By
Bahaa Halwany
Department of Ophthalmology
Medicals international

A. In Accessory structure
1. Dry eyes
2. Conjunctivitis
B. In Fibrous Tunic
1. Keratoconus
2. Refractive errors
C. In Vascular tunic
1. Uveitis
D. In Nervous Tunic
1. Color blindness
1. Retinal detachment
2. Diabetic retinopathy
3. Age-related Macular Degeneration
E. In interior of Eyeball
1. Glaucoma
2. Cataract
3. Floaters

Dry eyes either do not produce enough tears
or have poor tear quality
Any deficiency within the tear layers will cause
dry eyes
keratoconjunctivitis sicca (KCS) its due to an
inadequate amount of the water layer in tears.

Age
Gender
Medications
Medical conditions
Environmental conditions
Other factors

Artificial tear solution
Blocking the tear ducts with tiny silicone or
gel-like plugs that can be removed.

Infection of the conjunctiva.
Common in children and is very contagious.
Symptoms include:
 Red eyes
 Swelling of conjunctiva
 Watering of the eyes
 Itching
 Sensitivity to light
There are four types of
Conjunctivitis.

Types Symptoms /Description Treatment
Bacterial • Large amount of discharge
that is green to yellow in
color
•Usually lasts 3 to 5 days
Requires antibiotics eye
drops to help remove the
infection
Viral • Caused by viruses
• The discharge is clear and
watery
• Symptoms of cold may be
present
Will not respond to
antibiotics
Topical antiviral agents
Allergic • Caused by allergens such as
pollen, perfumes, cosmetics,
smoke, dust…
Can respond to allergy
treatment or disappear on
its own.
Chemical • Caused by chemicals
irritants such as air
pollution, smoke, or noxious
fumes.
Usually, no treatment is
needed

Keratoconus is a degenerative disorder
Structural changes within the cornea cause it
to thin and change to a more conical shape

Symptoms
• Distorted vision
with multiple
images
• Progressive
nearsightedness
• Irregular
astigmatism to
develop
• sensitivity to light
Causes
• Imbalance of enzymes
within the cornea;
becoming more
susceptible to oxidative
damage by free-
radicals
• Hereditary
predisposition
• Exposure to UV light
• Excessive eye rubbing
• Poorly fitted contact
• Chronic eye irritation
Treatment
• Rigid gas
permeable (RGP )
lenses
• Hybrid lens
• Intrastromal corneal
ring
segments(Intacs)
• Corneal collagen
cross-linking
• Corneal
transplantation

Type of Errors Reason Effects Correction
Myopia (Nearsightedness) • Lens is thickened
• The eyeball is too
long
• The cornea has too
much curvature
Image focused in front
of the retina
Concave lenses
Hypermetropia (Farsightedness) • Thin lens
•The cornea is not
curved enough
•Shortened eyeball
Image is focused behind
the retina
Convex lenses
Presbyopia Aging, lens looses
elasticity
Decline of
accommodation, close
objects difficult to see
Reading glasses
(convex lenses)

Type of Errors Reason Effects Correction
Astigmatism • Difference in degree
of curvature refraction
of the two different
meridians
•The inability of the
optics of the eye to focus
a point object into a sharp
focused image on the
retina.
•Vision is blurred
Cylindrical lenses
are used to correct
vision
Types of astigmatism Description
Regular astigmatism – principal meridians are
perpendicular
• With-the-rule astigmatism – the vertical meridian is
steepest
• Against-the-rule astigmatism – the horizontal
meridian is steepest
• Oblique astigmatism – the steepest curve lies in
between 120 and 150 degrees and 30 and 60 degrees.
Irregular astigmatism – principal meridians are not
perpendicular.
•Caused by a corneal scar or scattering in the
crystalline lens, and cannot be corrected by standard
spectacle lenses, but can be corrected by contact
lenses.

Inflammation of the uvea
Caused by Foreign organisms, injury, inflammatory diseases
Symptoms • Eye redness
• Blurred vision
• Increased sensitivity to light
• Floating spots before the eyes.
Treatment • Steroid eye drops
• Antibiotic
• If untreated glaucoma, cataracts, abnormal growth
of blood vessels will develop

Iritis:
• Inflammation of the
iris
• Associated with
autoimmune
disorders such as
rheumatoid arthritis.
• May develop
suddenly
• May last up to 8
weeks even with
treatment.
Cyclitis
• Inflammation of the
ciliary body.
• Develops suddenly
and may last several
month
Choroiditis
• An inflammation of
the choroid, the
layer beneath the
retina.
• Can be caused by an
autoimmune disease
such as lupus.

Absence or deficiency of one of the three cone
photopigments.
Color blindness is an inherited condition and
cannot be treated.
Other color vision problems are caused by:
Aging
Disease
Injury to the eye
Optic nerve problems

A disorder of the eye in which the
retina peels away from its underlying layer of
support tissue.
Initial detachment may be localized, or
broad but without rapid treatment the entire
retina may detach, leading to vision
loss and blindness.

Retinal Detachments Description
Rhegmatogenous retinal Detachment • Is a retinal break, hole or tear.
• Liquid from the vitreous gel
passes through the tear
• Accumulates behind the retina
• Flashing lights, floaters, or
a veil drawn over the field of vision may
be the initial symptoms.
Exudative retinal detachment • Is a breakdown in the normal inner or
outer blood-retinal barrier
• Allowing build-up of fluid beneath the
retina.
Traction retinal detachment • Scar tissue or other abnormal tissue
grows on the surface of the retina,
• Pulling the retina away from the layer
beneath it.

Identification of the hole through
microscopic headlight.
Sealed with diathermy, cryoprobe,
or laser
Sclera buckle made of
(silicone, plastic or sponge)
compresses the eye
Surgeon drains fluid from behind
the retina through a small slit in
the sclera
Air bubbles are placed into the
vitreous cavity keeping the hole in
proper position

• Injection of gas bubble into the
eye, after which laser or
freezing treatment is applied to
the hole.
• Seals the hole allowing the
retinal pigment epithelium back
into place.
• It’s simpler and less costly than
scleral buckle. If unsuccessful
scleral buckle still can be
performed.

1. Incision through the pars plana with
continuous irrigation
2. Insert of fiber optic light source through a
2nd incision
3. Insert of cutter through a 3rd incision
4. Removal of central vitreous and replaced
with BSS
5. Vacuum values are lowered when
approaching the retina
6. High speed cutting extracting the
remaining vitreous
7. Air is switched on and BSS is evacuated
using a cutter or a flute needle
8. Laser or cryo is used for retinal
detachment
9. Injection of silicon oil
10. Silicon-gas extraction occurs after 2weeks
to 4 months.

Is caused by the blood vessels of the retina not
receiving enough oxygen
If untreated it may lead to blindness
All people with diabetes are at risk

Types or Diabetic Retinopathy Description
Nonproliferative retinopathy: • Hemorrhages (bleeding) in the retina
• Leakage of blood causing a “wet retina”
• Diminishing vision.
Proliferative retinopathy: • New abnormal fragile vessels develop on
the surface of the retina
• May grow toward the center of the eye.
• These vessels frequently bleed into the
vitreous causing severe visual problems.

Stages Description
Mild non proliferative
retinopathy
Micro-aneurysms occur( swelling in the blood vessels)
Moderate non
proliferative
retinopathy
Some blood vessels that nourish retina are blocked
Vision may be diminished
Severe non proliferative
retinopathy
More blocking of blood vessels.
Retina send signals to the body to grow new blood vessels
for nourishment
Proliferative
retinopathy
New growth of abnormal and fragile vessels along the
retina and surface of the clear vitreous gel.
Bleed into vitreous causing severe visual problems
To prevent progression of Diabetic retinopathy People with diabetes
should control their levels of blood sugar, blood pressure, and blood
cholesterol.

Proliferative retinopathy:
treated with Scatter laser treatment
 Shrinking the abnormal blood vessels
If the bleeding is severe a vitrectomy is needed
Macular edema:
Macular edema is treated with laser surgery focal laser
treatment.

AMD destroys the macula, impairing central
vision.
It rarely causes blindness because only the
center of vision is affected.

Wet AMD, abnormal blood vessels behind the
retina start to grow under the macula and
leak blood and fluid, causing loss of central
vision

Laser Surgery
Photodynamic therapy
Anti-VEGF injection

Dry AMD, is a gradual breakdown of
the light-sensitive cells in the macula
 Treatment:
High dose of antioxidants and zinc
significantly reduces risk of advanced AMD
Stages Description/Symptoms
Early AMD  Small or medium sized dursen.
 No symptoms or vision loss
Intermediate AMD  Many medium-sized or one or more large sized dursen.
 Blurred spot in the center of the vision
 more light may be needed for reading and other tasking
Advanced AMD  Drusen with breakdown of light sensitive cells and supporting
tissue in the central retinal area
 Blurred spot in the center of vision which may get bigger and
darker with time taking more of central vision.

Increase in fluid pressure inside the eye leads
to:
Increase in IOL pressure
Optic nerve damage and loss of vision

Open-angle glaucoma: The structure of the
eye is normal but drainage of the aqueous
humor thru the trabecular meshwork is faced
with resistance due to narrowed openings of
the latter.

Angle-closure glaucoma: This happens when
the drainage canals get blocked or covered
over.
the iris is not as wide and open as it should
be. The outer edge of the iris bunches up
over the drainage canals, when the pupil
enlarges too much

Eye drops
Iridotomy
Trabeculoplasty
Cyclophotocoagulation
Microsurgery (trabeculectomy)

A cataract is a clouding of the lens inside
the eye which leads to a decrease in vision.
Two major types of cataract: Congenital and
Acquired cataract

Opacification of the lens obstructs light from
passing and being focused onto the retina
May be caused by injury, exposure to
ultraviolet rays, certain medication such as
steroids or complications of other diseases
such as diabetes.

Phacoemulsification is the most common procedure to
remove the opacified lens
1. Making a small incision and Paracentesis in some
cases
2. Injecting a viscoelastic solution into the anterior
chamber reducing shock into the intraocular tissues
3. Performing Capsulorhexis
4. Hydrodissection/hydrolineation
5. Sculpting the opacified nucleus and cortex by U/S
6. Irrigation/aspiration
7. Injecting viscoelastic again
8. Implanting IOL
9. Irrigation/aspiration
10. Suturing

Floaters are deposits of various size and
shapes within the eye’s vitreous humor.
Floaters are visible
because of the shadows
they cast on the retina or
their refraction of the light
that passes through them.

Floaters are due to degenerative changes of
the vitreous humor.
This gel-like substance consists of 99% water
and 1% solid elements.
The solid depolymerization of collagen makes
the hyaluronic acid release its trapped water,
thereby liquefying the gel.
The collagen breaks down into fibrils, which
are the floaters.

No treatment is usually recommended.
However, vitrectomy and laser vitreolysis
may be useful in severe cases.