Practice Of Optometry

"MICROCORNEA, CONGENITAL CATARACT, NYSTAGMUS_ Multiple Structural Abnormalities"
آنکھوں کی ساخت میں پیدائشی طور پہ نقص، انکا ممکنہ علاج اور نظر کی بحالی پہ یک دلچسپ کیس۔

🌀This case represents a unique combination of structural anomalies (microcornea, iris coloboma), developmental eye diseases (congenital cataract, nystagmus), and functional impairment (low vision in children). Rehabilitation is complicated by irregular corneal shape and difficulty in axial length measurement in children for one eye.

Complete Case description will be available on YouTube and health Blog.

💻Case presented by:
Dr. Inaam Taj Uddin Sarwer
Holistic Health Care Professional
Certified Optometrist
Vision Rehabilitation Expert

Federal Government Poly Clinic Hospital-Islamabad

MYOPIA IN 2050

Myopia is increasingly prevalent worldwide, and it is estimated that by 2050, 50% of the world population will be myopic.

Low- dose (0.01%) atropine has been shown to significantly decrease myopic progression in Asian children.
(AAO-BCSC: Pediatric Ophthalmology and Strabismus-2020-2021: Vol:6
page 180)

https://youtube.com/shorts/vn_vnW_CgvI?feature=shared

Hirschberg Corneal Reflex Test
This test is based on the presence of comparable corneal reflections by assessing the position of the corneal reflection in the squinting eye with that of the fixing eye.

An indication of the angle of manifest deviations can be obtained.

A spotlight is shone into the patient’s eyes and an estimated measurement is taken as to the angle of deviation, by observing the position of the corneal reflection of the deviating eye.

One mm displacement is equivalent to 7◦ or 15 prism dioptres.

Corneal reflections viewed at the pupil margin are roughly equivalent to a displacement of 10◦–15◦ (20–30 prism dioptres), those situated half way between the pupil and the limbus, to 25◦ (50 prism dioptres) and those at the limbus, to 45◦ (90 prism dioptres). Reflections displaced temporally indicate the presence of an eso-deviation whilst nasal displacement indicates an exo-deviation.






















#आंखोंकीजांच
#नेत्रचिकित्सा
#भेंगापन
िक्षा
#नेत्रजांच
#नेत्रचिकित्सक

👁️Subhyaloid hemorrhage👁️
آنکھ کے پردے میں خون آنا ۔
کیس ڈسکشن:
*Assessment and Management Protocol*
1. Clinical Presentation Overview

Age: 71 years
Comorbidity: Diabetes mellitus

Vision Loss: Sudden,
in OD), vision reduced to counting fingers at 1 meter

B-scan: Shows posterior vitreous detachment (PVD) and subhyaloid hemorrhage.

2. Pathophysiology

A subhyaloid hemorrhage occurs when blood collects between the posterior hyaloid face and the internal limiting membrane (ILM) of the retina. It often presents as a dense, boat-shaped or dome-shaped hemorrhage, typically associated with:

👉Diabetic retinopathy

👉Retinal vascular occlusions

👉Valsalva retinopathy

👉Terson syndrome (intraocular hemorrhage with intracranial bleed)

3. Diagnostic Workup

A. Clinical Examination

👉Visual acuity testing

👉Anterior segment examination

👉Fundus exam (dilated):

Shows a well-demarcated, boat-shaped pre-retinal hemorrhage

B. Imaging

1. B-scan ultrasonography

shows PVD and subhyaloid hemorrhage (hyperechoic fluid level under the posterior hyaloid membrane)

2. OCT (Optical Coherence Tomography)

to confirms location of hemorrhage between ILM and posterior hyaloid

Helpful to rule out associated macular traction or edema

3. Fundus Fluorescein Angiography (FFA)

Usually deferred until hemorrhage clears or in suspicion of neovascularization

Useful in diabetic patients to assess proliferative changes

4. Systemic workup

Blood sugar levels, HbA1c
Blood pressure
CBC and clotting profile (to rule out bleeding tendency)

4. Management Options

A. Conservative Management

Only for small hemorrhages or if vision is not severely affected:

👉Observation: Spontaneous resolution over weeks to months

👉Head elevation

👉Control systemic risk factors (diabetes, hypertension)

B. Active Intervention

Indicated in:

👉Dense hemorrhage involving the macula

👉Sudden, severe vision loss (as in this case)

👉Non-resolving hemorrhage (>2 weeks)

1. Nd:YAG Laser Hyaloidotomy / Membranotomy

For pre-macular (subhyaloid) hemorrhage:

Performed to create an opening in the ILM/posterior hyaloid, allowing blood to drain into the vitreous and clear faster

Quick visual recovery, but:

Requires clear view

Not suitable if PVD already exists or hemorrhage is too dense

2. Pars Plana Vitrectomy (PPV)

👉Preferred in this case due to:

👉Dense hemorrhage

👉Posterior vitreous detachment (increased risk of traction)

👉Diabetic background — possible proliferative diabetic retinopathy (PDR)

👉Removes hemorrhage, posterior hyaloid, and any neovascular membranes

👉Endolaser may be applied during surgery if PDR is confirmed

5. Postoperative and Long-Term Management

👉Post-surgical topical therapy: Antibiotic + steroid drops

👉Glycemic control: Essential to prevent recurrence

👉Follow-up fundus exams for diabetic retinopathy progression

Pan-retinal photocoagulation (PRP): If PDR is diagnosed intraoperatively or postoperatively