What are dioptres?

A dioptre, or diopter, is a unit of measurement of the optical power of a lens or curved mirror,
which is equal to the reciprocal of the focal length measured in metres (that is, 1/metres). For
example, a 3 dioptre lens brings parallel rays of light to focus at 1/3 metre

What is a posterior vitreous detachment?

 Condition where vitreous humour separates from the retina.

 Vitreous humour fills eye behind lens- attatched to retina at birth.
 Over time changes, shrinks, pockets of liquefaction
 Some stage may peel away from retina- usually sudden event
 When this occurs there is a characteristic pattern of symptoms:

 flashes of light (photopsia)

 a sudden dramatic increase in the number of floaters
 a ring of floaters or hairs just to the temporal side of the central vision

As a posterior vitreous detachment proceeds, adherent vitreous may pull on the retina. While
there are no pain fibers in the retina, vitreous traction may stimulate the retina, with resultant
flashes that can look like a perfect circle

Anatomy of the eye....

Retinal detachment:-What is it?

 Retina peels away from underlying layer of support tissue

 Initially localised but without rapid treatment entire retina may detach-
vision loss/ blindness
 Occassionally posterior vitreous humour detatchment tear in retina, tear
allows vitreous humour to seep in under retina and peel away like a
bubble

Causes:

 Rhegmatogenous retinal detachment – due to a hole, tear, or break in the retina that
allows fluid to pass from the vitreous space into the subretinal space between the
sensory retina and the retinal pigment epithelium.
 Exudative, serous, or secondary retinal detachment - due to inflammation, injury
or vascular abnormalities that results in fluid accumulating underneath the retina
without the presence of a hole, tear, or break.
 Tractional retinal detachment –when fibrovascular tissue, caused by an injury,
inflammation or neovascularization, pulls the sensory retina from the retinal pigment
epithelium
 Substantial number of cases occur from trauma
 Epidemiology:

 Although retinal detachment usually occurs in one eye, there is a 15% chance of developing
it in the other eye, and this risk increases to 25–30% in patients who have had cataracts
extracted from both eyes
 Normal eyes- risk is 5 in 100,000.
 More frequent in middle aged or elderly- 20 in 100,000
 More common in those with sever myopia- near sightedness as eyes
longer and retina stretched thin. Myopia associated with 67% cases

Treatments
 Several methods depend on finding and closing the breaks found in the
retina

 Cryopexy and Laser Photocoagulation

Cryotherapy (freezing) or laser photocoagulation are occasionally used alone to wall

off a small area of retinal detachment so that the detachment does not spread.

 Scleral buckle surgery

Scleral buckle surgery, eye surgeon sews one or more silicone bands (bands, tyres) to
the sclera (the white outer coat of the eyeball). The bands push the wall of the eye
inward against the retinal hole, closing the break or reducing fluid flow through it and
reducing the effect of vitreous traction thereby allowing the retina to re-attach.
Cryotherapy (freezing) is applied around retinal breaks prior to placing the buckle.
Often subretinal fluid is drained as part of the buckling procedure. The buckle remains
in situ. The most common side effect of a scleral operation is myopic shift. That is,
the operated eye will be more short sighted after the operation. Radial scleral buckle
is indicated to U-shaped tears or Fishmouth tears and posterior breaks.
Circumferential scleral buckle indicated to multiple breaks, anterior breaks and wide
breaks. Encircling buckles indicated to breaks more than 2 quadrant of retinal area,
lattice degeration located on more than 2 quadrant of retinal area, undetectable breaks,
and proliferative vitreous retinopathy.

 Pneumatic retinopexy

This operation is generally performed in the doctor's office under local anesthesia. It
is another method of repairing a retinal detachment in which a gas bubble (SF6 or C3F8
gas) is injected into the eye after which laser or freezing treatment is applied to the
retinal hole. The patient's head is then positioned so that the bubble rests against the
retinal hole. Patients may have to keep their heads tilted for several days to keep the
gas bubble in contact with the retinal hole. The surface tension of the air/water
interface seals the hole in the retina, and allows the retinal pigment epithelium to
pump the subretinal space dry and suck the retina back into place. This strict
positioning requirement makes the treatment of the retinal holes and detachments that
 occurs in the lower part of the eyeball impractical. This procedure is usually
combined with cryopexy or laser photocoagulation.

 Vitrectomy

Vitrectomy is an increasingly used treatment for retinal detachment. It involves the

removal of the vitreous gel and is usually combined with filling the eye with either a
gas bubble (SF6 or C3F8 gas) or silicon oil. Advantages of using gas in this operation is
that there is no myopic shift after the operation and gas is absorbed within a few
weeks. Silicon oil (PDMS), if filled needs to removed after a period of 2–8 months
depending on surgeon's preference. Silicon oil is more commonly used in cases
associated with proliferative vitreo-retinopathy (PVR). A disadvantage is that a
vitrectomy always leads to more rapid progression of a cataract in the operated eye. In
many places vitrectomy is the most commonly performed operation for the treatment
of retinal detachment.

Scotoma:-What is it?
-How does it relate to retinal detachment?

 area or island of loss or impairment of visual acuity surrounded by a field of normal or

relatively well-preserved vision
 may be due to a wide range of disease processes, affecting either the retina (in particular its
most sensitive portion, the macula) or the optic nerve itself.
 Similarly, scotomata may develop as a result of the increased intracranial pressure that
occurs in malignant hypertension.

General causes of nausea and vomiting

 many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial
pressure
 Digestive tract: gastritis, bowl obstruction, food poisoning
 Motion sickness
 Brain: concussion, cerebral haemorrage, migraine, tumours, intercranial hypertension
 Hypercalaemia, hyperglycaemia, hypoglycaemia,
 Alcohol, opioids,
 Pregnancy
 Self induced

Reattachment surgery (esp. Post-op and the posturing)

 Walk and move head in slow motion, avoid excessive reading or television,
avoid strenuous activity
 Sleep in metal shield to avoid putting pressure on eye
 Shower and wash carefully
  A long acting gas bubble may be placed in eye during surgery, helps hold
repaired retina till has chance to firm. Position face down until bubble
clears. Do not lie on back maintain head in position parallel to floor looking
down
 Mostly absorbed within 2 weeks
 Must not fly until gone

The drugs:-

Topical Tropicamide

 Tropicamide (Mydriacyl) is an anticholinergic used as a mydriatic

 Eye drops
 Parasympatholytic- reduces activity parasympathetic n.s
 Typically used during eye examinations
 Tropicamide is often preferred to atropine because atropine has a longer half-life, causing
prolonged dilation and blurry vision for up to a week

Zofran (Ondansetron)

 serotonin 5-HT3 receptor antagonist used mainly as an antiemetic to treat nausea and
vomiting following chemotherapy
 reduces the activity of the vagus nerve, which activates the vomiting center in the
medulla oblongata, and also blocks serotonin receptors in the chemoreceptor trigger
zone

Valoid (Cyclizine)

 antihistamine drug used to treat nausea, vomiting and dizziness associated with motion
sickness, vertigo and post-operatively following administration of general anaesthesia and
opioids. It is abused as an opiate/opioid-enhancing antihistamine booster and separately for
its anticholinergic effects[1].
 antimuscarinic action warrants caution in patients with prostatic hypertrophy, urinary
retention, or glaucoma

Atropine

 It is a competitive antagonist for the muscarinic acetylcholine receptor. It is classified as an

anticholinergic drug.
 temporarily paralyze the accommodation reflex, and as a mydriatic, to dilate the pupils
 degrades slowly, typically wearing off in 7 to 14 days
 Atropine is contraindicated in patients pre-disposed to narrow angle glaucoma.
Chloramphenicol, eye drops

 Chloramphenicol (INN) is a bacteriostatic antimicrobial. It is considered a

prototypical broad-spectrum antibiotic, alongside the tetracyclines.

 effective against a wide variety of Gram-positive and Gram-negative bacteria,

including most anaerobic organisms

Dexamethasone, eye drops

 glucocorticoid class of steroid hormones. It acts as an anti-inflammatory and

immunosuppressant