REFRACTIVE ERRORS
A state of refractive error(s) is termed ametropia against the ideal optical state when distant
points are no longer focused properly to the retina. Emmetropia ,in which the parallel rays of
light come to focus on the retina with the eye in a state of rest.
Hypermetropia (Hyperopia)
Farsightedness occurs when the parallel rays of light are focused behind the retina on account
of too short anteroposterior diameter of the eye, subnormal refractive power of the cornea or
lens, or posterior dislocation of the lens.
If the error is severe, greater accommodative effort may cause blurring of vision, eye strain,
headache, fatigue, convergent strabismus, eye-rubbing and lid inflammation. Convex lenses
correct the error.
Myopia
Shortsightedness occurs when the parallel rays of light come to focus in front of the retina on
account of the too long anterioposterior diameter of the eye, higher refractive power of the
cornea or lens, or anterior dislocation of the lens.
The major symptom is blurred vision for distant objects. The myopic child has difficulty in
reading the blackboard and pursuing the distant activities. He tends to keep the book and other
reading/writing matter close to his eyes. Frowning and squinting result from child’s inclination
to improve the visual activity by reducing the lid aperture. Concave lenses correct the error.
Astigmatism
It means there is difference in the refractive power of different meridians of the eye, usually
because of the irregularity in the curvature of the cornea or lens. As a result, parallel rays of
light fail to come to focus at a point. Astigmatism may be complicated by amblyopia.
Significant astigmatism leads to distortion of images, frowning, squinting, eyestrain, headache,
fatigue, eye-rubbing, lid hyperemia, indifference to schoolwork, and holding reading matter
close. Conditions predisposing to astigmatism are ocular trauma, periorbital and eyelid
hemangioma and ptosis. Cylindrical or spherocylindrical lenses correct the error.
Anisometropia
Difference in the refractive states of the two eyes may cause amblyopia or “lazy eye”. Early
correction is warranted. There is impairment/Paralysis of Accommodation.
It may result from premature presbyopia, overuse of cycloplegic substances (anticholinergics,
poisons), 3rd cranial nerve lesions, botulism, diphtheria, diabetes mellitus, syphilis, viral
infections, etc. Congenital inability to accomodate, though rare, is known.
Corneal Ulcers
Corneal ulcers may result from trauma (foreign body), malnutrition (xerophthalmia), adjoining
ophthalmic infection (conjunctivitis, dacrocystitis), exposure (exophthalmos, lagophthalmos),
diminished sensations (Riley-Day syndrome), exanthemata, or metabolic disorders
(tyrosinemia).
Manifestations include corneal haziness, hyperemia, lid edema, pain, photophobia, tearing and
blephorspasm. Pus may accumulate in the anterior chamber (hypopyon).
Pathogens causing corneal ulcers include Pseudomonas aeruginosa, N. gonorrhoeae and some
fungi.
Prompt treatment, both local and systemic, with attention to causative factor(s) is warranted to
safeguard against blindness.
Peter’s Anomaly
This is a congenital corneal opacity (leukoma) with corresponding defects in the anterior
chamber and iris.
Visual disorders
Amblyopia means subnormal vision in one or both eyes in spite of correction of significant
refractive error. The most important cause is sensory stimulation deprivation during the early
developmental life (sensory deprivation amblyopia).
Amaurosis means partial or total loss of vision in the form of profound impairment, near-
blindness, or blindness. It may follow developmental malformations, gestational/perinatal
infections, anoxia/ hypoxia, perinatal trauma, and certain genetic disorders. If it develops in a
child who once had good vision, the etiologic factors may be an ocular disease,
encephalopathy, vasculitis, migraine, leukemia, toxins, trauma, infectious or postinfectious
processes, demyelinating diseases, rapidly rising intracranial pressure, dysfunction of a shunt,
craniopharyngioma, neurodegenerative disease, tumors, gliomas of optic nerve or chiasm, etc.
Accompanying manifestations include strabismus, nystagmus, timidity, clumsiness,
behavioral changes, deterioration in school performance and shirking participation in school
activities.
Night blindness (nyctalopia) may be congenital or acquired (xerophthalmia, quinine and other
retinotoxic drugs, retinal, choroidal or vitrioretinal degeneration).
Diplopia, meaning double vision, usually occurs in strabismus and in proptosis. It may be a
warning sign for the ensuing raised ICP, a brain tumor, an orbital mass or myasthenia gravis.
Monocular diplopia points to existence of dislocated lens, or a defect in the media or the
macule.
Psychogenic vision problems, both malingering and conversion reaction, may be complained of
by the school going children.
Dyslexia means a specific reading disability due to a primary or developmental defect in the
higher cortical processing of graphic symbols. The associated symptoms include letter or word
reversal and mirror writing. An ophthalmologic evaluation is warranted. Treatment is directed
at remedial instruction and counseling of the child and the family.
