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Top 10 ophthalmic diseases

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Muhammad El Fateh

on 24 March 2013

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Transcript of Top 10 ophthalmic diseases

Top 10 ophthalmic diseases Trachoma Errors of refraction Diabetic Retinopathy AGE-RELATED MACULAR DEGENERATION Types:
- dry
- wet Cataract The causes
some lens protiens clump together and start to cloud small area of lens Glaucoma 2nd causing BLINDNESS
IOP + Opt.N. damage Predisposing factors:
• poor personal hygiene associated with poverty
• poor trash disposal
• insufficient water supply for washing
• shared sleeping space
• close association with domestic animals
•Swimming pools Classification:
- Myopia
- Hyperopia
- Presbyopia
- Astigmatism Risk factors
· Blood sugar levels
· Blood Pressure
· Duration of Diabetes
· Blood lipid levels (cholesterol and triglycerides)
· Ethnicity
· Pregnancy Corneal ulcer Causes:
-Mostly infections: • Bacterial -common in contact lenses (CL) wearers.
• Viral such as HSV/VZV
• Fungal : in steroid drops overuse
- Direct trauma
- Disorders causing dry eyes
- Chemical burns / caustic solutions.
* In fact, the risk increases 10-fold when using extended-wear soft CL. Eye Allergy Types:
- Seasonal Allergic Conjunctivitis (SAC):The most common type.
- Perennial Allergic Conjunctivitis (PAC): usually caused by allergens that are often present year-round. Stye Predisposing Factors:
• Diabetes Mellitus
• Poor general health and resistance.
• Shared fomites
• Blepharitis.
• Errors of refraction. KERATOCONUS Pathophysiology:
Genetic factors
dissolution of Bowman's layer, epithelium and stroma come into contact, cellular changes>>> bulging and scarring of the cornea People affected Pathophysiology Diagnosis Treatment 2013 last research: Early predictor for OAG : preventing the Silent Thief from stealing the human sight.. The time you may get it Risk factors
-the age
- diabetes
-prolonged exposure to sunlight Cataract’s Types:
- secondary
- congential
- traumatic
- radiation cataract Prevention may be by:
- Wearing sunglasses and a hat with a brim to block UV sunlight.
- quitting smoking.
- Having a comprehensive dilated eye exam after the age of 60 (at least once every two years).
- eating green leafy vegetables, fruit, and other antioxidants.
- As Researchers believe that good nutrition can help reducing the risk of age-related type. Common symptoms:
- blurry vision
- colors are faded
-halos around lights
- poor night visio
- double vision or multiple images Diagnosis:
- visual acuity test
- dilated eye exam
- tonometry Treatment:
- eyeglasses
- anti-glare sunglasses
-surgery Prevalence Rates for Cataract :
By race: white > black > Hispanic by number of cases: year 2000: 20,476,000 patients year 2010 : 24,410,000 patients. Predisposing factors Symptoms Conjunctiva
Early case:
- pain
- lid edema
- discharge
- lacrimation
- sensitivity to light
- Follicles (small sacs) in the upper palpebral conjunctiva If left without ttt:
- the follicles develop into large yellow or gray pimples
- Small blood vessels develop inside the cornea. By Repeated infections:
Fibrosis leading to:
1- Arlets line
2- Contraction and turning-in of the eyelids Cornea:
1- corneal follicles in the form of herbert bits & herbert rossettes
2- pannus(superficial vascularization + chronic inflammtory cells)
3- opacity… if bowman memb is destroyed
4- trachomatous ulcers Diagnosis:
1- by history (especially living or traveling in areas with high incidence of trachoma)
2- by examining the eyes: To see follicles or scarring.
(If laboratory facilities are available, a conjunctival sampleis taken to examine it with Giemsa staining
In underdeveloped countries, diagnosis is made based on an examination only. Treatment Prevention S A F E
Facial cleansing
Environmental improvements. Diagnosis:
- phoropter
- retinoscope Treatment:
1- asymptomatic: ---> left without ttt
2- symptomatic: ---> glasses, contact lenses, refractive surgery
- Myopia: ---> concave lens.
- Hyperopia: ---> convex lenses.
- Presbyopia: ---> bifocal lenses.
- Astigmatism: ---> Cylindrical lenses serve this purpose. Signs and symptoms:
• Drusen
• Pigmentary alterations
• Exudative changes
• Atrophy
• Visual acuity drastically decreasing
• Preferential hyperacuity perimetry changes
• Blurred vision
• Central scotomas
• Metamorphopsia
• Trouble discerning colors
• Slow recovery of visual function after exposure to bright light
• A loss in contrast sensitivity Causes and risk factors:
• HTN • Cholesterol • Obesity & Fat intake: especially in men
• Family history : raises the risk.
• Race: Caucasians > Africans• Exposure to sunlight especially blue light.
• Smoking
• Fibulin-5 mutation: Diagnosis:
- Amsler grid test
- Fluorescein angiography
- Recently, structured illumination light microscopy. Treatment Symptoms
· Spots
· Blurred vision
· Visual change
· dark visual areas
· Poor night vision
· washed out Colors
· Visual loss Statistics
· it may be the leading cause of visual impairment and blindness worldwide Treatment:
Laser eye surgery (photocoagulation) VitrectomyDrugsSteroids eye injections Symptoms:
• Red eye
• pain (especially when looking at bright lights )
• foreign body sensation
• lacrimation
• Pus / thick discharge
• Blurry vision
• lid edema
• corneal white spot Treatment: is
• to remove CL immediately -if they are the cause-
• to apply Cool compresses to the affected eye
• To avoid rubbing/touching the eye
• to wash hands often &dry them with a clean towel -to limit the infection spread-
• to control pain with oral (acetaminophen/ ibuprofen) or some mydriatic eye drops.
• to avoid patching the eye (as that creates a warm environment allowing bacteria to grow)
• Antibiotic eye drops (to prevent secondary bacterial infection)
• Daily Follow-up -as it’s not a simple condition-
• Hospitalization in non responding cases
• If it’s very severe, corneal transplantation may be required Prevention:
• by eye protection.
• Artificial tear drops to keep eyes lubricated.
• in case of CL:
* the patient should be very careful with cleaning them regularly by the specific disinfecting solution (not the tap water)
*wear them the right way
*Remove them every evening & Never sleep with them
*Remove them whenever the eyes are irritated Risk Factors:
- The individual sensitivity to the allergens.
- People with nasal allergies may also suffer from eye allergies. Triggers:
• Dust • Pet dander
• Grass &weeds • Plant pollen
• Mold Symptoms:
• Itching
• Redness
• lacrimation • Swelling
• Burning sensation • Blurry vision Diagnosis:
- symptoms
- a slit lamp examination may reveal chemosis, lid edema and dilated blood vessels.
-In severe cases we may check for Eosinophils by scraping the conjunctiva. Treatment:
1. washing the individual pillowcases, changing the air conditioning filter from time to time, taking a shower before bed to remove the antigens caught in hair &clothes and finally by avoiding rubbing eyes to prevent triggering the allergy
2. Cold Compresses appliance to closed eyes for 5 to 10 minutes, a few times per day.
3. OTC(over-the-counter) (Antihistaminic+ vasoconstrictor) Drops 4 times per day for about a week. Statistics:
It affects a reported 20% of the population worldwide and may be increasing in line with other atopic diseases like asthma as a result of environmental factors. 4% of them are children. Symptoms:
• A lump at the lash root
• Localized swelling of the eyelid.
• Pain (dull on the start, throbbing on pus formation).
• Redness
• Burning sensation
• Droopiness of the eyelid
• Scratchy sensation on the eyeball.
• Blurred vision.
• Mucous discharge in the eye. Signs:
Localized red swelling:
1.related to a lash
2.close to the lid margin
3.pointing on the skin Treatment:
• Hot fomentations.
• Local antibiotics: Eye drops & eye ointments.
• Systemic antibiotics: Especially in multiple styes.
• If a pointed stye occurred: Evacuate the pus through:
a.Epilation of the related hair follicle.
b.Horizontal incision of the formed abscess.
• In Recurrent cases: Test for possible predisposing factor (D.M.) Prevention:
- proper hygiene &hand washing. After awakening
- application of a warm washcloth to the eyelids for five to ten minutes
- avoid sharing cosmetic eye tools with others.
- Remove makeup every night before sleep and discard old or contaminated eye makeup. Types:
1-Puberty-Onset: the commonest form, begins in early adolescence at about age 14 to16 years. (usually bilateral )
2-Late-Onset: Begins in the late twenties or early thirties (bilateral and less severe)
3-Keratoconus Fruste: can occur at anytime throughout life. (Unilateral / bilateral ) Associated conditions:
1- Down syndrome
2-osteogenesis imperfecta
3-joint hypermobility How to diagnose?
1- measure visual acuity
2- measure corneal curvature by keratometer
3- detection for irregular astigmatism
4- slit lamp examination will show a ring of yellow-brown to olive-green pigmentation known as Fleischer ring
Realted occular diseases:
2-Pellucid marginal degeneration . It causes irregular astigmatism
3-Posterior keratoconus Treatment:
Early cases: contact lenses and glasses may be useful.
Late cases: surgical intervension must be done.
Surgeries include:
1- corneal transplant.
3-radial keratotomy.
3-corneal ring segment insert. Statistics:
the most common dystrophy of the cornea affecting 54.5 out of 100.000 individuals worldwide .
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