patients
