HYPERMETROPIA (FARSIGHTEDNESS)

• Hypermetropia (hyperopia) or long-sightedness is a refractive error in which objects placed at a closer distance appears blurry while distant objects appear normal
• It is the refractive state of the eye wherein parallel rays of light coming from infinity are focused behind the retina with accommodation being at rest

Clinical types of hypermetropia:

Simple hypermetropia: It includes axial and curvature hypermetropia. It may be hereditary.

Pathological hypermetropia: due to congenital or acquired conditions. It may be

• Senile or acquired hypermetropia:It occurs in old age due to
• Curvature hypermetropia:There is decreased curvature of the outer lens fibres with ageing
• Index hypermetropia: due to acquired sclerosis of the cortex (outer part) of the crystalline lens
• Positional hypermetropia:due to posterior subluxation of the lens
• Aphakic hypermetropia:Aphakia is the displacement of the lens from its normal pupillary position in the eye. It may be congenital or acquired condition
• Consecutive hypermetropia:- Due to surgically overcorrected myopia or pseudo-phakia with under-correction

Functional hypermetropia: Results from paralysis of accommodation as is seen in patients with third intracranial nerve palsy

Hypermetropia maybe

• Axial hypermetropia: The total refractive power of the eye is normal but there is an axial shortening of the eyeball
• Curvature hypermetropia: Curvature of the cornea, lens or both are increased (flatter) than the normal, resulting in a change in refractive power of the eye
• Index Hypermetropia: Due to the change in the refractive index of the lens with age
• Positional hypermetropia: results from the posteriorly placed crystalline lens of the eye
• Absence of crystalline lens: There is high hypermetropia in aphakia

Symptoms

A small amount of refractive error in young patients is usually corrected by mild accommodative effort, without producing any symptoms

• Asthenopia (eyestrain)
• Frontal or frontotemporal headache
• Watering
• Mild aversion to light
• Blurred or defective near vision, clear far vision

Signs

• Size of the eyeball may appear small
• The cornea may be slightly smaller than the normal
• The anterior chamber is comparatively shallow

Grading of hypermetropia

American Optometric Association (AOA)

• Low hypermetropia, when the error is < + 2D
• Moderate hypermetropia, when the error is between +2 to + 5D
• High hypermetropia, when the error is > + 5D

Complications

• Recurrent styes, blepharitis or chalazion
• Accommodative convergent squint may develop in children
• Amblyopia
• Predisposition to develop primary narrow-angle glaucoma

• Retinoscopy - reveals hypermetropic refractive error
• Fundus examination - Small optic disc which may look more vascular with ill-defined margins
• A-scan ultrasonography (biometry) - A short anteroposterior length of the eyeball

• Optical treatment - Basic principle of treatment is to prescribe convex (plus) lenses
• Refractive surgery

Ayurvedic Treatment

Internal medicines

• Pachanamrutha kashaya – initially to correct agni
• Vaiswanara choorna – initially to correct agni
• Shatpala ghrita
• Triphala Gritha mixed +Triphala choorna + honey
• Aswagandharishtha
• Sapthamrutha lauha

Procedures

• Virechana – Avipathi choorna
• Mukhalepa - Triphala+ Yastichoorna
• Seka - Triphala kashaya
• Siro lepa – Triphala + yashti+Lodra
• Jaloukavacharana – Forehead / eyelid
• Nasya - Ksheerabala avarthi , Jeevanthyadi gritha ,Dhanwantara taila
• Sirodhara/ Siropichu - ksheerabala Taila
• Anjana -Pasupatha varti , Chandanadai
• Tarpana - Jeevaneeya Gritha
• Putapaka – jeevaneeya putapaka