Pathological myopia is a major cause of blindness among people under 50 years old and can result in severe vision loss in extreme cases. Currently, its detection primarily relies on manual methods, which are slow and heavily dependent on the expertise of physicians, making them impractical for large-scale screening. To tackle these challenges, we propose SMLS-YOLO, an instance segmentation method based on YOLOv8n-seg. Designed for efficiency in large-scale screenings, SMLS-YOLO employs an extremely lightweight model. First, StarNet is introduced as the backbone of SMLS-YOLO to extract image features. Subsequently, the StarBlock from StarNet is utilized to enhance the C2f, resulting in the creation of the C2f-Star feature extraction module. Furthermore, shared convolution and scale reduction strategies are employed to optimize the segmentation head for a more lightweight design. Lastly, the model incorporates the Multi-Head Self-Attention (MHSA) mechanism following the backbone to further refine the feature extraction process. Experimental results on the pathological myopia dataset demonstrate that SMLS-YOLO outperforms the baseline YOLOv8n-seg by reducing model parameters by 46.9%, increasing Box mAP@0.5 by 2.4%, and enhancing Mask mAP@0.5 by 4%. Furthermore, when compared to other advanced instance segmentation and semantic segmentation algorithms, SMLS-YOLO also maintains a leading position, suggesting that SMLS-YOLO has promising applications in the segmentation of pathological myopia images.