Additional Information
Book Details
Abstract
Ideally suited for rapid reference and efficient, effective recall, Clinical Ophthalmology: A Systematic Approach will keep you up to date with current and evolving practice in the diagnosis and management of ophthalmic disorders, using a visually rich, succinct format that facilitates comprehension for trainees and practitioners. You’ll have access to the latest advances in the field.
- Grasp key information and effectively prepare for examinations with a pictorial, bulleted approach – both highly visual and concise, for more efficient study.
- Move rapidly throughout the text to find the information you need, with color coding and at-a-glance key points.
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Learn from two renowned experts in the field.
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Includes over 2,700 high-quality images, 1,000 of which appear for the first time in this edition.
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Master the latest advances in ophthalmology: radical changes in the management of macular disease, including the widespread introduction of VEGF inhibitor therapy; recent developments in the investigation and treatment of retinal vascular disease; new pharmaceutical interventions for a range of conditions, including infectious eye disease and glaucoma; and updated surgical procedures and methods, including oculoplastic, corneal, and glaucoma surgery.
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Guidance on examination, imaging, and recognition of systemic conditions associated with ocular disease.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Half title page | i | ||
| Dedication | ii | ||
| Clinical Ophthalmology: A Systematic Approach | iii | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Preface to the seventh edition | ix | ||
| Chapter 1 Eyelids | 1 | ||
| Introduction | 2 | ||
| Anatomy | 2 | ||
| Epidermis | 2 | ||
| Dermis | 3 | ||
| Terminology | 3 | ||
| Clinical | 3 | ||
| Histological | 3 | ||
| General considerations | 3 | ||
| Benign nodules and cysts | 4 | ||
| Chalazion | 4 | ||
| Pathogenesis | 4 | ||
| Diagnosis | 4 | ||
| Treatment | 4 | ||
| Other cysts | 4 | ||
| Benign epidermal tumours | 4 | ||
| Squamous cell papilloma | 4 | ||
| Basal cell papilloma | 7 | ||
| Actinic keratosis | 7 | ||
| Benign pigmented lesions | 8 | ||
| Freckle (ephelis) | 8 | ||
| Congenital melanocytic naevus | 8 | ||
| Acquired melanocytic naevus | 9 | ||
| Benign adnexal tumours | 9 | ||
| Syringoma | 9 | ||
| Pilomatricoma | 10 | ||
| Miscellaneous benign tumours | 10 | ||
| Capillary haemangioma | 10 | ||
| Port-wine stain | 13 | ||
| Cutaneous features | 13 | ||
| Sturge–Weber syndrome | 13 | ||
| Pyogenic granuloma | 14 | ||
| Xanthelasma | 14 | ||
| Neurofibroma | 15 | ||
| Malignant tumours | 15 | ||
| Rare predisposing conditions | 15 | ||
| Basal cell carcinoma | 16 | ||
| General features | 16 | ||
| Histology | 16 | ||
| Chapter 2 Lacrimal Drainage System | 65 | ||
| Anatomy | 66 | ||
| Physiology | 66 | ||
| Causes of a watering eye | 67 | ||
| Evaluation | 67 | ||
| External examination | 67 | ||
| Fluorescein disappearance test | 67 | ||
| Probing and irrigation | 67 | ||
| Jones dye testing | 67 | ||
| Contrast dacryocystography | 70 | ||
| Nuclear lacrimal scintigraphy | 70 | ||
| Acquired obstruction | 70 | ||
| Primary punctal stenosis | 70 | ||
| Secondary punctal stenosis | 70 | ||
| Canalicular obstruction | 70 | ||
| Nasolacrimal duct obstruction | 71 | ||
| Dacryolithiasis | 72 | ||
| Congenital obstruction | 72 | ||
| Nasolacrimal duct obstruction | 72 | ||
| Congenital dacryocele | 73 | ||
| Lacrimal surgery | 74 | ||
| Conventional dacryocystorhinostomy | 74 | ||
| Endoscopic surgery | 75 | ||
| Endolaser DCR | 75 | ||
| Balloon dacryocystoplasty | 75 | ||
| Lester Jones tube | 75 | ||
| Chronic canaliculitis | 75 | ||
| Diagnosis | 77 | ||
| Treatment | 77 | ||
| Differential diagnosis | 77 | ||
| Dacryocystitis | 77 | ||
| Acute dacryocystitis | 77 | ||
| Chronic dacryocystitis | 78 | ||
| Chapter 3 Orbit | 79 | ||
| Introduction | 80 | ||
| Anatomy | 80 | ||
| Clinical signs | 80 | ||
| Soft tissue involvement | 80 | ||
| Proptosis | 80 | ||
| Enophthalmos | 81 | ||
| Dystopia | 82 | ||
| Ophthalmoplegia | 82 | ||
| Dynamic properties | 82 | ||
| Fundus changes | 83 | ||
| Special investigations | 84 | ||
| Thyroid eye disease | 84 | ||
| Introduction | 84 | ||
| Thyrotoxicosis | 84 | ||
| Risk factors for ophthalmopathy | 84 | ||
| Pathogenesis of ophthalmopathy | 84 | ||
| Clinical manifestations | 84 | ||
| Soft tissue involvement | 85 | ||
| Lid retraction | 86 | ||
| Pathogenesis | 86 | ||
| Signs | 86 | ||
| Management | 86 | ||
| Proptosis | 87 | ||
| Signs | 87 | ||
| Management | 87 | ||
| Restrictive myopathy | 88 | ||
| Diagnosis | 88 | ||
| Chapter 4 Dry Eye Disorders | 121 | ||
| Definitions | 122 | ||
| Physiology | 122 | ||
| Tear film constituents | 122 | ||
| Spread of the tear film | 122 | ||
| Outer lipid layer | 122 | ||
| Middle aqueous layer | 122 | ||
| Inner mucous layer | 123 | ||
| Regulation of tear film components | 123 | ||
| Mechanism of disease | 123 | ||
| Classification | 123 | ||
| Sjögren syndrome | 124 | ||
| Clinical features | 124 | ||
| Symptoms | 124 | ||
| Signs | 125 | ||
| Special investigations | 125 | ||
| Tear film break-up time | 127 | ||
| Schirmer test | 127 | ||
| Ocular surface staining | 128 | ||
| Other tests | 128 | ||
| Treatment | 128 | ||
| Patient education | 128 | ||
| Tear substitutes | 128 | ||
| Mucolytic agents | 129 | ||
| Punctal occlusion | 129 | ||
| Anti-inflammatory agents | 129 | ||
| Contact lenses | 129 | ||
| Conservation of existing tears | 130 | ||
| Other options | 130 | ||
| Chapter 5 Conjunctiva | 131 | ||
| Introduction | 132 | ||
| Anatomy | 132 | ||
| Histology | 132 | ||
| Clinical features of conjunctival inflammation | 132 | ||
| Symptoms | 132 | ||
| Discharge | 132 | ||
| Conjunctival reaction | 132 | ||
| Lymphadenopathy | 134 | ||
| Bacterial conjunctivitis | 135 | ||
| Acute bacterial conjunctivitis | 135 | ||
| Diagnosis | 135 | ||
| Treatment | 135 | ||
| Adult chlamydial conjunctivitis | 137 | ||
| Pathogenesis | 137 | ||
| Urogenital infection | 137 | ||
| Diagnosis | 137 | ||
| Treatment | 137 | ||
| Trachoma | 139 | ||
| Pathogenesis | 139 | ||
| Diagnosis | 139 | ||
| Management | 139 | ||
| Neonatal conjunctivitis | 139 | ||
| Causes | 139 | ||
| Diagnosis | 141 | ||
| Treatment | 141 | ||
| Viral conjunctivitis | 142 | ||
| Adenoviral conjunctivitis | 142 | ||
| Pathogenesis | 142 | ||
| Presentation | 142 | ||
| Signs | 142 | ||
| Differential diagnosis | 142 | ||
| Management | 142 | ||
| Molluscum contagiosum conjunctivitis | 143 | ||
| Pathogenesis | 143 | ||
| Diagnosis | 144 | ||
| Treatment | 144 | ||
| Allergic conjunctivitis | 144 | ||
| Acute allergic conjunctivitis | 144 | ||
| Seasonal and perennial allergic conjunctivitis | 144 | ||
| Chapter 6 Cornea | 167 | ||
| Introduction | 168 | ||
| Anatomy and physiology | 168 | ||
| General aspects | 168 | ||
| Dimensions | 168 | ||
| Layers | 168 | ||
| Signs of corneal inflammation | 168 | ||
| Superficial lesions | 168 | ||
| Deep lesions | 169 | ||
| Documentation of clinical signs | 172 | ||
| Specular microscopy | 172 | ||
| Principles of treatment | 173 | ||
| Control of infection and inflammation | 173 | ||
| Promotion of epithelial healing | 173 | ||
| Bacterial keratitis | 173 | ||
| Pathogenesis | 173 | ||
| Pathogens | 173 | ||
| Risk factors | 175 | ||
| Clinical features | 175 | ||
| Investigations | 175 | ||
| Treatment | 178 | ||
| General considerations | 178 | ||
| Local therapy | 178 | ||
| Systemic antibiotics | 180 | ||
| Management of apparent treatment failure | 180 | ||
| Fungal keratitis | 180 | ||
| Introduction | 180 | ||
| Pathogenesis | 180 | ||
| Predisposing factors | 180 | ||
| Candida and filamentous keratitis | 180 | ||
| Clinical features | 180 | ||
| Investigations | 181 | ||
| Treatment | 182 | ||
| Microsporidial keratitis | 182 | ||
| Pathogenesis | 182 | ||
| Diagnosis | 182 | ||
| Treatment | 183 | ||
| Herpes simplex keratitis | 183 | ||
| Introduction | 183 | ||
| Herpes simplex virus (HSV) | 183 | ||
| Primary infection | 183 | ||
| Recurrent infection | 183 | ||
| Epithelial keratitis | 183 | ||
| Clinical features | 183 | ||
| Treatment | 184 | ||
| Disciform keratitis | 185 | ||
| Clinical features | 185 | ||
| Treatment | 185 | ||
| Necrotizing stromal keratitis | 185 | ||
| Neurotrophic ulceration | 185 | ||
| Other considerations | 186 | ||
| Prophylaxis | 186 | ||
| Complications | 186 | ||
| Keratoplasty | 187 | ||
| Herpes zoster ophthalmicus | 187 | ||
| Introduction | 187 | ||
| Pathogenesis | 187 | ||
| Mechanisms of ocular involvement | 187 | ||
| Risk of ocular involvement | 187 | ||
| Acute shingles | 188 | ||
| General features | 188 | ||
| Treatment | 188 | ||
| Eye disease | 188 | ||
| Acute eye disease | 188 | ||
| Chronic eye disease | 190 | ||
| Relapsing eye disease | 190 | ||
| Post-herpetic neuralgia | 190 | ||
| Interstitial keratitis | 191 | ||
| Pathogenesis | 191 | ||
| Chapter 7 Corneal and Refractive Surgery | 239 | ||
| Keratoplasty | 240 | ||
| Introduction | 240 | ||
| General indications | 240 | ||
| Donor tissue | 240 | ||
| Recipient prognostic factors | 240 | ||
| Penetrating keratoplasty | 241 | ||
| Technique | 241 | ||
| Postoperative management | 241 | ||
| Postoperative complications | 242 | ||
| Corneal graft rejection | 242 | ||
| Superficial lamellar keratoplasty | 244 | ||
| Deep anterior lamellar keratoplasty | 244 | ||
| Descemet stripping endothelial keratoplasty | 244 | ||
| Keratoprostheses | 245 | ||
| Refractive procedures | 245 | ||
| Introduction | 245 | ||
| Correction of myopia | 245 | ||
| Correction of hypermetropia (hyperopia) | 245 | ||
| Correction of astigmatism | 247 | ||
| Correction of presbyopia | 247 | ||
| Laser refractive procedures | 247 | ||
| Photorefractive keratectomy | 247 | ||
| Laser epithelial keratomileusis | 247 | ||
| Laser in situ keratomileusis | 247 | ||
| Chapter 8 Episclera and Sclera | 251 | ||
| Anatomy | 252 | ||
| Episcleritis | 252 | ||
| Simple episcleritis | 252 | ||
| Nodular episcleritis | 252 | ||
| Immune-mediated scleritis | 253 | ||
| Anterior non-necrotizing scleritis | 253 | ||
| Diffuse | 253 | ||
| Nodular | 254 | ||
| Anterior necrotizing scleritis with inflammation | 255 | ||
| Clinical features | 255 | ||
| Investigations | 256 | ||
| Complications | 256 | ||
| Scleromalacia perforans | 257 | ||
| Posterior scleritis | 258 | ||
| Diagnosis | 258 | ||
| Differential diagnosis | 258 | ||
| Important systemic associations of scleritis | 259 | ||
| Rheumatoid arthritis | 259 | ||
| Wegener granulomatosis | 259 | ||
| Relapsing polychondritis | 259 | ||
| Polyarteritis nodosa | 260 | ||
| Treatment of immune-mediated scleritis | 261 | ||
| Infectious scleritis | 261 | ||
| Causes | 261 | ||
| Treatment | 261 | ||
| Scleral discoloration | 261 | ||
| Alkaptonuria | 261 | ||
| Haemochromatosis | 261 | ||
| Blue sclera | 262 | ||
| Osteogenesis imperfecta | 262 | ||
| Type I | 262 | ||
| Type IIA | 262 | ||
| Ehlers–Danlos syndrome type VI | 262 | ||
| Other systemic associations | 263 | ||
| Miscellaneous conditions | 263 | ||
| Congenital ocular melanocytosis | 263 | ||
| Classification | 263 | ||
| Clinical features | 264 | ||
| Ipsilateral associations | 264 | ||
| Idiopathic sclerochoroidal calcification | 264 | ||
| Scleral hyaline plaque | 267 | ||
| Chapter 9 Lens | 269 | ||
| Acquired cataract | 270 | ||
| Age-related cataract | 270 | ||
| Subcapsular cataract | 270 | ||
| Nuclear cataract | 270 | ||
| Cortical cataract | 271 | ||
| Christmas tree cataract | 271 | ||
| Cataract maturity | 271 | ||
| Cataract in systemic diseases | 272 | ||
| Diabetes mellitus | 272 | ||
| Myotonic dystrophy | 273 | ||
| Atopic dermatitis | 273 | ||
| Neurofibromatosis type 2 | 273 | ||
| Secondary cataract | 273 | ||
| Chronic anterior uveitis | 273 | ||
| Acute congestive angle-closure | 273 | ||
| High myopia | 273 | ||
| Hereditary fundus dystrophies | 273 | ||
| Traumatic cataract | 273 | ||
| Management of age-related cataract | 273 | ||
| Preoperative considerations | 273 | ||
| Indications for surgery | 273 | ||
| Systemic preoperative assessment | 273 | ||
| Ophthalmic preoperative assessment | 273 | ||
| Biometry | 278 | ||
| Postoperative refraction | 278 | ||
| Intraocular lenses | 279 | ||
| Positioning | 279 | ||
| Design | 280 | ||
| Anaesthesia | 280 | ||
| Phacoemulsification | 281 | ||
| Introduction | 281 | ||
| Phacodynamics | 281 | ||
| Pumps | 282 | ||
| Handpiece | 282 | ||
| Viscoelastics | 282 | ||
| Technique | 283 | ||
| Small incision manual cataract surgery | 285 | ||
| Operative complications | 285 | ||
| Rupture of the posterior lens capsule | 285 | ||
| Posterior loss of lens fragments | 288 | ||
| Posterior dislocation of IOL | 288 | ||
| Suprachoroidal haemorrhage | 288 | ||
| Acute postoperative endophthalmitis | 289 | ||
| Pathogenesis | 289 | ||
| Prophylaxis | 290 | ||
| Clinical features | 290 | ||
| Differential diagnosis | 290 | ||
| Identification of pathogens | 290 | ||
| Treatment | 291 | ||
| Subsequent management | 293 | ||
| Delayed-onset postoperative endophthalmitis | 293 | ||
| Pathogenesis | 293 | ||
| Diagnosis | 293 | ||
| Posterior capsular opacification | 295 | ||
| Signs | 295 | ||
| Treatment | 296 | ||
| Anterior capsular fibrosis and contraction | 296 | ||
| Miscellaneous postoperative complications | 296 | ||
| Malposition of IOL | 296 | ||
| Cystoid macular oedema | 296 | ||
| Retinal detachment | 298 | ||
| Congenital cataract | 298 | ||
| Aetiology | 298 | ||
| Inheritance | 298 | ||
| Morphology | 298 | ||
| Systemic metabolic associations | 298 | ||
| Galactoasemia | 298 | ||
| Lowe syndrome | 301 | ||
| Fabry disease | 301 | ||
| Mannosidosis | 301 | ||
| Other metabolic disorders | 301 | ||
| Associated intrauterine infections | 302 | ||
| Congenital rubella | 302 | ||
| Toxoplasmosis | 302 | ||
| Cytomegalovirus infection | 302 | ||
| Varicella | 302 | ||
| Associated chromosomal abnormalities | 302 | ||
| Down syndrome (trisomy 21) | 302 | ||
| Edwards syndrome (trisomy 18) | 302 | ||
| Cri du chat syndrome (partial deletion of 5p) | 302 | ||
| Associated skeletal syndromes | 302 | ||
| Hallermann–Streiff–François syndrome | 302 | ||
| Nance–Horan syndrome | 302 | ||
| Management | 303 | ||
| Ocular examination | 303 | ||
| Systemic investigations | 303 | ||
| Treatment | 303 | ||
| Postoperative complications | 303 | ||
| Visual rehabilitation | 304 | ||
| Ectopia lentis | 304 | ||
| Without systemic associations | 304 | ||
| With systemic associations | 304 | ||
| Marfan syndrome | 304 | ||
| Weill–Marchesani syndrome | 306 | ||
| Homocystinuria | 306 | ||
| Other systemic associations | 306 | ||
| Management | 307 | ||
| Abnormalities of shape | 308 | ||
| Anterior lenticonus | 308 | ||
| Posterior lenticonus | 308 | ||
| Lentiglobus | 309 | ||
| Microspherophakia | 309 | ||
| Microphakia | 309 | ||
| Coloboma | 309 | ||
| Chapter 10 Glaucoma | 311 | ||
| Introduction | 312 | ||
| Aqueous secretion | 312 | ||
| Aqueous outflow | 312 | ||
| Anatomy | 312 | ||
| Physiology | 312 | ||
| Intraocular pressure | 313 | ||
| Concept of normal intraocular pressure | 313 | ||
| Fluctuation | 313 | ||
| Overview of glaucoma | 313 | ||
| Definition | 313 | ||
| Epidemiology | 313 | ||
| Classification | 313 | ||
| Tonometry | 313 | ||
| Goldmann tonometry | 313 | ||
| Principles | 313 | ||
| Technique | 314 | ||
| Sources of error | 314 | ||
| Other types of tonometry | 315 | ||
| Gonioscopy | 316 | ||
| Introduction | 316 | ||
| Overview | 316 | ||
| Optical principles | 316 | ||
| Indirect gonioscopy | 316 | ||
| Non-indentation gonioscopy | 317 | ||
| Indentation gonioscopy | 317 | ||
| Direct gonioscopy | 318 | ||
| Identification of angle structures | 319 | ||
| Grading of angle width | 320 | ||
| Shaffer system | 320 | ||
| Other systems | 322 | ||
| Pathological findings | 323 | ||
| Evaluation of the optic nerve head | 323 | ||
| Normal optic nerve head | 323 | ||
| Neuroretinal rim | 323 | ||
| Optic disc size | 323 | ||
| Cup–disc ratio | 323 | ||
| Changes in glaucoma | 324 | ||
| Optic nerve head | 324 | ||
| Subtypes of glaucomatous damage | 324 | ||
| Non-specific signs of glaucomatous damage | 324 | ||
| Peripapillary changes | 327 | ||
| Retinal nerve fibre layer | 327 | ||
| Imaging in glaucoma | 327 | ||
| Stereo disc photography | 327 | ||
| Confocal scanning laser tomography | 327 | ||
| Scanning laser polarimetry | 330 | ||
| Optical coherence tomography | 331 | ||
| Anterior chamber depth measurement | 331 | ||
| Perimetry | 331 | ||
| Definitions | 331 | ||
| Types of perimetry | 333 | ||
| Kinetic | 333 | ||
| Static | 333 | ||
| Suprathreshold | 333 | ||
| Threshold | 333 | ||
| Sources of error | 333 | ||
| Humphrey Field Analyzer | 334 | ||
| Testing patterns | 334 | ||
| Testing strategies | 334 | ||
| Displays | 334 | ||
| Reliability indices | 336 | ||
| Glaucoma hemifield test | 336 | ||
| Global indices | 337 | ||
| Computer analysis of serial fields | 338 | ||
| Short-wave automated perimetry | 338 | ||
| Frequency-doubling contrast test | 338 | ||
| Ocular hypertension | 338 | ||
| Definition | 338 | ||
| Risk factors for developing glaucoma | 339 | ||
| Pre-perimetric glaucoma | 340 | ||
| Management | 340 | ||
| Primary open-angle glaucoma | 340 | ||
| Introduction | 340 | ||
| Definition | 340 | ||
| Risk factors | 340 | ||
| Genetics | 341 | ||
| Steroid responsiveness | 341 | ||
| Pathogenesis of glaucomatous optic neuropathy | 341 | ||
| Screening | 341 | ||
| Diagnosis | 341 | ||
| History | 341 | ||
| Examination | 342 | ||
| Visual field defects | 342 | ||
| Management | 343 | ||
| Patient instruction | 343 | ||
| Treatment goals | 344 | ||
| Medical therapy | 344 | ||
| Laser trabeculoplasty | 346 | ||
| Surgery | 346 | ||
| Prognosis | 346 | ||
| Normal-pressure glaucoma | 346 | ||
| Definition | 346 | ||
| Pathogenesis | 346 | ||
| Risk factors | 347 | ||
| Differential diagnosis | 347 | ||
| Diagnosis | 347 | ||
| Treatment | 347 | ||
| Primary angle-closure glaucoma | 348 | ||
| Introduction | 348 | ||
| Overview | 348 | ||
| Classification | 348 | ||
| Mechanism | 348 | ||
| Risk factors | 350 | ||
| Diagnosis | 350 | ||
| Symptoms | 350 | ||
| Signs | 350 | ||
| Provocation testing | 351 | ||
| Treatment | 351 | ||
| Primary angle-closure suspect (PACS) | 351 | ||
| Chronic presentation of PAC and PACG | 351 | ||
| Acute and subacute presentation of PAC and PACG | 351 | ||
| Differential diagnosis of an acute elevation of IOP | 353 | ||
| Classification of secondary glaucoma | 353 | ||
| Open-angle | 353 | ||
| Angle-closure | 354 | ||
| Pseudoexfoliation | 355 | ||
| Pseudoexfoliation syndrome | 355 | ||
| Introduction | 355 | ||
| Chapter 11 Uveitis | 401 | ||
| Introduction | 402 | ||
| Anatomical classification | 402 | ||
| Definitions | 402 | ||
| Clinical features | 402 | ||
| Acute anterior uveitis | 402 | ||
| Chronic anterior uveitis | 404 | ||
| Posterior uveitis | 406 | ||
| Special investigations | 406 | ||
| Indications | 406 | ||
| Skin tests | 407 | ||
| Serology | 407 | ||
| Syphilis | 407 | ||
| Toxoplasmosis | 408 | ||
| Enzyme assay | 408 | ||
| HLA tissue typing | 409 | ||
| Imaging | 409 | ||
| Radiology | 410 | ||
| Biopsy | 410 | ||
| Principles of treatment | 410 | ||
| General principles | 410 | ||
| Mydriatics | 410 | ||
| Preparations | 410 | ||
| Indications | 410 | ||
| Topical steroids | 411 | ||
| Indications | 411 | ||
| Complications | 411 | ||
| Periocular steroid injection | 411 | ||
| Intraocular steroids | 411 | ||
| Systemic steroids | 412 | ||
| Antimetabolites | 412 | ||
| Indications | 412 | ||
| Azathioprine | 412 | ||
| Methotrexate | 413 | ||
| Mycophenolate mofetil | 413 | ||
| Calcineurin inhibitors | 413 | ||
| Ciclosporin | 413 | ||
| Tacrolimus | 413 | ||
| Biological blockers | 413 | ||
| Intermediate uveitis | 413 | ||
| Overview | 413 | ||
| Diagnosis | 413 | ||
| Course | 415 | ||
| Complications | 415 | ||
| Treatment | 415 | ||
| Systemic associations | 415 | ||
| Differential diagnosis | 415 | ||
| Uveitis in spondyloarthropathies | 415 | ||
| HLA-B27 and spondyloarthropathies | 415 | ||
| Ankylosing spondylitis | 416 | ||
| Reiter syndrome | 416 | ||
| Psoriatic arthritis | 416 | ||
| Uveitis in juvenile arthritis | 416 | ||
| Juvenile idiopathic arthritis | 416 | ||
| Overview | 416 | ||
| Arthritis | 418 | ||
| Anterior uveitis | 418 | ||
| Differential diagnosis | 418 | ||
| Familial juvenile systemic granulomatosis syndrome | 420 | ||
| Uveitis in bowel disease | 420 | ||
| Ulcerative colitis | 420 | ||
| Crohn disease | 420 | ||
| Whipple disease | 422 | ||
| Uveitis in renal disease | 422 | ||
| Tubulointerstitial nephritis and uveitis (TINU) | 422 | ||
| IgA glomerulonephritis | 422 | ||
| Sarcoidosis | 422 | ||
| Definition | 422 | ||
| Presentation | 422 | ||
| Pulmonary disease | 422 | ||
| Skin lesions | 422 | ||
| Other manifestations | 422 | ||
| Investigations | 424 | ||
| Ocular features | 424 | ||
| Behçet syndrome | 426 | ||
| Overview | 426 | ||
| Diagnostic criteria | 426 | ||
| Additional features | 427 | ||
| Ocular features | 427 | ||
| Treatment of posterior uveitis | 428 | ||
| Differential diagnosis | 429 | ||
| Toxoplasmosis | 429 | ||
| Introduction | 429 | ||
| Pathogenesis | 429 | ||
| Mode of human infection | 430 | ||
| Congenital toxoplasmosis | 430 | ||
| Acquired toxoplasmosis | 430 | ||
| Toxoplasma retinitis | 430 | ||
| Pathogenesis | 430 | ||
| Clinical features | 431 | ||
| Complications | 433 | ||
| Treatment | 433 | ||
| Toxocariasis | 433 | ||
| Pathogenesis | 433 | ||
| Chronic endophthalmitis | 435 | ||
| Posterior pole granuloma | 435 | ||
| Peripheral granuloma | 435 | ||
| Miscellaneous parasitic uveitis | 436 | ||
| Onchocerciasis | 436 | ||
| Pathogenesis | 436 | ||
| Systemic features | 436 | ||
| Ocular features | 437 | ||
| Cysticercosis | 438 | ||
| Diffuse unilateral subacute neuroretinitis | 439 | ||
| Choroidal pneumocystosis | 440 | ||
| Uveitis in acquired immunodeficiency syndrome | 441 | ||
| Introduction | 441 | ||
| Pathogenesis | 441 | ||
| Systemic features | 441 | ||
| Serology | 442 | ||
| Treatment | 442 | ||
| Ocular features | 442 | ||
| HIV microangiopathy | 442 | ||
| Cytomegalovirus retinitis | 442 | ||
| Clinical features | 443 | ||
| Systemic treatment | 443 | ||
| Intravitreal treatment | 444 | ||
| Prognosis | 444 | ||
| Progressive retinal necrosis | 444 | ||
| Miscellaneous viral uveitis | 445 | ||
| Acute retinal necrosis | 445 | ||
| Herpes simplex anterior uveitis | 445 | ||
| Varicella zoster anterior uveitis | 445 | ||
| Congenital rubella | 446 | ||
| Subacute sclerosing panencephalitis | 447 | ||
| Fungal uveitis | 447 | ||
| Presumed ocular histoplasmosis syndrome | 447 | ||
| Pathogenesis | 447 | ||
| General signs | 447 | ||
| Exudative maculopathy | 447 | ||
| Cryptococcosis | 449 | ||
| Pathogenesis | 449 | ||
| Systemic features | 449 | ||
| Ocular features | 449 | ||
| Endogenous fungal endophthalmitis | 449 | ||
| Coccidioidomycosis | 450 | ||
| Bacterial uveitis | 450 | ||
| Tuberculosis | 450 | ||
| Pathogenesis | 450 | ||
| Anterior segment involvement | 450 | ||
| Tuberculous uveitis | 450 | ||
| Syphilis | 451 | ||
| Pathogenesis | 451 | ||
| Stages | 452 | ||
| Syphilitic uveitis | 452 | ||
| Lyme disease | 452 | ||
| Brucellosis | 454 | ||
| Endogenous bacterial endophthalmitis | 454 | ||
| Cat-scratch disease | 456 | ||
| Leprosy | 456 | ||
| white dot syndromes | 457 | ||
| Multiple evanescent white dot syndrome | 457 | ||
| Acute idiopathic blind spot enlargement syndrome | 458 | ||
| Acute posterior multifocal placoid pigment epitheliopathy | 458 | ||
| Multifocal choroiditis and panuveitis | 459 | ||
| Punctate inner choroidopathy | 460 | ||
| Serpiginous choroidopathy | 461 | ||
| Progressive subretinal fibrosis and uveitis syndrome | 461 | ||
| Acute macular neuroretinopathy | 462 | ||
| Acute zonal occult outer retinopathy | 463 | ||
| Primary stromal choroiditis | 464 | ||
| Vogt–Koyanagi–Harada syndrome | 464 | ||
| Pathogenesis | 464 | ||
| Phases | 465 | ||
| Uveitis | 465 | ||
| Sympathetic ophthalmitis | 465 | ||
| Birdshot retinochoroidopathy | 467 | ||
| Miscellaneous anterior uveitis | 469 | ||
| Fuchs uveitis syndrome | 469 | ||
| Lens-induced uveitis | 469 | ||
| Phacoanaphylactic endophthalmitis | 469 | ||
| Phacogenic non-granulomatous uveitis | 471 | ||
| Miscellaneous posterior uveitis | 471 | ||
| Acute retinal pigment epitheliitis | 471 | ||
| Acute idiopathic maculopathy | 472 | ||
| Acute multifocal retinitis | 473 | ||
| Solitary idiopathic choroiditis | 473 | ||
| Frosted branch angiitis | 473 | ||
| Idiopathic retinal vasculitis, aneurysms and neuroretinitis syndrome | 473 | ||
| Chapter 12 Ocular Tumours | 475 | ||
| Benign epibulbar tumours | 476 | ||
| Conjunctival naevus | 476 | ||
| Conjunctival papilloma | 476 | ||
| Dermoid | 476 | ||
| Diagnosis | 476 | ||
| Systemic associations | 476 | ||
| Dermolipoma | 479 | ||
| Pyogenic granuloma | 480 | ||
| Conjunctival epithelial melanosis | 480 | ||
| Miscellaneous tumours | 481 | ||
| Malignant and premalignant epibulbar tumours | 481 | ||
| Primary acquired melanosis | 481 | ||
| Melanoma | 482 | ||
| Diagnosis | 482 | ||
| Treatment | 483 | ||
| Prognosis | 483 | ||
| Ocular surface squamous neoplasia | 483 | ||
| Definition | 483 | ||
| Diagnosis | 483 | ||
| Treatment | 486 | ||
| Lymphoproliferative lesions | 486 | ||
| Kaposi sarcoma | 486 | ||
| Iris tumours | 486 | ||
| Iris naevus | 486 | ||
| Iris melanoma | 486 | ||
| Overview | 486 | ||
| Diagnosis | 486 | ||
| Treatment | 487 | ||
| Metastatic tumours | 488 | ||
| Miscellaneous tumours | 488 | ||
| Iris cysts | 488 | ||
| Primary | 488 | ||
| Secondary | 492 | ||
| Ciliary body tumours | 492 | ||
| Ciliary body melanoma | 492 | ||
| Signs | 493 | ||
| Investigations | 493 | ||
| Treatment | 495 | ||
| Differential diagnosis | 495 | ||
| Medulloepithelioma | 495 | ||
| Tumours of the choroid | 496 | ||
| Choroidal naevus | 496 | ||
| Histology | 496 | ||
| Signs | 496 | ||
| Investigations | 496 | ||
| Atypical naevus | 496 | ||
| Suspicious naevus | 496 | ||
| Differential diagnosis | 496 | ||
| Choroidal melanoma | 496 | ||
| Pathology | 496 | ||
| Adverse prognostic factors | 498 | ||
| Signs | 498 | ||
| Special investigations | 498 | ||
| Systemic investigations | 501 | ||
| Principles of treatment | 501 | ||
| Brachytherapy | 502 | ||
| External beam radiotherapy | 503 | ||
| Stereotactic radiotherapy | 503 | ||
| Transpupillary thermotherapy | 503 | ||
| Trans-scleral choroidectomy | 503 | ||
| Enucleation | 503 | ||
| Differential diagnosis | 503 | ||
| Circumscribed choroidal haemangioma | 504 | ||
| Diagnosis | 504 | ||
| Treatment | 504 | ||
| Differential diagnosis | 504 | ||
| Diffuse choroidal haemangioma | 504 | ||
| Optic disc melanocytoma | 504 | ||
| Choroidal osteoma | 506 | ||
| Diagnosis | 506 | ||
| Differential diagnosis | 506 | ||
| Metastatic tumours | 506 | ||
| Diagnosis | 507 | ||
| Systemic investigations | 510 | ||
| Management | 510 | ||
| Neural retinal tumours | 510 | ||
| Retinoblastoma | 510 | ||
| Pathology | 510 | ||
| Genetics | 510 | ||
| Presentation | 512 | ||
| Signs | 513 | ||
| Investigations | 513 | ||
| Treatment of small tumours | 513 | ||
| Treatment of medium-size tumours | 513 | ||
| Treatment of large tumours | 513 | ||
| Treatment of extraocular extension | 513 | ||
| Follow-up | 515 | ||
| Differential diagnosis | 516 | ||
| Astrocytoma | 517 | ||
| Diagnosis | 518 | ||
| Tuberous sclerosis | 518 | ||
| Vascular retinal tumours | 520 | ||
| Capillary haemangioma | 520 | ||
| Overview | 520 | ||
| Diagnosis | 520 | ||
| Treatment | 522 | ||
| Von Hippel–Lindau syndrome | 522 | ||
| Cavernous haemangioma | 523 | ||
| Racemose haemangioma | 523 | ||
| Vasoproliferative tumour | 524 | ||
| PRIMArY Intraocular lymphoma | 525 | ||
| Overview | 525 | ||
| Ocular features | 525 | ||
| Neurological features | 526 | ||
| Investigations | 527 | ||
| Treatment | 527 | ||
| Tumours of the retinal pigment epithelium | 527 | ||
| Typical congenital hypertrophy of the RPE | 527 | ||
| Atypical congenital hypertrophy of the RPE | 527 | ||
| Signs | 527 | ||
| Systemic associations | 527 | ||
| Combined hamartoma of the retina and RPE | 527 | ||
| Congenital hamartoma of the RPE | 528 | ||
| Paraneoplastic syndromes | 529 | ||
| Bilateral diffuse uveal melanocytic proliferation | 529 | ||
| Cancer-associated retinopathy | 531 | ||
| Melanoma-associated retinopathy | 531 | ||
| Chapter 13 Retinal Vascular Disease | 533 | ||
| Retinal circulation | 534 | ||
| Arterial system | 534 | ||
| Capillaries | 534 | ||
| Venous system | 534 | ||
| Diabetic retinopathy | 534 | ||
| Introduction | 534 | ||
| Prevalence | 534 | ||
| Risk factors | 534 | ||
| Pathogenesis | 535 | ||
| Classification | 536 | ||
| Signs | 536 | ||
| Microaneurysms | 536 | ||
| Retinal haemorrhages | 536 | ||
| Exudates | 536 | ||
| Diabetic macular oedema | 537 | ||
| Focal maculopathy | 539 | ||
| Diffuse maculopathy | 541 | ||
| Ischaemic maculopathy | 541 | ||
| Clinically significant macular oedema | 541 | ||
| Cotton wool spots | 541 | ||
| Venous changes | 542 | ||
| Intraretinal microvascular abnormalities | 542 | ||
| Arterial changes | 543 | ||
| Proliferative retinopathy | 543 | ||
| Treatment | 543 | ||
| Argon laser treatment of clinically significant macular oedema | 543 | ||
| Other treatments for maculopathy | 545 | ||
| Laser photocoagulation for proliferative retinopathy | 546 | ||
| VEGF inhibition for proliferative retinopathy | 549 | ||
| Advanced diabetic eye disease | 549 | ||
| Diagnosis | 549 | ||
| Indications for pars plana vitrectomy | 550 | ||
| Visual results of pars plana vitrectomy | 551 | ||
| Retinal venous occlusive disease | 551 | ||
| Pathogenesis | 551 | ||
| Predisposing factors | 551 | ||
| Common | 551 | ||
| Uncommon | 551 | ||
| Systemic assessment | 552 | ||
| All patients | 552 | ||
| Selected patients according to clinical indication | 552 | ||
| Branch retinal vein occlusion | 552 | ||
| Classification | 552 | ||
| Diagnosis | 553 | ||
| Prognosis | 553 | ||
| Further management | 553 | ||
| Treatment of macular oedema | 554 | ||
| Treatment of neovascularization | 555 | ||
| Impending central retinal vein occlusion | 555 | ||
| Non-ischaemic central retinal vein occlusion | 555 | ||
| Diagnosis | 555 | ||
| Follow-up | 556 | ||
| Prognosis | 556 | ||
| Treatment of macular oedema | 557 | ||
| Ischaemic central retinal vein occlusion | 557 | ||
| Diagnosis | 557 | ||
| Prognosis | 557 | ||
| Follow up | 557 | ||
| Treatment of neovascularization | 558 | ||
| Papillophlebitis | 558 | ||
| Diagnosis | 558 | ||
| Prognosis | 559 | ||
| Hemiretinal vein occlusion | 559 | ||
| Systemic treatment in retinal vein occlusion | 559 | ||
| Retinal arterial occlusive disease | 559 | ||
| Aetiology | 559 | ||
| Atherosclerosis-related thrombosis | 559 | ||
| Carotid embolism | 559 | ||
| Uncommon causes | 561 | ||
| Systemic assessment | 561 | ||
| All patients | 561 | ||
| Selected patients | 562 | ||
| Amaurosis fugax | 562 | ||
| Branch retinal artery occlusion | 562 | ||
| Diagnosis | 562 | ||
| Follow-up | 563 | ||
| Prognosis | 563 | ||
| Central retinal artery occlusion | 563 | ||
| Diagnosis | 563 | ||
| Follow-up | 564 | ||
| Prognosis | 564 | ||
| Cilioretinal artery occlusion | 564 | ||
| Treatment of acute retinal artery occlusion | 564 | ||
| Systemic prophylaxis following retinal arterial occlusion | 565 | ||
| Asymptomatic retinal embolus | 566 | ||
| Ocular ischaemic syndrome | 566 | ||
| Pathogenesis | 566 | ||
| Diagnosis | 566 | ||
| Management | 566 | ||
| Differential diagnosis | 566 | ||
| Hypertensive disease | 567 | ||
| Retinopathy | 567 | ||
| Signs | 567 | ||
| Choroidopathy | 568 | ||
| Sickle-cell retinopathy | 569 | ||
| Sickling haemoglobinopathies | 569 | ||
| Proliferative retinopathy | 570 | ||
| Diagnosis | 570 | ||
| Treatment | 570 | ||
| Differential diagnosis of peripheral retinal neovascularization | 572 | ||
| Non-proliferative retinopathy | 572 | ||
| Asymptomatic lesions | 572 | ||
| Symptomatic lesions | 572 | ||
| Anterior segment features | 572 | ||
| Retinopathy of prematurity | 573 | ||
| Pathogenesis | 573 | ||
| Active disease | 573 | ||
| Location | 573 | ||
| Extent | 574 | ||
| Staging | 574 | ||
| Other features | 574 | ||
| Regression | 576 | ||
| Screening | 576 | ||
| Treatment | 576 | ||
| Cicatricial disease | 576 | ||
| Retinal artery macroaneurysm | 576 | ||
| Diagnosis | 576 | ||
| Prognosis | 579 | ||
| Management | 579 | ||
| Primary retinal telangiectasiA | 580 | ||
| Idiopathic macular telangiectasia | 581 | ||
| Type 1: aneurysmal telangiectasia | 581 | ||
| Type 2: perafoveal telangiectasia | 581 | ||
| Occlusive telangiectasia | 582 | ||
| Coats disease | 582 | ||
| Diagnosis | 582 | ||
| Treatment | 583 | ||
| Prognosis | 583 | ||
| Differential diagnosis | 583 | ||
| Eales disease | 583 | ||
| Radiation retinopathy | 586 | ||
| Purtscher retinopathy | 586 | ||
| Benign idiopathic haemorrhagic retinopathy | 586 | ||
| Valsalva retinopathy | 588 | ||
| Lipaemia retinalis | 588 | ||
| Retinopathy in blood disorders | 589 | ||
| Leukaemia | 589 | ||
| Classification | 589 | ||
| Ocular features | 589 | ||
| Anaemia | 589 | ||
| Hyperviscosity | 590 | ||
| Congenital vascular anomalies | 591 | ||
| Retinal macrovessel | 591 | ||
| Arteriovenous communications | 592 | ||
| Chapter 14 Acquired Macular Disorders | 593 | ||
| Introduction | 594 | ||
| Anatomical landmarks | 594 | ||
| Retinal pigment epithelium | 594 | ||
| Bruch membrane | 595 | ||
| Clinical evaluation of macular disease | 595 | ||
| Symptoms | 595 | ||
| Slit-lamp biomicroscopy | 595 | ||
| Visual acuity | 596 | ||
| Snellen visual acuity | 596 | ||
| Very poor visual acuity | 596 | ||
| LogMAR acuity | 597 | ||
| LogMar charts | 597 | ||
| Contrast sensitivity | 598 | ||
| Amsler grid | 598 | ||
| Charts | 599 | ||
| Technique | 600 | ||
| fundus Fluorescein angiography | 601 | ||
| Principles | 601 | ||
| Technique | 602 | ||
| Phases of the angiogram | 603 | ||
| Causes of hyperfluorescence | 604 | ||
| Causes of hypofluorescence | 604 | ||
| Systematic approach to reporting angiograms | 608 | ||
| Indocyanine green angiography | 608 | ||
| Principles | 608 | ||
| Adverse effects | 609 | ||
| Causes of hyperfluorescence | 611 | ||
| Hypofluorescence | 611 | ||
| Clinical indications | 611 | ||
| Optical coherence tomography | 611 | ||
| Definition | 611 | ||
| Principles | 611 | ||
| Indications | 611 | ||
| Normal appearance | 611 | ||
| Age-related macular degeneration | 611 | ||
| Introduction | 611 | ||
| Classification | 612 | ||
| Epidemiology | 612 | ||
| Risk factors | 613 | ||
| Drusen | 613 | ||
| Histopathology | 613 | ||
| Clinical features | 614 | ||
| Fluorescein angiography | 614 | ||
| Lesions related to drusen | 614 | ||
| Prophylactic antioxidant supplementation in AMD | 615 | ||
| Recommendations for use | 615 | ||
| Regimen | 616 | ||
| Other considerations | 616 | ||
| Non-exudative (dry) AMD | 616 | ||
| Diagnosis | 616 | ||
| Management | 616 | ||
| Retinal pigment epithelial detachment | 616 | ||
| Pathogenesis | 616 | ||
| Serous PED | 616 | ||
| Fibrovascular PED | 619 | ||
| Drusenoid PED | 619 | ||
| Haemorrhagic PED | 619 | ||
| Retinal pigment epithelial tear | 619 | ||
| Choroidal neovascularization | 620 | ||
| Pathogenesis | 620 | ||
| Clinical features | 621 | ||
| Fluorescein angiography | 621 | ||
| Indocyanine green angiography | 622 | ||
| Optical coherence tomography | 623 | ||
| Treatment with anti-VEGF agents | 623 | ||
| Ranibizumab (Lucentis) | 624 | ||
| Bevacizumab (Avastin) | 624 | ||
| Pegaptanib (Macugen) | 624 | ||
| Technique of intravitreal injection | 625 | ||
| Photodynamic therapy (PDT) | 625 | ||
| Combination therapies | 626 | ||
| Argon laser photocoagulation | 626 | ||
| Experimental treatments | 626 | ||
| Haemorrhagic AMD | 627 | ||
| Retinal angiomatous proliferation | 627 | ||
| Diagnosis | 627 | ||
| Treatment | 628 | ||
| Polypoidal choroidal vasculopathy | 628 | ||
| Overview | 628 | ||
| Diagnosis | 628 | ||
| Treatment | 629 | ||
| Age-related macular hole | 629 | ||
| Overview | 629 | ||
| Pathogenesis | 629 | ||
| Stages | 629 | ||
| Investigations | 629 | ||
| Surgery | 629 | ||
| Differential diagnosis of age-related macular hole | 631 | ||
| Macular microhole | 631 | ||
| Central serous chorioretinopathy | 632 | ||
| Overview | 632 | ||
| Clinical features | 632 | ||
| Investigations | 633 | ||
| Course | 633 | ||
| Management | 633 | ||
| Cystoid macular oedema | 633 | ||
| Pathogenesis | 633 | ||
| Diagnosis | 633 | ||
| Causes | 635 | ||
| Epimacular membrane | 635 | ||
| Pathogenesis | 635 | ||
| Classification | 635 | ||
| Diagnosis | 636 | ||
| Management | 636 | ||
| Degenerative myopia | 637 | ||
| Pathogenesis | 637 | ||
| Diagnosis | 637 | ||
| Complications | 637 | ||
| Angioid streaks | 641 | ||
| Ocular considerations | 641 | ||
| Histology | 641 | ||
| Diagnosis | 641 | ||
| Complications | 641 | ||
| Systemic associations | 641 | ||
| Pseudoxanthoma elasticum | 641 | ||
| Occasional associations | 643 | ||
| Choroidal folds | 643 | ||
| Pathogenesis | 643 | ||
| Causes | 643 | ||
| Chapter 15 Hereditary Fundus Dystrophies | 647 | ||
| Introduction | 648 | ||
| Applied anatomy | 648 | ||
| Inheritance | 648 | ||
| Classification | 648 | ||
| Investigations | 648 | ||
| Electroretinography | 648 | ||
| Principles | 648 | ||
| Standard ERG | 649 | ||
| Multifocal ERG | 649 | ||
| Electro-oculography | 649 | ||
| Dark adaptometry | 650 | ||
| Colour vision tests | 650 | ||
| Principles | 650 | ||
| Colour vision tests | 651 | ||
| Generalized photoreceptor dystrophies | 651 | ||
| Typical retinitis pigmentosa | 651 | ||
| Inheritance | 651 | ||
| Diagnosis | 652 | ||
| Ocular associations | 654 | ||
| Atypical retinitis pigmentosa | 654 | ||
| Important systemic associations | 654 | ||
| Bassen–Kornzweig syndrome (abetalipoproteinaemia) | 654 | ||
| Refsum disease | 654 | ||
| Kearns–Sayre syndrome | 654 | ||
| Bardet–Biedl syndrome | 655 | ||
| Usher syndrome | 655 | ||
| Progressive cone dystrophy | 656 | ||
| Leber congenital amaurosis | 656 | ||
| Stargardt disease and fundus flavimaculatus | 657 | ||
| Bietti corneoretinal crystalline dystrophy | 660 | ||
| Alport syndrome | 661 | ||
| Familial benign fleck retina | 661 | ||
| Pigmented paravenous chorioretinal atrophy | 661 | ||
| Congenital stationary night blindness | 662 | ||
| With normal fundus | 662 | ||
| With abnormal fundus | 662 | ||
| Congenital monochromatism (achromatopsia) | 664 | ||
| Rod monochromatism (complete achromatopsia) | 664 | ||
| Blue cone monochromatism (incomplete achromatopsia) | 665 | ||
| Macular dystrophies | 665 | ||
| Juvenile Best macular dystrophy | 665 | ||
| Multifocal vitelliform lesions without Best disease | 665 | ||
| Pattern dystrophy | 665 | ||
| Adult-onset macular vitelliform dystrophy | 665 | ||
| Butterfly-shaped macular dystrophy | 665 | ||
| Multifocal pattern dystrophy simulating fundus flavimaculatus | 665 | ||
| Macroreticular pattern dystrophy | 667 | ||
| North Carolina macular dystrophy | 667 | ||
| Familial dominant drusen | 668 | ||
| Sorsby pseudoinflammatory dystrophy | 669 | ||
| Benign concentric annular macular dystrophy | 669 | ||
| Central areolar choroidal dystrophy | 670 | ||
| Dominant cystoid macular oedema | 670 | ||
| Sjögren–Larsson syndrome | 670 | ||
| Familial internal limiting membrane dystrophy | 670 | ||
| Generalized choroidal dystrophies | 670 | ||
| Choroideremia | 670 | ||
| Gyrate atrophy | 671 | ||
| Generalized choroidal dystrophy | 674 | ||
| Progressive bifocal chorioretinal atrophy | 674 | ||
| Vitreoretinal dystrophies | 674 | ||
| Juvenile X-linked retinoschisis | 674 | ||
| Pathogenesis | 674 | ||
| Diagnosis | 674 | ||
| Stickler syndrome | 675 | ||
| Classification | 675 | ||
| Systemic features | 675 | ||
| Ocular features | 676 | ||
| Wagner syndrome | 676 | ||
| Familial exudative vitreoretinopathy | 678 | ||
| Enhanced S-cone syndrome and Goldmann–Favre syndrome | 678 | ||
| Snowflake vitreoretinal degeneration | 679 | ||
| Dominant neovascular inflammatory vitreoretinopathy | 679 | ||
| Dominant vitreoretinochoroidopathy | 681 | ||
| Kniest dysplasia | 681 | ||
| Albinism | 681 | ||
| Introduction | 681 | ||
| Tyrosinase-negative oculocutaneous albinism | 682 | ||
| Tyrosinase-positive oculocutaneous albinism | 683 | ||
| Ocular features | 683 | ||
| Associated systemic syndromes | 683 | ||
| Ocular albinism | 683 | ||
| Cherry-red spot at macula | 683 | ||
| Pathogenesis | 683 | ||
| GM1 gangliosidosis (generalized) | 684 | ||
| Mucolipidosis type I (sialidosis) | 684 | ||
| GM2 gangliosidosis | 684 | ||
| Tay–Sachs disease | 684 | ||
| Sandhoff disease | 684 | ||
| Niemann–Pick disease | 684 | ||
| Type A (acute neuronopathic) | 685 | ||
| Type B (chronic non-neuronopathic) | 685 | ||
| Farber disease | 685 | ||
| Chapter 16 Retinal Detachment | 687 | ||
| Introduction | 688 | ||
| Anatomy of the peripheral retina | 688 | ||
| Pars plana | 688 | ||
| Ora serrata | 688 | ||
| Vitreous base | 688 | ||
| Innocuous peripheral retinal degenerations | 689 | ||
| Definitions | 689 | ||
| Retinal detachment | 689 | ||
| Vitreous adhesions | 689 | ||
| Vitreoretinal traction | 690 | ||
| Posterior vitreous detachment | 690 | ||
| Retinal break | 691 | ||
| Clinical examination | 692 | ||
| Head-mounted indirect ophthalmoscopy | 692 | ||
| Scleral indentation | 693 | ||
| Goldmann three-mirror examination | 693 | ||
| Fundus drawing | 694 | ||
| Finding the primary break | 696 | ||
| Ultrasonography | 697 | ||
| Principles | 697 | ||
| Technique | 698 | ||
| Rhegmatogenous retinal detachment | 698 | ||
| Pathogenesis | 698 | ||
| Dynamic vitreoretinal traction | 698 | ||
| Complications of acute PVD | 698 | ||
| Lattice degeneration | 700 | ||
| Snailtrack degeneration | 701 | ||
| Degenerative retinoschisis | 701 | ||
| ‘White with pressure’ and ‘white without pressure’ | 702 | ||
| Diffuse chorioretinal atrophy | 703 | ||
| Significance of myopia | 703 | ||
| Symptoms | 704 | ||
| Signs | 705 | ||
| General | 705 | ||
| Fresh retinal detachment | 707 | ||
| Long-standing retinal detachment | 707 | ||
| Proliferative vitreoretinopathy | 708 | ||
| Differential diagnosis | 709 | ||
| Degenerative retinoschisis | 709 | ||
| Uveal effusion syndrome | 709 | ||
| Choroidal detachment | 709 | ||
| Prophylaxis | 710 | ||
| Characteristics of break | 710 | ||
| Other considerations | 711 | ||
| Clinical examples | 712 | ||
| Choice of treatment modalities | 713 | ||
| Technique of laser photocoagulation | 713 | ||
| Technique of cryotherapy | 713 | ||
| Causes of failure | 714 | ||
| Surgery | 715 | ||
| Indications for urgent surgery | 715 | ||
| Choice of technique | 715 | ||
| Pneumatic retinopexy | 715 | ||
| Principles of scleral buckling | 715 | ||
| Technique of scleral buckling | 717 | ||
| Drainage of subretinal fluid | 717 | ||
| Fresh retinal detachment | 719 | ||
| Long-standing retinal detachment | 720 | ||
| Causes of failure | 720 | ||
| Tractional retinal detachment | 721 | ||
| Pathogenesis of diabetic tractional retinal detachment | 721 | ||
| Diagnosis | 721 | ||
| Exudative retinal detachment | 722 | ||
| Pathogenesis | 722 | ||
| Diagnosis | 722 | ||
| Treatment | 723 | ||
| Pars plana vitrectomy | 723 | ||
| Introduction | 723 | ||
| Instrumentation | 723 | ||
| Tamponading agents | 724 | ||
| Indications | 725 | ||
| Rhegmatogenous retinal detachment | 725 | ||
| Tractional retinal detachment | 725 | ||
| Technique | 725 | ||
| Basic vitrectomy | 725 | ||
| Closure of giant tears | 725 | ||
| Proliferative vitreoretinopathy | 725 | ||
| Tractional retinal detachment | 727 | ||
| Postoperative complications | 727 | ||
| Raised intraocular pressure | 727 | ||
| Cataract | 728 | ||
| Band keratopathy | 728 | ||
| Chapter 17 Vitreous Opacities | 729 | ||
| Introduction | 730 | ||
| Muscae volitantes | 730 | ||
| Vitreous haemorrhage | 730 | ||
| Asteroid hyalosis (Benson disease) | 730 | ||
| Synchisis scintillans (cholesterolosis bulbi) | 730 | ||
| Amyloidosis | 730 | ||
| Vitreous cyst | 733 | ||
| Chapter 18 Strabismus | 735 | ||
| Introduction | 736 | ||
| Definitions | 736 | ||
| Anatomy of extraocular muscles | 736 | ||
| Principles | 736 | ||
| Horizontal rectus muscles | 737 | ||
| Vertical rectus muscles | 737 | ||
| Spiral of Tillaux | 738 | ||
| Oblique muscles | 738 | ||
| Muscle pulleys | 739 | ||
| Nerve supply | 739 | ||
| Ocular movements | 739 | ||
| Ductions | 739 | ||
| Versions | 739 | ||
| Vergences | 740 | ||
| Positions of gaze | 740 | ||
| Laws of ocular motility | 741 | ||
| Sensory considerations | 741 | ||
| Basic aspects | 741 | ||
| Sensory adaptations to strabismus | 744 | ||
| Suppression | 744 | ||
| Abnormal retinal correspondence | 744 | ||
| Microtropia | 745 | ||
| Consequences of strabismus | 745 | ||
| Motor adaptation to strabismus | 745 | ||
| Amblyopia | 745 | ||
| Classification | 745 | ||
| Diagnosis | 746 | ||
| Treatment | 746 | ||
| Clinical evaluation | 746 | ||
| History | 746 | ||
| Visual acuity | 747 | ||
| Testing in preverbal children | 747 | ||
| Testing in verbal children | 747 | ||
| Tests for stereopsis | 748 | ||
| TNO | 748 | ||
| Frisby | 748 | ||
| Lang | 748 | ||
| Titmus | 749 | ||
| Frisby–Davis distance stereotest | 750 | ||
| Tests for binocular fusion in infants without manifest squint | 750 | ||
| Base-out prism | 750 | ||
| Binocular convergence | 750 | ||
| Tests for sensory anomalies | 750 | ||
| Worth four-dot | 750 | ||
| Bagolini striated glasses | 751 | ||
| 4 Δ prism test | 752 | ||
| Synoptophore | 753 | ||
| Grades of binocular vision | 754 | ||
| Detection of abnormal retinal correspondence | 754 | ||
| Measurement of deviation | 755 | ||
| Hirschberg test | 755 | ||
| Krimsky and prism reflection tests | 755 | ||
| Cover–uncover test | 755 | ||
| Alternate cover test | 757 | ||
| Prism cover test | 757 | ||
| Maddox wing | 758 | ||
| Maddox rod | 758 | ||
| Motility tests | 758 | ||
| Ocular movements | 758 | ||
| Near point of convergence | 758 | ||
| Near point of accommodation | 758 | ||
| Fusional amplitudes | 759 | ||
| Postoperative diplopia test | 759 | ||
| Investigation of diplopia | 759 | ||
| Electronic Hess test | 760 | ||
| Lees screen | 760 | ||
| Changes with time | 761 | ||
| Clinical examples | 761 | ||
| Refraction and fundoscopy | 763 | ||
| Cycloplegia | 763 | ||
| Change of refraction | 764 | ||
| When to prescribe | 764 | ||
| Heterophoria | 765 | ||
| Vergence abnormalities | 765 | ||
| Convergence insufficiency | 765 | ||
| Divergence insufficiency | 765 | ||
| Near reflex insufficiency | 765 | ||
| Spasm of the near reflex | 765 | ||
| Esotropia | 765 | ||
| Early-onset esotropia | 766 | ||
| Signs | 766 | ||
| Initial treatment | 766 | ||
| Subsequent treatment | 767 | ||
| Differential diagnosis | 768 | ||
| Accommodative esotropia | 768 | ||
| Refractive accommodative esotropia | 768 | ||
| Non-refractive accommodative esotropia | 768 | ||
| Treatment | 769 | ||
| Microtropia | 770 | ||
| Other esotropias | 770 | ||
| Near esotropia (non-accommodative convergence excess) | 770 | ||
| Distance esotropia | 770 | ||
| Acute (late-onset) esotropia | 770 | ||
| Secondary (sensory) esotropia | 770 | ||
| Consecutive esotropia | 770 | ||
| Cyclic esotropia | 771 | ||
| High myopia esotropia | 771 | ||
| Exotropia | 771 | ||
| Constant (early-onset) exotropia | 771 | ||
| Intermittent exotropia | 771 | ||
| Diagnosis | 771 | ||
| Classification | 771 | ||
| Treatment | 771 | ||
| Sensory exotropia | 772 | ||
| Consecutive exotropia | 772 | ||
| Special syndromes | 772 | ||
| Duane retraction syndrome | 772 | ||
| Signs | 772 | ||
| Classification (Huber) | 773 | ||
| Treatment | 773 | ||
| Brown syndrome | 773 | ||
| Classification | 774 | ||
| Diagnosis | 774 | ||
| Treatment | 774 | ||
| Monocular elevator deficit | 774 | ||
| Möbius syndrome | 774 | ||
| Congenital fibrosis of the extraocular muscles | 774 | ||
| Strabismus fixus | 774 | ||
| Alphabet patterns | 774 | ||
| ‘V’ pattern | 776 | ||
| Causes | 776 | ||
| Treatment | 776 | ||
| ‘A’ pattern | 777 | ||
| Causes | 777 | ||
| Treatment | 777 | ||
| Surgery | 778 | ||
| Weakening procedures | 778 | ||
| Recession | 778 | ||
| Disinsertion | 778 | ||
| Posterior fixation suture | 779 | ||
| Strengthening procedures | 779 | ||
| Treatment of paretic strabismus | 779 | ||
| Lateral rectus palsy | 779 | ||
| Superior oblique palsy | 779 | ||
| Adjustable sutures | 780 | ||
| Indications | 780 | ||
| Initial steps | 780 | ||
| Postoperative adjustment | 780 | ||
| Botulinum toxin chemodenervation | 780 | ||
| Chapter 19 Neuro-ophthalmology | 783 | ||
| Neuroimaging | 784 | ||
| Computed tomography | 784 | ||
| Physics | 784 | ||
| Contrast enhancement | 784 | ||
| Indications | 784 | ||
| Magnetic resonance imaging | 785 | ||
| Physics | 785 | ||
| Weighting | 785 | ||
| Contrast enhancement | 785 | ||
| Limitations | 785 | ||
| Neuro-ophthalmic indications | 785 | ||
| Angiography | 788 | ||
| Magnetic resonance angiography | 788 | ||
| Computed tomographic angiography | 788 | ||
| Computed tomographic venography | 789 | ||
| Conventional catheter angiography | 789 | ||
| Optic nerve | 789 | ||
| Anatomy | 789 | ||
| General structure | 789 | ||
| Anatomical subdivisions | 789 | ||
| Visual evoked potential | 790 | ||
| Signs of optic nerve dysfunction | 790 | ||
| Optic atrophy | 790 | ||
| Primary optic atrophy | 790 | ||
| Secondary optic atrophy | 791 | ||
| Consecutive optic atrophy | 791 | ||
| Classification of optic neuritis | 791 | ||
| Ophthalmoscopic classification | 791 | ||
| Aetiological classification | 792 | ||
| Demyelinating optic neuritis | 792 | ||
| Overview | 792 | ||
| Multiple sclerosis | 792 | ||
| Association between optic neuritis and multiple sclerosis | 793 | ||
| Clinical features of demyelinating optic neuritis | 793 | ||
| Treatment of demyelinating optic neuritis | 794 | ||
| Parainfectious optic neuritis | 794 | ||
| Infectious optic neuritis | 794 | ||
| Non-infectious optic neuritis | 794 | ||
| Sarcoid | 794 | ||
| Autoimmune | 795 | ||
| Neuroretinitis | 795 | ||
| Non-arteritic anterior ischaemic optic neuropathy | 796 | ||
| Arteritic anterior ischaemic optic neuropathy | 796 | ||
| Diagnosis of giant cell arteritis | 796 | ||
| Treatment of giant cell arteritis | 798 | ||
| Ophthalmic manifestations of giant cell arteritis | 798 | ||
| Arteritic anterior ischaemic optic neuropathy | 798 | ||
| Other manifestations | 798 | ||
| Posterior ischaemic optic neuropathy | 798 | ||
| Diabetic papillopathy | 798 | ||
| Leber hereditary optic neuropathy | 799 | ||
| Hereditary optic atrophy | 799 | ||
| Kjer-type optic atrophy | 799 | ||
| Behr syndrome | 800 | ||
| Wolfram syndrome | 800 | ||
| Nutritional optic neuropathy | 800 | ||
| Papilloedema | 801 | ||
| Pathogenesis | 801 | ||
| Cerebrospinal fluid and causes of raised intracranial pressure | 801 | ||
| Diagnosis of raised intracranial pressure | 801 | ||
| Stages of papilloedema | 802 | ||
| Congenital optic disc anomalies | 802 | ||
| Tilted disc | 802 | ||
| Optic disc pit | 803 | ||
| Optic disc drusen | 805 | ||
| Optic disc coloboma | 805 | ||
| Morning glory anomaly | 808 | ||
| Optic nerve hypoplasia | 808 | ||
| Myelinated nerve fibres | 809 | ||
| Aicardi syndrome | 810 | ||
| Miscellaneous anomalies | 810 | ||
| Pupillary reactions | 812 | ||
| Anatomy | 812 | ||
| Light reflex | 812 | ||
| Near reflex | 812 | ||
| Afferent pupillary defect | 812 | ||
| Absolute afferent pupillary defect | 812 | ||
| Relative afferent pupillary defect | 812 | ||
| Oculosympathetic palsy (Horner syndrome) | 813 | ||
| Anatomy | 813 | ||
| Causes | 813 | ||
| Signs | 814 | ||
| Pharmacological tests | 814 | ||
| Adie pupil | 815 | ||
| Other abnormal reactions | 815 | ||
| Light-near dissociation | 815 | ||
| Chiasm | 816 | ||
| Anatomy | 816 | ||
| Pituitary gland | 816 | ||
| Chiasmal neural pathways | 816 | ||
| Anatomical variants | 817 | ||
| Parachiasmal vascular structures | 817 | ||
| Physiology | 822 | ||
| Pituitary hormones | 822 | ||
| Causes of hypopituitarism | 822 | ||
| Pituitary adenomas | 823 | ||
| Basophil adenoma | 823 | ||
| Acidophil adenoma | 824 | ||
| Chromophobe adenoma | 824 | ||
| Special investigations of pituitary adenomas | 825 | ||
| Treatment of pituitary adenomas | 826 | ||
| Craniopharyngioma | 826 | ||
| Meningioma | 826 | ||
| Retrochiasmal pathways | 827 | ||
| Optic tract | 827 | ||
| Overview | 827 | ||
| Incongruity | 827 | ||
| Clinical features | 827 | ||
| Optic radiations | 828 | ||
| Anatomy | 828 | ||
| Temporal radiations | 828 | ||
| Anterior parietal radiations | 828 | ||
| Main radiations | 829 | ||
| Striate cortex | 829 | ||
| Clinical features | 829 | ||
| Causes | 830 | ||
| Ocular motor nerves | 830 | ||
| 3rd nerve | 830 | ||
| Nuclear complex | 830 | ||
| Fasciculus | 830 | ||
| Basilar | 830 | ||
| Intracavernous | 830 | ||
| Intraorbital | 831 | ||
| Pupillomotor fibres | 832 | ||
| Signs | 832 | ||
| Aberrant regeneration | 832 | ||
| Causes of isolated 3rd nerve palsy | 832 | ||
| Treatment | 833 | ||
| 4th nerve | 833 | ||
| Anatomy | 833 | ||
| Signs | 834 | ||
| Bilateral involvement | 834 | ||
| Special tests | 834 | ||
| Causes of isolated 4th nerve palsy | 835 | ||
| 6th nerve | 835 | ||
| Nucleus | 835 | ||
| Fasciculus | 836 | ||
| Basilar | 837 | ||
| Intracavernous and intraorbital | 837 | ||
| Signs | 837 | ||
| Differential diagnosis | 838 | ||
| Supranuclear disorders of ocular motility | 838 | ||
| Conjugate eye movements | 838 | ||
| Saccadic movements | 838 | ||
| Smooth pursuit movements | 838 | ||
| Non-optical reflexes | 839 | ||
| Horizontal gaze palsy | 839 | ||
| Anatomy | 839 | ||
| Signs | 839 | ||
| Vertical gaze palsy | 840 | ||
| Anatomy | 840 | ||
| Parinaud (dorsal midbrain) syndrome | 840 | ||
| Progressive supranuclear palsy | 841 | ||
| Nystagmus | 841 | ||
| Introduction | 841 | ||
| Physiological principles | 841 | ||
| Classification | 841 | ||
| Physiological nystagmus | 841 | ||
| Vestibular nystagmus | 842 | ||
| Motor imbalance nystagmus | 843 | ||
| Primary congenital nystagmus | 843 | ||
| Spasmus nutans | 843 | ||
| Latent nystagmus | 844 | ||
| Periodic alternating nystagmus | 844 | ||
| Convergence-retraction nystagmus | 844 | ||
| Downbeat nystagmus | 844 | ||
| Upbeat nystagmus | 844 | ||
| See-saw nystagmus | 845 | ||
| Ataxic nystagmus | 845 | ||
| Bruns nystagmus | 845 | ||
| Sensory deprivation nystagmus | 845 | ||
| Surgery for nystagmus | 845 | ||
| Nystagmoid movements | 846 | ||
| Ocular flutter and opsoclonus | 846 | ||
| Ocular bobbing | 846 | ||
| Carotid stenosis | 846 | ||
| Diagnosis | 846 | ||
| Treatment | 847 | ||
| Intracranial aneurysms | 847 | ||
| Anatomy | 847 | ||
| Neurological considerations | 847 | ||
| Neuro-ophthalmic considerations | 848 | ||
| Ocular motor nerve palsies | 848 | ||
| Visual loss | 849 | ||
| Terson syndrome | 849 | ||
| Ocular myopathies | 849 | ||
| Myasthenia gravis | 849 | ||
| Systemic myasthenia | 849 | ||
| Ocular myasthenia | 850 | ||
| Edrophonium test | 850 | ||
| Myotonic dystrophy | 852 | ||
| Chronic progressive external ophthalmoplegia | 852 | ||
| Signs | 852 | ||
| Kearns–Sayre syndrome | 852 | ||
| Oculopharyngeal dystrophy | 853 | ||
| Eaton–Lambert myasthenic syndrome | 854 | ||
| Neurofibromatosis | 854 | ||
| Neurofibromatosis type 1 | 854 | ||
| Diagnostic criteria | 854 | ||
| Systemic features | 854 | ||
| Ophthalmic features | 854 | ||
| Neurofibromatosis type 2 | 854 | ||
| Diagnostic criteria | 855 | ||
| Ophthalmic features | 855 | ||
| Migraine | 855 | ||
| Clinical features | 855 | ||
| Common migraine | 856 | ||
| Classical migraine | 856 | ||
| Cluster headache | 857 | ||
| Other types of migraine | 858 | ||
| Treatment | 858 | ||
| Differential diagnosis | 858 | ||
| Visual phenomena | 858 | ||
| Neuralgias | 858 | ||
| Facial spasm | 859 | ||
| Essential blepharospasm | 859 | ||
| Clinical features | 859 | ||
| Treatment | 859 | ||
| Hemifacial spasm | 860 | ||
| Chapter 20 Ocular Side-effects of Systemic Medication | 861 | ||
| Cornea | 862 | ||
| Vortex keratopathy | 862 | ||
| Chlorpromazine | 863 | ||
| Argyrosis | 863 | ||
| Chrysiasis | 863 | ||
| Amantadine | 863 | ||
| Lens | 863 | ||
| Steroids | 863 | ||
| Other drugs | 863 | ||
| Uveitis | 863 | ||
| Rifabutin | 863 | ||
| Cidofovir | 864 | ||
| Retina | 864 | ||
| Antimalarials | 864 | ||
| Drugs | 864 | ||
| Retinopathy | 864 | ||
| Screening | 865 | ||
| Phenothiazines | 865 | ||
| Drug-induced crystalline maculopathies | 866 | ||
| Other drugs | 866 | ||
| Optic nerve | 868 | ||
| Ethambutol | 868 | ||
| Amiodarone | 869 | ||
| Vigabatrin | 869 | ||
| Topiramate | 869 | ||
| Chapter 21 Trauma | 871 | ||
| Eyelid trauma | 872 | ||
| Periocular haematoma | 872 | ||
| Laceration | 872 | ||
| Orbital fractures | 873 | ||
| Blow-out orbital floor fracture | 873 | ||
| Diagnosis | 873 | ||
| Treatment | 874 | ||
| Blow-out medial wall fracture | 875 | ||
| Roof fracture | 875 | ||
| Lateral wall fracture | 877 | ||
| Trauma to the globe | 877 | ||
| Introduction | 877 | ||
| Definitions | 877 | ||
| Principles of evaluation | 877 | ||
| Blunt trauma | 878 | ||
| Corneal | 878 | ||
| Hyphaema | 879 | ||
| Anterior uvea | 879 | ||
| Intraocular pressure | 880 | ||
| Lenticular | 881 | ||
| Globe rupture | 881 | ||
| Vitreous haemorrhage | 881 | ||
| Commotio retinae | 882 | ||
| Choroidal rupture | 882 | ||
| Retinal breaks and detachment | 884 | ||
| Optic nerve | 884 | ||
| Shaken baby syndrome | 885 | ||
| Penetrating trauma | 885 | ||
| Causes | 885 | ||
| Corneal | 886 | ||
| Scleral | 886 | ||
| Retinal detachment | 886 | ||
| Superficial foreign bodies | 886 | ||
| Subtarsal | 886 | ||
| Corneal | 887 | ||
| Intraocular foreign bodies | 888 | ||
| Initial management | 889 | ||
| Technique of removal | 889 | ||
| Siderosis | 889 | ||
| Chalcosis | 890 | ||
| Enucleation | 891 | ||
| Bacterial endophthalmitis | 891 | ||
| Chemical injuries | 891 | ||
| Causes | 891 | ||
| Pathophysiology | 891 | ||
| Management | 892 | ||
| Emergency treatment | 892 | ||
| Grading of severity | 893 | ||
| Medical treatment | 894 | ||
| Surgery | 895 | ||
| Index | 897 |