REFRACTIVE ERRORS
CONTENT
Introduction
Definition of Refractive errors
Types of Refractive Errors
Myopia
Hypermetropia
Strabismus
Astigmatism
Presbyopia
Etiology of Refractive errors
Risk Factors of Refractive Errors
Clinical Manifestations
Diagnostic Evaluation
Medical and Surgical Management
Nursing Management
Complications
Summary and Conclusion
INTRODUCTION
Refractive errors are one of the most common vision problems
people experience.
Refractive errors are a type of vision problems that makes it hard to
see clearly.
It is something about natural shape of your eyes that makes your
vision blurry.
It can develop at any point in your life but most common in children.
DEFINITION
Refractive disorder are abnormalities of refraction that occurs in
[Link], vision is impaired because of shortened or elongated
eyeball which prevents light ray from focusing sharply on retina.
EMMETROPIA is normal optical condition of eye.
TYPES OF REFRACTIVE
ERRORS
• Myopia
• Hypermetropia
• Strabismus
• Astigmatism
• Presbyopia
MYOPIA
Myopia is also known as Near Sightedness.
It is a condition in which an image of a distant objects becomes
focused infront of retina.
It is caused by the refractive error in cornea , refractive error in lens
or a combination of two.
In this condition, distant objects appears out of focus and may cause
headache and /or eye strain.
HYPERMETROPIA
It is also known as Hyperopia or Far Sightedness.
When parallel rays of light comes to focus behind the retina, when
accommodation is at rest is called hypermetropia.
In this ,focal plane of light entering the eye Is posterior to retina ,
resulting in sharper visual acuity for object at distance and decreased
visual acuity for closer objects.
It occurs due to decrease in curvature of eye lens or shortening of eye
ball.
It can be corrected using suitable convex lens.
STRABISMUS
Inability of eye to focus in the same direction. Commonly called cross
eyed.
A) ESOTROPIA : Eye turned in the direction of nose.
B) EXOTROPIA : Eye turns outward.
ASTIGMATISM
It is a condition in which an abnormal curvature of the cornea can
cause two focal points to fall in two different locations, making
objects up close and at a distance appear blurry.
Astigmatism cause eye strain and may be combined with near
sightedness or far Sightedness .
It may be hereditary or muscular deficit.
PRESBYOPIA
Presbyopia is an age related refractive error where the eye’s lens
loses flexibility, making it difficult to focus on close objects.
Need to increase the distance between the object and eyes.
Distant vision remains unchanged.
Convex lens is used for correction of presbyopic eyes.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
Blurred vision
Double vision
Squinting
Headache
Eye strain
Difficulty in doing close work ,letter appears blurred after sometime during
reading, headache, burning and dryness in eye.
Trouble focusing when reading or looking at computer.
Inability to see object at close range in Hyperopia
Inability to see object at distance in myopia.
Eyeball position is not symmetrical in strabismus.
Eye irritation or weakness in the eyes.
In children, there are initial signs such as crossed eyes ,continuous blinking
of eyes
Difficulty in focusing near Irritation
objects
Squinting Headache
Irritation or redness Blinking of
in eyes eyes
Itchiness in eye
Double vision
DIAGNOSTIC EVALUATION
History and physical examination
VISUAL ACUITY TESTING : It is done to check vision loss with the
help of
SNELLEN’S CHART.
REFRACTION: Refractive errors are diagnosed through the
process known as Refraction .The patient is asked to view on eye
chart while lenses of different strength are systematically placed
in front of eye. The patient is asked if the lenses sharpen or
worsen vision.
MEDICAL MANAGEMENT
CONSERVATIVE MANAGEMENT
1. EYE Glasses: It is often used to hold the lenses necessary to correct
errors of refraction.
They are beneficial because of low cost , easy to use , durability and
availability.
2. CONTACT LENSES: It may be hard lens or soft lens.
SURGICAL MANAGEMENT
RADIAL KERATOTOMY : It is an outpatient surgical procedure for
treatment of mild to moderate myopia.
EPIKERATOPHAKIA: In this procedure, donor corneal tissue is surgically
grafted into patients own cornea to alter it’s Refractive ability. The
donor corneal tissue is frozen and reshaped to the specific strength
and size needed by patient.
LASER- ASSISTED IN SITU KERATOMILEUSIS (LASIK) : It uses a laser to
change the shape of cornea and helps to make vision clearer.
NURSING MANAGEMENT
Assess the general condition of the eye of the patient.
Identify the cause of Refractive errors.
Maintain sterility of eye droppers ,tubes of medication and other
items ,it reduces the risk of infection.
Advice the patient regarding the use of lens.
Use aseptic technique while doing dressing of Surgical site to prevent
infection.
Advice patient not to share eye makeup with others.
Advice patient not to rub the eyes.
Advice patient not to use dirty clothes to clean the eyes.
Demonstrate the proper administration of eye drops or ointment.
Teach the patient to avoid itching in the eye.
Teach the patient regarding use of eye glasses.
Teach patient about complications that may occur due to use of
lenses.
COMPLICATIONS
Corneal edema
Corneal abrasions
Dryness of epithelium
Irritation
Laceration (minute breaks)
SUMMARY
In this presentation, we discussed about the definition of Refractive
errors and it’s types . We also discussed about the Etiology, clinical
manifestations, risk factors, pathophysiology, diagnostic Evaluation,
and it’s medical , surgical and nursing management, complications.
BIBLIOGRAPHY
Adult Medical Surgical Nursing (Volume 2) – [Link] vati, Prabhjot
Kaur and Lakhwinder Kaur Page no. 1069 to
[Link] Hossain Mirzae
Adult Health Nursing , USHA UKHANDE ,Pg no. 1040 &1041
Medical surgical nursing , Louis white , pg 685 & 686
[Link] [Link] Kaur
