Common Eye Diseases and their Management

Description

Since the last edition of this book, there have been a number of advances in the fields of glaucoma, corneal disease, medical retina and genetics. This new edition discusses these developments while also providing an introduction to the specialty of clinical ophthalmology for medical students, trainee ophthalmologists, optometrists, general practitioners, and anyone with a special interest in the subject. Common Eye Diseases and their Management, 5th Edition contains a brief introduction and outline of the anatomy of the eye and orbit, with emphasis placed on the efficacy of modern treatments in later chapters. References are deliberately kept to a minimum to engage readers with a conversational approach and each chapter ends with a concise summary to assist the reader with remembering the key points for each topic. Preface to the Second Edition Preface to the Third Edition Preface to the Fourth Edition Preface to the Fifth Edition Acknowledgements Contents Part I: Introducing the Eye 1: The Scope of Ophthalmology Patient Communication Historical Background Making a Career in Ophthalmology 2: Basic Anatomy and Physiology of the Eye Introduction Basic Structure of the Eye and Supporting Structures The Globe The Outer Layer of the Eye The Middle Layer The Inner Layer Blood Supply The Optic Nerve The Visual Pathway The Eyelids The Lacrimal Apparatus The Extraocular Muscles Physiology of the Eye The Eyelids The Tear Film The Cornea The Aqueous Humour The Vitreous Body The Lens The Ciliary Body Accommodation The Retina Summary 3: Examination of the Eye How to Find Out What a Patient Can See Visual Acuity Visual Field Colour Vision Spectacles How to Start Examining an Eye Evaluating the Pupil External Eye and Lids The Globe How to Use the Ophthalmoscope Other Tests Available in an Eye Department Part II: Primary Eye Care Problems 4: Long Sight, Short Sight 5: Common Diseases of the Eyelids The Watering Eye Impaired Drainage of Tears The Lacrimal Passageway Acute Dacryocystitis Excessive Secretion of Tears The Dry Eye Causes of Dry Eye Signs Slit Lamp Examination Schirmer’s Test Tear Film Break-Up Time Management of the Dry Eye Deformities of the Eyelids The Normal Eyelid Epicanthus Entropion Ectropion Lagophthalmos Blepharospasm Redundant Lid Skin Ptosis Causes of Ptosis Ingrowing Eyelashes (Trichiasis) Infections of the Eyelids Meibomian Gland Infection Styes Blepharitis Molluscum Contagiosum Orbital Cellulitis Allergic Disease of the Eyelids Lid Tumours Benign Tumours Malignant Tumours Lid Injuries 6: Common Diseases of the Conjunctiva and Cornea Subconjunctival Haemorrhage Conjunctivitis Symptoms Signs Microscopy Conjunctival Culture Causes Bacterial Conjunctivitis Chlamydia Conjunctivitis Trachoma Adenoviral Conjunctivitis Herpes Simplex Conjunctivitis Acute Haemorrhagic Conjunctivitis Other Infective Agents Allergic Conjunctivitis Hay Fever Conjunctivitis Atopic Conjunctivitis Vernal Conjunctivitis (Spring Catarrh) Secondary Conjunctivitis Corneal Foreign Body Signs and Symptoms Treatment Corneal Ulceration Types of Corneal Ulcer Due to Direct Trauma Due to Bacteria Due to Acanthamoeba Due to Viruses Treatment of Herpes Simplex Keratitis Due to Damage to the Corneal Nerve Supply Due to Exposure Corneal Dystrophies Corneal Degenerations Corneal Oedema Absent Corneal Sensation Herpes Zoster Ophthalmicus (Shingles of the Eye) 7: The Red Eye Red Eye Which Is Not Painful and Sees Normally Subconjunctival Haemorrhage Conjunctivitis Acute Chronic Checklist of Causes Episcleritis Red Painful Eye Which May See Normally Scleritis Red Painful Eye Which Cannot See Acute Glaucoma Acute Iritis Acute Keratitis Neovascular Glaucoma 8: Failing Vision Failing Vision in Eyes Which Look Normal When the Fundus Is Normal When the Fundus Is Abnormal In Relation to Systemic Disease Sudden Loss of Vision in One Eye Treatable Causes of Failing Vision Untreatable Causes of Failing Vision 9: Headache History Classification Cerebrospinal Fluid Blood Vessels Blood Nerves Bones Meninges The Eyes Pain Referred from Other Sites Drugs Post-traumatic Headache 10: Contact Lenses Types Side-Effects Indications Cosmetic Therapeutic Part III: Problems of the Eye Surgeon 11: Cataract The Lens Aetiology Age Diabetes Secondary Trauma Congenital Factors Toxicity Symptoms Signs Reduced Visual Acuity Findings of Ophthalmoscopy Findings on Slit Lamp Microscopy Other Important Signs Management When to Operate Age of the Patient Traumatic Cataract The Cataract Operation Time Spent in Hospital Convalescence Summary 12: Glaucoma Normal Intraocular Pressure Maintenance of Intraocular Pressure Measurement of Intraocular Pressure Clinical Types of Glaucoma Primary Open Angle Glaucoma Pathogenesis and Natural History Symptoms Signs Treatment Normal Pressure Glaucoma (NPG) Management Acute Angle Closure Glaucoma Pathogenesis and Natural History Symptoms Signs Treatment Secondary Glaucoma Secondary to Vascular Disease in the Eye Secondary to Uveitis Secondary to Tumours Secondary to Trauma Drug-Induced Glaucoma Secondary to Abnormalities in the Lens Congenital or Developmental Glaucoma 13: Retinal Detachment Incidence Pathogenesis Classification Rhegmatogenous Retinal Detachment Tractional Retinal Detachment Exudative Retinal Detachment Rhegmatogenous Retinal Detachment The Presence of Breaks in Retinal Detachment Retinal Degeneration The Vitreous Posterior Vitreous Detachment Retinal Breaks Formation Mechanism of Rhegmatogenous Retinal Detachment Rhegmatogenous Retinal Detachment Associated with Trauma Signs and Symptoms of Retinal Tear and Retinal Detachment Flashes (‘Photopsiae’) Floaters Shadow Traction Retinal Detachment Exudative Retinal Detachment Management of Rhegmatogenous Retinal Detachment Prophylaxis Retinal Surgery Cryobuckle Vitrectomy Prognosis 14: Squint Types of Squint Squint in Childhood Amblyopia of Disuse Causes of Squint in Childhood Refractive Error Opaque Media Disease of the Retina or Optic Nerve Congenital or Acquired Muscle Weakness Abnormalities of Facial Skeleton Diagnosis Management of Squint in Childhood Squint in Adults Anatomy of the Extraocular Muscles Causes of Adult Squint Diagnosis Hess Screen Treatment Ocular Muscle Imbalance Summary 15: Tumours of the Eye and Adnexae The Globe Choroidal Melanoma Choroidal Metastases Retinoblastoma Melanoma of the Iris The Eyelids Benign Tumours Malignant Tumours of the Eyelids The Conjunctiva Benign Lesions Benign Pigmented Lesions of the Conjunctiva Non-Pigmented Lesions Malignant Lesions The Orbit (see Table 15.1) Exophthalmos and Proptosis Causes of Proptosis (see Table 15.2) Assessment of Proptosis Summary 16: Ocular Trauma Injuries to the Globe Contusion Perforation Intraocular Foreign Body Sympathetic Ophthalmia Injuries to the Eyelids Injuries to the Orbit Radiational Injuries Chemical Injuries Summary Part IV: Problems of the Medical Ophthalmologist 17: Testing Visual Acuity Introduction Measuring for Spectacles Objective Refraction Subjective Refraction Automated Refraction Summary 18: The Inflamed Eye The Role of Autoimmunity in Uveitis Anterior Uveitis Symptoms Signs Complications Causes Management Heterochromic Iridocyclitis (Fuch’s) Intermediate Uveitis (Pars Planitis) Treatment and Management Posterior Uveitis Symptoms Signs Causes Management Specific Uveitis Entities Toxoplasmosis Toxocariasis Tuberculosis Presumed Ocular Histoplasmosis Syphilis Sarcoidosis Behcet’s Disease Birdshot chorioretinopathy Sympathetic Ophthalmia Other Causes Endophthalmitis and Panophthalmitis Episcleritis and Scleritis Summary 19: The Ageing Eye Changes in the Eyes with Age The External Eye The Globe Eye Disease in the Elderly Age Related Macular Degeneration Management Cataract Glaucoma Deformities of the Eyelids Temporal Arteritis Stroke Summary 20: The Child’s Eye How the Normal Features Differ from Those in an Adult How to Examine a Child’s Eye Screening of Children’s Eyes Congenital Eye Defects Lacrimal Obstruction Epicanthus Ptosis Congenital Nystagmus Structural Abnormalities of the Globe Other Eye Conditions in Childhood Abnormalities of Refraction Squint Amblyopia of Disuse Leucocoria Retinopathy of Prematurity Ophthalmia Neonatorum Uveitis Optic Atrophy Juvenile Retinal and Macular Degenerations The Phakomatoses Summary 21: Systemic Disease and the Eye Introduction Diabetes Mellitus Eyelids Ocular Movements Cornea and Conjunctiva Anterior Chamber Iris Lens Retina and Vitreous Background Retinopathy The Pre-Proliferative Stage Proliferative Retinopathy Diabetic Maculopathy Treatment Treatments for DMO Treatments for Proliferative Diabetic Eye Disease Prognosis Thyroid Eye Disease Management Hypertension The Effect of Age on the Retinal Blood Vessels The Effects of Raised Blood Pressure on the Retinal Vessels ‘Malignant’ Hypertension Retinal Vascular Occlusions Management Retinal Artery Occlusions Ischaemic Optic Neuropathy Anaemia The Leukaemias Sickle Cell Disease Onchocerciasis Extraocular Features Ocular Features Management Acquired Immune Deficiency Syndrome (AIDS) Ocular Manifestations of Coronavirus (Covid-19) Ocular Manifestations of Ebola Virus Disease Connective Tissue Disease Mucocutaneous Diseases Summary 22: Neuro-Ophthalmology The Optic Disc Normal Disc Congenital Disc Anomalies Pale Disc Optic Atrophy Swelling of the Optic Disc Apparent Swelling Vascular Postoperative Papilloedema (‘True Papilloedema’) Optic Neuritis Other Causes Multiple Sclerosis Ocular Findings Optic or Retrobulbar Neuritis Nystagmus Internuclear Ophthalmoplegia Other Features Defects in the Visual Fields Abnormalities of the Pupil The Abnormally Dilated Pupil The Abnormally Constricted Pupil Double Vision Assessment of Eye Movements in Diplopia Causes of Diplopia Summary 23: Genetics and the Eye Basic Genetic Mechanisms Autosomal Recessive Inheritance Autosomal Dominant Inheritance Sex-Linked Recessive Inheritance Retinitis Pigmentosa Mitochondrial Inheritance Leber’s Hereditary Optic Neuropathy (LHON) Digenic or Polygenic Inheritance Chromosomal Abnormalities Multifactorial Diseases Gene Therapy Summary 24: Drugs and the Eye Introduction Treatment of Infection Drops Which Widen the Pupil Parasympathetic Antagonists Sympathetic Agonist Indications, Effects and Adverse Events for Mydriatics Drops Which Constrict the Pupil Drugs in the Treatment of Open Angle Glaucoma Drugs in the Treatment of Acute Angle Closure Glaucoma Drugs in the Treatment of Allergic Eye Disease Local Anaesthesia in Ophthalmology Drugs and Contact Lenses Artificial Tears Anti-Inflammatory Drugs and the Eye Diagnostic Agents Used the Eye Corneal Protection in Unconscious Patients or Patients with Exposed Eyes Retinal Pharmacotherapy: Anti-Angiogenic Drugs and the Eye, and Intraocular Steroids Vitreomacular Traction Damage to the Eyes by Drugs Administered Systemically Summary Part V: Visual Impairment 25: Blindness Definition Benefits for the Visually Handicapped Standards of Vision for Various Occupations Colour Blindness Incidence and Cause of Blindness Aids for the Visually Impaired Artificial Eyes Further Reading Index