Ophthalmology E-Book

Bruce James

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Lecture Notes
• Sprache: Englisch

Seitenzahl: 405

Veröffentlichungsjahr: 2012

Beschreibung

Beautifully illustrated throughout, Ophthalmology Lecture Notes concentrates on the most common eye problems that health practitioners are expected to diagnose and manage.

The book begins with a brief introduction to ocular anatomy and eye examination, and then focuses on core conditions in ophthalmology. The highly structured text includes self assessment material at the end of each chapter, as well as a series of clinical cases at the end of the book – all designed to facilitate easy access to information, making the book an ideal resource for both study and revision, while the brand new companion website at www.wiley.com/go/james/ophthalmology features all of the book’s illustrations and images.

Whether you need to develop your knowledge for clinical practice, or refresh that knowledge in the run up to examinations, Ophthalmology Lecture Notes will help foster a systematic approach to the clinical situation for all medical students and hospital doctors.

Leseprobe

Contents

Preface to eleventh edition

Preface to first edition

Acknowledgements

Abbreviations

1 Anatomy

Introduction

Gross anatomy

The orbit

The eyelids (tarsal plates)

The lacrimal drainage system

Detailed functional anatomy

The ocular blood supply

The third, fourth and sixth cranial nerves

Multiple choice questions

Answers

2 History, symptoms and examination

Introduction

General ophthalmic history

Specific ophthalmic history

Examination

Multiple choice questions

Answers

3 Clinical optics

Introduction

Ametropia

Accommodation and presbyopia

Optical correction after cataract extraction

Contact lenses

Spectacles

Low-vision aids

Refractive surgery

Multiple choice questions

Answers

4 The orbit

Introduction

Clinical features

Investigation of orbital disease

Differential diagnosis of orbital disease

Multiple choice questions

Answers

5 The eyelids

Introduction

Abnormalities of lid position

Inflammations of the eyelids

Benign lid lumps and bumps

Malignant tumours

Abnormalities of the lashes

Multiple choice questions

Answers

6 The lacrimal system

Introduction

Abnormalities in tear flow and evaporation – dry eye

Disorders of tear drainage

Infections of the nasolacrimal system

Multiple choice questions

Answers

7 Conjunctiva, cornea and sclera

Introduction

Conjunctiva

Cornea

Sclera

Multiple choice questions

Answers

8 The lens and cataract

Introduction

Cataract

Change in lens shape

Change in lens position (ectopia lentis)

Cataract – the world perspective

Multiple choice questions

Answers

9 Uveitis

Introduction

Epidemiology

Specific conditions associated with uveitis

Sympathetic ophthalmitis

Multiple choice questions

Answers

10 Glaucoma

Introduction

Pathophysiology

Classification

Pathogenesis

Chronic open angle glaucoma

Primary angle closure glaucoma

Secondary glaucoma

Congenital glaucoma

Prognosis of the glaucomas

Multiple choice questions

Answers

11 Retina and choroid

Introduction

Symptoms of retinal disease

Acquiredm acular disease

Vitreous floaters and posterior vitreous detachment

Retinal detachment

Inherited retinal and photoreceptor dystrophies

Juvenile macular dystrophies

Albinism

Retinal tumours

Choroidal lesions, including melanoma

Multiple choice questions

Answers

12 Retinal vascular disease

Introduction

Signs of retinal vascular disease

Diabetic retinopathy

Arterial occlusion

Venous occlusion

Arteriosclerosis and hypertension

Retinopathy of prrematurity

Sickle cell retinopathy

Abnormal retinal blood vessels

Abnormalities of the blood

Multiple choice questions

Answers

13 The pupil and its responses

Introduction

Ocular causes of pupillary abnormality

Neurological causes of an abnormal pupil

Light–near dissociation

Multiple choice questions

Answers

14 Disorders of the visual pathway

Introduction

The optic nerve

The chiasm

Optic tract, radiation and visual cortex

Multiple choice questions

Answers

15 Eye movements and their disorders

Introduction

Anatomy and physiology

Non-paralytic squint

Paralytic squint

Disease of the extraocular muscles

Gaze palsies

Abnormal oscillations of the eyes

Multiple choice questions

Answers

16 Trauma

Introduction

History, symptoms and signs

Examination

Treatment

Prognosis

Multiple choice questions

Answers

17 Tropical ophthalmology: eye diseases in the developing world

Introduction

Providing eye care in the developing world

Cataract

Tropical diseases

Multiple choice questions

Answers

18 Services for the visually handicapped

Introduction

Blind registration

Services for children with impaired sight

Additional help

19 Clinical cases

Introduction

Clinical cases

Self assessment EMQs

Useful references

Textbooks

Basic science

Review journals

Ophthalmic journals

Websites

Organizations producing patient information literature

Answers to EMQs

Appendix: Visual acuity equivalence table

Index

We dedicate this book to Chris Chew, co -contributor and our esteemed friend and colleague, who died in 2004. We valued his insightful contributions, and his company is missed

This edition first published 2011 © 2011 by Bruce James and Anthony Bron

First published 1960

Second edition 1965

Third edition 1968

Fourth edition 1971

Fifth edition 1974

Sixth edition 1980

Seventh edition 1986

Eighth edition 1997

Ninth edition 2003

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell.

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Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

James, Bruce, 1957-

Lecture notes. Ophthalmology/Bruce James, Anthony Bron. - 11th ed.

p.; cm.

Ophthalmology

Includes bibliographical references and index.

ISBN-13: 978-1-4443-3558-3 (pbk.: alk. paper)

ISBN-10: 1-4443-3558-8 (pbk.: alk. paper)

1. Ophthalmology-Outlines, syllabi, etc. I. Bron, Anthony J. II. Title. III. Title: Ophthalmology.

[DNLM: 1. Eye Diseases-Handbooks. 2. Eye Diseases-Problems and Exercises. WW 39]

RE50.T73 2011

617.7-dc22

2011007516

Preface to eleventh edition

Welcome to the 11th edition of Ophthalmology Lecture Notes! As in the past, our aim has been to make the diagnosis and management of eye disease a palatable process and once again we stress the value of a good history and careful clinical examination of the eye.

The eye is remarkably accessible. Optical and digital techniques give access to the structures of the eye at cellular level. Specular microscopy can image the corneal endothelial cells which regulate corneal hydration and transparency; digital fluorescein angiography allows the retinal capillary bed to be explored in ischaemic retinal disease; optical coherence tomography allows the layers of the retina to be dissected and confocal microscopy provides a three-dimen-sional view of the optic nerve head. The shape of the cornea can be plotted digitally and, outside the globe, orbital structures and the visual pathway can be viewed by neuroimaging.

Therapeutically, lasers are used to relieve acute, angle closure glaucoma, to lower ocular pressure in chronic glaucoma, to open up an opaque lens capsule following cataract surgery and to seal retinal holes. Sight-threatening diabetic retinopathy can be treated effectively by retinal photocoagulation, to remove the angiogenic stimulus to vasoproliferation. More recently it has become possible to inhibit new vessel formation in diabetic retinopathy, macular degeneration and other retinal vascular disorders by intravitreal injections of anti-angiogenic drugs.

These techniques are matched by technological innovations in microsurgery, responsible for dramatic advances in cataract and vitreoretinal surgery. Cataracts are now removed by phacoemulsification, using an oscillating ultrasonic probe, and optical function is restored by insertion of a lens which unfolds within the eye. Vitreoretinal surgery employs inert gases to flatten the detached retina and endoscopic probes which allow manipulations in the vitreous space and the dissection of microscopic membranes from the retinal surface.

Despite these advances, most ophthalmic diagnoses can still be made from a good history and clinical examination of the eye. This book aims to teach skills which will be useful to anyone engaged in medical practice. Many systemic disorders have ocular features which are critical in diagnosis. This book covers the ophthalmic features of systemic hypertension, diabetes, sarcoidosis, endocarditis, demyelinating disease and space-occupying lesions of the brain. It also explains how to recognize iritis, distinguish various forms of retinopathy and understand the difference between papilloedema and papillitis.

As in the tenth edition, each chapter provides a set of learning objectives and a summary of key points, as well as bullet lists for emphasis. You can test your understanding with the multiple choice questions and picture quizzes at the end of each chapter. In this edition, we have updated all the chapters and added new extended matching questions (EMQs) to bring this small volume up to date.

Chapter 19 offers classical case histories, which will let you test your diagnostic skills. The final section of the book provides a list of further reading and the details of attractive websites which offer an expanded view of the speciality. Try some of these out.

We hope that you will have as much fun reading these Lecture Notes as we did putting them together.

Bruce James

Anthony Bron

Preface to first edition

This little guide does not presume to tell the medical student all that he needs to know about ophthalmology, for there are many larger books that do. But the medical curriculum becomes yearly more congested, while ophthalmology, still the ‘Cinderella’ of medicine, is generally left until the last, and only too readily goes by default. So it is to these harassed final year students that the book is principally offered, in the sincere hope that they will find it useful; for nearly all eye diseases are recognized quite simply by their appearance, and a guide to ophthalmology need be little more than a gallery of pictures, linked by lecture notes.

My second excuse for publishing these lecture notes is a desire I have always had to escape from the traditional textbook presentation of ophthalmology as a string of small isolated diseases, with long unfamiliar names, and a host of eponyms. To the nineteenth century empiricist, it seemed proper to classify a long succession of ocular structures, all of which emerged as isolated brackets for yet another sub catalogue of small and equally isolated diseases. Surely it is time now to try and harness these miscellaneous ailments, not in terms of their diverse morphology, but in simpler clinical patterns; not as the microscopist lists them, but in the different ways that eye diseases present. For this, after all, is how the student will soon be meeting them.

I am well aware of the many inadequacies and omissions in this form of presentation, but if the belaboured student finds these lecture notes at least more readable, and therefore more memorable, than the prolix and time honoured pattern, perhaps I will be justified.

Patrick Trevor-Roper

Acknowledgements

Numerous colleagues have provided valuable advice in their specialist areas, for which we are most grateful. The authors wish to thank Tom Meagher and Manoj Parulekar for providing additional pictures for the eleventh edition. We are particularly grateful to Professor Allen Foster at the London School of Hygiene and Tropical Medicine, who kindly provided the illustrations for the chapter on tropical ophthalmology. Asha Sharma kindly provided orthoptic advice. Thanks are due also to our editors and the staff at Wiley Blackwell for their encouragement, efficiency and patience during the production of this edition. We are also grateful to our copy editor, Joanna Brocklesby, for her meticulous reading of the text.

Bruce James

Anthony Bron

Abbreviations

AIDS acquired immunodeficiency syndrome AION anterior ischaemic optic neuropathy AMD age -related macular degeneration ARM age -related maculopathy CMV cytomegalovirus CNS central nervous system CRVO central retinal vein occlusion CSF cerebrospinal fluid CT computed tomography DCR dacryocystorhinostomy ENT ear, nose and throat ERG electroretinogram ESR erythrocyte sedimentation rate GCA giant cell arteritis GI gastrointestinal GPC giant papillary conjunctivitis HAART highly active anti-retroviral therapy HIV human immunodeficiency virus HLA human leucocyte antigen HSV herpes simplex ICG indocyanine green angiography INR international normalized ratio IOL intraocular lens KP keratic precipitate LASEK laser assisted subepithelial keratomileusis LASIK laser assisted in situ keratomileusis LGB lateral geniculate body MLF medial longitudinal fasciculus MRA magnetic resonance angiogram MRI magnetic resonance imaging NSAID non steroidal anti-inflammatory drug OCT optical coherence tomogram PAS peripheral anterior synechiae PEE punctate epithelial erosions PHMB polyhexamethylene biguanide PMN polymorphonuclear leucocyte PPRF parapontine reticular formation PRK photorefractive keratectomy PS posterior synechiae PVR proliferative vitreoretinopathy RAPD relative afferent pupil defect RPE retinal pigment epithelium TB tuberculosis TNF tumour necrosis factor UV ultraviolet VA visual acuity VEGF vascular endothelial growth factor VKH Vogt- Koyanagi- Harada disease

1

Anatomy

Learning objective

To learn the anatomy of the eye, the orbit and the third, fourth and sixth cranial nerves, to permit an understanding of medical conditions affecting these structures.

Introduction

A knowledge of ocular anatomy and function is important to the understanding of eye diseases. A brief outline is given below.

Gross anatomy

The eye (Figure 1.1) comprises:

A tough outer coat which is transparent anteriorly (thecornea) and opaque posteriorly (the sclera). The junction between them is called the limbus. The extraocular muscles attach to the outer sclera while the optic nerve leaves the globe posteriorly.A rich vascular coat (the uvea) forms the choroid posteriorly and the ciliarybody and iris anteriorly. The choroid lines the retina, to which it is firmly attached and nourishes its outer two-thirds.The ciliary body contains the smooth ciliary muscle, whose contraction allows the lens to take up a more curved shape which permits focusing for near objects. The ciliary epithelium secretes aqueous humour and maintains the ocular pressure. The ciliary body provides attachment for the iris, which forms the pupillary diaphragm.The lens lies behind the iris, supported by the zonular fibrils, which run from the lens equator to the ciliary body. When the eye is focused for distance, tension in the zonule maintains a flattened profile of the lens.The cornea anteriorly and the iris and central lens posteriorly form the ante-rior chamber, whose periphery is the iridocorneal angle or drainage angle. The angle is lined by a meshwork of cells and collagen beams called the trabecular meshwork, through which aqueous drains into Schlemm’s canal and thence into the venous system via the aqueous veins. This is the basis of aqueous drainage.Between the iris, lens and ciliary body lies the posterior chamber, a narrow space distinct from the vitreous body. Both the anterior and posterior chambers are filled with aqueous humour. Between the lens and the retina lies the vitreous body, occupying most of the posterior segment of the eye.