Hypermetropia also known as "Hyperopia' or "Farsightedness" is a common type of refractive error where distant objects may be seen more clearly than objects that are near.

1. HYPERMETROPIA
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2. HYPERMETROPIA
 Hypermetropia is the dioptric condition of eye in
which parallel rays of light coming from infinity are
foccused behind the retina with accomodation at rest.

3. Etiology
Hypermetropia can be grouped as:
 1. Axial hypermetropia:
 Commonest form, total refractive power of eye
is normal but there is axial shortening of
eyeball.
 Small eye, although too short, is not necessarily
hypermetropic since there may be uniform
diminution of all the parts. As a matter of fact,
highly hypermetropic eyes are almost invariably
also smaller than normal.

4.  About 1mm shortening of the A-P diameter of the eye
results in 3 dioptres of hypermetropia.
 High hypermetropia occurs in Microopthalmos and
nanophthalmos due to markedly short axial length.
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5.  2.Curvature hypermetropia:
 Curvature of the cornea, lens or both is flatter than the
normal resulting in a decrease in the refractive power of
the eye.
 About 1mm increase in radius of curvature results in 6
dioptres of hypermetropia.
 E.g. Cornea plana.

6.  3.Index hypermetropia:
 Accounts for the hypermetropia of old age and is
attributable to the increased R.I. of the cortex of the
lens relative to the nucleus so that overall power of the
lens decreases.

7.  4.Positional hypermetropia:
 Backward displacement of the lens e.g.: Buphthalmos
 5.Absence of lens:
 Either congenitally or acquired
 High hypermetropia.

8. Clinical types
 1. Simple developmental hypermetropia
 2. Pathological hypermetropia results due to either
Congenital or Acquired conditions of the eye ball. It
includes:-
 Index hypermetropia :- due to cortical sclerosis
 Positional hypermetropia:- due to posterior subluxation
of lens
 Aphakia :- congenital or acquired absence of lens.
 Consecutive hypermetropia :- due to surgically
overcorrected myopia.

9. Nomenclature
1. Latent hypermetropia implies hypermetropia
corrected by inherent tone of ciliary muscle.
2. Manifest hypermetropia is remaining portion of
hypermetropia not corrected by ciliary tone. It consists
of
i)Facultative :-corrected by patient’s accommodative
effort.
ii) Absolute :-not corrected by accommodative effort.

10. CLINICAL PICTURE
 SYMPTOMS
-symptoms are noticed chiefly after close work, especially
in the evening by artificial light.
 Eyes ache and burn; they may feel dry so blinking
movements are more frequent than usual or there may
be lacrimation.
 The conjunctiva and edges of the lids become
hyperemic and if near work is persisted in, headaches,
usually frontal, develop.
 Apparent presbyopia commences at an earlier age than
usual.

11. SIGNS
 Size of eyeball:- SMALL
 Diameter of the cornea is often reduced and regular
astigmatism is common.
 Anterior chamber is comparatively shallow, pre-disposes
to Angle closure glaucoma.
 Fundus examination:-
• May appear normal on ophthalmoscopy.
• Bright reflex; suggesting the appearance of watered silk.
• In some cases optic neuritis is nearly simulated i.e.
Pseudopapillitis.
 5. Biometry may reveal short A-P length of eye ball.

12. COMPLICATIONS
1. Recurrent styes, blepharitis or chalazia.
2. Accommodative convergent squint
3. Amblyopia
4. Development of primary narrow angle glaucoma .

13. STYE BLEPHARITIS CHALAZION
COMPLICATIONSOF HYPERMETROPIA

14. ACCOMODATIVE CONVERGENT SQUINT

15. TREATMENT
A. OPTICAL TREATMENT
Basic principle is to prescribe convex lenses so
that light rays are brought to focus on retina.
Fundamental rules of prescribing glasses in
hypermetropia :-
 1. Total amount of hypermetropia should always
be measured under complete cycloplegia.
 2. The spherical correction given to patient
should be acceptable to patient, however
astigmatism should be fully corrected.

16.  3. Gradually increase the spherical correction at
6 months interval till patient accepts manifest
hypermetropia
 4. In presence of accommodative convergent
squint full correction should be given in first
sitting.
 5.If there is associated amblyopia full correction
with occlusion therapy should be started.
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18. Surgical treatment
1. Photorefractive keratectomy(PRK)
2. Laser Assisted In Situ Keratomileusis(LASIK)
3. Thermokeratoplasty
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19. Photorefractive keratectomy(PRK)
Photorefractive keratectomy consists of the
application of energy of the ultraviolet range
generated by an argon fluoride (ArF) excimer laser
to the anterior corneal stroma to change its
curvature and, thus, to correct a refractive error.
Used to correct mild to moderate hypermetropia
(+1 D to +4 D).
Problems-haze, regression effect & prolonged
epithelial healing.
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20. Laser Assisted In Situ Keratomileusis
(LASIK)
In situ- “In place” keratomileusis- “to shape cornea”
LASIK=“to shape cornea in place”
Principle:- The central cornea must be made steeper.
This is accomplished by directing the laser beam to
remove tissue from around this area.
Corrects +1 D to +4 D
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21. Thermokeratoplasty
Involves creation of two sets of 8 spot burns using
Holmium YAG laser in a ring pattern at the peripheral
cornea
Heat => coagulation - up to 90% of corneal depth
Coagulation => collagen shrinkage in periphery =>
generalised central steepening => correct hyperopia up
to +2.5D.
Heating collagen to a critical temperature of 55-
600C will cause it to shrink, inducing changes in
the corneal curvature.
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22. Thermokeratoplasty
Thermokeratoplasty is avoided in the central
cornea because of scarring, but can be used in
midpheripheral cornea to induce peripheral
flattening and central steepening to correct
hyperopia.
If the temperature is too high --- local necrosis
If the source of heat is non uniform or non
uniformly applied --- irregular astigmatism.
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23. Thermokeratoplasty
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24. D/D:
1) Papilledema
2) Pseudopapillitis
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