THE POSTERIOR EYE SEGMENT DISEASES by Inuri Kumaranayaka



Introduction

The posterior segment of the eye is the name given to the two posterior thirds of the eye that span from the wall behind the crystalline lens to the wall at the back of the eye. They encompass the vitreous humour, the retina, the choroid and the optic nerve

Retinal Detachment

It is an eye condition where the most sensitive layer of the eye which is the retina were separated and peeled away from the back of the eye. Retinal detachment describes the separation of the neurosensory retina (NSR) from the retinal pigment epithelium (RPE) caused by a breakdown of the forces that attach the NSR to the RPE.

Signs and Symptoms- Retinal Detachment
  • Flashes of light (photopsia)
  • Increase in floaters
  • Curtain-like visual field defect 
  • sudden reduced or loss vision                                                                                                            
Risk Factors --Retinal Detachment
    Aging
    Injury or trauma
    Diabetes
    Extreme near-sightedness
    Previous incidence of retinal detachment in the other eye
    Previous history of major eye surgery 
    History of other eye diseases 
    Family history of retinal detachment
Treatment/ Management - Retinal Detachment

  • Vitreo-retinal surgery – vitrectomy where gas/silicone oil is inserted in the eye to help the retina adhere back to the wall of the eye.
  • Scleral buckling                       
Macular Hole

It is an eye condition where there is a break on the centre portion of the retina called the macula. Macula is vital and responsible for us to focus on our central vision while reading, driving, looking at fine details and recognising faces. Full thickness macular hole (FTMH) affects approximately 3 in 1000 individuals, in the sixth or seventh decade of their life. 

Signs and Symptoms

* Severe impairment or dark spot on central vision
* Blurred and distorted central vision (metamorphopsia)
* Straight lines or objects may appear wavy and look bent
* Reduced reading vision

Risk Factors

* Age
* Inflammation in the eye (uveitis)
* Severe near-sightedness
* Vitreous traction
* Retinal detachment
* Macula pucker
* Diabetes
* Retinal vein occlusion
* Eye trauma or injury

Treatment/Management

* Vitreo-retinal surgery



Central Serous Retinopathy (CSR)


Also known as Central Serous Chorioretinopathy, is a sporadic disorder of the outer blood-retinal barrier. It is characterized by a localized detachment of the sensory retina at the macula secondary to focal retinal pigment epithelium (RPE) defects, consequently results in fluid builds up under the retina.

Signs and Symptoms - Central Retinopathy

  • Diminished contrast sensitivity Distorted and blurred central vision
  • Straight lines may appear wavy or bent in the affected eye (metamorphopsia)
  • Micropsia/ macropsia – seeing objects appear in their abnormal size
  • Loss of colour saturation

Risk Factors - Central Retinopathy

*  Emotional stress or type A personality
*  Untreated hypertension
* Alcohol use
*  Autoimmune disease (ie: systemic lupus erythematosus)
*  Organ transplantation
*  Gastro-oesophageal reflux
*  Cushing’s disease
*  Use of steroid (topical, oral, inhaled or through a vein) 

Treatment/Management 

  • Argon laser photocoagulation
  •    Photodynamic therapy (PDT) 







Vitreous Haemorrhage 


Bleeding of your vitreous gel inside the eye as a result of numbers of conditions that cause blood to leak from damaged abnormal blood vessels or bleeding from other parts of the eye into the vitreous.

Signs and Symptoms 

  • Sudden and painless vision loss
  • Black spot appearance or floaters on affected eye


Risk Factors 

  • Damage to normal blood vessels –     Ocular trauma or injury can cause normal blood vessel to rupture and lead to bleeding. Eye problems like retinal tear and retinal vein occlusions also can cause damage to normal blood vessels, then lead to vitreous haemorrhage.   

  • Growth of abnormal blood vessels –    new abnormal blood vessels are usually fragile and prone to bleed into the eye, thus cause vitreous haemorrhage.   

  • Bleeding from other part of the eye –   such as from retinal macroaneurysms, tumors and other pathological conditions of the eye that may cause them to bleed into the vitreous. 

Treatment/Management 

Scatter pan-retinal photocoagulation (PRP) laser
Vitreo-retinal surgery – pars plana vitrectomy with endolaser pan-retinal photocoagulation  

Kansaki testbook 

https://www.aao.org/eye-health/diseases/what-is-central-serous-retinopathy 

 ,Sep. 21, 2022,what-is-central-serous-retinopathy,online available at https://www.aao.org/eye-health/diseases/what-is-central-serous-retinopathy

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