MODUL 1 :

OPHTHALMOL
OGY

CASE 3
GROUP 7
:MYOPIA
WULAN-FADZELY-ARIF

AMRI
-SAFUAN ARIF-NADIAH-

CASE
A young female patient, 15 years old, was diagnosed of moderate
myopia ODS, based on the following:
History : blurry vision on both eyes, especially if she needs to see
in a distance (far sight). It occurred for the past 7 years. History of
spectacle prescription(+) since she was on 3 rd grade and has been
changed once a year, the last prescription was S-5.0 D for both
eyes. Red eyes (-), tearing (-), discharge (-), photophobia (-), pain
(-), foreign body sensation (-), systemic disease (-), history of using
spectacles (-). There is a history in the family of using spectacles,
and her brother is currently using (+) spherical glasses.
Physical finding : general state: Mild/Good nutrition/Conscious
Vital sign : BP=120/80mmHg, Pulse=80x/min, Breathing=20x/min,
Temp=37.1C
Ophthalmology findings :
Visual acuity: OD:6/60; corrected S-5.75D 6/6

OS:6/60; corrected S-5.75D 6/6

 Intraocular pressure: OD:Tn

Anterior

OS:Tn

Eye

OD

OS

Palpebra

Normal

Normal

Cilia

Normal

Normal

Bulbar
conjunctiva /
palpebral
conjunctiva

Normal/hypere
mic (-)

Normal/hypere
mic (-)

Cornea

Clear

Clear

COA

Normal

Normal

Iris

Dark brown,
crypt (+)

Dark brown,
crypt (+)

Pupil

Round, central,
light reflex(+)

Round, central,
light reflex(+)

Lens

Transparent

Transparent

MYOPIA
ANATOMY
&
PHYSIOLOG
Y OF EYE

PROGNOSIS

COMPLICATIO
NS

GEOMETRI
CAL OPTICS

TREATMEN
T

DD

DEFINITION

CM

ETIOLOGY

PATHO
GENESIS

ANATOMY OF EYE

REFRACTIVE
MEDIA
Cornea
Aqueous humor
Lens
Vitreous humor

Segments & Chambers of

Eyeball

SEGMENT
S

Anterior
segment
(lens)
Posterior
segment
(from lens
backwards)

Anterior chamber
-anterior border : post cornea
-posterior border : ante iris
Posterior chamber
-anterior border : post iris
-posterior border : lens +
zonules
-lateral border : ciliary body

PHYSIOLOGY OF VISION
Integration of
light sense, form
sense, sense of
contrast and
colour sense

Involve
photoreceptors

PROCESSING &
TRANSMISSION
OF VISUAL
SENSATION

PHOTOTRANSDUCT
ION

VISUAL
PERCEPTION
Photoreceptors
ganglion
cells lateral
geniculate
body primary
visual cortex

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GEOMETRICAL
OPTICS

GEOMETRICAL OPTICS

REFLECTION

Change in path of
light rays without
any change in the
medium

REFRACTION

Change in path of
light rays travelling
from 1 medium to
another of different
density

Reflection
Laws of reflection:
The incident ray, the reflected ray and
the normal at the point of incident, all lie
in the same plane.
Angle of incidence (2) = angle of
reflection (1)
1 2

Refraction
Laws of refraction:
The incident and refracted rays are on opposite
sides of the normal and all the three are in the
same plane.
The ratio of sine of angle
of incidence(i) to the sine
of angle of refraction(r) is
constant(=refractive index, n)

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MYOPIA

DEFINITION
A type of refractive error in which parallel rays of
light coming from infinity are focused in front of
the retina when accommodation is at rest
= short-sightedness

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ETIOLOGY
anteroposterior length of eyeball
curvature of cornea/lens
refractive index of lens

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CLASSIFICATIONS
1. According to amount of Diopters

<3D : mild myopia

3-5D : moderate myopia
>5D : high myopia

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PATHOGENESIS
AP length of eyeball AXIAL TYPE MYOPIA
Underdevelopment of cornea curvature of
cornea CURVATURAL TYPE MYOPIA
thickness of cornea/lens refractive index of
lens INDEX TYPE MYOPIA

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CLINICAL MANIFESTATIONS
Poor vision for distance
Squinting of eyes
Eye appear larger
Deep Anterior Chamber (AC)
Large, sluggishly reacting pupils
Opthalmoscopy : myopic cresent

Pathomechanism of Blurred
Vision & Squinting of Eyes
The light coming into the eye from distant objects
focuses in front of the retina which makes vision
blurry. Squinting eyes.

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MANAGEMENT & TREATMENT

Optical concave spheris lens
Spectacles
Contact lens
Surgical
Radial keratotomy
Photorefractive keratectomy
Laser in situ keratomileusis
Phakic IOLs

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PROGNOSIS
Early onset and high myopia have a worse
prognosis for long term visual acuity.
Tend to have a higher rate of myopic progression
with longer axial lengths.
Greater risk for developing myopic retinal
degeneration.

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COMPLICATIONS

Cataract complicated
Glaucoma
Retinal detachment
Choroidal haemorrhage
Strabismus convergens

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DIFFERENTIAL
DIAGNOSIS

Myopia
Focal
point of
parallel
incident
light
rays

Causes

Vision

Possible
complications

Anterior to
the
retina

Eyeball too
long
(axial myopia).
Excessive
refractive
power
(refractive
myopia).

Very good
near
vision.
Poor distance
vision.

Increased risk of
retinal
detachment.
See p. 434 for
complications
specific to
pathologic
myopia.

Optical
correction

Diverging
lenses
(minus or
concave
lenses).

Hyperopia
Focal
point of
parallel
incident
light
rays

Causes

Posterior to Eyeball too

the
short
Retina
(axial
hyperopia).
Insufficient
refractive
power
(refractive
hyperopia

Vision

Possible
complications

Optical
correction

Poor near
vision.
Accommodatio
n
usually permits
normal
distance
vision (in young
patients and in
slight to
moderate
hyperopia).

Disposition to
acute angle
closure
glaucoma
(shallow anterior
chamber).
Caution
is advised
with diagnostic
and therapeutic
mydriasis.
Esotropia

Convergin
g lenses
(plus or
convex
lenses).

Astigmatism
Focal point
of parallel
incident
light
rays
Lack of a
focal
point

Causes

Vision

Anomalies in
the
curvature of
the
normally
spherical
surfaces of the
refractive
media
(cornea and
lens).

Patients
see
everything
distorted.

Possible
complicatio
ns

Risk of
refractive
amblyopia.

Optical
correction

Cylindrical
lenses;
eyeglass
correction
is only
possible
where
astigmatism
is regular.

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