EYE LID

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Jincy VargheseFellow optom

The eye foundation

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Mobile tissue curtains placed in frontof the eyeballs.

Act as shutters protecting the eyes

from injuries and excessive light. pper lid is limited by eyebrow !

lower lid merges with chee".

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GLAND TYPE OF

GLAND

LOCATION

Meiobomiangland

Sebaceousgland

Witin teta!sus

"eis gland Sebaceousgland

Lid ma!gin

Moll gland S#eat gland Lid ma!gin

$!ause Accesso!%lac!imal gland

Fo!ni& o'con(uncti)a

Wol'ing Accesso!%

lac!imal gland

*++e! ma!gin

o' ta!sus

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Disorders of eyelid

Congenital Inflammatory In the position of Lashes and lidmargin

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COLOBOMACOLOBOMA

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A full thic"ness triangular gap in thetissue of the lids.

sually occurs near the nasal side

and involves the upper lid morefre#uently than lower the lid.

Treatment $ surgical correction

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%t is a semicircular fold of s"in whichcovers the medial canthus

%t is a bilateral condition

%t is the common congenital anomaly

Treatment & surgical correction

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%n this condition the extent of thepalpebral 'ssure is decreased. %tappears contracted at the outer

canthus.

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(xtra row of lashes in place ofopening of meibomian gland.

The aberrant lashes tend to be

thinner shorter and less pigmentedthan normal cilia.

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)*(+,A-%T% %t is a sub acute or chronic

in/ammation of the lid margins.

TYPES #uamous blepharitis lcerative blepharitis

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%t is usually associated with seborrhoeaof scalp0dandru12. %t is not aninfective condition

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Squamous Blepharitis

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-edness of eyelid margin

)urning ! discomfort

(piphora

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3hite dandru1 li"e scales are seenon lid margin

underlying surface is found to behyperaemic. )ut no ulceration.

Madarosis ! tylosis

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-emoval of scales from the lid marginwith baby shampoo

Antibiotic ! steroid eye ointment

cales is removed by a moistened

cotton tip 4 twice

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%t is chronic staphylococcal infectionof the lid margin.

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chronic irritation

itching

mild lacrimation

gluing of cilia

photophobia ! redness

*oss of eyelashes

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%56

yellow crusts are seen at the root of

cilia

mall ulcers are seen around the baseof the eyelash

*oss of cilia or misdirected cilia

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Ulcerative Blepharitis

خر

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*id scrub & with a cotton tip

(pilation of loose and diseased

eyelashes

Antibiotic & steroid eye ointmentor

drops

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%t is a meiobomian gland dysfunction

%t is characteri7ed by white frothysecretion on the eyelid margin andcanthi

At the opening of lid margin

meiobomian gland becomeprominent with secretions

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3atering

8ischarge & mainly at the canthi

Foreign body sensation

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3hite frothy secretion on the eyelidmargin

9n pressing the lid margin & secretion

is expressed as tooth paste

9n evertion of the eyelids & seen

vertical yellowish strea"s shiningthrough the conjuctiva

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,ot compress

Vertical lid massage

teroid & antibiotic ointment

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%t is a chronic non infectivegranulomatous in/ammation of themeibomian gland

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painless swelling in the eyelid

Mild heaviness

8rooping of the eyelid

$

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non tender

roundish: 'rm lesion with in the tarsalplate of variable si7e

6o signs of in/ammation

9n eversion4 the nodule is velvety red or

purple

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Antibiotics

,ot formentation

%!;

intralesional injection oflong acting steroid

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%t is an acute suppurativein/ammation of gland of the <eis orMoll

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Acute pain

welling

ense of heaviness and discharge

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-edness and oedema

wollen area at the lid margin & it

whitish:round:raised pus point

welling li"e tender

Matting of eyelashes

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,ot compresses:

antibiotics:

anti4in/ammatory and analgesics

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%t is a suppurative in/ammation ofthe meibomian gland associated withbloc"age of the duct.

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similar to hordeolum externum.

Tenderness and swelling is away from

the lid margin

pus point on the tarsal conjunctiva

seen as yellowish2

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similar to external hordeolum exceptthat pus is formed:

it should be drained by a verticalincision from the tarsal conjunctiva.

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+T9% Abnormal drooping of the upper eye

lid. 6ormal4 upper one sixth of the

cornea ie.about = mm : in ptosis itcovers more than = mm

Types ;ongenital Ac#uired

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%t is associated with congenitalwea"ness of the levator palpebraesuperioris and superior rectus muscle

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+artial or complete trigeminal nervepalsy 0> rd2 nerve palsy

May be neurogenic or myogenic

May be mechanical or traumatic

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,istory age of onset: duration: variability of ptosis during the day: diplopia: old photographs.

ymptoms of systemic problems

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Marginal re/ex distance it is the distance between the upper lid

margin and corneal re/ection of a pen

torch:the normal is ?4?.@ mm.

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Vertical 'ssure height

it is the distance between the lowerlid and upper lid margins

The upper lid normally rests about =mm below the upper limbus and=mm above the lower limbus

%n normally males 4 BC mm !females D4B= mm.

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+lacing a thumb 'rmly against thepatients brow to the frontalis musclewith the eyes in down ga7e then

loo"s up far: 5rades 6ormal & B@ mm

5ood & B=4B? mm Fair @4BB mm +oor ?mm or less

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pper lid crease

it is the vertical distance between lidmargin and the lid crease

%n females BC mm ! males D mm

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+retarsal show

it is the distance between the lidmargin and the s"in fold with theeyes in the primary position

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%ncreased innervation

Fatiguability

9cular motility defect

Jaw win"ing phenomenon

)ell phenomenon

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%t refers to inward misdirection of ciliawith normal position of the lidmargin.

+seudotrichiasis & the inward turningof lashes along with the lid margin is

called pseudotrichiasis.

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Trichiasis

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foreign body sensation

+hotophobia

%rritation

+ain and lacrimation

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re/ex blepharospasm

photophobia:

conjunctiva may be congested:

causative disease trachoma :blepharitis etc may be present.

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(pilation

(lectrolysis

urgical correction

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%t is an inward turning of eyelidmargin:lower eyelid entropion is moremuch more common than upper

eyelid

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foreign body sensation:

%rritation:

+ain: *acrimation and discharge:

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%nturning of the lower lid

;onjunctival congestion

8ischarge with matting of eyelashes

)lepharospasm

uper'cial corneal opacities

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The degree of inturning it divided in to threegrades

5rade % $ The posterior lid border is

inrolled. 5rade %% $ entropion includes inturning upto the inter marginal strip.

5rade %%% $ whole lid margin including theanterior border is in turned.

MA6A5(M(6T surgical correction

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9ut rolling or outward turning of thelid margin.

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(piphora:

%rritation:

8iscomfort:

Mild photophobia

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lid margin is outrolled.

8epending upon the degree of out rollingit can be divided into three grades

5rade % $ only punctum iseverted

5rade %% $ lid margin is evertedand palpebral conjunctiva is visible

5rade %%%$ fornix is also visible.

Management & surgical correction

GN

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%n this condition: lids becomeadherent with the eyeball as a resultof adhesions between the palpebral

and bulbar conjunctiva

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+ain and redness

3atering & due to inade#uate

lacrimal drainage

8iplopia

;osmetic dis'gurement

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-estriction of ocular movement

Visible 'brotic band

cornea present in the anterior part$anterior symblepharon:

in the fornix $ posterior symblepharon: seen in the whole lid $ total

symblepharon.

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%nability to close the eyelids.%ncomplete closure of the palpebral

aperture.

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%t refers to the adhesions betweenmargins of the upper and lower lids

%t may be complete or incomplete .

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+artial or complete absence of theeyebrow :palpebral 'ssure:eyelashes: and conjunctiva.

%t is unilateral or bilateral.

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Absence of eye lashes 8ue to blepharitis: leprosy.

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Thic"ening of lid margin

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,ori7ontal lengthening and verticalshortening of the lids

The palpebral 'ssures appear wide

hori7ontally This may be unilateral or bilateral

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((T,A* E.-F(**93 9+T9M(T-%T T,( (( F968AT%96

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%t is the mucous membranecovering the under surface ofthe lids and anterior surface ofthe eyeball up to cornea.

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Palpebral$ ;overingthe lid 4 'rmilyadherent.

Forniceal$;overing the

fornices & loose &thrown in to folds.

Bulbar $;overing the

eyeball & loosely

attached except atlimbus.

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696 +(;%F%; *acrimation %rritation taining )urning +hotophobia -edness

+(;%F%; +ain F) sensation in

cornealinvolvement

%tching inallergic:blephritisand dry eyes

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;auses %rritation by smo"e:dust

or fumes (xposure to wind and

sun )ath and swimming

ymptoms

May be present F)sensation

igns

9nly redness

Treatment

eGd containingphenylephrine ornapha7oline

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;96J6;T%VA* ;%**A-

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;onjunctival;onjunctival

congestioncongestion

;illiary;illiary

congestioncongestion

A++(A-(6;(A++(A-(6;( VesselVessel

super'cialsuper'cial

H)rightH)right

red Hmostlyred Hmostly

in thein the

foenicesfoenices

VesselsVessels

deep Hvioletdeep Hviolet

or dus"yor dus"y

red Hred H

mostly at themostly at the

limbuslimbus

)*998)*998V((*V((*

Fill up fromFill up fromthe fornixthe fornix

Fill up fromFill up fromthe limbusthe limbus

8%(A(8%(A( ;onjunctivits;onjunctivits Eeratitis:iridoEeratitis:irido

cyclitis:orcyclitis:or

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welling of theconjunctiva

-elated to allergiesor an eye infection

Also be acomplication of eyesurgery or occur

from rubbing theeye too much

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ymptoms (ye will loo" blood

hot and feeling oftightness in the

e1ected eye Treatment 8oes not re#uire Tx )loodshot

apperencedisappear in = to >wee"s

(tiology ;oughing:"no"ing

or rubbing of eyetoo much

8iabetes or highblood pressurepatients are moreli"ely to get

8irect trauma tothe eye ball

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They are round swelling due toaggregation of lymphocytes andother cells at adenoid layer

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%56 Multiple:discrete:slig

htly elevated lesions

(ncircled by tinyblood vessels

i7e can vary from

C.@ to @ mm relatedto the severity andduration

(T%9*95

Viral andchlamydialinfection

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een in ;hronic blepharitis Allergic

conjunctivitis )acterial

conjunctivitis ;* wearer uperior limbic

"eratoconjunctivitis Floppy eyelid

syndrome

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Fre#uently seen in upper palpebralconjunctiva

'ne mosaic li"e pattern of elevated

polygonal hyperaemic areas -eddish /at topped raised areas (ach consist of dilated blood vessels

at centre with surroundinglymphocytes

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%56 9utside epithelium

;oagulated exudates

loosely adherent tothe in/amedconjunctivalepithelium

;an be easily peeled

o1 with out anybleeding

F9-M %6 Adenoviral infection Vernal

conjunctivitis +neumococcal

conjunctivitis 5onococcal

conjunctivitis

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F9-M %6

)acterial infection

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Aetiology 8iphtheria )eta4haemolytic

streptococci

%56 %nclude epithelium %n'ltrate the

superior layer ofconjunctivalepithelium

(pithelium is

injured if removalattempted

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This is a yellowishtriangular depositon the conjunctivanear the limbus

6ormally symptomless but whenin/amed it treatedwith topical steroids

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Found in elderly people who areexposed to strong sunlight:dust andwind

The apex of the triangle is away fromthe cornea: and it e1ects the nasal

side 'rst then the temporal

5rowth is very slow or absent

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Triangular 'bro vascular subepithelial in growth of degenerativebulbar conjunctival tissue

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A small grey: corneal opacity: developsnear the nasal limbus

The conjunctiva overgrows the opacityand progressively encroaches on to thecornea

A deposit of iron 0stoc"ers line2 may beseen in the advancing head ofpterygium

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)A;T(-%A* ;96J6;T%V%T% Mucopurulent +urulent

Membranus +seudomembranus ;hronic bacterial ;hronic angular

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M+T9M -edness: burning

and discharge +hotophobia tic"iness of eye lid ;oloured haloes

around the light

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%56 ,yperaemia +apillary reaction Mucopurulent

discharge *id oedema ;ongestion and

chemosis

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Adult gonococci

M+T9M

,yper acutecondition

(xtremely profuse:thic": creamy puss

from the eyes

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M+T9Mhighly toxic and illpatientpyrexial

membrane %56

high temperaturelid edemamembrane

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Adult infection

M+T9M

%rritation %tching

discomfort

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%56 ,yperemia (xcoriation of conj

epithelium ;ongestion at

medial and latarlcanthus

cantymucopurulant

discharge

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T-A;,9MA 9ne of the

leading cause of

preventableblindness %s a chronic

"eratoconjunctivitis

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M+T9M F) sensation %tching

3atering photophobia and redness Mucopurulent discharge if secondary

infection

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%56 ;onjunctival signs ;ongestion Follicle +apillary

hyperplasia ;onj scarring ;oncretions

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8ue to allergic or hypersensitivityreaction

;onjunctiva is ten times moresensitive than the s"in to allergens

%t is due to antigen antibody reaction

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M+T9M

%tching

-edness

*acrimations

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%56 welling of the eye

lid Mild chemosis 8i1use papillary

response -arely cornea

involved

T-(ATM(6T Allergen removal eGd corticosteroid Tab antihistamine ;ombination of

vasoconstrictorwith antihistamine

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%s a bilateral:recurrent seasonalallergicconjunctivitis in

children0@4B= yrs2 ;ause4exogenous

allergens T+( +A*+()-A* *%M)A* M%I(8

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M+T9M %ntense itching *acrimation -opy discharge +hotophobia

burning and F)sensation

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%56 5iant papilla +tosis ,yperaemia Mucus discharge +unctate

"eratopathy ;orneal ulcer ;oble stone

papillae

T-(ATM(6T ;old compression Topical steroid Topical

antihistamine Topical non

steriodial antiin/amatory drugs

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8ry:lustreless condition of theconjunctiva.

8ue to vitamin A de'ciency.

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JIJI K TJIJI K T

FELLOW OPTOMFELLOW OPTOM

THE EYE FOUNDATIONTHE EYE FOUNDATION

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;ornea is a transparent : avascular :watch glass li"e structure . %t forms

anterior one sixth of outer 'brouscoat of the eyeball and it is the mostsensitive and delicate structure of the

eye.

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Diameter Anterior 4BB mm 0V2

4 B= mm 0,2 +osterior & BB.@ mm Radius of curvature Anterior & .D mm

+osterior & .@ mm Thickness

centre & C.@= mm periphery & B.C mm

Refractive index & B.>> Refractive power & ?? 8

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1. Epithelium

2. owman!s mem"rane#. Stroma$. Duan!s la%er&.

Descemet!s mem"rane'. Endothelium

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S%mptoms pain decreased visual acuity

halos photophobia lacrimation

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Epithelium $

erosions: oedema: 'laments:sp"s

Stroma $

in'ltrates: oedema:vascularisation: deposits !scarring

Descemet!s mem"rane $ brea"s: folds: localised thic"ening

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Deposition of pi(ments $it is associated with a variety

of disorders)orneal sensation $ loss of corneal sensation in viral "eratitis

!neuroparalytic

"eratitis

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Micro cornea

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This is a rare unilateral or bilateralcondition

ignsigns ;orneal diameter is BCmm or less Ac shallow

9ther dimensions are normal.

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-are bilateral: non progressive:enlargement of cornea.

ignsigns

K ;orneal diameter B>mm or moreK 8eep AcK ,igh myopia ! astigmatismK

6ormal visual acuity

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Si(nsK evere decrease of corneal

curvature 0E $ =C4>C82

K ,ypermetropiaK hallow A; andK +redisposition to angle closure

glaucoma

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K sually bilateral condition

K 9paci'cation !vasculari7ation of

peripheral or entire cornea.

K -estricted to peripheral cornea 4

sclerali7ation 4 cornea appearsmaller.

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Si(ns %t associated with increased corneal

thic"ness A variable decrease in corneal

transparency

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S%mptoms

;oloured halos

8ecreased visualacuity

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K %n cornealoedema:epithelium raised

into largevesicles or bullaeK *eading to

bullous"eratopathy

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;ommonest causative organisms

K +neumococus

K taphylococusK +seudomonasK 5onococcus.

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M+T9M Acute pain -edness

*acrimation +hotophobia 8ecreased VA 3hite spot on the cornea

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%56

Mar"ed blepharospasm *id oedema ;iliary congestion of

the conjunctiva ,ypopyon may be

presentK %op may be increasedK greyish white :

circumscribedin'ltration

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Formation of 'brous tissue6ot arranged regularly They refract the light irregularly

Therefore the scar is more or less The scar is thin & opacity is slight &

6ebula%f rather more dense & Macula%f still more dense ! white 4*eucoma

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K ;omplication ofbacterial "eratitis

K 8ue to the e1ect

of intra ocularpressureK Associated with

sever pain

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Topical forti'ed drops Atropine sulphate ,ot fermentation

Analgesics with antacids 9rally aceta7olamide

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%nfective mode 4 %njury with vegetativematerial 0 thorn: branch of tree2

;ommon causative fungi areaspergillus: ;andida and fusarium.

ymptoms same as for the bacterial

ulcer

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diagram Treatment crapping !

debridment of

the ulcer Antifungal drugs0natamycin:nicon7ole 2

Atropinesulphates

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Acanthamoeba is a free living

proto7oa: it is found in stagnant

water : ;* solution and ;* cases.

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S%mptoms )lurred vn evere pain

Si(ns *imbitis ;hronic tromal

"eratitis &brea"down

of cornealepithelium

;orneal abscesswhich may perforate

6odular scleritis is afre#uent 'ndings

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8iagram Treatment )rolene drops

!ointments

6eomycin drops!ointment %n resistant

cases: a

therapeutic +Emay be re#uired

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;ommon viral infections include ,erpes simplex "eratitis ,erpes 7oster ophthalmicus

Adenovirus "eratitis

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9cular involvement by ,V occurs intwo forms : primary ! recurrent with

following lesions

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Primar% herpesinfection

K "in lesionsK Acute follicular

conjunctivitisK Fine epithelial

punctuate "eratitisK ;oarse epithelial

punctuate "eratitisK 8endritic ulcer

Recurrent herpesinfection

K Active epithelial"eratitis 4 dendritic

! geographicalulcers

K tromal "eratitis &disciform "eratitis.

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S%mptoms K Acute painK -ednessK

*acrimationK +hotophobiaK )lurring of vn

Si(ns K ;ircum ;iliary

congestionK %nitially sp"s and

they to formerosions

K The erosionscoalesce to form

dendriticK ;orneal sensation is

diminished or absent

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Treatment K 8ebridment of

the ulcer

K Anti viralagents

K Atropine or

homatropine

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8iagram *arger epitheliallesion

Typical

geographicalcon'guration(nlargement of

dendritic ulcer.

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%t is a deep "eratitis with disc li"e oedemamainly caused by herpes virus

)linical features K Focal disc shaped

K tromal oedemaK 8escemetLs foldsK 8eep vascularisationK )ullous "eratopathyK

absent or diminished corneal sensation

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Treatment K ,eal any

associatedepithelial lesion

K Topicalcorticosteroidsunder antiviral

coverK ;ycloplegics

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%t is a common infection caused bythe varicella & 7oster virus. Theinfection mainly e1ects the elderly

pts.S%mptoms $ Vesicular eruptions around the eye :

forehead and scalp ever pain +hotophobia ! lacrimation

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tage %K +unctate epithelial "eratitisK Micro dendritesK 6ummular "eratitisK 8isciform "eratitisK ensation is diminished or absenttage %%K 6ummular ! 8isciform "eratitistage %%%K 6ummular "eratitis

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6umular diagram TreatmentK 9ral acyclovirK trong

analgesicsK Antibiotic

corticosteroidsK Topical steroidsK

TopicalantibioticsK cycloplegics

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-.SimplexK 8endritic ulcer &

thin: branching:with terminal bulbs

K

;orneal sensationdecreasedK Mild iritis

-. osterK 8endritic ulcer &

coarse : nonbranching: no

terminal bulbs:stain poorly with/uorescein

K ;orneal sensationmar"edlydecreased

K iritis

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)linical featuresK (pithelial

erosions to severulceration

K econdaryinfection ! evenperforation

K The lower third

of the cornea iscommonlya1ected .

8iagram

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S%mptomsK Mild ocular irritationK *acrimationK +hotophobia

Si(ns K ub4epithelial

in'ltrates at theperiphery

K eparated from thelimbus

K *esion spreadcircumferentially

K Form a /uoresceinstaining ulcer

K ;orneal sensation is

una1ected

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TreatmentK Topical

corticosteroidsK Mild cycloplegics

K -x of blepharitis toprevent recurrence

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%56K tarts at the palpebral area :patches

of grey in'ltrates at the marginK lowly undermining the epithelium !

super'cial stromaK %t involves the entire circumference

of the corneaK ,ealing & periphery & healed area

vascularised :thinned ! opa#ue

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ymptomsK ever painK +hotophobiaK *acrimation

K 8ecreased the vn &irregularastigmatism.

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TreatmentK Topical corticosteroidK ;ycloplegicsK

;onjunctival excisionK );*K ystemic corticosteroids

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8egenerationsK sually unilateral !asymmetrical

K *ocated peripheryK accompanied by

vascularisationK 6o inheritance patternK 9nset & middle life or

laterK econdary to

compromising factors

8ystrophiesK )ilateral !symmetrical

K *ocated centrallyK 6o vascularisation

K ,ereditaryK (arly in onsetK nrelated to any

systemic or localdisease or condition

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it is bilateral lipid degeneration ofperipheral cornea: a1ecting the mostelderly persons.

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%t is deposition of calcium salts in thesub epithelial layer of the cornea :! ischaracterised by a hori7ontal band

shaped opacity.

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K Most of ptsasymptomatic

K )ut the others &recurrent corneal

erosionsK +hotophobia !

lacrimationK Visual loss

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5ranular dystrophiesK tarts & puberty :progresses very slowly

K 8iscrete: crumb li"ewhite granule & ant.troma of the central

corneaK AsymptomaticK Few pts complain of

light scattering

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Macular dystrophiesK tarts & early life with

signi'cant impairmentof vn

K *esions are focal :grey

&white :poorly de'nedopacity in cloudystroma

K *esions spread to the

entire corneal stromaincluding theperipheral cornea.

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*attice dystrophyK +resents in early lifewith recurrenterosions

K *esions arebranching spiderli"e deposits in thestroma

K 8i1use corneal ha7eK ;orneal sensation

diminished

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;orneal guttataK ;ommon aging

processK (xcrescences

formed by astressedendothelium

K 8isrupt the normal

endothelial mosaic! appears a dar"spot.

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Fuchs endothelialdystrophy

K A1ect in elderlypeoples & females

K ;orneal guttataK (ndothelial

decompensationK (pithelial oedema

! bullous"eratopathy.

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%t is a bilateral conical protrusion of thecentral part of the cornea withthinning of its central and inferiorparacentral areas.

M+T9MK %mpaired vn & irregular myopic

astigmatism

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%rregular retinoscopic re/ex 8istortion of mires of "eratometer VogtLs straie

+rominent corneal nerves Thinning of the cornea withprotrusion

MoonsonLs sign FleischerLs ring

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VogtLs straie MoonsonLs sign

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FleischerLs ring

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;omplication

K Acute hydropsK %ntolerance to ;*

Acute hydrops

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-igid ;* +iggy & bac" ;* ;>- ;I* %6TA; +E 8A*E

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K -are :bilateral : marginaldegeneration.

K Thinning involves in the inferiorcornea.

K (ctasia above thinned areaK Acute hydrops is complicationK 6o vascularisation

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8iagram TreatmentK sually not

re#uiredK ;orrection of

astigmatism by-5+ ;*

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%t is scattered all over the cornea:usually due to viral infection.

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ymptomsK %rritationK *acrimationK +hotophobia

ignsK (pithelial opacities

& scattered all overthe cornea

K +oorly stain with/uorescein

K ensation may bediminished

K ;iliary congestion

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This is a bilateral chronic in/ammationof the superior tarsal and bulbarconjunctiva with oedema of thesuperior limbal conjunctiva.

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ymptomsK F) sensationK +hotophobiaK +ain

K Mucoid discharge

ignsK +apillary

hypertrophy of thesuperior tarsus

K ,yperaemia !"eratinisation of thesuperior bulbarconjunctiva.

K +unctate epithelium! 'laments.

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Ms 8,%6A 56A6Fellow optometrist

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The in/ammation of uveal tract.

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B2 Anterior veitis & %n/ammation ofiris and anterior part of ciliary body.

=2 %ntermediate veitis & %nvolvementof posterior part of ciliary body andextreme periphery of retina. 0+ars

planitis2

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Granulomatous

Non-granulomato

D. PathologicalClassifcation

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us granulomatous

B. Aetiology 9rganismalinvasion

Antigen4antibody

reaction=. Course

a2 9nset %nsidious Acute

b2 8uration ;hronic hort

c2%n/ammation

Moderate evere

Granulomatous

Non-granulomato

us

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>. Pathology a2 *esion ;ircumscribed 8i1use

b2 %ris Focal reaction 8i1usereaction

c2 Eeraticprecipitates

Mutton fat Fine plenty

d2 %ris

adhesions

;oarse: few:

thic"

Fine: plenty:

thin?.Investigations

May bepositive

6egative

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%n/ammation of iris and ciliary body8ilatation of blood vessels

%ris stromal edema.

S*+,S / *ris pattern altered.*ris colouraltered. *ris thickened.0lsoaccompanied "% ciliar% con(estionconunctival h%peraemia andchemosis of conunctiva.

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3lare formation4 Exudation of 'brin4rich /uid and in/ammatory cells in thetissues

(xudates escape into anterior chamber

+lasmoid a#ueous

S*+,S / 05ueous 6are 7like the "eamof proector in smoke% theatre8

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9PS 3:R;0T*:,$ 6utrition ofcorneal endothelium is a1ected

due to toxins

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;orneal endothelium becomes stic"y

and edematous

;ells des#uamated at places

Inflammatory cell t!c" to en#ot$el!allayer a cell%lar #e&o!t '

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S*+, < 9eratic precipitates F O ( M A T IO N O F A ( L T T ( I A N G L E

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S*+, < Posterior s%nechiae 7more in lowerpart of pupil due to e=ect of (ravit%8

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3hen adhesions are locali7ed anda mydriatic is instilled: it causesintervening portions of circle of

pupil to dilate.

IGN ) Fetoone# &%& !l

*#%e to !rre+%lar

#!latat !on an# ! a !+n of

&reen t or & at !r !t ! ',

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3hen exudate is more extensive

9rgani7ation of exudate across entirepupillary area

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Film of opa#ue 'brous tissue in pupillaryarea

S*+,S < :cclusio pupillae or lockedpupil

(xudates 'll up posterior chamber if thereis much of cyclitis

3hen these adhesions organi7e: the iris

adheres to lens capsule.S*+,S < Total posterior s%nechiae

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S*+, < Ectropion of uveal

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pi(ment 7due to contraction ofor(ani>in( exudates upon iris8

3ith recurrent attac"s or severecases: the whole circle of pupillarymargin gets tied to lens capsule.

S*+,S < 0nnular or rin(s%nechiae or Seclusio pupillae

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;ollection of a#ueous behind iris sincea#ueous drainage is hampered.

%ris is hence bowed forwards li"e sail.

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S*+, < *ris om"e 7anteriorcham"er is funnel shaped i.e.

deepest in centre shallowest atperipher%8

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As iris bulges forward and comes into contactwith cornea

Adhesions of iris to cornea at peripherydevelopS*+,S < Peripheral anterior s%nechiae

9bliteration of 'ltration angle 0,ypertensive

iridocyclitis2S*+,S < Rise in *:T 7secondar% (laucoma8

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;yclitic membraneformed behind lens

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Finally: degenerativechanges in ciliary

body

Vitreous becomes /uid

6utrition of lens

impairedS*+,S < )omplicated

cataract

P$t$!! -%l-! .! l l -e t$e

$t$!! -% l-! .! l l -e t$e

e/ent%al!ty'

/ent%al!ty'

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M+T9M %56

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M+T9M

+ain 8iminished vision -edness of eye lacrimation photophobia haloes around light

%56

igns of vascularcongestion

igns of exudation igns of pupillary

changes

;haracter ;onjunctivitis

%ridocyclitis

5laucoma

T d Ab t M " d M " d

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Tenderness Absent Mar"ed Mar"ed

Vision 5ood Fair +oor

9nset 5radual suallygradual

udden

ystemiccomplicatio

ns

Absent *ittle +rostration and

vomiting

* l

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*ocalK vision: refraction: fundus examination

K %9T by chiot7 Tonometer

K lit *amp examination

Focal &K (6T: 8ental: 5enito4urinatory

examination for septic focus.

For associated systemic disorders

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&K ;);: (-: MT: I4ray chest & Tuberculosis

K rine: )lood examination48iabetes

K V8-*: Eahn Test & syphilisK rethral smear & gonorrhoeae

K rine culture & for T%

K )lood culture & epticemia

K A*9 Titre: ;4reactive protein & forrheumatic disorders

K creening test for auto immunedisorders

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EYE LID

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