Lens -

- Transparant , avascular , crystraline biconvex

structure.

- Refrative powr of lens - 16 D.

- Lens consist of - Protein

- CHO
- Water.
 Structure of lens

lens capsule Lens epithelium Lens Fiber

Ftbrous protein Epithelial tissue protein fiber

Nutrition supply by aqueous humour – Lens

 GLAUCOMA
Glaucoma is characterised by increase IOP
resulting atrophy of optic nerve leads to irreversible
Blindness.

Increase IOP is most common cause and only

modifiable cause.
If Increase IOP but not demage optic nerve Known as
Intra-occular Hypertension (IOH)

Painless Painfull
24-30 mm.Hg 30-60 mm.Hg

Risk Factor -
- Family history. D.M.,
Corticoteriod intake, Cardio vascular disorder.
Classification –
Type of Glaucoma -
a. Primary adult angle Glaucoam
(i) Primary open angle Glucoma (POAG)
(ii) Primary closer angle Glaucoma (PCAG)

(b) Secondary Glaucoma -

(C) Congenital Glaucom -

(i) POAG - Most common Type .
- Increase IOP Resulting peripheral retinal damage
and anterior angle is normal.
* It is painless and peripheral vision loss.
* Tunnel Vision loss.
* Thieft of sight.
* Aqueous outflow into trabecular meshwork cause
lens or pupil dilation form sympathetic stimulation.
(ii) PACG -
- It is medical emergency.

Due to suddenly increase IOP and sever pain.

- PCAG in this the episode occur in dim light.

- The angle of anterior chamber is increase so
suddenly increase IOP which cause severe pain.
- Required medical emergency.
(B) Secondary Glaucoma -
Occur due to -

- D.M
- Injury
- Cataract
- Infection
- Tumor in cilliary process
- Conrticosteroid use
(C) Congenital Glaucoma -
- Maternal infection - Torch.
- D.M
Cause - structure changes in trabecular maswark.
P.P - Due to etiological factor
Increase acqous humore production.
Or
Decrease A.H (drainage) -- Increase IOP
Damage optic nerve of retina
Develop - Glucoma | Blindness
- Early sign is decrease accommodation and
increase IOP.
S/S -
* Halos (in white line a colour layer is seen due to
retinal compression)
- Blurred vision.
* Corneal edematous. (water collect in corneal
layer)

- Corneal erythmatous. (Redness)

D/E -
* Opthalmoscopy - Increase cupping of disk. (Optic
disk)

* Perimetery - Decrease peripheral vision

* Tomomatary - Seen increase IOP (More than 21

mm.Hg)
* Gonioscopy - Measure the angle of anterior
chamber. (Normal angle - 45)
Rx-
Medical Rx -
1. Parasymphatho miomatic | miomatic | myatic -
MOA - They decrease IOP by opening the angle of
anterior chamber and Increase outflow.

ex- Pilocarphine.
Ecothiophate
2. Sympathomiomatic

B-Adrenargic Blocker Alpha- Adrenargic Agonist

Block the B-Receptore Apraclonidine

on cilliary process. Brominids

So decrease AH.
TIMOLOL - D.O.C
Patient but don’t have cardiac and copd disease
because – Decrease H.R & Broncoconstriction
-Most widely used drug
Contraindicated in - Cardiac pt., COPD | Asthma

Bitaxolol use in cardiac disease copd Pt.

Dose - 0.25 mg
3. PG - Latanoprosal
MOA - Increase Uveoscteral outflow

Increase A.H dranage

Decrage IOP
4. Carbonic Anhydrase Enzyme -
MOA - It decrease the A.H Production resulting
decrease IOP.

CO2 + H2O

C.A H2CO3 H + HCO3

Increase AH
Ex- Acetazolamide.
5. Osmotic Agent -

Maninto 20%

Increase blood osmalarity.

Resulting decrease A.H osmalarity

Decrease IOP.
- Instruct the client to avoid anticholinergic
medication.

Surgery -
(i) Trabeculoplasty -
Reconstrection of the trabeculimaswork and open
the canal.
Resulting increase Absorption | dranage of A.H.
- Use lesser rays.
(ii) Trabeculectomy -
Resection of trabeculimash work.

Increase A.H dranage

Decrease IOP
(iii) Iridectomy -
- In PACG
- In which resect the iris and open the angle.

Increase A.H outflow

NOTE = Antipsychatic Olzapine drug - Increase

weight
(iv) Cyclotherapy - (Cryotherapy)

Use - 70 temp. Cryocope use

to destroye cilliary process.

Increase A.H production

Decrease IOP
Nsg Role -
- Avoide all activity which increase - IOP.
Weight-lifting , Straining , Avoid constipation.
- Avoid to take life time medication.
- Avoid Atropine sulphate.

Because pupill dilatation

- Monitor H.R if less than 60 BPM.

Stope | Avoide sympathomiomatic.

 Cataract .
-Cataract is characterised by opacification of lens
resulting blurred vision.

Most common cause - Senile cataract. (>50year)

Most common cause of blindness in india.
Risk Factor -
- Exposure of Uv-rays.
- Exposeure of bright light.
- High altitude space

Diet - Low protein diet.

- Vit-A, C deficiency diet
- Smoking – toxin - demage lens protein.
Classification of Cataract -

(a) Senile Cataract -

- Age Related.
- Most Common Type.

(b) Secondary Cataract –

Due to - D.M

Sarbitol
 Demage lens protein

Seen lens apperance snow strom apperance

Copper Toxicity.

Wilison Disease Seen- sunflower

apperance of lens.
- Corticosterid intake.
- Trauma
- Gradual painless blurring of central vision is the
chief clinical manifestation.

Due to Age Na/ k pump Due to age amino-acid

Na+ retain in lens. Decrease protien production

Increase Osmolarity Denaturation of protein.
 Fluid retaintion in lens.

Opacification of lens.
Cataract

Sign / Symptoms ::
Early sign – Glare
- Dazzling effect.
- Halos.
- Blurred vision
- Lens swelling
- Secondary myopic shift
- pain
- Perly white lens. late sign
- Visiual acquity decrease.
- Vision loss gradually.
D/E -
- Visual Acquity.
- Opthalmoscopy - Seen - perly white lens.
- Slit lens examination - anterior eye

Rx-
Pre-operative -
- Administor mydratics - To dilate the pupil.
ex- atropine sulphate.
Surgery -
(i) ICCE - Intracapsular cataract extrecsion.
Remove lens with entire lens capsule.

(ii) ECCE - (Ettracapsular cataract extrecsion)

In this remove lens with anterior capsule and
intact pasterior capusle.
Topical anesthesia used in cataract - Surgery.
 Retinal Detachment
- Characterised by Hole in the retina liquification of
vitrous humour and fluid accumulation
Resulting sepration of sensorynaural layer from
epithelial layer. (Tear in Retina)
Cause - Age most common 40-60 year
- Degenration of retina vitorus humor.
- Myopia 40%
Traction Force.

- Trauma.
- D.M.
P.P – Due to Etiological
Degeration of Retina Myopia

Hole in Retina Increase viteroretinal

Traction force
Liquification occur

Increase Fluid accumulation in retinal

Sepration of Retina
S/S -
* Floaters - Spot present in visiual fild.
* Feeling falling o curtain.
* Painless vision loss.
* Blurred vision.
D/E - Opthalmoscopy
Partial sepration Complet sepration
of retina of retina.

Horse shoe Funnel Shaped

Rx- 6 wk rest

* Rest - Movement resctrict

Prevent from complet tearing.

* Provide eyeshield
Surgical Rx -
1. Sub-Retinal fluid dranage (SRF) -
Drain the fluid with niddle which attached with
tube from subretinal space.
2. Sclear buckling .
- In the provide splint to the retina which hold with
choroid untill tissue scar is formed
Air - Sulfahexa phloride (SF6) | silicon or air buble
is injected vitours cavity. which help in
addation of retinal with choroid.
(ii) Cryotherapy -
- Cold cryoprobe is applied through the retinal
which help in adbesion of retina.

- Gas - argan
- 70 temp.
(iii) Diatherapy -
- Heatprobe is applied in retina which help in to
produce healing the retinal and help in adbesion.

Melignancy Condition

Enucleation - Removal of eyeball.

Exentration - Removla of eyeball with surrounding
tissue and orbit.
 CHEMICAL AGENT
Outside hospital – Irrigate eye with tap water –
10 -15 minute with 1 liter

Inside hospital – Normal saline 1 lit, 10 -15 minute

Than montor eye ph 7 arround
If PH > 6 – Contiue wash eye
* Penetrating Object to eye ball -

Rx -
Q. Never try to remove living organism (living)
- Cover the eye ball with gauze peices.
* Ptosis | drolling of Eyelid -
1-2 mm cover the pupil

Cause -
- Levator palpabriae superiorus muscles (LPS)
- Levator palpabrie frontalise.
- Mysthania gravis.

D/E - Tensiolon Test

Rx - Bleproplasty -