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Book Details
Abstract
Highly praised in its first three editions, Cornea has become a market-leading cornerstone text and the immediate go-to resource for anyone working in this hugely popular and evolving sub-specialty. Offered over two volumes and featuring the knowledge of over 200 experts worldwide, it presents state-of-the-art coverage of the expanding range of contemporary corneal surgery, new diagnostic technology, and medical management of corneal and external disease as well as ocular surface disease. This updated edition includes 20 brand-new chapters, while an enhanced focus on images provides key visual guidance in this challenging field.
- Exceptionally clear illustrations, diagnostic images, and step-by-step surgical photographs offer superb visual guidance.
- 20 brand-new chapters cover the latest advances in the field, such as DMEK, Ultra-Thin DSEK and DSAEK techniques; endothelial cell transplantation; keratoplasty and prosthokeratoplasty techniques; collagen cross-linking; and new refractive surgical techniques (presbyopic implants and SMILE surgery).
- Boasts over 170 chapters with unique, cutting-edge content, as well as 2,300 clear illustrations – 670 of which are new to this edition.
- Presents a detailed exposition of the growing number of techniques for lamellar keratoplasty, including outcomes.
- Includes new sections on the latest developments in the management of ocular surface disease.
- Key point overviews in each chapter offer easier access to crucial information.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| 9780323357586v1_WEB | 1 | ||
| Front Cover | 1 | ||
| Inside Front Cover | 2 | ||
| Cornea | 3 | ||
| Copyright Page | 6 | ||
| Table Of Contents | 7 | ||
| Video Table of Contents | 13 | ||
| Preface | 16 | ||
| Acknowledgements | 17 | ||
| Dedication | 18 | ||
| Acknowledgement to the Founding Editors | 19 | ||
| List of Contributors | 20 | ||
| I Basic Science: Cornea, Sclera, Ocular Adnexa Anatomy, Physiology and Pathophysiologic Responses | 35 | ||
| 1 Cornea and Sclera | 35 | ||
| Chapter Outline | 36 | ||
| Key Concepts | 35 | ||
| Introduction | 35 | ||
| Anatomy and Physiology | 35 | ||
| Structure of the cornea and sclera | 35 | ||
| Dimensions and optical properties of the cornea | 38 | ||
| Corneal epithelium | 38 | ||
| Limbal stem cells and lineage of corneal epithelial cells | 39 | ||
| Layered structure of the corneal epithelium | 42 | ||
| Superficial cells | 42 | ||
| Wing cells | 43 | ||
| Basal cells | 43 | ||
| Basement membrane | 43 | ||
| Physiology of the corneal epithelium | 43 | ||
| Epithelial movement | 44 | ||
| Fibronectin-integrin system | 44 | ||
| Hyaluronan | 45 | ||
| Proteolytic enzymes | 45 | ||
| Cytokines and growth factors | 45 | ||
| Stroma of the cornea and sclera | 45 | ||
| Bowman’s layer | 45 | ||
| Structure of the stroma | 46 | ||
| Cells | 46 | ||
| Collagen | 47 | ||
| Proteoglycans | 48 | ||
| Physiology of the stroma | 49 | ||
| ECM and stromal repair | 49 | ||
| Cytokines and growth factors | 49 | ||
| Endothelium | 49 | ||
| Descemet membrane | 49 | ||
| Endothelial cells | 50 | ||
| Physiology of the endothelium | 51 | ||
| Innervation | 51 | ||
| Vascular system | 52 | ||
| Oxygen and nutrient supply | 52 | ||
| Development of the Anterior Eye Segment | 52 | ||
| References | 54 | ||
| 2 The Conjunctiva | 58 | ||
| Chapter Outline | 59 | ||
| Key Concepts | 58 | ||
| Embryology | 58 | ||
| Anatomy | 58 | ||
| Histology | 61 | ||
| Mucocutaneous junction | 61 | ||
| Palpebral and forniceal conjunctiva | 61 | ||
| Bulbar conjunctiva | 62 | ||
| The corneoscleral limbus | 62 | ||
| Conjunctival goblet cells | 63 | ||
| Substantia propria | 64 | ||
| Vascular Supply | 64 | ||
| Lymphatic Drainage | 64 | ||
| Nerve Supply | 65 | ||
| Normal Flora | 65 | ||
| Physiology of the Conjunctiva | 65 | ||
| References | 66 | ||
| 3 Tear Film | 68 | ||
| Chapter Outline | 69 | ||
| Key Concepts | 68 | ||
| Overview and Function | 68 | ||
| Tear Layer Thickness | 68 | ||
| Tears Reflect the Health of the Ocular Surface | 70 | ||
| Control of Tear Secretion | 70 | ||
| Analytical Methods | 71 | ||
| Peptide Components of Tears | 71 | ||
| Acknowledgments | 74 | ||
| References | 74 | ||
| 4 Eyelids and the Corneal Surface | 77 | ||
| Chapter Outline | 78 | ||
| Key Concepts | 77 | ||
| Introduction | 77 | ||
| Anatomy | 77 | ||
| Eyelid skin | 77 | ||
| Eyelid muscles: protractors | 79 | ||
| Orbicularis oculi | 79 | ||
| Eyelid muscles: retractors | 79 | ||
| Upper lid retractor: levator palpebrae superioris | 79 | ||
| Upper lid retractor: Müller’s muscle | 79 | ||
| Upper lid retractor: frontalis | 79 | ||
| Lower lid retractors | 80 | ||
| Orbital septum | 80 | ||
| Orbital fat | 80 | ||
| Tarsus | 80 | ||
| Meibomian glands | 80 | ||
| Conjunctiva | 81 | ||
| Lacrimal glands | 82 | ||
| Eyelid margin | 82 | ||
| Canthal tendons | 82 | ||
| Lacrimal drainage system | 82 | ||
| Vascular supply | 82 | ||
| Lymphatic drainage | 82 | ||
| Nerves | 83 | ||
| Blink reflex and tear flow | 83 | ||
| References | 83 | ||
| 5 A Matrix of Pathologic Responses in the Cornea | 84 | ||
| Chapter Outline | 85 | ||
| Key Concepts | 84 | ||
| Anatomical Regions of the Cornea | 84 | ||
| General Pathologic Responses of the Cornea | 84 | ||
| 1. Defects and their repair | 84 | ||
| 2. Fibrosis and vascularization | 84 | ||
| 3. Edema and cysts | 84 | ||
| 4. Inflammation and immune responses | 86 | ||
| 5. Deposits | 86 | ||
| 6. Proliferation | 86 | ||
| Specific Pathologic Responses of the Cornea | 86 | ||
| Pathologic Responses of the Corneal Epithelium | 88 | ||
| 1. Defects and their repair | 88 | ||
| 2. Fibrosis and vascularization | 89 | ||
| 3. Edema and cysts | 89 | ||
| Epithelial edema | 89 | ||
| 4. Inflammation and immune responses | 89 | ||
| 5. Deposits | 89 | ||
| Elements | 89 | ||
| Drugs | 89 | ||
| Corneal dystrophies and degenerations | 90 | ||
| 6. Proliferation | 90 | ||
| The Pathologic Responses of the Subepithelial Zone | 90 | ||
| 1. Defects and their repair | 90 | ||
| 2. Fibrosis and vascularization | 91 | ||
| Subepithelial avascular fibrosis | 91 | ||
| Subepithelial vascular fibrosis | 91 | ||
| 3. Edema and cysts | 91 | ||
| 4. Inflammation and immune responses | 91 | ||
| 5. Deposits | 93 | ||
| 6. Proliferation of the epithelial basement membrane | 93 | ||
| Pathologic Responses of the Corneal Stroma | 93 | ||
| 1. Defects and their repair | 93 | ||
| 2. Fibrosis and vascularization | 93 | ||
| Stromal fibrosis | 94 | ||
| Stromal vascularization | 94 | ||
| 3. Edema and cysts | 95 | ||
| 4. Inflammation and immune responses | 95 | ||
| 5. Deposits | 95 | ||
| Topical and systemic drugs | 95 | ||
| Ocular diseases | 95 | ||
| Systemic diseases | 95 | ||
| Deposits from dystrophies and degenerations of the stroma | 96 | ||
| 6. Proliferation | 96 | ||
| Pathologic Responses of the Corneal Endothelium and Descemet Membrane | 96 | ||
| 1. Defects (and their repair) | 96 | ||
| Defects in the endothelium | 96 | ||
| Defects in Descemet membrane | 96 | ||
| 2. Fibrosis and vascularization posterior to Descemet membrane | 96 | ||
| Posterior collagenous layer (PCL) | 97 | ||
| Using the PCL to date the onset of endothelial or Descemet membrane disease with transmission electron microscopy | 97 | ||
| 3. Edema and cysts | 97 | ||
| 4. Inflammation and immune responses | 97 | ||
| 5. Deposits | 98 | ||
| Topical and systemic drugs | 98 | ||
| Ocular and systemic diseases | 98 | ||
| Corneal dystrophies and degenerations | 98 | ||
| 6. Proliferation | 98 | ||
| The Immune Response: Components and Reactions in the Eye | 98 | ||
| Overview | 98 | ||
| Cells of inflammation and the immune response | 99 | ||
| Cells of the lymphoid system | 99 | ||
| B lymphocytes | 99 | ||
| T lymphocytes | 100 | ||
| Null lymphocytes | 100 | ||
| Cells of the myeloid system | 104 | ||
| Macrophages and the mononuclear phagocytic system | 104 | ||
| Dendritic cells | 104 | ||
| Langerhans cells | 104 | ||
| Other cells of the myeloid system | 104 | ||
| Polymorphonuclear leukocytes | 104 | ||
| Eosinophils | 105 | ||
| Basophils | 105 | ||
| Mast cells | 105 | ||
| Soluble Mediators/Receptors of Inflammation | 105 | ||
| Adhesion molecules | 105 | ||
| Cytokines | 106 | ||
| Chemokines | 106 | ||
| Complement | 106 | ||
| Tissue Components of the Ocular Immune System | 106 | ||
| Mucosa-associated immune system (MALT) | 106 | ||
| The lacrimal functional unit (LFU) | 106 | ||
| The Cell-Mediated Immune (CMI) Response | 106 | ||
| Major histocompatibility complex | 106 | ||
| Antigen presentation and T-cell activation | 107 | ||
| Cell-mediated immune response | 107 | ||
| The Humoral (Antibody-Mediated) Immune Response | 107 | ||
| Immunoglobulins | 107 | ||
| Characteristics of immunoglobulins | 107 | ||
| Anterior Chamber Associated Immune Deviation (ACAID) | 108 | ||
| Immune Hypersensitivity Reactions | 108 | ||
| Type I hypersensitivity response (atopic, allergic reactions) | 108 | ||
| Type II (cytotoxic) hypersensitivity response | 108 | ||
| Type III hypersensitivity response (immune complex) | 108 | ||
| Type IV (delayed-type hypersensitivity [DTH]) response | 109 | ||
| References | 109 | ||
| II Examining and Imaging the Cornea and External Eye | 111 | ||
| 1 Basic Evaluation of the Cornea and External Eye | 111 | ||
| 6 Examination of the Lids | 111 | ||
| Chapter Outline | 112 | ||
| Key Concepts | 111 | ||
| General Principles | 111 | ||
| History of the Patient | 111 | ||
| Dermatologic Examination | 111 | ||
| Eyelid Position | 111 | ||
| Tear Meniscus and Puncta | 114 | ||
| Anterior Eyelid | 114 | ||
| Posterior Eyelid | 115 | ||
| Meibomian Gland Expression | 115 | ||
| Mucocutaneous Junction | 116 | ||
| Meibomian Gland Imagery | 116 | ||
| References | 117 | ||
| 7 Slit Lamp Examination and Photography | 119 | ||
| Chapter Outline | 120 | ||
| Key Concepts | 119 | ||
| Section I: Examination | 119 | ||
| The instrument | 119 | ||
| Forms of illumination | 122 | ||
| Direct illumination | 122 | ||
| Diffuse illumination | 122 | ||
| Broad-beam illumination | 122 | ||
| Optical section | 125 | ||
| Tyndall light/anterior chamber cells and flare | 128 | ||
| Specular reflection | 131 | ||
| Indirect illumination | 133 | ||
| Proximal illumination | 133 | ||
| Sclerotic scatter | 134 | ||
| Direct and indirect retroillumination from the iris | 136 | ||
| Retroillumination from the fundus | 138 | ||
| Transillumination of the iris | 139 | ||
| The peripheral cornea (gonioscopy) | 139 | ||
| Vital dyes | 140 | ||
| The Seidel test | 143 | ||
| Section II: Photography | 143 | ||
| The instrument | 144 | ||
| Preparing for photography | 144 | ||
| Focus | 146 | ||
| The photographic format | 146 | ||
| Centration | 146 | ||
| Control of artifacts | 146 | ||
| The final image | 147 | ||
| Color balance and sensitivity | 147 | ||
| Subject reflectivity and exposure | 147 | ||
| Duration of exposure | 147 | ||
| Diffuse illumination | 147 | ||
| Broad-beam illumination | 147 | ||
| Optical section | 148 | ||
| Combined direct focal and diffused illumination | 148 | ||
| Tyndall light/anterior chamber cells and flare | 148 | ||
| Specular reflection | 148 | ||
| Proximal illumination | 148 | ||
| Sclerotic scatter | 148 | ||
| Direct retroillumination from the iris | 148 | ||
| Indirect retroillumination from the iris | 148 | ||
| Retroillumination from the fundus | 149 | ||
| Transillumination of the iris | 149 | ||
| The peripheral cornea | 149 | ||
| Vital dyes | 149 | ||
| The Seidel test | 149 | ||
| Techniques specific to keratoconus | 149 | ||
| Documenting the Fleischer ring | 149 | ||
| Munson’s sign | 149 | ||
| Further reading | 150 | ||
| References | 150 | ||
| 8 Tear Film Evaluation | 151 | ||
| Chapter Outline | 152 | ||
| Key Concepts | 151 | ||
| General Inspection | 151 | ||
| Slit Lamp Examination | 153 | ||
| Tear Stability | 153 | ||
| Tear Production | 154 | ||
| Tear Composition and Characteristics | 154 | ||
| Tear ferning | 155 | ||
| Tear osmolarity | 155 | ||
| Meibomian Gland Structure and Excreta | 155 | ||
| Tear Clearance Tests | 156 | ||
| Staining of the Ocular Surface | 156 | ||
| Tests of Visual Function | 156 | ||
| Conclusion | 156 | ||
| References | 156 | ||
| 9 Corneal Diagnostic Techniques | 158 | ||
| Chapter Outline | 159 | ||
| Key Concepts | 158 | ||
| Corneal Staining | 158 | ||
| Pachymetry | 161 | ||
| Esthesiometry | 163 | ||
| Summary | 164 | ||
| References | 164 | ||
| 2 Laboratory Investigations | 166 | ||
| 10 Practical Ophthalmic Microbiology for the Detection of Corneal Pathogens | 166 | ||
| Chapter Outline | 167 | ||
| Key Concepts | 166 | ||
| Introduction | 166 | ||
| Central Laboratory Versus In-Office Testing | 166 | ||
| Communication: Ophthalmologist and Laboratory | 166 | ||
| Corneal Specimen Collection | 168 | ||
| Transport media | 168 | ||
| Mailing of diagnostic specimens | 168 | ||
| Stains and Cytologic Specimens | 169 | ||
| Bacterial Laboratory Diagnosis | 169 | ||
| Mycobacteria | 169 | ||
| Nocardia and Actinomyces | 169 | ||
| Antibiotic Susceptibility Testing | 170 | ||
| Laboratory Diagnosis of Fungal Infection | 170 | ||
| Laboratory Detection of Acanthamoeba and Microsporidia | 171 | ||
| Laboratory Diagnosis of Adenovirus Infection | 172 | ||
| Laboratory Testing for Herpes Simplex Virus | 173 | ||
| Laboratory Testing for Varicella-Zoster Virus and Epstein–Barr Virus | 174 | ||
| Laboratory Testing for Chlamydia | 174 | ||
| Laboratory Diagnosis: Unusual Requests | 174 | ||
| Summary | 175 | ||
| References | 175 | ||
| 11 Molecular Genetics of Corneal Disease | 176 | ||
| Chapter Outline | 177 | ||
| Key Concepts | 176 | ||
| Review of Genetics and Human Disease | 176 | ||
| Techniques Used to Identify Disease-causing Genes | 178 | ||
| Disease-causing Mutations Versus Nondisease-causing Sequence Variations | 179 | ||
| Terminology | 179 | ||
| Epithelial and Subepithelial Corneal Dystrophies | 179 | ||
| Epithelial basement membrane dystrophy (EBMD, OMIM | 179 | ||
| Epithelial recurrent erosion dystrophies (ERED, OMIM | 179 | ||
| Subepithelial mucinous corneal dystrophy (SMCD, OMIM | 179 | ||
| Meesmann corneal dystrophy (MCD, OMIM | 180 | ||
| Lisch epithelial corneal dystrophy (LECD, OMIM | 180 | ||
| Gelatinous drop-like corneal dystrophy (GDLD, OMIM | 180 | ||
| Epithelial-Stromal TGFBI Dystrophies | 180 | ||
| TGFBI Dystrophies | 180 | ||
| Reis–Bücklers corneal dystrophy (RBCD, OMIM | 180 | ||
| Thiel–Behnke corneal dystrophy (TBCD, OMIM | 180 | ||
| Lattice corneal dystrophy, type 1 (LCD1, OMIM | 181 | ||
| Granular corneal dystrophy, type 1 (GCD1, OMIM | 181 | ||
| Granular corneal dystrophy, type 2 (GCD2, OMIM | 182 | ||
| Stromal Dystrophies | 183 | ||
| Macular corneal dystrophy (MCD, OMIM | 183 | ||
| Schnyder corneal dystophy (SCD, OMIM | 183 | ||
| Congenital stromal corneal dystrophy (CSCD, OMIM | 183 | ||
| Fleck corneal dystrophy (FCD, OMIM | 183 | ||
| Posterior amorphous corneal dystrophy (PACD, OMIM | 183 | ||
| Central cloudy dystrophy of Francois (CCDF, OMIM | 183 | ||
| Pre-Descemet corneal dystrophy (PDCD) | 184 | ||
| Endothelial Dystrophies | 184 | ||
| Fuchs dystrophy (FECD1-8, OMIM | 184 | ||
| Posterior polymorphous corneal dystrophy (PPCD, OMIM | 184 | ||
| Congenital hereditary endothelial dystrophy (CHED, OMIM | 185 | ||
| X-linked endothelial corneal dystrophy (XECD) | 185 | ||
| Other Conditions | 185 | ||
| Keratoconus (OMIM | 185 | ||
| X-linked megalocornea (MGC1, OMIM | 185 | ||
| Cornea plana (CNA2, OMIM | 185 | ||
| EDICT syndrome (OMIM | 186 | ||
| Familial amyloidosis, gelosin type (Meretoja syndrome, MIM | 186 | ||
| Conclusion | 186 | ||
| References | 186 | ||
| 3 Imaging Techniques of the Cornea | 189 | ||
| 12 Keratometry and Topography | 189 | ||
| Chapter Outline | 190 | ||
| Key Concepts | 189 | ||
| Keratometry | 189 | ||
| Corneal Topography | 191 | ||
| Placido disk-based topographers | 191 | ||
| Slit scanning tomography | 192 | ||
| Scheimpflug tomography | 192 | ||
| Topographic Maps | 192 | ||
| Axial curvature map | 193 | ||
| Instantaneous or tangential curvature map | 193 | ||
| Refractive power map | 193 | ||
| Elevation map | 195 | ||
| Pachymetric map | 195 | ||
| Difference map | 195 | ||
| Quantitative indices | 196 | ||
| Screening with topographic indices | 197 | ||
| Applications | 197 | ||
| Cataract surgery | 197 | ||
| Refractive surgery | 198 | ||
| Corneal surgery | 198 | ||
| Conclusion | 199 | ||
| References | 199 | ||
| 13 Corneal Shape Analysis | 200 | ||
| Chapter Outline | 201 | ||
| Key Concepts | 200 | ||
| Scheimpflug Principle | 200 | ||
| 3D Image – Cornea and Lens Densitometry | 200 | ||
| Elevation Maps – Enhanced Elevation | 202 | ||
| Elevation maps can detect the ectatic location more accurately than the anterior curvature | 202 | ||
| Elevation maps can distinguish pseudokeratoconus from the anterior curvature | 202 | ||
| Enhanced reference surface | 202 | ||
| Comprehensive Corneal Thickness Evaluation | 202 | ||
| Spatial variation of corneal thickness | 203 | ||
| Segmental Tomography | 204 | ||
| Aberrometry and Corneal Power | 204 | ||
| Conclusion | 205 | ||
| References | 205 | ||
| 14 Specular Microscopy | 207 | ||
| Chapter Outline | 208 | ||
| Key Concepts | 207 | ||
| Optical Principles of Specular Microscopy | 207 | ||
| Patient Preparation | 209 | ||
| Standardization of Imaging Techniques | 209 | ||
| Instrumentation | 210 | ||
| Qualitative Specular Microscopy | 214 | ||
| Epithelium | 214 | ||
| Endothelium: miscellaneous bright and dark structures | 214 | ||
| Endothelium: morphometry | 215 | ||
| Quantitative Specular Microscopy | 215 | ||
| Specular Microscopy in Clinical Trials and the Value of a Reading Center | 217 | ||
| Clinical Applications for Specular Microscopy | 218 | ||
| Cataract extraction with intraocular lens implantation | 219 | ||
| Refractive surgery and collagen cross linking | 221 | ||
| Penetrating keratoplasty | 221 | ||
| Endothelial keratoplasty | 223 | ||
| Donor corneas | 223 | ||
| References | 224 | ||
| 15 Confocal Microscopy | 228 | ||
| Chapter Outline | 229 | ||
| Key Concepts | 228 | ||
| Background | 228 | ||
| Historical overview | 228 | ||
| Current confocal systems in clinical use | 228 | ||
| In Vivo Confocal Imaging Techniques | 230 | ||
| Normal corneal structures | 230 | ||
| Confocal microscopy through-focusing | 230 | ||
| Clinical Applications | 233 | ||
| Wound healing following injury or refractive surgery | 233 | ||
| Infectious keratitis | 235 | ||
| Imaging changes in the sub-basal nerve plexus | 235 | ||
| Advanced Technology: Second Harmonic Generation Imaging of Corneal Collagen Architecture | 237 | ||
| Human corneal stromal collagen organization | 237 | ||
| Conclusions | 238 | ||
| References | 239 | ||
| 16 High Resolution Ultrasound | 241 | ||
| Chapter Outline | 242 | ||
| Key Concepts | 241 | ||
| Ultrasound Biomicroscopy: High Resolution Ultrasound | 241 | ||
| Examination Techniques With Ultrasound Biomicroscopy | 241 | ||
| Normal cornea | 243 | ||
| The Use of UBM in Disease | 244 | ||
| Corneal disease | 244 | ||
| Limbal abnormalities | 244 | ||
| Implantable miniature telescope (IMT) | 244 | ||
| Imaging through corneal opacities | 245 | ||
| IOL complications | 246 | ||
| Uveitis–Glaucoma–Hyphema (UGH) Syndrome | 246 | ||
| Anterior segment tumors | 247 | ||
| Summary | 248 | ||
| References | 249 | ||
| 17 Anterior Segment Optical Coherence Tomography | 250 | ||
| Chapter Outline | 251 | ||
| Key Concepts | 250 | ||
| Introduction | 250 | ||
| Keratoconus screening | 250 | ||
| Refractive Surgery Evaluation | 252 | ||
| LASIK flap evaluation | 252 | ||
| Refractive enhancement | 252 | ||
| LASIK complications | 252 | ||
| Corneal Power Measurement and Intraocular Lens Power Calculation | 252 | ||
| Corneal Opacities | 253 | ||
| Superficial nodular corneal scarring | 253 | ||
| Stromal opacities | 253 | ||
| Planning of phototherapeutic keratectomy | 253 | ||
| Cornea Transplant | 254 | ||
| Endothelial keratoplasty | 254 | ||
| Femtosecond enabled keratoplasty | 254 | ||
| Refractive Implants | 254 | ||
| Corneal implants | 254 | ||
| Phakic intraocular lenses | 254 | ||
| Ocular Surface Tumors | 255 | ||
| Ocular surface squamous neoplasia | 255 | ||
| Melanoma and nevus | 255 | ||
| Other Anterior Segment OCT Applications | 255 | ||
| Financial disclosure | 255 | ||
| References | 256 | ||
| III Differential Diagnosis of Selected Problems in Cornea and External Eye Disease | 257 | ||
| 18 Congenital Corneal Opacities | 257 | ||
| Chapter Outline | 258 | ||
| Key Concepts | 257 | ||
| Differential Diagnosis | 257 | ||
| History and Physical Examination | 257 | ||
| Sclerocornea (S TUMPED) | 260 | ||
| Tears in the Endothelium and Descemet Membrane (S T UMPED) | 262 | ||
| Congenital glaucoma | 262 | ||
| Birth trauma | 263 | ||
| Corneal Ulcers and Inflammation (ST U MPED) | 264 | ||
| Viral diseases | 265 | ||
| Herpes simplex virus infection | 265 | ||
| Congenital rubella | 265 | ||
| Bacterial diseases | 265 | ||
| Neurotrophic keratitis | 266 | ||
| Metabolic Diseases (STU M PED) | 266 | ||
| Mucopolysaccharidosis | 266 | ||
| Mucolipidosis | 269 | ||
| Other metabolic diseases | 269 | ||
| Cystinosis | 269 | ||
| Fabry’s disease | 269 | ||
| Tyrosinemia | 270 | ||
| Gangliosidoses | 270 | ||
| Miscellaneous Syndromes | 270 | ||
| Fetal alcohol syndrome | 270 | ||
| Fryns syndrome | 270 | ||
| Posterior Corneal Defect (STUM P ED) | 270 | ||
| Peters anomaly (STUM P ED) | 270 | ||
| Posterior keratoconus (STUM P ED) | 273 | ||
| Congenital anterior staphyloma (STUM P ED) | 273 | ||
| Endothelial Dystrophy (STUMP E D) | 274 | ||
| Congenital hereditary endothelial dystrophy | 274 | ||
| Posterior polymorphous corneal dystrophy (PPCD) | 275 | ||
| Congenital stromal corneal dystrophy (CSCD) | 276 | ||
| Other dystrophies | 277 | ||
| Congenital Dermoids (STUMPE D) | 277 | ||
| Corneal Keloids | 280 | ||
| References | 280 | ||
| 19 Peripheral Corneal Disease | 284 | ||
| Chapter Outline | 285 | ||
| Key Concepts | 284 | ||
| The Peripheral Cornea: Susceptibility and Response to Disease | 284 | ||
| Congenital/Developmental/Inherited Disorders of the Peripheral Cornea | 284 | ||
| Inflammatory/Autoimmune Disorders of the Peripheral Cornea | 286 | ||
| Neoplastic Disorders of the Peripheral Cornea | 289 | ||
| Degenerative Disorders of the Peripheral Cornea | 290 | ||
| Infectious Disorders of the Peripheral Cornea | 292 | ||
| References | 293 | ||
| 20 The Corneal Ulcer | 294 | ||
| Chapter Outline | 295 | ||
| Key Concepts | 294 | ||
| Diagnosis | 294 | ||
| Treatment | 298 | ||
| References | 299 | ||
| 21 Corneal Edema | 300 | ||
| Chapter Outline | 301 | ||
| Key Concepts | 300 | ||
| Physiology | 300 | ||
| Epithelial and endothelial barriers | 300 | ||
| Tear evaporation | 300 | ||
| Intraocular pressure | 300 | ||
| Metabolically active mechanisms | 300 | ||
| Diagnosis | 302 | ||
| Clinical history | 302 | ||
| Examination | 302 | ||
| Ancillary tests | 303 | ||
| Pachymetry | 303 | ||
| Specular microscopy | 303 | ||
| In vivo confocal microscopy | 303 | ||
| Anterior segment optical coherence tomography | 303 | ||
| Treatment | 303 | ||
| Control of associated abnormalities | 304 | ||
| Inflammation | 304 | ||
| Intraocular pressure | 304 | ||
| Management of epithelial and stromal edema | 304 | ||
| Hypertonic agents | 304 | ||
| Bandage contact lens | 304 | ||
| Anterior stromal cautery | 304 | ||
| Conjunctival flap | 304 | ||
| Amniotic membrane | 304 | ||
| Excimer laser | 304 | ||
| Penetrating keratoplasty | 304 | ||
| Endothelial keratoplasty | 304 | ||
| Collagen cross-linking | 305 | ||
| References | 305 | ||
| 22 Corneal Deposits | 306 | ||
| Chapter Outline | 307 | ||
| Key Concepts | 306 | ||
| Superficial Deposits | 306 | ||
| Pigmented deposits | 306 | ||
| Cornea verticillata | 306 | ||
| Striate melanokeratosis | 306 | ||
| Epithelial iron lines | 306 | ||
| Spheroidal degeneration | 308 | ||
| Adrenochrome deposition | 308 | ||
| Nonpigmented deposits | 308 | ||
| Subepithelial mucinous corneal dystrophy | 308 | ||
| Coat’s white ring | 309 | ||
| Calcific band keratopathy | 309 | ||
| Fluoroquinolone deposits | 310 | ||
| Mucin balls | 310 | ||
| Refractile/crystalline deposits | 311 | ||
| Meesmann dystrophy | 311 | ||
| Gelatinous droplike dystrophy | 311 | ||
| Tyrosinemia II (Richner−Hanhart syndrome) | 311 | ||
| Intraepithelial ointment | 311 | ||
| Gout (urate) | 311 | ||
| Stromal Deposits | 311 | ||
| Pigmented deposits | 311 | ||
| Phenothiazines | 311 | ||
| Corneal blood staining | 312 | ||
| Bilirubin | 312 | ||
| Siderosis | 313 | ||
| Nonpigmented deposits | 313 | ||
| Granular dystrophy | 313 | ||
| Macular dystrophy | 313 | ||
| Fleck dystrophy | 313 | ||
| Lipid deposition | 314 | ||
| Mucopolysaccharidoses | 314 | ||
| Refractile/crystalline deposits | 314 | ||
| Lattice dystrophy | 314 | ||
| Schnyder central crystalline dystrophy | 315 | ||
| Bietti crystalline dystrophy | 315 | ||
| Immunoglobulin deposition | 316 | ||
| Cystinosis | 316 | ||
| Deep Stromal Deposits | 316 | ||
| Pigmented deposits | 316 | ||
| Copper deposition associated with Wilson’s disease | 316 | ||
| Chalcosis | 317 | ||
| Ocular chrysiasis | 317 | ||
| Mottled cyan opacification of the posterior cornea | 317 | ||
| Nonpigmented deposits | 317 | ||
| Cornea farinata | 317 | ||
| Pre-Descemet corneal dystrophy | 318 | ||
| X-linked ichthyosis | 318 | ||
| Ocular argyrosis | 318 | ||
| Refractile/crystalline deposits | 319 | ||
| Polymorphic amyloid degeneration | 319 | ||
| References | 319 | ||
| 23 The Red Eye | 321 | ||
| Chapter Outline | 322 | ||
| Key Concepts | 321 | ||
| History | 321 | ||
| Identify the risk factors | 321 | ||
| Onset and duration of disease | 321 | ||
| Laterality | 324 | ||
| Pain | 324 | ||
| Vision loss | 325 | ||
| Identifying Abnormalities in the Ocular Structures | 325 | ||
| General appearance | 325 | ||
| Skin | 325 | ||
| Eyelids | 325 | ||
| Periorbital masses and globe position | 326 | ||
| Recognizing Distinctive Ocular Signs | 326 | ||
| Eyelid margins | 326 | ||
| Tear film and tear volume | 327 | ||
| Discharge | 327 | ||
| Findings of the palpebral and tarsal conjunctiva | 327 | ||
| Findings of the bulbar conjunctiva | 328 | ||
| Corneal findings | 328 | ||
| Additional testing | 329 | ||
| Constructing a Differential Diagnosis | 329 | ||
| Classification schemes | 329 | ||
| Conclusion | 330 | ||
| References | 330 | ||
| 24 Minimal Visual Loss | 331 | ||
| Chapter Outline | 332 | ||
| Key Concepts | 331 | ||
| History | 331 | ||
| Examination Techniques | 331 | ||
| Visual acuity | 331 | ||
| Pinhole aperture | 333 | ||
| Contrast sensitivity function (CSF) | 333 | ||
| Diagnostic rigid contact lens refraction | 333 | ||
| Technique | 333 | ||
| Potential acuity meter (PAM) | 334 | ||
| Retinoscopy | 334 | ||
| Slit lamp examination | 334 | ||
| Fluorescein evaluation | 334 | ||
| Keratometry | 334 | ||
| Computerized corneal topography | 334 | ||
| Wavefront analysis | 335 | ||
| Tear film interferometry | 335 | ||
| Confocal microscopy | 336 | ||
| Selected Conditions Causing Minimal Visual Loss | 336 | ||
| Dry eye disease | 336 | ||
| Ectatic disorders | 336 | ||
| Keratoconus | 336 | ||
| Ectasia following refractive surgery | 337 | ||
| Pellucid marginal degeneration | 337 | ||
| Terrien marginal degeneration | 337 | ||
| Punctate epithelial keratitis (PEK) | 337 | ||
| Corneal scars | 337 | ||
| Corneal dystrophies | 337 | ||
| Anterior corneal dytrophies | 337 | ||
| Epithelial basement membrane dystrophy | 337 | ||
| Meesmann dystrophy | 338 | ||
| Reis–Bücklers dystrophy | 338 | ||
| Stromal corneal dystrophies | 338 | ||
| Granular dystrophy | 338 | ||
| Lattice dystrophy | 338 | ||
| Macular dystrophy | 338 | ||
| Endothelial disorders | 338 | ||
| Fuchs endothelial dystrophy | 338 | ||
| Posterior polymorphous dystrophy (PPMD) | 339 | ||
| Iridocorneal endothelial syndrome | 339 | ||
| Corneal degenerations | 339 | ||
| Pterygium | 339 | ||
| Corneal warpage | 339 | ||
| Keratorefractive surgery | 339 | ||
| References | 339 | ||
| IV Eye Banking | 341 | ||
| 25 Eye Banking | 341 | ||
| Chapter Outline | 342 | ||
| Key Concepts | 341 | ||
| Eye Banking: an Evolution | 341 | ||
| Tissue Acquisition | 341 | ||
| Screening | 341 | ||
| Recovery | 341 | ||
| Tissue Preservation and Storage | 343 | ||
| Donor Eligibility | 343 | ||
| Tissue Evaluation and Suitability | 343 | ||
| Facilities, Equipment, Instruments, and Supplies | 343 | ||
| Quality Assurance and Distribution | 343 | ||
| Future Considerations | 344 | ||
| References | 344 | ||
| 26 Medical Standards for Eye Banking | 346 | ||
| Chapter Outline | 347 | ||
| Key Concepts | 346 | ||
| Eye Bank Association of America Medical Standards | 346 | ||
| Federal and State Regulations | 348 | ||
| Standards Relating to Safety of Tissue | 349 | ||
| Dystrophies and degenerations | 349 | ||
| Endophthalmitis and microbial keratitis | 349 | ||
| Rabies | 350 | ||
| Hepatitis B | 351 | ||
| Hepatitis C | 351 | ||
| HIV I and II | 352 | ||
| Other infectious agents | 352 | ||
| Prion disease | 353 | ||
| Malignancies | 353 | ||
| Recalls and Market Withdrawals | 354 | ||
| Primary Graft Failure | 354 | ||
| Mechanical and Optical Integrity | 355 | ||
| Future Challenges and Opportunities | 355 | ||
| References | 355 | ||
| V The Ocular Adnexa | 358 | ||
| 1 Diseases of the Lid: Anatomic Abnormalities | 358 | ||
| 27 Malposition of the Eyelids | 358 | ||
| Chapter Outline | 359 | ||
| Key Concepts | 358 | ||
| Entropion | 358 | ||
| Congenital entropion | 358 | ||
| Involutional entropion | 360 | ||
| Cicatricial entropion | 360 | ||
| Acute spastic entropion | 361 | ||
| Differential diagnosis | 361 | ||
| Medical management | 361 | ||
| Surgical management | 361 | ||
| Congenital entropion | 362 | ||
| Involutional entropion | 362 | ||
| Cicatricial entropion | 363 | ||
| Ectropion | 364 | ||
| Congenital ectropion | 364 | ||
| Involutional ectropion | 364 | ||
| Cicatricial ectropion | 364 | ||
| Paralytic ectropion | 365 | ||
| Mechanical ectropion | 365 | ||
| Inflammatory ectropion | 365 | ||
| Medical management | 365 | ||
| Surgical management | 365 | ||
| Involutional ectropion | 365 | ||
| Congenital ectropion | 366 | ||
| Paralytic ectropion | 366 | ||
| Cicatricial ectropion | 366 | ||
| Complications | 366 | ||
| Trichiasis and Distichiasis | 366 | ||
| Management of trichiasis | 367 | ||
| Management of distichiasis | 367 | ||
| Floppy Eyelid Syndrome | 367 | ||
| Treatment | 369 | ||
| Lid Imbrication Syndrome | 369 | ||
| Treatment | 370 | ||
| Lagophthalmos | 370 | ||
| Treatment | 372 | ||
| Eyelid Retraction | 374 | ||
| Treatment | 375 | ||
| References | 375 | ||
| 2 Diseases of the Lid: Tumors | 378 | ||
| 28 Benign Lid Tumors | 378 | ||
| Chapter Outline | 379 | ||
| Key Concepts | 378 | ||
| Histology of the Eyelid Skin | 378 | ||
| Approach to Diagnosis and Management | 380 | ||
| Benign Tumors of the Epidermis | 380 | ||
| Acrochordon | 380 | ||
| Epidermal inclusion cyst | 381 | ||
| Seborrheic keratosis | 381 | ||
| Milia | 382 | ||
| Keratoacanthoma | 382 | ||
| Inverted follicular keratosis | 383 | ||
| Cutaneous horn | 383 | ||
| Linear epidermal nevus | 383 | ||
| Nodular elastosis with cysts and comedones (Favre-Racouchot syndrome) | 383 | ||
| Actinic keratosis (solar keratosis) | 383 | ||
| Dermoid and epidermoid cysts | 383 | ||
| Oncocytoma | 384 | ||
| Phakomatous choristoma | 384 | ||
| Benign Tumors of the Dermis | 384 | ||
| Tumors derived from neural tissue | 384 | ||
| Neurofibroma | 384 | ||
| Neurilemoma | 385 | ||
| Neuroma | 385 | ||
| Granular cell tumor | 385 | ||
| Tumors derived from smooth muscle | 385 | ||
| Leiomyoma | 385 | ||
| Tumors derived from vascular tissue | 385 | ||
| Nevus flammeus | 385 | ||
| Capillary hemangioma | 386 | ||
| Cherry hemangioma | 387 | ||
| Cavernous hemangioma | 387 | ||
| Varix | 387 | ||
| Lymphatic malformation | 387 | ||
| Arteriovenous malformation | 388 | ||
| Pyogenic granuloma | 388 | ||
| Glomus tumor | 388 | ||
| Intravascular papillary endothelial hyperplasia | 388 | ||
| Angiolymphoid hyperplasia with eosinophilia | 389 | ||
| Tumors derived from histiocytes | 389 | ||
| Xanthelasma | 389 | ||
| Xanthoma | 389 | ||
| Juvenile xanthogranuloma | 389 | ||
| Tumors derived from fibrous tissue | 390 | ||
| Dermatofibroma | 390 | ||
| Benign Tumors of the Eyelid Adnexa | 390 | ||
| Tumors of sweat gland origin | 390 | ||
| Tumors of eccrine sweat gland origin | 390 | ||
| Syringoma | 390 | ||
| Eccrine spiradenoma | 391 | ||
| Eccrine acrospiroma | 391 | ||
| Eccrine hidrocystoma | 391 | ||
| Pleomorphic adenoma | 391 | ||
| Tumors of apocrine sweat gland origin | 391 | ||
| Apocrine hidrocystoma | 391 | ||
| Cylindroma | 392 | ||
| Syringocystadenoma papilliferum | 392 | ||
| Tumors of hair follicle origin | 392 | ||
| Trichoepithelioma | 392 | ||
| Trichoadenoma | 393 | ||
| Trichofolliculoma | 393 | ||
| Trichilemmoma | 393 | ||
| Pilomatricoma | 393 | ||
| Tumors of sebaceous gland origin | 394 | ||
| Sebaceous gland hyperplasia | 394 | ||
| Sebaceous adenoma | 394 | ||
| Benign Melanocytic Lesions | 394 | ||
| Nevocellular nevi | 394 | ||
| Junctional nevi | 394 | ||
| Compound nevi | 394 | ||
| Melanoma | 394 | ||
| Intradermal nevi | 395 | ||
| Variants of nevocellular nevi | 395 | ||
| Congenital nevus | 395 | ||
| Blue nevus | 395 | ||
| Nevus of Ota | 396 | ||
| Freckle | 396 | ||
| Lentigo simplex | 396 | ||
| Lentigo senilis | 396 | ||
| Lentigo maligna | 396 | ||
| Conclusion | 396 | ||
| References | 396 | ||
| 29 Malignant Eyelid Tumors | 399 | ||
| Chapter Outline | 400 | ||
| Key Concepts | 399 | ||
| Basal Cell Carcinoma | 399 | ||
| Clinical appearance | 399 | ||
| Biologic behavior | 402 | ||
| Clinical diagnosis | 402 | ||
| Treatment | 402 | ||
| Mohs micrographic surgery | 402 | ||
| Frozen section control | 403 | ||
| Ionizing radiation therapy | 403 | ||
| Chemotherapy | 403 | ||
| Recurrence | 403 | ||
| Squamous Cell Carcinoma | 403 | ||
| Premalignant Lesions | 404 | ||
| Actinic keratosis | 404 | ||
| Bowen’s disease | 404 | ||
| Epidemiology and Differential Diagnosis | 405 | ||
| Squamous cell carcinoma | 405 | ||
| Clinical presentation | 405 | ||
| Biologic behavior | 405 | ||
| Treatment | 405 | ||
| Sebaceous cell carcinoma | 405 | ||
| Etiology | 406 | ||
| Clinical presentation | 406 | ||
| Treatment | 406 | ||
| Prognosis | 407 | ||
| Merkel cell carcinoma (trabecular carcinoma) | 407 | ||
| Normal Merkel cell | 407 | ||
| Merkel cell carcinomas | 407 | ||
| Clinical presentation | 407 | ||
| Histopathology | 408 | ||
| Treatment | 408 | ||
| Localized disease | 408 | ||
| Extraregional disease | 408 | ||
| Malignant melanoma | 408 | ||
| Lentigo maligna melanoma | 408 | ||
| Superficial spreading melanoma | 409 | ||
| Nodular melanoma | 409 | ||
| Treatment | 409 | ||
| Kaposi sarcoma | 410 | ||
| Clinical presentation | 410 | ||
| Histopathology | 410 | ||
| Treatment | 410 | ||
| Systemic Associations | 411 | ||
| Basal cell nevus syndrome (Gorlin-Goltz syndrome) | 411 | ||
| Systemic manifestations | 411 | ||
| Ophthalmic manifestations | 411 | ||
| Treatment | 411 | ||
| Xeroderma Pigmentosum | 411 | ||
| Cutaneous abnormalities | 412 | ||
| Ocular abnormalities | 412 | ||
| Neurologic abnormalities | 412 | ||
| Treatment | 412 | ||
| Muir–Torre Syndrome | 412 | ||
| Summary | 412 | ||
| References | 413 | ||
| 3 Diseases of the Lid: Inflammation and Infections | 416 | ||
| 30 Blepharitis | 416 | ||
| Chapter Outline | 417 | ||
| Key Concepts | 416 | ||
| Classification | 416 | ||
| Differential Diagnosis | 419 | ||
| Management | 420 | ||
| References | 420 | ||
| 31 Meibomian Gland Dysfunction and Seborrhea | 421 | ||
| Chapter Outline | 422 | ||
| Key Concepts | 421 | ||
| Normal Anatomy of the Meibomian Glands | 421 | ||
| Terminology | 421 | ||
| Physiology | 423 | ||
| Classification of Meibomian Gland Dysfunction | 424 | ||
| Diagnosis of Meibomian Gland Dysfunction | 424 | ||
| Associated Conditions | 426 | ||
| Associated sequelae | 427 | ||
| Histopathology | 427 | ||
| Models of Meibomian Gland Dysfunction | 428 | ||
| Lipid Composition and Behavior of Human Meibomian Secretion | 428 | ||
| Role of Microorganisms | 428 | ||
| Treatment | 428 | ||
| Conclusion | 429 | ||
| References | 429 | ||
| 32 Eyelid Infections | 431 | ||
| Chapter Outline | 432 | ||
| Key Concepts | 431 | ||
| Viral Infections | 431 | ||
| Herpes simplex virus | 431 | ||
| Varicella-zoster virus | 431 | ||
| Molluscum contagiosum | 433 | ||
| Human papillomavirus (HPV) | 434 | ||
| Bacterial Infections | 434 | ||
| Hordeolum | 434 | ||
| Preseptal cellulitis | 435 | ||
| Impetigo contagiosa | 435 | ||
| Rare bacterial infections | 435 | ||
| Anthrax | 435 | ||
| Syphilis | 436 | ||
| Mycobacterial infections | 436 | ||
| Actinomyces canaliculitis | 436 | ||
| Fungal Infections | 437 | ||
| Blastomycosis | 437 | ||
| Coccidiomycosis | 437 | ||
| Cryptococcosis | 437 | ||
| Dermatophytosis/tinea palpebrum | 437 | ||
| Sporotrichosis | 438 | ||
| Mucormycosis | 438 | ||
| Parasitic Eyelid Infections | 438 | ||
| Demodicosis | 438 | ||
| Phthiriasis and pediculosis palpebrarum | 439 | ||
| Leishmaniasis | 439 | ||
| Ophthalmomyiasis externa | 440 | ||
| References | 440 | ||
| 4 Disorders of Tear Production and the Lacrimal System | 443 | ||
| 33 Dry Eye | 443 | ||
| Chapter Outline | 444 | ||
| Key Concepts | 443 | ||
| Definition | 443 | ||
| Lacrimal Functional Unit: Anatomy and Physiology | 443 | ||
| Pathophysiology | 445 | ||
| Etiopathogenic Classification | 445 | ||
| Aqueous tear-deficient dry eye (ADDE, tear-deficient dry eye; lacrimal tear deficiency) | 445 | ||
| Sjögren syndrome dry eye | 445 | ||
| Non-Sjögren syndrome dry eye | 446 | ||
| Primary lacrimal gland deficiencies | 446 | ||
| Secondary lacrimal gland deficiencies | 447 | ||
| Obstruction of the lacrimal gland ducts | 448 | ||
| Reflex hyposecretion | 448 | ||
| Reflex sensory block | 448 | ||
| Reflex motor block | 449 | ||
| Evaporative dry eye | 449 | ||
| Intrinsic causes | 449 | ||
| Meibomian gland dysfunction | 449 | ||
| Increased tear film exposure | 449 | ||
| Extrinsic causes | 449 | ||
| Ocular surface disease | 449 | ||
| Contact lens wear | 449 | ||
| Diagnosis of Dry Eye | 449 | ||
| History | 449 | ||
| Physical examination | 450 | ||
| Diagnostic tests | 450 | ||
| Tear film stability | 450 | ||
| Diagnostic dye staining: ocular surface health | 451 | ||
| Corneal sensation | 451 | ||
| Tear film composition | 452 | ||
| Osmolarity | 452 | ||
| Tear protein analysis | 452 | ||
| Aqueous tear flow and turnover | 453 | ||
| Schirmer test | 453 | ||
| Delayed tear clearance | 453 | ||
| Other noninvasive methods for assessing the tear film | 453 | ||
| Systemic Work-Up | 454 | ||
| Management of Dry Eyes | 454 | ||
| Tear supplementation: lubricants | 454 | ||
| Tear retention | 454 | ||
| Punctal occlusion | 454 | ||
| Moisture chamber spectacles | 455 | ||
| Contact lenses | 455 | ||
| Tarsorrhaphy | 455 | ||
| Tear stimulation: secretagogues | 455 | ||
| Biological tear substitutes | 455 | ||
| Serum | 455 | ||
| Salivary gland autotransplantation | 456 | ||
| Anti-inflammatory therapy | 456 | ||
| Cyclosporine | 456 | ||
| Corticosteroids | 456 | ||
| Tetracyclines | 457 | ||
| Macrolides | 457 | ||
| Essential fatty acids | 457 | ||
| Topical vitamin A (retinol) | 457 | ||
| Mucolytics | 457 | ||
| Dry Eye in the Surgical Patient | 458 | ||
| Treatment Guidelines | 458 | ||
| References | 459 | ||
| 34 Dacryoadenitis, Dacryocystitis, and Canaliculitis | 463 | ||
| Chapter Outline | 464 | ||
| Key Concepts | 463 | ||
| Dacryoadenitis | 463 | ||
| Dacryocystitis | 466 | ||
| Canaliculitis | 468 | ||
| References | 469 | ||
| 35 Epiphora | 471 | ||
| Chapter Outline | 472 | ||
| Key Concepts | 471 | ||
| Introduction | 471 | ||
| Etiology | 471 | ||
| Overproduction | 471 | ||
| Outflow obstruction | 471 | ||
| Lacrimal pump failure | 474 | ||
| Differential Diagnosis | 474 | ||
| Evaluation | 475 | ||
| Treatment | 475 | ||
| Overproduction | 475 | ||
| Outflow obstruction | 476 | ||
| Lacrimal pump failure | 477 | ||
| Summary | 477 | ||
| References | 477 | ||
| VI The Conjunctiva | 479 | ||
| 1 Conjunctival Disease: Tumors | 479 | ||
| 36 Epithelial Tumors of the Conjunctiva | 479 | ||
| Chapter Outline | 480 | ||
| Key Concepts | 479 | ||
| Benign Tumefactions | 479 | ||
| Benign hereditary intraepithelial dyskeratosis | 479 | ||
| Pseudoepitheliomatous hyperplasia, large cell acanthoma and keratoacanthoma | 481 | ||
| Conjunctival squamous papilloma | 482 | ||
| Inverted conjunctival papillomas | 482 | ||
| Dacryoadenoma | 482 | ||
| Sebaceous adenoma | 483 | ||
| Pterygia and pingueculae | 483 | ||
| Malignant Tumefactions | 483 | ||
| Non-invasive ocular surface squamous neoplasia / conjunctival intraepithelial neoplasia | 483 | ||
| Invasive ocular surface squamous neoplasia | 487 | ||
| Corneal epithelial dysmaturation and epithelial dysplasia | 487 | ||
| Mucoepidermoid carcinoma | 490 | ||
| Spindle cell carcinoma | 490 | ||
| Adenoid squamous carcinoma | 491 | ||
| Clear cell carcinoma | 491 | ||
| Sebaceous cell carcinoma | 491 | ||
| Basal cell carcinoma | 493 | ||
| References | 493 | ||
| 37 Medical and Surgical Management of Ocular Surface Squamous Neoplasia | 497 | ||
| Chapter Outline | 498 | ||
| Key Concepts | 497 | ||
| Initial Considerations | 497 | ||
| Surgical Management of OSSN | 497 | ||
| “No-touch” technique | 497 | ||
| Intraoperative adjunctive treatments | 500 | ||
| Mitomycin C | 500 | ||
| Amniotic membrane transplant (AMT) | 500 | ||
| Postoperative management and complications | 500 | ||
| Standard postoperative regimen | 500 | ||
| Neoadjuvant treatments | 500 | ||
| Complications of surgical resection | 500 | ||
| Medical Management of OSSN | 501 | ||
| Radiotherapy | 501 | ||
| Photodynamic therapy | 501 | ||
| Anti-vascular endothelial growth factor (VEGF) | 501 | ||
| Topical chemotherapeutic and immunomodulatory agents | 501 | ||
| Antimetabolites | 501 | ||
| 5-Fluorouracil | 501 | ||
| Mitomycin C | 502 | ||
| Immunomodulators | 502 | ||
| Interferon α2b | 502 | ||
| Retinoic acid | 503 | ||
| Future Directions | 503 | ||
| Financial support | 503 | ||
| References | 503 | ||
| 38 Melanocytic Neoplasms of the Conjunctiva | 505 | ||
| Chapter Outline | 506 | ||
| Key Concepts | 505 | ||
| Introduction | 505 | ||
| Conjunctival Nevus | 505 | ||
| Conjunctival Melanosis | 508 | ||
| Epithelial congenital melanosis | 508 | ||
| Subepithelial congenital melanosis | 508 | ||
| Secondary acquired melanosis | 508 | ||
| Primary acquired melanosis | 508 | ||
| Malignant Melanoma | 510 | ||
| References | 513 | ||
| 39 Subepithelial Tumors of the Conjunctiva | 514 | ||
| Chapter Outline | 515 | ||
| Key Concepts | 514 | ||
| Congenital Lesions | 514 | ||
| Choristomas | 514 | ||
| Dermoid and dermolipoma | 514 | ||
| Ectopic lacrimal gland; simple and complex choristomas | 516 | ||
| Epibulbar osseous and neuroglial choristomas | 517 | ||
| Hamartomas | 518 | ||
| Conjunctival cysts | 519 | ||
| Reactive, Degenerative, and Inflammatory Lesions | 520 | ||
| Pyogenic granuloma/capillary hemangioma | 520 | ||
| Pinguecula/pterygium | 521 | ||
| Elastofibroma oculi | 521 | ||
| Nodular fasciitis | 521 | ||
| Granulomatous and histiocytic lesions | 521 | ||
| Epibulbar molluscum contagiosum | 523 | ||
| Keloid | 523 | ||
| Amyloid | 523 | ||
| Hematic cyst | 523 | ||
| Neoplastic Lesions | 523 | ||
| Fibrous histiocytoma | 523 | ||
| Kaposi’s sarcoma | 528 | ||
| Oncocytoma (oxyphilic adenoma) | 529 | ||
| Basal cell carcinoma | 529 | ||
| Malignant melanoma | 529 | ||
| Lymphoid lesions | 529 | ||
| Other Subconjunctival Neoplastic Lesions | 532 | ||
| References | 534 | ||
| 2 Conjunctivitis | 539 | ||
| 40 Conjunctivitis | 539 | ||
| Chapter Outline | 540 | ||
| Key Concepts | 539 | ||
| Conjunctival Injection | 539 | ||
| Conjunctivitis | 539 | ||
| Morphologic responses | 541 | ||
| Papillae | 541 | ||
| Follicles | 541 | ||
| Membranes | 542 | ||
| Cicatrizing changes | 543 | ||
| Granulomas | 544 | ||
| Type of exudate | 544 | ||
| Anatomic localization | 544 | ||
| Acute Conjunctivitis | 544 | ||
| Acute papillary conjunctivitis | 544 | ||
| Acute follicular conjunctivitis | 545 | ||
| Adenovirus | 545 | ||
| Inclusion conjunctivitis | 545 | ||
| Ocular herpes infections | 545 | ||
| RNA-containing viruses | 546 | ||
| Poxviruses | 546 | ||
| Acute membranous conjunctivitis | 546 | ||
| Chronic Conjunctivitis | 547 | ||
| Giant papillary conjunctivitis | 547 | ||
| Vernal keratoconjunctivitis | 547 | ||
| Atopic keratoconjunctivitis | 547 | ||
| Secondary giant papillary conjunctivitis | 548 | ||
| Chronic papillary conjunctivitis | 548 | ||
| Masquerade syndrome | 548 | ||
| Intraepithelial neoplasia | 548 | ||
| Malignant melanoma | 548 | ||
| Sebaceous cell carcinoma | 548 | ||
| Lacrimal drainage system infection | 548 | ||
| Chronic dacryocystitis | 548 | ||
| Chronic canaliculitis | 548 | ||
| Superior limbic keratoconjunctivitis | 549 | ||
| Floppy eyelid syndrome | 549 | ||
| Blepharoconjunctivitis | 549 | ||
| Staphylococcal/Demodex and seborrheic | 549 | ||
| Meibomian gland dysfunction | 549 | ||
| Keratoconjunctivitis sicca | 549 | ||
| Mucus-fishing syndrome | 549 | ||
| Toxic papillary keratoconjunctivitis | 549 | ||
| Chronic follicular conjunctivitis | 550 | ||
| Chlamydia | 550 | ||
| Trachoma | 550 | ||
| Inclusion conjunctivitis | 550 | ||
| Moraxella | 550 | ||
| Molluscum contagiosum | 550 | ||
| Toxic follicular conjunctivitis | 550 | ||
| Lyme disease | 550 | ||
| Chronic membranous conjunctivitis | 551 | ||
| Cicatrizing and granulomatous conjunctivitis | 551 | ||
| References | 551 | ||
| 41 Bacterial Conjunctivitis | 553 | ||
| Chapter Outline | 554 | ||
| Key Concepts | 553 | ||
| Nonspecific and Specific Natural Defenses | 553 | ||
| Manifestations of Conjunctivitis | 555 | ||
| Discharge | 555 | ||
| Membranes and pseudomembranes | 555 | ||
| Papillae and follicles | 556 | ||
| Classification | 556 | ||
| Hyperacute bacterial conjunctivitis | 556 | ||
| Associated ocular and systemic complications | 557 | ||
| Diagnosis | 557 | ||
| Treatment | 558 | ||
| Acute conjunctivitis | 558 | ||
| Associated ocular and systemic complications | 560 | ||
| Diagnosis | 560 | ||
| Treatment | 560 | ||
| Chronic conjunctivitis | 563 | ||
| Associated ocular complications | 564 | ||
| Diagnosis | 564 | ||
| Treatment | 564 | ||
| Unusual causes of bacterial conjunctivitis | 564 | ||
| Immunodeficiency and AIDS | 564 | ||
| References | 564 | ||
| 42 Viral Conjunctivitis | 568 | ||
| Chapter Outline | 569 | ||
| Key Concepts | 568 | ||
| DNA Viruses | 568 | ||
| Adenoviruses | 568 | ||
| Pharyngoconjunctival fever | 568 | ||
| Epidemic keratoconjunctivitis | 570 | ||
| Acute nonspecific follicular conjunctivitis | 571 | ||
| Chronic conjunctivitis | 571 | ||
| Laboratory diagnosis | 572 | ||
| Treatment | 572 | ||
| Herpes simplex virus (HSV) | 574 | ||
| Varicella-zoster virus (VZV) | 575 | ||
| Epstein−Barr virus (EBV) | 575 | ||
| Cytomegalovirus (CMV) | 575 | ||
| Variola and vaccinia virus | 575 | ||
| Molluscum contagiosum virus | 575 | ||
| RNA Viruses | 576 | ||
| Picornaviruses | 576 | ||
| Paramyxoviruses | 576 | ||
| Togaviruses | 576 | ||
| Flaviviruses | 577 | ||
| Filoviruses | 577 | ||
| References | 577 | ||
| 43 Chlamydial Infections | 579 | ||
| Chapter Outline | 580 | ||
| Key Concepts | 579 | ||
| Introduction | 579 | ||
| Biology | 579 | ||
| Laboratory Tests for Chlamydia | 579 | ||
| Trachoma | 581 | ||
| Epidemiology | 581 | ||
| Clinical manifestations | 581 | ||
| Pathophysiology | 583 | ||
| Treatment | 583 | ||
| Public health efforts | 584 | ||
| Neonatal Inclusion Conjunctivitis | 584 | ||
| Adult Inclusion Conjunctivitis | 585 | ||
| Lymphogranuloma Venereum | 585 | ||
| Chlamydia psittaci and Chlamydia pneumoniae | 586 | ||
| Conclusion | 586 | ||
| References | 586 | ||
| 44 Ophthalmia Neonatorum | 588 | ||
| Chapter Outline | 589 | ||
| Key Concepts | 588 | ||
| Pathogenesis | 588 | ||
| The Role of Sexually Transmitted Diseases | 590 | ||
| Causes of Neonatal Conjunctivitis | 590 | ||
| Chemical | 590 | ||
| Bacterial | 590 | ||
| Chlamydial | 591 | ||
| Viral | 592 | ||
| Fungal | 592 | ||
| Laboratory Diagnosis | 592 | ||
| Treatment | 593 | ||
| Ocular Prophylaxis | 593 | ||
| References | 594 | ||
| 45 Parinaud Oculoglandular Syndrome | 596 | ||
| Chapter Outline | 597 | ||
| Key Concepts | 596 | ||
| History | 596 | ||
| Directed Work-up | 596 | ||
| Individual Etiologies | 598 | ||
| Cat-scratch disease | 598 | ||
| Tularemia | 600 | ||
| Tuberculosis | 601 | ||
| Sporotrichosis | 602 | ||
| Syphilis | 602 | ||
| Other causes | 602 | ||
| References | 603 | ||
| 46 Seasonal and Perennial Allergic Conjunctivitis | 605 | ||
| Chapter Outline | 606 | ||
| Key Concepts | 605 | ||
| Introduction | 605 | ||
| Clinical Findings | 605 | ||
| Pathophysiology | 607 | ||
| Local Treatments | 609 | ||
| Systemic Treatments | 610 | ||
| Future Developments | 610 | ||
| Conclusion | 611 | ||
| References | 611 | ||
| 47 Vernal and Atopic Keratoconjunctivitis | 613 | ||
| Chapter Outline | 614 | ||
| Key Concepts | 613 | ||
| Vernal Keratoconjunctivitis | 613 | ||
| Definition | 613 | ||
| Demographics | 613 | ||
| Symptoms | 613 | ||
| Signs | 613 | ||
| Pathophysiology | 615 | ||
| Diagnosis | 616 | ||
| Treatment | 616 | ||
| Atopic Keratoconjunctivitis | 617 | ||
| Definition | 617 | ||
| Demographics | 617 | ||
| Symptoms | 617 | ||
| Signs | 617 | ||
| Pathophysiology | 618 | ||
| Diagnosis | 619 | ||
| Treatment | 619 | ||
| References | 620 | ||
| 48 Giant Papillary Conjunctivitis | 623 | ||
| Chapter Outline | 624 | ||
| Key Concepts | 623 | ||
| Symptoms and Signs | 623 | ||
| Histopathology and Immunopathology | 626 | ||
| Pathophysiology | 627 | ||
| Differential Diagnosis | 628 | ||
| Treatment | 628 | ||
| Prognosis | 629 | ||
| References | 629 | ||
| 49 Mucous Membrane Pemphigoid | 631 | ||
| Chapter Outline | 632 | ||
| Key Concepts | 631 | ||
| Introduction | 631 | ||
| Epidemiology | 633 | ||
| Pathogenesis | 633 | ||
| Diagnosis | 634 | ||
| Ocular Manifestations | 634 | ||
| Management of Ocular Mucous Membrane Pemphigoid | 636 | ||
| Medical management | 636 | ||
| Dry eye syndrome (DES) | 636 | ||
| Chronic blepharitis and meibomitis | 636 | ||
| Immunomodulatory | 637 | ||
| Surgical treatment | 638 | ||
| Epilation | 638 | ||
| Lid surgery | 638 | ||
| Fornix reconstruction | 639 | ||
| Corneal surgery | 639 | ||
| Conclusion | 639 | ||
| Acknowledgments | 639 | ||
| References | 639 | ||
| 50 Erythema Multiforme, Stevens–Johnson Syndrome, and Toxic Epidermal Necrolysis | 641 | ||
| Chapter Outline | 642 | ||
| Key Concepts | 641 | ||
| Introduction | 641 | ||
| History | 641 | ||
| Classification | 641 | ||
| Incidence | 643 | ||
| Clinical Findings | 643 | ||
| Initial presentation | 643 | ||
| Eye findings | 643 | ||
| Acute eye findings | 643 | ||
| Chronic eye findings | 644 | ||
| Nonocular findings | 644 | ||
| Recurrent Disease | 646 | ||
| Incidence of ocular complications | 646 | ||
| Differential Diagnosis | 646 | ||
| Ocular disorders | 646 | ||
| Dermatologic manifestations | 646 | ||
| Etiology | 646 | ||
| Pathogenesis | 647 | ||
| Histopathology | 647 | ||
| Skin | 647 | ||
| Eye | 648 | ||
| Management | 648 | ||
| Systemic disease | 648 | ||
| Ophthalmic disease | 649 | ||
| Acute stage | 649 | ||
| Chronic stage | 651 | ||
| Conclusions | 652 | ||
| References | 653 | ||
| 51 Toxic Conjunctivitis | 657 | ||
| Chapter Outline | 658 | ||
| Key Concepts | 657 | ||
| Introduction | 657 | ||
| Toxicity versus Allergy | 657 | ||
| Cellular mechanisms | 657 | ||
| Signs and symptoms | 657 | ||
| Diagnostic testing | 660 | ||
| Toxic Keratoconjunctivitis Related to Topical Medications | 660 | ||
| Methods of assessing toxicity | 660 | ||
| Toxicity of specific agents | 660 | ||
| Antivirals | 660 | ||
| Glaucoma medications | 661 | ||
| Antibiotics and antifungals | 661 | ||
| Anesthetics | 662 | ||
| Preservatives | 662 | ||
| Follicular conjunctivitis | 663 | ||
| Hurricane keratitis | 663 | ||
| Drug-induced mucous membrane pemphigoid | 663 | ||
| Other Causes of Toxic Keratoconjunctivitis | 664 | ||
| Cosmetics and skin care products | 664 | ||
| Hair care products | 664 | ||
| Tear gas weapons and lacrimating agents | 664 | ||
| Therapeutic Considerations | 665 | ||
| References | 665 | ||
| 52 Superior Limbic Keratoconjunctivitis | 667 | ||
| Chapter Outline | 668 | ||
| Key Concepts | 667 | ||
| Introduction and Epidemiology | 667 | ||
| Clinical Presentation | 667 | ||
| Etiology | 667 | ||
| Histopathology | 670 | ||
| Treatment Modalities | 670 | ||
| Medical treatment | 670 | ||
| Surgery | 671 | ||
| Differential Diagnosis | 671 | ||
| Summary | 672 | ||
| References | 672 | ||
| 53 Ligneous Conjunctivitis | 673 | ||
| Chapter Outline | 674 | ||
| Key Concepts | 673 | ||
| Epidemiology | 673 | ||
| Clinical Findings | 673 | ||
| Pathophysiology/Histopathology | 675 | ||
| Etiology | 675 | ||
| Treatment | 676 | ||
| References | 678 | ||
| 54 Conjunctivochalasis | 680 | ||
| Chapter Outline | 681 | ||
| Key Concepts | 680 | ||
| Introduction | 680 | ||
| Epidemiology | 680 | ||
| Pathophysiology | 682 | ||
| Clinical Presentation | 683 | ||
| Diagnosis | 684 | ||
| Management | 684 | ||
| Conclusion | 686 | ||
| References | 686 | ||
| VII Diseases of the Cornea | 687 | ||
| 1 Developmental Abnormalities of Cornea | 687 | ||
| 55 Developmental Corneal Anomalies of Size and Shape | 687 | ||
| Chapter Outline | 688 | ||
| Key Concepts | 687 | ||
| Absence of the Cornea | 689 | ||
| Anomalies of Size | 690 | ||
| Megalocornea | 690 | ||
| Microcornea | 691 | ||
| Anomalies of Shape | 692 | ||
| Oval cornea | 692 | ||
| Astigmatism | 692 | ||
| Sclerocornea (cornea plana) | 693 | ||
| Posterior keratoconus | 694 | ||
| Keratoglobus | 694 | ||
| Congenital Anterior Staphyloma and Keratectasia | 695 | ||
| References | 696 | ||
| 56 Axenfeld-Rieger Syndrome and Peters Anomaly | 699 | ||
| Chapter Outline | 700 | ||
| Key Concepts | 699 | ||
| Terminology | 699 | ||
| Axenfeld-Rieger Syndrome | 699 | ||
| History | 699 | ||
| Clinical features | 701 | ||
| Cornea | 701 | ||
| Iridocorneal angle | 702 | ||
| Iris | 702 | ||
| Glaucoma | 703 | ||
| Other ocular findings | 703 | ||
| Nonocular findings | 703 | ||
| Face | 703 | ||
| Teeth | 703 | ||
| Umbilical | 704 | ||
| Genital | 704 | ||
| Others | 704 | ||
| Differential diagnosis | 704 | ||
| Pathogenesis | 705 | ||
| Genetics | 705 | ||
| Chromosome 4q, RIEG1, PITX2 | 705 | ||
| Chromosome 13q, RIEG2 | 705 | ||
| Chromosome 6p, FOXC1 | 705 | ||
| Genotype-phenotype correlations | 706 | ||
| Natural history | 706 | ||
| Treatment | 706 | ||
| Peters Anomaly | 706 | ||
| History | 706 | ||
| Clinical features | 706 | ||
| Cornea | 706 | ||
| Anterior chamber | 707 | ||
| Lens | 707 | ||
| Glaucoma | 707 | ||
| Other ocular findings | 707 | ||
| Nonocular findings | 707 | ||
| Differential diagnosis | 707 | ||
| Pathogenesis | 707 | ||
| Genetics | 708 | ||
| Natural history | 708 | ||
| Treatment | 708 | ||
| References | 708 | ||
| 2 Corneal Manifestations of Systemic Disease and Therapies | 710 | ||
| 57 Corneal Manifestations of Metabolic Diseases | 710 | ||
| Chapter Outline | 711 | ||
| Key Concepts | 710 | ||
| Introduction | 710 | ||
| Disorders of Carbohydrate Metabolism | 710 | ||
| Diabetes mellitus: diabetic keratopathy | 710 | ||
| Lysosomal Storage Disorders | 713 | ||
| Introduction | 713 | ||
| Mucopolysaccharidoses | 716 | ||
| MPS I | 717 | ||
| Hurler syndrome (MPS I-H) | 717 | ||
| Scheie syndrome (MPS IS) | 718 | ||
| Hurler Scheie (MPS I H/S) | 719 | ||
| Hunter syndrome (MPS II) | 719 | ||
| Sanfilippo syndrome (MPS III) | 719 | ||
| Morquio syndrome (MPS IV) | 719 | ||
| Maroteaux–Lamy syndrome (MPS VI) | 719 | ||
| Sly syndrome (MPS VII) | 720 | ||
| Natowicz syndrome (MPS IX) | 720 | ||
| Corneal histopathology in MPS | 720 | ||
| Disorders of Lipid and Lipoprotein Metabolism | 720 | ||
| Dyslipoproteinemias | 720 | ||
| Hyperlipoproteinemias and Schnyder corneal dystrophy | 721 | ||
| Hypolipoproteinemias | 722 | ||
| Lipidoses | 723 | ||
| Fabry’s disease | 723 | ||
| Multiple sulfatase deficiency | 724 | ||
| Generalized gangliosidoses | 724 | ||
| Drug-induced lipidoses | 724 | ||
| Chloroquine | 724 | ||
| Amiodarone | 724 | ||
| Other agents | 725 | ||
| Disorders of Glycosaminoglycan and Lipid Metabolism | 726 | ||
| Mucolipidoses | 726 | ||
| Galactosialidosis | 726 | ||
| Disorders of Amino Acid, Nucleic Acid, and Protein Metabolism | 727 | ||
| Cystinosis | 727 | ||
| Tyrosinemia II | 728 | ||
| Alkaptonuria | 729 | ||
| Amyloidosis | 729 | ||
| Gout | 731 | ||
| Porphyria | 731 | ||
| References | 732 | ||
| 58 Skeletal and Connective Tissue Disorders with Anterior Segment Manifestations | 736 | ||
| Chapter Outline | 737 | ||
| Key Concepts | 736 | ||
| Classification of Skeletal Disorders | 736 | ||
| Craniofacial dysostosis syndromes | 738 | ||
| Crouzon syndrome | 738 | ||
| Apert syndrome | 740 | ||
| Saethre–Chotzen syndrome | 741 | ||
| Goldenhar syndrome | 741 | ||
| Hallermann–Streiff syndrome (oculomandibulodyscephaly, François dyscephalic syndrome) | 741 | ||
| Treacher Collins syndrome (mandibulofacial dysostosis; Franceschetti syndrome) | 742 | ||
| Ehlers–Danlos syndrome | 742 | ||
| Osteogenesis imperfecta | 745 | ||
| Stickler syndrome (hereditary progressive arthro-ophthalmopathy), Wagner syndrome, and Marshall syndrome | 746 | ||
| Kniest dysplasia | 747 | ||
| Marfan syndrome | 747 | ||
| Oculo-dento-osseous dysplasia | 750 | ||
| Sotos syndrome | 751 | ||
| Dermo-chondro-corneal dystrophy of François | 751 | ||
| Werner syndrome | 751 | ||
| Syndrome of acromegaly, cutis verticis gyrata, and corneal leukoma of Rosenthal and Kloepfer | 751 | ||
| Hypophosphatasia | 751 | ||
| Treatment of Ocular and Corneal Abnormalities in Skeletal Disorders | 752 | ||
| References | 752 | ||
| 59 Granulomatosis with Polyangiitis and Other Systemic Inflammatory Diseases | 757 | ||
| Chapter Outline | 758 | ||
| Key Concepts | 757 | ||
| Granulomatosis with Polyangiitis | 757 | ||
| Epidemiology, etiology, and pathogenesis | 757 | ||
| Systemic manifestations | 757 | ||
| Limited granulomatosis with polyangiitis | 759 | ||
| Ocular manifestations | 759 | ||
| Management | 760 | ||
| Inflammatory Bowel Disease | 760 | ||
| Epidemiology, etiology, and pathogenesis | 760 | ||
| Systemic manifestations | 760 | ||
| Ocular manifestations | 761 | ||
| Management | 762 | ||
| Whipple Disease | 762 | ||
| Epidemiology, etiology, and pathogenesis | 762 | ||
| Systemic manifestations | 762 | ||
| Ocular manifestations | 762 | ||
| Management | 763 | ||
| Chronic Granulomatous Disease | 763 | ||
| Epidemiology, etiology, and pathogenesis | 763 | ||
| Systemic manifestations | 763 | ||
| Ocular manifestations | 764 | ||
| Management | 764 | ||
| Kawasaki Disease | 764 | ||
| Epidemiology, etiology, and pathogenesis | 764 | ||
| Systemic manifestations | 764 | ||
| Ocular manifestations | 765 | ||
| Management | 765 | ||
| References | 765 | ||
| 60 Nutritional Disorders | 769 | ||
| Chapter Outline | 770 | ||
| Key Concepts | 769 | ||
| Metabolism of Vitamin A | 769 | ||
| Historical Considerations | 769 | ||
| Classification and Clinical Manifestations of Xerophthalmia | 771 | ||
| Night blindness (XN) | 771 | ||
| Conjunctival xerosis (X1A) and Bitot spots (X1B) | 771 | ||
| Corneal xerosis (X2) | 772 | ||
| Corneal ulceration/keratomalacia (X3A/X3B) | 773 | ||
| Pathogenesis of corneal ulceration | 774 | ||
| Interactions with Other Factors | 775 | ||
| Epidemiology | 776 | ||
| Treatment | 777 | ||
| Other Nutritional Deficiencies | 778 | ||
| Vitamin B (riboflavin) | 778 | ||
| Vitamin C | 778 | ||
| Other nutrients | 778 | ||
| Discrete colliquative keratopathy | 778 | ||
| Summary | 778 | ||
| References | 779 | ||
| 61 Hematologic Diseases and Malignancies | 782 | ||
| Chapter Outline | 783 | ||
| Key Concepts | 782 | ||
| Basics of Hematology | 782 | ||
| Anemia | 782 | ||
| Iron deficiency anemia | 782 | ||
| Systemic manifestations | 782 | ||
| Ophthalmic manifestations | 782 | ||
| Thalassemia | 784 |