KEMPAPURA, BANGALURU

Biology Investigatory Project 2023-2024

To study different eye diseases through various case studies

Madeeha Ahmed, XII B

Registration Number:
This is to certify that Madeeha Ahmed of class XII

B of Sindhi High School has satisfactorily

completed the Biology investigatory project on

‘To study different eye diseases through various

case studies’ as prescribed by CBSE for the

AISSCE course for the year 2023- 2024.

Date:

Signature of Internal Examiner

Signature of External Examiner

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I am deeply grateful to my school, Sindhi High
School, Hebbal, Bangaluru, my Principal Mrs.
Rachna Sharma and my teachers who have given me
the opportunity and encouragement to do this
project.

I take this opportunity to gratefully acknowledge my

Biology teacher Mrs. Nani N and our lab assistant
Mrs. Anita K for providing valid support guidance
and advice on planning and executing on this project
on the study of various type and treatment of eye
diseases

I also wish to thank my parents, friends and above all

the Almighty for the smooth completion of this
project.

Date: Signature:

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Sl. No. Content Page No.
1 Introduction 5-21
2 Aim 22
3 Materials required 23
4 Procedure 24
5 General observations 25 – 70
6 Observation table 71-75
7 Graph 76
8 Result 77-78
9 Inference 79-81
10 Bibliography 82

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EYE
Eyes are one of the most important organs of the body. A healthy pair
of eyes means a clear vision, which plays a major role in day-to-day
life and quality of experiences.

Humans have binocular vision, meaning that both the eyes create a
single combined image. Optical components create an image, which
further gets perceived and interpreted by the brain via connecting
neurons. The entire machinery works in quite an intricate manner.

The eye is an important and one of the most complex sensory organs
that we humans are endowed with. It helps us in visualizing objects
and helps us in light perception, colour, and depth perception.
Besides, these sense organs are pretty much similar to cameras, and
they help us see objects when light coming from outside enters
them.

The eye is a spherical organ located inside the skull (within a bone
structure called the “orbit”), which connects to our brain through
the optic nerve (ON). We are born with two eyes that allow us to see
the world where we live, by decoding a sensorial input (information
that enters the eye in form of light) and by “translating” it into
electrical information that can travel through the ON to the neurons
of our brain. The brain then processes and integrates this data, using
it for different purposes, such as helping us see where we are
walking, recognize someone’s face, see colours, etc.

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ANATOMY OF THE EYE

A human eye is roughly 2.3 cm in diameter and is almost a spherical

ball filled with some fluid.
It consists of the following parts:

The orbit is the bony cavity that contains the eyeball, muscles,
nerves, and blood vessels, as well as the structures that produce and
drain tears. Each orbit is a pear-shaped structure that is formed by
several bones.

The outer covering of the eyeball consists of a relatively tough, white

layer called the sclera (or white of the eye).

Near the front of the eye, in the area protected by the eyelids, the
sclera is covered by a thin, transparent membrane (conjunctiva),
which runs to the edge of the cornea. The conjunctiva also covers the
moist back surface of the eyelids and eyeballs.

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Light enters the eye through the cornea, the clear, curved layer in
front of the iris and pupil. The cornea serves as a protective covering
for the front of the eye and also helps focus light on the retina at the
back of the eye.

After passing through the cornea, light travels through the pupil (the
black dot in the middle of the eye).

The iris—the circular, coloured area of the eye that surrounds the
pupil—controls the amount of light that enters the eye. The iris
allows more light into the eye (enlarging or dilating the pupil) when
the environment is dark and allows less light into the eye (shrinking
or constricting the pupil) when the environment is bright. Thus, the
pupil dilates and constricts like the aperture of a camera lens as the
amount of light in the immediate surroundings changes. The size of
the pupil is controlled by the action of the pupillary sphincter muscle
and dilator muscle.

Behind the iris sits the lens. By changing its shape, the lens focuses
light onto the retina. Through the action of small muscles (called the
ciliary muscles), the lens becomes thicker to focus on nearby objects
and thinner to focus on distant objects.

The retina contains the cells that sense light (photoreceptors) and
the blood vessels that nourish them. The most sensitive part of the
retina is a small area called the macula, which has millions of tightly
packed photoreceptors (the type called cones). The high density of
cones in the macula makes the visual image detailed, just as a high-
resolution digital camera has more megapixels.

Each photoreceptor is linked to a nerve fibre. The nerve fibres from

the photoreceptors are bundled together to form the optic nerve.

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THE GLANDULAR APPARATUS
The eye is kept moist by secretions of the lacrimal glands (tear
glands). These almond-shaped glands under the upper lids extend
inward from the outer corner of each eye. Each gland has two
portions. One portion is in a shallow depression in the part of the eye
socket formed by the frontal bone. The other portion projects into
the back part of the upper lid. The ducts from each gland, three to 12
in number, open into the superior conjunctival fornix, or sac. From
the fornix, the tears flow down across the eye and into the puncta
lacrimation, small openings at the margin of each eyelid near its
inner corner. The puncta are openings into the lacrimal ducts; these
carry the tears into the lacrimal sacs, the dilated upper ends of the
nasolacrimal ducts, which carry the tears into the nose.

The evaporation of the tears as they flow across the eye is largely
prevented by the secretion of oily and mucous material by other
glands. Thus, the meibomian, or tarsal glands, consist of a row of
elongated glands extending through the tarsal plates; they secrete
an oil that emerges onto the surface of the lid margin and acts as a
barrier for the tear fluid, which accumulates in the grooves between
the eyeball and the lid barriers.

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ACCOMMODATION
The image of an object brought close to the eye would be formed
behind the retina if there were no change in the focal length of the
eye. This change to bring the image of an object upon the retina is
called accommodation. The point nearer than which
accommodation is no longer effective is called the near point of
accommodation. In very young people, the near point of
accommodation is quite close to the eye, about 7 cm (about 3
inches) in front at 10 years old. At 40 years the distance has increased
to about 16 cm (about 6 inches), and at 60 years it is 100 cm, or 1
metre (39 inches). Thus, a 60-year-old would not be able to read a
book held at the convenient distance of about 40 cm (16 inches), and
the extra power required would have to be provided by convex
lenses in front of the eye, an arrangement called the presbyopic
correction.

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WORKING OF EYE
The different parts of your eye work together to help you see
images and send visual information to your brain. This process all
happens extremely quickly. When you look at an object:

1. Light enters your eye through the cornea and goes to your
lens. Your pupil gets bigger and smaller to control the amount
of light that gets into your eye.
2. Your cornea and lens refract (bend) the light to bring what
you’re seeing into focus.
3. Light reaches the retina at the back of your eye, and the retina
changes the images into electrical impulses or signals.
4. The optic nerve transfers these signals to the part of your
brain that’s responsible for vision (visual cortex). The optic
nerve carries signals from both eyes at once.
5. Your brain interprets what you’ve seen. It combines the visual
information from both eyes and brings it all together into one
clear image.

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VOLUNTARY CENTRE
The eyes are under voluntary control, and it is thought that the
cortical area subserving voluntary eye movements is in the frontal
cortex. Stimulation of this in primates causes movements of the
eyes that are well coordinated, and a movement induced by this
region prevails over one induced by stimulation of the occipital
cortex. The existence of a separate centre in humans is revealed by
certain neurological disorders in which the subject is unable to
fixate voluntarily but can do so reflexly; e.g., he or she can follow a
moving light.

CONDITIONS THAT AFFECT THE EYES

 Age-related changes in vision: Your eyes change as you age.
Many people get floaters and flashers. In some cases, cataracts,
macular degeneration or a detached retina can occur as you
get older. Presbyopia (losing near-focus vision) usually starts
to affect people around age 45.

 Cancer: Tumours can result from intraocular melanoma and

retinoblastoma.

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 Disease: Many types of eye disease can affect the eyes,
including congenital (present at birth) cataracts, glaucoma and
optic atrophy. Corneal disease includes many diseases that
affect the cornea. Optic neuritis causes inflammation in the
optic nerve.

 Infection and irritation: Pink eye (conjunctivitis), blepharitis,

a stye, chalazion and dry eyes cause redness, swelling and
discomfort. Watery eyes can result when the eye doesn’t drain
tears properly or the eyes are irritated or dry.

 Inherited disorders: Retinitis pigmentosa is an inherited

condition (passed down through families) that can lead to
blindness.

 Injuries: Corneal abrasions and a detached retina can result

from trauma to the eye. Accidents can cause eye bleeding, a
black eye, burns and irritation. Foreign objects can also
damage the eye.

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  Problems with the muscles in the eyes: Strabismus (crossed
eyes) or amblyopia (lazy eye) can cause changes in how the
eyes appear. They can also lead to vision changes.

 Vision problems: Astigmatism and hyperopia (farsightedness)

affect how the eye refracts (bends) light and brings images into
focus. Colour blindness makes it difficult or impossible to see
different colours. Conversion insufficiency affects the eyes’
ability to work together. Some people have problems seeing at
night.

Some conditions affect the eyes directly. Other disorders begin in

different parts of your body and lead to problems in your eyes. These
include:

 Autoimmune disorders, including lupus, thyroid eye disease,

Sjogren’s syndrome and multiple sclerosis (MS).
 Cardiovascular problems such as arterial disease, high blood
pressure and high cholesterol.
 Diabetes, which can lead to diabetes-related retinopathy.
 Genetic disorders such as Marfan syndrome.

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COMMON TREATMENTS FOR CONDITIONS THAT
AFFECT THE EYES
 Corrective lenses: Glasses or contact lenses help you see
clearly. Your provider may also recommend vision correction
surgery. People with presbyopia can use special reading
glasses to help with up-close vision.
 Eyedrops or an eye patch: If you have an eye injury, your
provider may recommend flushing out your eye with water.
You may also need eye drops or an eye patch so your eye can
heal.
 Medications: Your provider may recommend antibiotics to
treat infection. You may need other drugs to manage a health
condition that’s causing eye problems.
 Surgery: Depending on your symptoms, you may need
cataract surgery or a procedure to reattach a retina. Providers
also perform surgery to correct crossed eyes, remove tumors
or transplant a cornea.

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COMMON SYMPTOMS OF EYE CONDITIONS
Signs of eye problems include:

 Eye pain, redness, swelling, bleeding or discharge

 Eyes that cross or point in different directions

 Eyes that sting, itch, burn or are very dry

 Flashes of light, especially in your peripheral (side)

vision.

 Headaches and squinting

 Inability to move your eyes or open or close your

eyelid

 Many spots or one dark spot in the middle of your

field of vision

 Sensitivity to light or trouble seeing in low light

 Vision changes, including cloudy or blurry vision

and double vision

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COMMON EYE DISORDERS AND DISEASES

The leading causes of blindness and low vision in the world are
primarily age-related eye diseases such as age-related macular
degeneration, cataract, diabetic retinopathy, and glaucoma. Other
common eye disorders include amblyopia and strabismus.

REFRACTIVE ERRORS: Refractive errors are the most frequent eye

problems. Refractive errors include myopia (near-sightedness),
hyperopia (farsightedness), astigmatism (distorted vision at all
distances), and presbyopia that occurs between age 40–50 years
(loss of the ability to focus up close, inability to read letters of the
phone book, need to hold newspaper farther away to see clearly)
can be corrected by eyeglasses, contact lenses, or in some cases
surgery.

AGE-RELATED MACULAR DEGENERATION: Macular degeneration,

often called age-related macular degeneration (AMD), is an eye
disorder associated with aging and results in damaging sharp and
central vision. Central vision is needed for seeing objects clearly
and for common daily tasks such as reading and driving. AMD
affects the macula, the central part the retina that allows the eye to
see fine details.

There are two forms of AMD—wet and dry.

 Wet AMD is when abnormal blood vessel behind the retina

start to grow under the macula, ultimately leading to blood
and fluid leakage. Bleeding, leaking, and scarring from these

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 blood vessels cause damage and lead to rapid central vision
loss. An early symptom of wet AMD is that straight lines
appear wavy.
 Dry AMD is when the macula thins overtime as part of aging
process, gradually blurring central vision. The dry form is
more common and accounts for 70–90% of cases of AMD and
it progresses more slowly than the wet form. Over time, as
less of the macula functions, central vision is gradually lost in
the affected eye. Dry AMD generally affects both eyes.

CATARACT: Cataract is a clouding of the eye’s lens and is the leading

cause of blindness worldwide. Cataracts can occur at any age
because of a variety of causes and can be present at birth. Over time,
cataracts can lead to vision loss. The good news is
that surgery can get rid of cataracts. Cataract surgery
is safe and corrects vision problems caused by cataracts.

There are 5 main types of cataracts:

 Age-related cataracts: As you get older, a cataract can develop
because of natural changes in the lens of your eye. This is the most
common type of cataract.

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 Traumatic cataracts: Serious eye injuries can damage your lens
and cause a cataract.

 Radiation cataracts: Some types of radiation can cause

cataracts. This includes ultraviolet (UV) rays from the sun and
radiation treatment for cancer.

 Secondary cataracts: After cataract surgery, it’s possible to

develop scar tissue in the eye — which can make your vision
cloudy again. This is called a secondary cataract.

 Pediatric cataracts: Children can get cataracts, too. They can be

born with cataracts (congenital cataracts) or develop them later.
Cataracts in children are rare, and they’re usually genetic.

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DIABETIC RETINOPATHY: Diabetic retinopathy (DR) is a common
complication of diabetes. It is characterized by progressive damage
to the blood vessels of the retina, the light-sensitive tissue at the
back of the eye that is necessary for good vision. The risks of DR are
reduced through disease management that includes good control
of blood sugar, blood pressure, and lipid abnormalities.

GLAUCOMA: Glaucoma is a group of diseases that can damage the

eye’s optic nerve and result in vision loss and blindness. Glaucoma
occurs when the normal fluid pressure inside the eyes slowly rises
There are two major categories “open angle” and “closed angle”
glaucoma.
 Open angle, is a chronic condition that progress slowly over
long period of time without the person noticing vision loss
until the disease is very advanced, that is why it is called
“sneak thief of sight.”
 Angle closure can appear suddenly and is painful.

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AMBLYOPIA: Amblyopia, also referred to as “lazy eye,” is the most
common cause of vision impairment in children. Amblyopia is the
medical term used when the vision in one of the eyes is reduced
because the eye and the brain are not working together properly.
The eye itself looks normal, but it is not being used normally
because the brain is favouring the other eye.

STRABISMUS: Strabismus involves an imbalance in the positioning

of the two eyes. Strabismus can cause the eyes to cross in
(esotropia) or turn out (exotropia). Strabismus is caused by a lack of
coordination between the eyes. As a result, the eyes look in
different directions and do not focus simultaneously on a single
point. In most cases of strabismus in children

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EYE CARE
To keep your eyes healthy, you should:

 Get regular eye exams so your provider can monitor your

health and detect eye problems early.

 Maintain a healthy weight, eat a balanced diet and quit

smoking if you smoke.

 Wear protective glasses during contact sports, when working

with chemicals or when doing

 Activities that might damage your eyes, such as using

fireworks.

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To study and learn about different eye
diseases through various case studies.

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 Medical history of patients
 Diagnostic reports
 Doctor’s prescriptions
 Notebook
 Pen/Pencil

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 Interpretation of Eye diseases and its types.

 Analysing symptoms & causes for the various eye diseases.

 Challenges encountered by doctors and the patient during

surgery.

 Case study walkthrough with the Doctor

 Data compilation for each case study

 Graphical representation on various types of eye diseases

 Final inference based on the research and discussion with

doctor.

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 CASE STUDIES
RELATED TO EYE DISEASES

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 CASE-1
ACUTE MUCOPURULENT CONJUNCTIVITIS
MEDICAL HISTORY OF THE PATIENT
The patient is a 9-year-old boy who reports a 3-day history of
irritation and itching in both eyes, with yellow discharge in both eyes
and sticking or gluing of the eyelids upon waking, blurry vision, light
sensitivity.
No history of eye trauma or surgery.

PHYSICAL EXAMINATION
 Engorgement of vessels resulting in discomfort and foreign
body sensation
 Mild photophobia – difficulty in tolerates light.
 Mucopurulent discharge from the eyes
 Sticking together of lid margins with discharge during sleep
 Slight blurring of vision due to mucous flakes in front of cornea
 Swelling of conjunctiva
 Cilia are matted together with yellow crust.

CAUSES
Common causative bacteria are: staphylococcus aureus, Koch-
weeks bacillus, pneumococcus and streptococcus.

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SYMPTOMS
 Red eye: Either unilateral, bilateral, or sequentially bilateral
 Discharge: Classically purulent, but may be thin or thick muco-
purulent or watery
 Irritation, burning, stinging, discomfort
 Tearing
 Light sensitivity
 Fluctuating or decreased vision

DIAGNOSIS
Acute Mucopurulent Conjunctivitis

TREATMENT
 Topical antibiotics to control infection. Treatment may be
started with chloramphenicol (1%), gentamycin (0.3%),
Framycetine eye drops 3-4 hourly in day and Ointment at night.
 Irrigation of conjunctival sac with sterile warm saline once or
twice a day. Frequent eyewash should be avoided as it will
wash away the lysozyme and other protective proteins present
in tears.
 Dark goggles may be used to prevent photophobia.
 No bandage should be applied in patients with mucopurulent
conjunctivitis. Exposure to air keeps the temperature of
conjunctival cul-de-sac low which inhibits the bacterial
growth.
 No Steroids should be applied, otherwise will flare up and
bacterial corneal ulcer may develop.

CONCLUSION
Conjunctivitis — more commonly known as “pink eye” — is an
infection of the mucus membranes that coat your eyes and the
insides of your eyelids.

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 CASE- 2
CORNEAL ULCER
MEDICAL HISTORY OF THE PATIENT
A 42-year-old female complaining of significant ocular burning,
foreign body sensation and blurred vision in her left eye which had
started 2 days prior. Pain occurs due to mechanical effects of lids.
After questioning, she reported accidentally sleeping with her soft
contact lenses in.

PHYSICAL EXAMINATION
 Lids are swollen.
 Marked blepharospasm.
 Conjunctiva is chemosed and shows conjunctival hyperaemia
and ciliary congestion.
 Cornea shows rough and yellowish white area of ulcer.
 Anterior chamber may or may not show pus (hypopyon)
 The Iris may be slightly muddy in colour and pupil small due to
associated toxin induced iritis.

CAUSES
Corneal ulcers are most commonly caused by an infection with
bacteria, viruses, fungi, or a parasite Acanthamoeba keratitis occurs
in contact lens users. It is more likely to happen in people who make
their own homemade cleaning solutions.

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Wearing contact lenses, especially soft contacts that are left in
overnight, may cause a corneal ulcer.

SYMPTOMS
 Blurry or hazy vision
 Eye that appears red or bloodshot
 Itching and discharge
 Sensitivity to light (photophobia)
 Very painful and watery eyes
 White patch on the cornea

DIAGNOSIS
The Corneal scraping and microbiological assessment

TREATMENT
 Local antibiotics that work against many kinds of bacteria.
 Corticosteroid eye drops may be used to reduce swelling and
inflammation in certain conditions.
 Antibiotic eye ointment should be applied at night.
 Systemic analgesics and anti-inflammatory drugs such as
paracetamol and ibuprofen relieve the pain.
 Vitamins (A, B-Complex and C) helps in early healing of ulcer
 Hot fomentation
 Rest, good diet and fresh air, may have smoothing effect.

CONCLUSION
The cornea is the clear tissue at the front of the eye. A corneal ulcer
is an open sore in the outer layer of the cornea. It is often caused by
infection. Corneal ulcers are considered an ophthalmologic
emergency because of their potential to permanently impair vision
or perforate the eye.
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 CASE- 3
DIABETIC RETINOPATHY
MEDICAL HISTORY OF THE PATIENT
A 55-year-old male with uncontrolled diabetics from past 20 years.
Complaining of blurring of vision

PHYSICAL EXAMINATION
 Slit lamp examination.
 Fundus examination
 Optical coherence tomography (OCT)

CAUSES
 Uncontrolled diabetic for long years

SYMPTOMS
 Blurring of vision
 Halos around light
 floaters

DIAGNOSIS
Diabetic retinopathy

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TREATMENT
 Laser eye treatment
 IV injections
 Surgery

CONCLUSION
Diabetic retinopathy is an eye condition that can cause vision loss
and blindness in people who have diabetes. It affects blood vessels
in the retina (the light-sensitive layer of tissue in the back of your eye)

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 CASE-4
SNOWFLAKE CATARACT

MEDICAL HISTORY OF THE PATIENT

A 27-year-old man came with complaints of defective vision in both
eyes for 1 year. He is a known case of type 1 diabetes mellitus on
insulin treatment since childhood. His best corrected visual acuity
(BCVA) in right eye is 3/60 and left eye 6/18. He had history of
uncontrolled sugar 4 to 5 years back after which there was a gradual
diminution of vision. His blood sugars are controlled now for the past
1 year.

PHYSICAL EXAMININATION
Ophthalmoscopy followed by slit-lamp examination. Diagnosis is
best made with the pupil dilated. Well-developed cataracts appear
as grey, white, or yellow-brown opacities in the lens.
Examination of the red reflex through the dilated pupil with the
ophthalmoscope held about 30 cm away usually discloses subtle
opacities.

CAUSES
A cataract forms when the lens of the eye becomes clouded.
Cataracts can be caused by many diseases or circumstances. A
snowflake cataract is a rare type of cataract that is connected to
diabetes.

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SYMPTOMS
 White or blue spots in the pupil that are visible when looking at
a bright light.
 The appearance of “halos” around lights
 Blurry or double vision

DIAGNOSIS
Diabetic Cataract – Snowflake cataract

TREATMENT
 Surgical removal of the cataract
 Placement of an intraocular lens

CONCLUSION
Cataracts are common in diabetes patients especially with
uncontrolled blood sugar and longer duration. Because of osmotic
swelling of lens fibre due to metabolic changes in type 1 diabetes
mellitus, opacification of cortical lens fibres occurs. Special type of
diabetic cataract—snowflake cataract—are very uncommon and are
seen in type 1 diabetes patients with uncontrolled blood sugar

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 CASE-5
MYOPIA - REFRACTIVE ERRORS

MEDICAL HISTORY OF THE PATIENT

Patient is a 10-year-old girl, she complaint of Blurry vision when
looking at distant objects like class blackboard. Frequently she gets
headache, and her eyes are strained. She is complaining of this
condition from last 6 months.

PHYSICAL EXAMINATION
Eye doctors check for refractive errors as part of a comprehensive
eye exam. The exam is simple and painless. Doctor asks to read
letters that are up close and far away. Then, they give some eye
drops to dilate (widen) the pupil and check for other eye problems.

CAUSES
Myopia occurs when light rays entering the eyes focus in front of
the retina, instead of focusing on it. Myopia can be inherited and is

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a genetic disease as well as can be developed due to environmental
conditions.

SYMPTOMS
 Blurry vision when looking at distant objects.
 The need to squint or partially close the eyelids to see clearly.
 Seeing a glare or halo around bright lights
 Headaches
 Eye strain

DIAGNOSIS
Near sightedness (myopia)

TREATMENT
Refractive errors can be corrected with glasses or contact lenses or
fix the refractive error with surgery (LASIK) after the age of 21.

CONCLUSION
Near sightedness (myopia) is a common vision condition in which
near objects appear clear, but objects farther away look blurry. It
occurs when the shape of the eye — or the shape of certain parts of
the eye — causes light rays to bend (refract) inaccurately. Light rays
that should be focused on nerve tissues at the back of the eye (retina)
are focused in front of the retina.

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 CASE-6
HYPEROPIA - REFRACTIVE ERRORS

MEDICAL HISTORY OF THE PATIENT

Patient 50 years old female came with complain about blur while
reading or near task but distant is fine. She has a problem with adapt
to progressive lens in the last 20 year ago until now. Another
problem is driving at night because of glare, blue, flare in night-time
and light sensitive in daytime. She has met Ophthalmologist every
year to routine check eye health and doctor said eye health is looking
good just some dry eye and prescribe artificial tear.

No Headache, no Diplopia just blur at nearby.

PHYSICAL EXAMINATION
Preliminary eye exam : An eye care specialist diagnoses refractive
errors with an eye exam. Performed visual acuity test. This will help
determine which type of refractive error she has and how much it’s
affecting her vision.

CAUSES
Farsightedness happens when your eyeball grows too short from
front to back, or when there are problems with the shape of your

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cornea (clear front layer of the eye) or lens (an inner part of the eye
that helps the eye focus).
These problems make light focus behind the retina, instead of on it
and that makes nearby objects look blurry.

SYMPTOMS
 Nearby objects may appear blurry.
 You need to squint to see clearly.
 You have eyestrain, including burning eyes, and aching in or
around the eyes.
 You have general eye discomfort or a headache after doing
close tasks, such as reading, writing, computer work or
drawing, for a time.

DIAGNOSIS
Farsightedness (hyperopia)

TREATMENT
 Eyeglasses.
 Contact lenses.
 Vision correction surgery such as LASIK and photorefractive
keratectomy (PRK).

CONCLUSION
Farsightedness makes nearby objects look blurry. It happens when
the eyeball grows too short from front to back, or when there are
problems with the shape of the cornea or lens. These problems make
light focus behind the retina, instead of on it.

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 CASE- 7
AGE-RELATED MACULAR DEGENERATION

MEDICAL HISTORY OF THE PATIENT

A 75-year-old man was treated for dry age-related macular
degeneration (AMD) over several years. His medical history is
significant for treatment of systemic hypertension for approximately
the past 15 years. At his initial presentation, visual acuity was 20/25
and 20/40 in the right and left eyes, respectively.
He denied flashes, floaters, pain, or photophobia. No history of
ocular surgeries or previous eye trauma.

PHYSICAL EXAMINATION
Examination of the back of your eye: to looks for fluid or blood or a
mottled appearance that's caused by yellow deposits that form
under the retina, called drusen. People with macular degeneration
often have many drusen.
Amsler grid to test for changes in your central vision.
Fluorescein angiography: The images will show if you have leaking
blood vessels or retinal changes.
Dilated Fundus Exam

OCT macula showing decreased central macular thickness

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CAUSES
No one knows exactly what causes dry macular degeneration.
Research indicates that it may be a combination of family genes and
environmental factors, including smoking, obesity, and diet.

The condition develops as the eye ages. Dry macular degeneration

affects the macula. The macula is the area of the retina that's
responsible for clear vision in the direct line of sight. Over time,
tissue in the macula may thin and lose cells responsible for vision.

SYMPTOMS
 Loss of the central vision you need to see details straight ahead
 Blurry or wavy areas in your central vision
 Colours may also seem less bright than before
 Trouble seeing in low lighting.

DIAGNOSIS
Progression to neovascular AMD

TREATMENT
 Dietary supplements (vitamins and minerals)- Atorvastatin,
levothyroxine, beta carotene, calcium carbonate
 Intravitreal injections of ranibizumab
 latanoprost in both eyes (OU) at bedtime

- 40 -
CONCLUSION

Age-related macular degeneration is the leading cause of blindness

in elderly populations. The most consistent risk factors associated
with this ocular condition are increasing age and cigarette smoking.

Age-related macular degeneration (AMD) is an eye disease

that can blur your central vision. It happens when aging causes
damage to the macula — the part of the eye that controls sharp,
straight-ahead vision. The macula is part of the retina (the light-
sensitive tissue at the back of the eye).

AMD is a common condition — it’s a leading cause of vision

loss for older adults.

- 41 -
 CASE- 8
TRACHOMTOUS SCARRING (TS)

MEDICAL HISTORY OF THE PATIENT

A patient aged 12-year girl complaint of redness pain and discharge
in left eye from past 2 days.

PHYSICAL EXAMINATION
Doctors primarily diagnose trachoma by examining the eyes and
eyelids of the patient with the aid of light and simple magnifiers.
The conjunctival surface of the upper eyelid shows a follicular and
inflammatory response
The cornea may have limbal follicles, superior neovascularization
(pannus), and punctate keratitis.
Eye discharge containing mucus or pus.
Eyelid swelling

CAUSES
Trachoma is a bacterial infection of the eyes caused by Chlamydia
trachomatis.

The bacteria are transmitted via direct or indirect contact. Contact

with the affected person's eye or nose are the main ways the
infection is spread. Closed living spaces and poor sanitation increase
the spread of the disease.

- 42 -
SYMPTOMS
 Redness of the eyes
 Itching, and irritation of the eyes and eyelids
 Discharge from the eyes,
 Swelling of the eyelids
 eye pain, and photophobia

DIAGNOSIS
Trachomatous Scarring (TS)

TREATMENT
 Antibiotics- Azithromycin, Erythromycin or doxycycline
 Eye ointment - tetracycline ointment
 Facial cleanliness is important.
 Environmental improvement (such as access to clean water
and hygiene measures to reduce the fly population) to reduce
human transmission.
 Surgery may be required for relieving entropion and trichiasis
and maintaining complete lid closure.

CONCLUSION
Trachoma is a contagious ocular infection with Chlamydia
trachomatis that causes conjunctival inflammation. As a result,
repeated bouts can lead to conjunctival scarring, trichiasis
(introversion of the eyelashes), corneal opacity, and irreversible
blindness. Trachoma is the leading infectious cause of blindness
worldwide.

- 43 -
 CASE- 9
GIANT PAPILLARY CONJUNCTIVITIS (GPC)

MEDICAL HISTORY OF THE PATIENT

Patent - 22 years / Male
Presenting VA (OU): 20/20 with contact lens
Chief Complaints: Irritation/discomfort in the left eye which
increased in intensity after lens removal since 1 month or so.
The patient was using lenses about 8-10 hours/day. His ocular and
medical history was negative, and he was not using any medications
nor had any allergies.

PHYSICAL EXAMINATION
There are no specific lab tests available for diagnosing GPC.
Physicians typically look at the size of the lesions beneath the eyelids
and account for his history of wearing contact lenses.
They also look at how the lenses move on your eyes when you blink
and examine your contact lenses for damage or eye deposit buildup.
His right eye was perfectly fine. However, in his left eye the signs
observed were:
 Enlarged papillae (macro papillae)-apices stained with
fluorescence in Zone 2
 Rough appearance of upper tarsal conjunctiva in Zone 2 & 3.
 Conjunctival hyperemia more at the superior region
 Mild swelling around upper lids
 Strands of mucus at inner canthus and underneath the upper
palpebral conjunctiva underneath the lids

While examining his contact lenses under high magnification with

the slit lamp, his right lens was in good condition with no deposits
and regular edge with no defects. His left lenses were also free of
deposits but had a fine edge defect.

- 44 -
CAUSES
GPC seems to be caused by the following:

 A contact lens, artificial eye, or exposed stitches rubbing

against the eyelid.
 Deposits of proteins or other substances on the contact lenses
 An allergy, either to contact lenses or the chemicals used to
clean them.

SYMPTOMS
 Ropy/stringy discharge
 Severe itching after lens removal
 Foreign Body sensation/Discomfort under the upper lid
 Red and painful eyes
 Swollen and droopy eyelids
 Lens intolerance

DIAGNOSIS
Contact lens induced papillary conjunctivitis (CLPC).

TREATMENT
 Topical mast cell stabilizers
 Eye drop- Flurometholone (0.1%)
 Refresh Tears (CMC)
 Removal of lens deposits early.

- 45 -
  Lens removal from the left eye completely and cold
compression.
 Replacement of soft lenses more frequently
 Improve hygiene – more rigorous surfactant cleaning, more
frequent enzyme use.

CONCLUSION
Giant papillary conjunctivitis (GPC) causes swelling, redness, and
irritation in the lining of the membrane inside your eyelids. Contact
lens wearers have the highest risk of developing GPC. People with an
artificial eye or stitches can also be vulnerable.

Unhygienic, mishandling and unawareness about contact lens wear

may lead to vision threating complications.

- 46 -
 CASE- 10
PTERYGIUM (SURFER'S EYE)

MEDICAL HISTORY OF THE PATIENT

Patent - 62 years / Male, he had first noticed the changed appearance
of his eye about 5 years ago. It had started as a small raised,
reddened area in the nasal corner of his eye. Apart from a slight
itching at times it had not bothered him, but over the years it had
increased in size and was spreading across his eye.

PHYSICAL EXAMINATION
A wing-shaped vascular thickening could be seen extending from his
nasal conjunctiva, across his iris and encroaching on the pupil.
Increase in the size and spread of the lesion.
An unpleasant appearance of eye due to the size of the lesion.
A slit lamp exam to look at the front and inside of your eye.
Visual acuity test to check how well patient can see letters or
symbols on a chart 20 feet away.

CAUSES
Pterygium is an overgrowth of your conjunctiva tissue. It is caused
by an elastotic degeneration of collagen and fibrovascular
proliferation, with an overlying epithelium.

- 47 -
It’s thought to be caused by:

 Long-term exposure to the sun’s ultraviolet (UV) light (most

common cause).
 Eye irritation from hot and dry weather, wind and dust.

SYMPTOMS
 A slightly raised pink growth on your eye.
 Red, irritated, or swollen eyes.
 Dry eyes, itchy eyes or burning eyes.
 Feeling like you have sand or grit is in your eye.
 Teary eyes.

DIAGNOSIS
Pterygium (Surfer's Eye)

TREATMENT
 Surgery – is the only treatment that can remove a pterygium
 Eye ointments or lubricating (wetting) drops / artificial tears or
decongestant drops
 Steroid eye drops or eye ointments to reduce pain, redness,
itching and swelling.

CONCLUSION
Pterygium is a degenerative disorder of the conjunctiva. It is usually
seen as a triangular fleshy fibrovascular proliferation from the
bulbar conjunctiva onto the cornea, located mostly on the nasal
side.

Ultraviolet light exposure due to outdoor occupation is a major risk

factor for the development of pterygium. Other factors associated
with pterygium development are age, being male and having dry
eyes.

- 48 -
 CASE- 11
BLEPHARITIS

MEDICAL HISTORY OF THE PATIENT

Patient: 27 years/ Female
Chief Complaints: Itching, irritation, redness, and sore eyelids from
almost 18 months. Crusty eyelids with the loss of eyelashes.
Difficulty in opening of eyelids after waking up and worsen in the
morning associated with blur vision.
No complain of headache, No history of ocular - glasses, surgery or
trauma

PHYSICAL EXAMINATION
A complete examination of the periocular area, the eye, and the
conjunctival surface is performed. Examination reveals:
Eyelash loss and/or misdirection
Telangiectasia on the anterior eyelid
Hard scales/collarettes encircling the lash base
Examination of the tear film may show instability and rapid
evaporation.
Small ulcers, bleeding on removal of crust
The diagnosis of blepharitis is usually based on a typical patient
history and characteristic slit-lamp biomicroscopic findings.
Ancillary testing, such as conjunctival cultures, can be helpful.

- 49 -
CAUSES
Blepharitis commonly occurs when tiny oil glands near the base of
the eyelashes become clogged, causing irritation and redness.

The exact cause of blepharitis isn't clear. It might be associated with

one or more of the following:

 Seborrheic dermatitis — dandruff of the scalp and eyebrows

 Infection
 Clogged or malfunctioning oil glands in your eyelids
 Rosacea — a skin condition characterized by facial redness.
 Allergies, including allergic reactions to eye medications,
contact lens solutions or eye makeup.

SYMPTOMS
 Irritation, itching, sore and red lid margins
 Lacrimation
 Crusty eyelids or eyelashes
 Gluing of cilia
 Loss of eyelashes
 Sensitivity to light

DIAGNOSIS
Anterior Blepharitis

TREATMENT
Keeping eyelids clean and free of crusts, warm compresses,
antibiotics, or steroid eye drops
Antibiotic ointment - topical antibiotic (e.g. Chloramphenicol
ointment)
Massage the eyelids- Massaging helps to force out the oily fluid from
the meibomian glands which then helps to stabilize the tear film on
the surface of the eye.
- 50 -
CONCLUSION
Blepharitis is a common eye condition that makes your eyelids red,
swollen, irritated, and itchy. It can cause crusty dandruff-like flakes
on your eyelashes.

Blepharitis can be uncomfortable. But it isn’t contagious, and it

usually doesn’t cause any lasting damage to your eyes.

The main treatment for blepharitis is regularly cleaning your eyelids

and keeping them free of crusts.

Blepharitis usually doesn’t go away completely.

- 51 -
 CASE- 12
STYE
MEDICAL HISTORY OF THE PATIENT
A 33-year-old female presented with a chief complaint of a three- to
four-day history of left eyelid swelling, pain, and redness. The
patient denied any trauma, discharge, or change in vision, and
reported no systemic symptoms or other complaints.

PHYSICAL EXAMINATION
On examination, the lower portion of the left eyelid was
erythematous and swollen, as well as warm and tender to palpation
Through examination of eye , shows Mucous discharge in the eye,
Discomfort during blinking and tearing
Visual acuity, slit lamp, and dilated funduscopic exam is necessary
to rule-out extension of eyelid pathology.

CAUSES
A stye is caused by an infection of oil glands in the eyelid. The
bacterium staphylococcus is commonly responsible for most of
these infections.

- 52 -
SYMPTOMS
 A red lump on your eyelid that is similar to a boil or a pimple
 Eyelid pain
 Eyelid swelling
 Tearing

DIAGNOSIS
Stye (hordeolum)

TREATMENT
 Warm compression: applying a warm washcloth to your closed
eyelid
 Massage: gently massaging the eyelid.
 Antibiotics: Chloramphenicol, Amoxicillin
 Painkillers

CONCLUSION
A stye is a bacterial infection involving one or more of the small
glands near the base of your eyelashes. It is like a boil or a pimple
and is often painful. Most styes are harmless to your eye and won't
affect your ability to see clearly.

- 53 -
 CASE- 13
BLACK EYES

MEDICAL HISTORY OF THE PATIENT

A 14-year-old boy had face injury while playing football 2 days back
He complaint of swelling, pain in left eye and headache. He has
difficulty in opening eye also has blurring in vision.

PHYSICAL EXAMINATION
Through examination of the affected eye. Check the vision and test
the motion of the eye.

CAUSES
The main cause of black eye is Trauma: blunt trauma to the face or
head, such as a punch, blow, or fall.
A black eye occurs when fluid collects in the tissues surrounding the
eye, usually after an injury to the area.

SYMPTOMS
 Discoloration: The most noticeable symptom of a black eye is
discoloration around the affected eye.
 Swelling: The affected area may be puffy, tender, and painful
to the touch.
 Pain: The affected area is sore and uncomfortable, especially
when moving the eye or the surrounding facial muscles.
 Red patch on the eye
- 54 -
  Blurriness

DIAGNOSIS
Black eye (periorbital hematoma)

TREATMENT
Cold and warm treatment help relieve a black eye

CONCLUSION
A black eye is a bruise in the tissues around the eye. It is called a black
eye because of the bluish-dark color of the bruising in the tissue
around the eye. This happens because the capillaries, or tiny blood
vessels, have burst and leaked blood under the skin. A black eye can
happen when something strikes a person on the face. This could be
a ball, a fist, a door, or another item.

A black eye normally disappears within 1 to 2 weeks, and it does

not normally need medical attention.

- 55 -
 CASE- 14
EYE INJURIES (OCULAR TRAUMA)

MEDICAL HISTORY OF THE PATIENT

A 35-year-old male patient admitted with history of injury at
workplace. A small metal piece has accidently entered the right eye
while hamming. Chief complaints were severe pain, photophobia,
blepharospasm, ocular pain, and difficulty in seeing.

PHYSICAL EXAMINATION

Check eyes for swelling, redness, bruising, bleeding or tenderness.

Evaluate how patient’s pupils contract (get bigger or smaller) and
how eyes move. Feel for abnormalities in eyeball and the bones and
muscles surrounding the eye. Look for foreign objects in the eye.

Test vision, dilate pupils and use special equipment to look inside
the eye during an eye exam.

Right eye examination revealed central corneal laceration with

incarceration of lens matter, multiple foreign bodies also seen
embedded in the eyelid margins and in the left cornea. Computed
ocular tomography showed a retained intraocular foreign body
(IOFB) in the right eye.

- 56 -
CAUSES
Many foreign objects enter the conjunctiva of the eye as a result of
mishaps that occur during everyday activities.

SYMPTOMS
 Pain and swelling in right eye
 Problems with eye movement
 Changes in vision, like blurred vision

DIAGNOSIS
Perforating eye injury

TREATMENT
 An anesthetic drop will be used to numb the eye’s surface.
 Using magnifier to locate and remove any foreign objects
 Repair of the rapture globe by surgery

CONCLUSION
A foreign object in the eye is something that enters the eye from
outside the body. It can be anything that does not naturally belong
there, from a particle of dust to a metal shard. When a foreign object
enters the eye, it will most likely affect the cornea or the conjunctiva.

A foreign object that lands on the front part of the eye cannot get lost
behind the eyeball, but they can cause scratches on the cornea.
These injuries usually are minor. However, some types of foreign
objects can cause infection or damage your vision.

Foreign objects that may land in your eye accidently during everyday
activities can be difficult to anticipate or avoid. To prevent getting a
foreign object in your eye, always wear protective eyewear.

- 57 -
 CASE- 15
STRABISMUS (CROSSED EYES)

MEDICAL HISTORY OF THE PATIENT

A 4-year-old boy presents with occasional crossing of his eyes. His
parents believe that her left eye deviates nasally more than the right.
Family History: Father has history of strabismus.

PHYSICAL EXAMINATION
His left eye is crossed inward (esotropic). His face is symmetric.
An assessment of visual acuity, pupil reactivity, and the extent of
extraocular movements
Slit-lamp examination is done to detect signs of cataract
Funduscopic examination is done to detect signs of structural
defects

CAUSES
Strabismus can be caused by problems with the eye muscles, the
nerves that transmit information to the muscles, or the control
center in the brain that directs eye movements.

SYMPTOMS
 Eyes that look misaligned.
 Eyes that do not move together.

- 58 -
  Frequent blinking or squinting, especially in bright sunlight.
 Tilting the head to look at things.
 Faulty depth perception
 Double vision

DIAGNOSIS
Strabismus (crossed eyes)

TREATMENT
Treatment for strabismus may include eyeglasses, prisms, vision
therapy, or eye muscle surgery.

CONCLUSION
Strabismus (crossed eyes) is a condition in which one eye is turned
in a direction that is different from the other eye.

Strabismus is often inherited, with about 30 percent of children with

strabismus having a family member with a similar problem.

- 59 -
 CASE- 16
AMBLYOPIA
MEDICAL HISTORY OF THE PATIENT
A 5-year-old girl was referred by her local optometrist for suspected
decreased vision in her left eye found on a screening exam. Her
mother had not noticed any vision problems. She has had normal
growth and development.
Family History: No history of amblyopia or strabismus

PHYSICAL EXAMINATION
Thoroughly examine the child’s vision by Put drops in the eye to
make the pupil bigger. Shine a light in each eye. Cover one eye at a
time and test whether each eye can follow a moving object.
Perform vision exam.

CAUSES
Amblyopia occurs when there is a major difference between the two
eyes in their ability to focus.

- 60 -
SYMPTOMS
 Bump into things on a particular side a lot.
 Experience a large difference in nearsightedness or
farsightedness between the two eyes.
 Favor one side of the body.
 Have crossed eyes.
 Have a droopy eyelid.
 Shut one eye or squint a lot.
 Frequently tilt their head to one side.

DIAGNOSIS
Amblyopia (Lazy Eye)

TREATMENT
Eye patches for kids : wear a patch over the better eye for at least a
few hours per day. The patch forces the brain to use the images from
the weaker eye, eventually making that eye stronger.

Glasses: Eyeglasses are also a common lazy eye treatment.

Eye drops: For mild cases, doctor will recommend eye drops
(atropine) to temporarily blur vision in the better eye, to force the
brain to use the weaker eye.

CONCLUSION

Amblyopia, often called lazy eye or lazy vision, is a serious eye

condition that affects vision. Poor sight develops in one eye during
infancy or childhood and gets worse over time if not treated.

In a child with amblyopia, one eye has blurred vision, and the other
has clear vision. The brain begins to ignore the blurry eye and uses
only the eye with clear vision. Eventually, the brain learns to rely on
the stronger eye, allowing the weaker eye to worsen.

- 61 -
 CASE- 17
GLAUCOMA
MEDICAL HISTORY OF THE PATIENT
The patient, a 61-year-old female retired school teacher, has not had
an eye exam in 10 years. She admits to mild eye burning feeling after
reading for long periods of time or in the afternoons. She denies any
flashes, floaters, pain, redness or double vision.
Past medical history: Hypertension

PHYSICAL EXAMINATION
An examination of the external eye, the pupils, a direct or slit-lamp
ophthalmoscopic exam, an assessment of ocular motility, visual
fields, and visual acuity, and a measurement of the IOP

CAUSES
Hereditary causes, High myopia, Diabetics, and hypertension

SYMPTOMS
 No symptoms in early stages
 Gradually, patchy blind spots in your side vision. Side vision
also is known as peripheral vision
 In later stages, difficulty seeing things in your central vision

- 62 -
DIAGNOSIS
Primary open-angle glaucoma

TREATMENT
Treatment includes laser surgery and/or topical medications (eg,
prostaglandin analogs, beta-blockers) and often requires incisional
surgery to increase aqueous drainage.

CONCLUSION
Glaucoma can occur at any age but is more common in older adults.
It is one of the leading causes of blindness for people over the age of
60.

Primary open-angle glaucoma is an optic neuropathy associated

with high IOP and a characteristic visual field loss. The primary
problem with open-angle glaucoma is a defect in the trabecular
meshwork. The normal draining process of the aqueous humor
therefore is disrupted, which causes a rise in intraocular pressure
(IOP). Months or years later, the increased pressure leads to a
thinned, damaged optic disc. This results in vision loss initially in the
periphery.

- 63 -
 CASE- 18
SENILE CATARACTS

MEDICAL HISTORY OF THE PATIENT

A 74-year-old man, progressively diminished vision in both eyes from
last 2 years. Loss of vision in left eye in the past 6 months.
No history of prolonged illness, diabetes, or hypertension

PHYSICAL EXAMINATION
Several tests can help the doctor diagnose a patient with a senile
cataract.

 Dilatation.
 Slit lamp examination.
 Red reflex test

CAUSES
Senility (aged), Diabetics

SYMPTOMS
 With senile cataracts, the center of the eye's lens becomes
thick and discolored.
 Noticeable changes in the appearance of the affected eye(s),
including cloudiness, yellow, or pearl white cataract.
 Blurred and cloudy vision
- 64 -
  Haloes around lights
 Washed-out colors

DIAGNOSIS
Age-related cataracts

TREATMENT
Cataract Surgery

CONCLUSION
Senile cataract refers to cloudiness, hardening, and yellowing of the
central region of the lens in the eye called the nucleus. It usually
develops in older patients. These changes are part of the aging
process of the eye.

- 65 -
 CASE- 19
COMPUTER VISION SYNDROME

MEDICAL HISTORY OF THE PATIENT

A patient of age 44-year-old man complaining of eye strain, dry eyes,
blurred vision, redness, burning eyes, excessive tears, double vision,
headache, glare sensitivity, fatigue, neck, shoulder, and back pain
from past 6 months. He uses computer extensively, almost 10-12
hours in a day.

PHYSICAL EXAMINATION
Computer Vision Syndrome can only be diagnosed through a
comprehensive eye examination with a vision specialist. The special
eye and vision testing will focus on assessing the individual's visual
function at the viewing distances for the computer or other digital
device working distances. The comprehensive eye exam will also
include testing for any undetected and/or untreated vision problems
that can contribute to or be mistaken for Computer Vision
Syndrome.

CAUSES
The main causes of Computer Vision Syndrome include an
unsuitable environment and the improper use of eyeglasses or
contact lenses. To prevent CVS, changes need to be made to improve
these conditions.

- 66 -
SYMPTOMS
 Blurred vision
 Dry, red eyes
 Eye irritation
 Headaches
 Neck or back pain

DIAGNOSIS
Computer Vision Syndrome (Digital Eye Strain)

TREATMENT
For Dryness – lubricating eye drop

A few simple changes to your workspace can improve your

symptoms and prevent new problems:

Cut the glare: Change the lighting around you to reduce the effect
on your computer screen by using anti glare lens (blue block)

Rearrange your desk: The best position for your monitor is slightly
below eye level, about 20 to 28 inches away from your face

Give your eyes a break: Follow the 20-20-20 rule. Look away from
the screen every 20 minutes or so and look at something around 20
feet away for about 20 seconds. Blink often to keep your eyes
moist. If they feel dry, try some eye drops.

CONCLUSION
As we enter the 21st century, the growing use of computers in the
home and office brings with it an increase in health risks, especially
for the eyes. One eye problem, called Computer Vision Syndrome
(CVS), is afflicting more and more people who find themselves
constantly in front of computer screens.

- 67 -
the pain and discomfort associated with the problem can affect
workplace performance or the enjoyment of home activities. With a
few preventative measures, however, the symptoms associated
with CVS can be easily erased.

- 68 -
 CASE- 20
DRY EYE

MEDICAL HISTORY OF THE PATIENT

A patient is 51 years old female. She admits to symptoms of ocular
irritation and burning when she wakes up in the morning. The eyes
also feel dry in the afternoon and look red. She complains of eye
pressure and eye strain when she is using computer for long hours.

PHYSICAL EXAMINATION
Ophthalmologist perform eye exam, examines her eyelids and the
surface of the eye. Also check how is her blink frequency.
Perform test to measures the quality or the thickness of your tears,
also measure how quickly tears are produced.

CAUSES
Dry eye results from a variety of causes, but aging is the single
highest factor.
Other causes of dry eye can include:

 Illness (including rheumatoid arthritis, lupus, Graves'

disease, diabetes, scleroderma, and Sjogren's syndrome).
 Hormonal changes in women after menopause and during
pregnancy.

- 69 -
  Poor blinking habits while reading or looking at a computer
screen for long periods of time.
 A dry, indoor environment.
 Contact lenses.

SYMPTOMS
 Dry, gritty or burning sensation
 Redness, watery or teary eyes
 Itching and light sensitivity
 Eye pressure and eyestrain

DIAGNOSIS
Dry eye

TREATMENT
Give your eyes a rest. Take frequent breaks when you’re reading or
using a computer. Practicing the 20/20/20 rule may help.
Take omega-3 fatty acid supplements.
Artificial tears: Artificial tears lubricate and soothe your eyes,
temporarily relieving symptoms.
Ointments: If your eyes dry out while you sleep, you can use a thicker
lubricant at night, such as an ointment.
Topical cyclosporine A eye drops : treat inflammation in your tear
glands so they produce more and better quality tears
Varenicline nasal spray: Varenicline increases basal tear production
by directly stimulating your trigeminal nerve.

CONCLUSION
Dry eye happens when your eyes don't make enough tears to stay
wet, or when your tears don't work correctly. This can make your
eyes feel uncomfortable, and in some cases it can also cause vision
problems

- 70 -
Case Age Symptoms Diagnosis Treatment
no. (yrs)
 Red eye
1 9 Acute Topical antibiotics
 Discharge mucopurulent and irrigation of
 Irritation conjunctivitis conjunctival sac
 Tearing
 Light sensitivity

 Blurry
2 42 Corneal ulcer Local antibiotics,
 Eye bloodshot corticosteroid eye
 Itching and drops and antibiotic
discharge eye ointment
 Sensitivity to light
 White patch on
the cornea
 Blurring of vision Diabetic
3 55 Laser eye treatment,
 Halos around light retinopathy
Surgery
 floaters

 White or blue
4 27 Snowflake Surgical removal of
spots in the pupil the cataract and
cataract
 The appearance placement of an
of “halos” around intraocular lens
lights
 Blurry or double
vision
 Blurry vision
5 10 Nearsightedness Refractive errors
 Seeing a glare or
(myopia) corrected with glasses
halo around
bright lights
 Headaches
 Eye strain
- 71 -
  Nearby objects
6 50 Farsightedness eyeglasses /contact
may appear
(hyperopia) lenses/vision
blurry.
correction surgery
 Eye strain
 Eye discomfort
 Headache after
doing close tasks
 Loss of the central
7 75 Progression to Dietary supplements
vision neovascular (vitamins and
 Blurry areas in AMD minerals and
central vision intravitreal injections
 Colours seem of ranibizumab
less bright than
before
 Trouble seeing in
low lighting
 Redness of the
8 12 Trachomatous Antibiotics, facial
eyes scarring (TS) cleanliness,
 Itching of the eyes
environmental
and eyelids
improvement
 Discharge from
the eyes,
 Swelling of the
eyelids
 eye pain, and
photophobia
 Ropy/stringy
9 22 Contact lens Topical mast cell
discharge induced stabilizers, eye
 Severe itching papillary
conjunctivitis. drops, refresh tears
after lens removal
 Foreign Body
sensation
 Red and painful
eyes
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  Swollen and
droopy eyelids
 Lens intolerance
 A slightly raised
10 62 Pterygium Surgery
pink growth on (surfer's eye)
your eye.
 Red, irritated, or
swollen eyes.
 Dry eyes, itchy
eyes or burning
eyes.
 Teary eyes.
 Irritation, itching,
11 27 Anterior Antibiotic ointment,
sore and red lid blepharitis massage the eyelids
margins.
 Lacrimation
 Crusty eyelids or
eyelashes
 Gluing of cilia
 Loss of eyelashes
 Sensitivity to light
 A red lump on
12 33 Stye Warm compression,
your eyelid that is (hordeolum) massage, antibiotics
similar to a boil.
 Eyelid pain
 Eyelid swelling
 Tearing
 Discoloration
13 14 Black eye Cold and warm
 Swelling (periorbital treatment
 Pain hematoma)
 Red patch on the
eye
 Blurriness

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  Pain and swelling
14 35 Ocular trauma Removal of foreign
in eye
objects, antibiotic
 Problems with
ointment
eye movement
 Changes in vision,
like blurred vision
 Eyes that look
15 4 Strabismus Eyeglasses, prisms,
misaligned. (crossed eyes) vision therapy, or
 Eyes that do not
eye muscle surgery
move together.
 Frequent blinking
 Tilting the head to
look at things.
 Faulty depth
perception
 Double vision
 Favor one side of
16 5 Amblyopia Eye patches for kids,
the body. (lazy eye) glasses, eye drops
 Have crossed
eyes.
 Have a droopy
eyelid.
 Shut one eye or
squint a lot.
 Gradually, patchy
17 61 Primary open- Laser surgery and/or
blind spots in angle topical medications
your side vision. glaucoma
 In later stages,
difficulty seeing
things in your
central vision
 Blurred and Senile
18 74 cataracts Cataract surgery
cloudy vision

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  Haloes around
lights
 Washed-out
colours
 Blurred vision
19 44 Computer Cut the glare,
 Dry, red eyes vision rearrange your desk
 Eye irritation syndrome and follow 20-20-20
 Headaches (digital eye rule
 Neck or back pain strain)
 Dry, gritty or
20 51 Dry eye 20-20-20 rule,
burning sensation artificial tears, topical
 Redness, watery cyclosporine a eye
or teary eyes drops, varenicline
nasal spray
 Itching and light
sensitivity
 Eye pressure and
eyestrain

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- 76 -
After careful analysis of all the case studies, we can conclude that
eye diseases are preventable and treatable. The aging of the human
eye involves a series of changes in visual performance that can be
readily detected in the healthy adult.

Diseases like conjunctivitis and ulcer have symptoms like itching,

irritation, discharge, and light sensitivity. For Cases 1, 2, 8 and 9
patient complaint of these symptoms and were diagnosed with
Conjunctivitis, Ulcer and Trachomatous scarring. Common treatment for
such diseases is tropical antibiotics and antibiotic eye ointment.

Cases 3,4, 7 and 18 are mostly related to old age or chronic disease
like diabetic. In such cases patient complains of blurring and double
vision, Halos around light and loss of central vision. Treatment is
usually through surgery and dietary supplements. Diseases in such
cases are Cataract, Diabetic retinopathy, and AMD.

Another common eye disorder in children is Myopia and among

adults are Hyperopia, Computer Vision syndrome and Dry eye. Cases
5, 6 ,19 and 20 are examples of such disorders. Symptoms are blurry
vision, headaches, and eye strain. Refractive errors are corrected
through glasses for children and for adults treatment is done
through eyeglasses /contact lenses or vision correction surgery.
Prevention is done by following 20-20-20 rule.

Cases 12, 13 and 14 are examples of Stye/Black eye/Ocular trauma.

In these cases, there will be swelling, pain and red patches in eye.
Common treatment is warm/cold compression and antibiotic
ointment.

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There are some genetic eye diseases/disorders or by birth. Cases 15
and 16 are example of such cases. Strabismus (crossed eyes) and
Amblyopia (lazy eye), in these cases eyes look misaligned. Eyes do
not move together. Treatment is done through eyeglasses or eye
muscle surgery.

Most of the eye diseases if treated on time is curable, there by

reduction in percentage of vision impairment or blindness in the
population.

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Eye is one of the important sense organs of our body. eyes giving us
the ability to see. Eyes play a critical role in helping you interact with
the world. The parts of the eye work together to allow you to see.
Many injuries, diseases and conditions can cause problems with how
the eyes work. The early and common symptoms related to eye
should not be ignored. If any symptoms are detected contact your
eye provider for an eye exam.

Among children 60% were diagnosed with myopia. Although myopia

is not very harmful disorder can be treated easily and we should take
preventive measures to avoid it. And each year, diabetic retinopathy
accounts almost 10% of all new cases of blindness.

The most common symptoms

 Red Eyes, Dry eyes with itching or burning.
 Excess discharge or tearing
 Eye pain and Swelling
 Floaters/flashers , Halos/glare , blurred vision
 Growing bump on the eyelid
 Change in iris colour
 Difficulty focusing on near or distant objects.
 Headaches
 Photophobia

Common treatment or medication

 Topical antibiotics
 Corticosteroid eye drops
 Antibiotic eye ointment
 Laser eye treatment
 Cataract surgery
 Refractive errors corrected with glasses.

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  Dietary supplements (vitamins and minerals)
 Refresh tears
 Warm/Cold compression
 Massage the eyelids.
 Follow 20-20-20 rule.

There are several medical conditions that lead to vision and eye
health problems.
 Diabetes: People who suffer from diabetes for many years may be
at risk of a condition known as diabetic retinopathy.
 High Blood Pressure: The issues with your blood pressure can
result in damage to the blood vessels in and around the eyes.
 Measles: If measles affects the eyes, it can result in conjunctivitis.
 Shingles: Shingles are a painful viral infection that result in
blisters and rashes around the body. If they affect the face
(particularly the eye area), this can result in eye pain,
inflammation around the eyes, and swelling of the eyelids.
 Rosacea: is a skin condition that leads to redness of the face.
When the rosacea is located around the eyes, it can result in dry
eye, itchy eyes, burning sensation around the eyes, and redness
of the eyes.

Leading causes of vision impairment and blindness are:

 Refractive errors
 Cataract
 Diabetic retinopathy
 Glaucoma
 Age-related macular degeneration.

When it comes to having good vision for a lifetime, it’s ultimately

important to be in good overall health. Protecting your eyes from
the sun and from trauma is important, but eating right, exercise,
and regular checkups can go a long way to prevent other sorts of
ocular health problems later in life. Always wear protective eyewear
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to prevent injuries, especially during contact sports or if you have a
job working with tools that could potentially lead to eye injuries
(welding, metalwork, woodworking, etc). Limit the screen time for
better vision and overall heath.

Adding powerful vitamins, antioxidants and minerals to your diet

can improve your vision and overall eye health. Nutrients, such as
lutein and zeaxanthin, vitamin C, vitamin E and zinc reduces the
risk of certain serious eye diseases like age-related macular
degeneration and cataracts.

For good eye health, include below food sources in your diet.
 Dark green leafy vegetables
 Colorful fruits and vegetables like broccoli, corn and peas.
 Oranges, grapefruit, strawberries, papaya, green peppers and
tomatoes
 Vegetable oils (including safflower and corn oil), nuts, wheat
germ and sweet potatoes.
 Salmon, tuna and other cold-water fish
 Red meat, oysters and other shellfish, and nuts and seeds

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 https://my.clevelandclinic.org
 https://www.cdc.gov/visionhealth
 https://www.nei.nih.gov/learn-about-eye-health/eye-
conditions-and-diseases
 https://www.ncbi.nlm.nih.gov/pmc/journals/797/
 https://www.webmd.com/eye-health/common-eye-
problems

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