Errors of refraction
The normal state of refraction is called emmetropia, i.e. emmetropia is
condition of refraction of the eye in which, with accommodation fully
relaxed, parallel rays of light come to focus on the retina.
Emmetropia
Amtropia:
Is the condition of refraction of the eye in which, with accommodation
completely relaxed, parallel rays of light do not come to focus on the
retina.
Types of ametropia:
1- Myopia.
2- Hypermetropia.
3- Astigmatism
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4- Presbyopia.
5- Aniso-metropia.
6- Aphakia.
Myopia (short sight)
It is the condition of refraction of the eye in which, with
accommodation fully relaxed, parallel rays of light to focus in front the
retina.
Types of myopia:
1- Axial myopia: is due to an increase of the anteroposterior axis of
the eye.(most common)
Types of axial myopia:
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Simple myopia: is the most common type, it is not
accompanied by degenerative changes in the eye. It starts
around 14 yrs and progress till 25 yrs of age.
Progressive myopia (malignant or degenerative): it starts
around 7 yrs of age and progress. It may reach 15-25 D, and has
degenerative fundal changes.
Congenital myopia: very rare condition, the child is born
myopic and soon reaches 10D and becomes stationary for life.
The prognosis is better than progressive myopia.
2- Refractive myopia: the refractive system of the eye becomes
more powerful, and it includes 2 types:
Curvature myopia: due to increase the curvature of the cornea
(Keratoconus) or due to lens Subluxation.
Index myopia: is due to an increase in the refractive index of the
ocular media especially the lens.
3- Abnormal forward position of the lens i.e. anterior dislocation of
the lens.
Symptoms of myopia:
1- Indistinct vision for far (the only symptom in simple myopia).
2- Discomfort after near work.
3- There may be dark spots in front the eye, known as musce
volitantes, due to vitreous degeneration.
4- Night blindness due to peripheral degeneration of the retina.
Signs:
Simple myopia, the eyes looks normal.
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Changes in progressive myopia:
1- The globe is large.
2- A/C is deep.
3- Convergent squint.
4- Fundal changes.
Complications (only in degenerative myopia):
1- Retinal detachment.
2- Macular lesion.
3- Optic atrophy.
4- Vitreous detachment.
5- Complicated cataract.
6- Convergent squint.
Treatment:
Correction by concave lenses (-ve): glasses or contact lenses.
Refractive surgery.
Hypermetropia (far sight)
It is a condition of refraction of the eye in which, with accommodation
fully relaxed, parallel rays to focus behind the retina.
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Types:
1- Axial Hypermetropia: (Small anteroposterior diameter of the eye).
2- Refractive Hypermetropia (decreased refractive power of the
eye).
Symptoms:
Blurring of both distance and near vision.
Signs:
Small eye.
Shallow anterior chamber.
Pseudo-papilitis.
Treatment:
Correction is by convex lenses (+ve): glasses or contact lenses.
Refractive surgery.
Astigmatism:
Optical condition of the eye in which parallel rays do not come to a
point focus, as a refractive power of the eye is not same in all
meridians.
Etiology:
1- Corneal astigmatism
2- Lenticular astigmatism
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Types:
1- Simple astigmatism: astigmatism is called simple when principal
meridian is emmetropic while the other is ammetropic, i.e.
Myopic or hypermetropic simple astigmatism.
2- Compound astigmatism: in this condition both meridians are
ammetropic compound astigmatism.
3- Mixed astigmatism: here one meridian is myopic and the other is
hypermetropic.
Symptoms:
Defective vision.
Headache.
Signs:
Optic disc is oval in shape.
Retinal vessels are blurred in one of the 2 principal meridians.
Treatment:
Correction is by cylindrical lenses: glasses or contact lenses.
Refractive surgery.
Presbyopia:
Presbyopia is recession of the near point. The refractive power of the
lens varies with the distance of object of regard i.e. change in the
refractive power of the lens is known as accommodation.
Steps of accommodation:
Contraction of the ciliary muscle.
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The lens moves forward.
The lens becomes more convex anteriorly.
Types of presbyopia:
Physiological presbyopia: due to sclerosis of the lens (age-
related), it affects both eyes and becomes evident at the age of
40.
Pathological presbyopia: here the reduction of the
accommodative power is due to affection of the ciliary muscles,
e.g. chronic simple glaucoma.
Treatment:
The treatment consists of the provision of convex lens for near work.
Anisometropia:
It is a condition in which there is difference in the refractive state
between the two eyes. Minor differences are almost the rule but when
a large difference is present, vision is usually uni-ocular and sometimes
there is amblyopia of one eye.
Treatment:
Prescribing glasses, provided that the difference in power of the lenses
should not exceed 5D, otherwise disparity in size of retinal images
(aniseikonia) will result in diplopia. In cases of big difference contact
lenses are the treatment of choice.
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Aphakia:
Aphakia denotes an eye from which the lens has been removed and has
in consequence a high degree of Hypermetropia (+10D).
Signs of Aphakia:
1- Absence of the Purkinje-Sanson normally seen on the anterior and
posterior surface of the lens.
2- A deep anterior chamber.
3- Tremulous iris.
4- Presence of iridecyomy.
5- Black pupil.
6- High Hypermetropia.
7- Complete loss of accommodation.
8- Ohthalmoscopically, the fundus details appear smaller than
normal.
Treatment:
1- Spectacle correction.
2- Contact lenses.
3- Intra-ocular lens implantation.
4- Refractive surgery.
Psuedophakia:
Psuedophakia is presence of artificial lens.
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Difference between aphakia and psuedophakia:
Aphakia psuedophakia
Purkinje-Sanson image Absent present
Anterior chamber Deep Normal depth
Iris tremulous Not tremulous
State of refraction High Hypermetropia May be normal
Accommodation Lost lost
Fundscopy The fundal details The fundal details
appear smaller than appear the same size.
normal
