Comprehensive Ophthalmology

629 Pages·2015·78.74 MB·English

by  A K Khurana

Comprehensive
Ophthalmology
S I X t h E d I t I O n
Comprehensive
OphthalmOlOgy
aK Khurana
ms faico cto (London)
Senior Professor and Head
Regional Institute of Ophthalmology
Postgraduate Institute of Medical Sciences
Rohtak, India
aruj K Khurana
dnb (Sankara Nethralaya, Chennai) fico
Department of Ophthalmology
Himalayan Institute of Medical Sciences
Jolly Grant, Dehradun (UK), India
Bhawna Khurana
ms dnb fico
Department of Ophthalmology
All India Institute of Medical Sciences (AIIMS)
Rishikesh (UK), India
The Health Sciences Publisher
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Dedicated
To my parents and teachers for their blessings
To my students for their encouragement
To my children for their patience
To my wife for her understanding
Preface
Journey of Comprehensive Ophthalmology, beginning from January 1996, has been satisfying, as it has
succeeded in serving the needs of the students at large. Toroughly revised and updated sixth edition of the
book retains its well accepted style of presenting the text. However, to make it more user-friendly its layout
has been re-organized into six sections as against two sections in the ffth edition.
Section 1: Anatomy and Physiology of Eye includes two chapters. First chapter is devoted to essential
aspects of Anatomy and Development of the Eye, and second chapter covers Physiological aspects of
various ocular structures including Physiology of Vision in a concise manner.
Section II: Optics and Refraction. Out of two chapters of this section one is devoted to Elementary and
Physiological Optics and the other describes Errors of Refraction and Accommodation in depth.
Section III: Diseases of Eye. Tis section covers important diseases of various structure components of the
eyeball, ocular adnexa and visual pathway in fourteen chapters.
Section IV: Ocular Terapeutics. Tis section comprises two chapters one each on Ocular Pharmacology,
and Lasers and Cryotherapy in Ophthalmology.
Section V: Systemic and Community Ophthalmology includes two chapters one on each topic.
Section VI: Practical Ophthalmology. Tis section includes chapters on Clinical Methods in Ophthalmology
and diferent other aspects essential to the practical examinations such as Ophthalmic Cases, Darkroom
Procedures, and Ophthalmic Instruments.
Review of Ophthalmology. Tis companion to the textbook provides an in depth revision of the subject
at a glance and an opportunity for self-assessment, and thus makes it the book of choice for preparing for
various postgraduate entrance examinations.
Salient Features of the Book
ƒ Each chapter begins with a brief overview highlighting the topics covered followed by relevant applied
anatomy and physiology. Te text is then organized in such a way that the students can easily understand,
retain and reproduce it. Various levels of headings, subheadings, bold face and italics given in the text
will be helpful for a quick revision of the subject.
ƒ Text is complete and up-to-date with recent advances. To be true, some part of the text is in more detail
than the requirement of undergraduate students. But this very feature of the book makes it a useful
handbook for the postgraduate students as well.
ƒ Text is illustrated with plenty of diagrams, comprising clinical photographs and clear-line diagrams
which provide vivid and lucid details.
ƒ Operative steps of important surgical techniques have been given in the relevant chapters.
ƒ Wherever possible important information has been given in the form of tables and fow charts.
Sixth Edition of the book has been possible as a result of active criticism, suggestions and generous help
of many teachers and students. Surely, I owe sincere thanks to them all. Tose who need special mention are
Prof. R.C. Nagpal, Prof. Harsh Bahadur and Prof. Renu Dhasmana from HIMS, Jolly Grant, Dehradun; Prof.
G.S. Bajwa, DMC, Ludhiana; Prof. R.N. Bhatnagar, Gian Sagar Medical College, Rajpura; Prof. P.S. Sandhu,
Faridkot; Prof. S.S. Shergill, Amritsar; Prof. Dharamveer, Patiala; Prof. S.M. Bhati and Prof. Nitin Batra from
CMC, Ludhiana; Prof. V.P. Gupta, UCMS, New Delhi; Prof. K.P. Chaudhary, GMC, Shimla; Prof. Atul Kumar,
and Prof. Tanuj Dada from Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi; Prof. Vishnu Gupta
and Prof. B.P. Guliani from VMMC, New Delhi; Prof. Amod Gupta, Prof. Jagat Ram and Prof. M.R. Dogra
from PGIMER, Chandigarh and Dr.Mahipal S. Sachdev, Medical Director, Centre for Sight, New Delhi.
viii Comprehensive Ophthalmology
I acknowledge the special help rendered by Prof. S. Sood from GMC, Chandigarh by contributing fundus
photographs and OCT pictures; Dr. Santosh Honavar from CFS, Hyderabad for some fgures of orbital
tumours and Dr. Shweta Goel for her sincere help in updating this edition. I am grateful to Dr. C.S. Dhull,
Director, PGIMS and Dr. S.S. Sangwan, Vice-Chancellor, University of Health Sciences, Rohtak for providing
an academic atmosphere conducive to such a venture. I acknowledge with humble thanks, the respect,
afection and cooperation of faculty members of Regional Institute of Ophthalmology (RIO), PGIMS, Rohtak
namely Dr. S.V. Singh, Dr. J.P. Chugh, Dr. V.K. Dhull, Dr. R.S. Chauhan, Dr. Manisha Rathi, Dr. Neebha Anand,
Dr. Manisha Nada, Dr. Urmil Chawla, Dr. Ashok Rathi, Dr. Sumit Sachdeva, Dr. Sumeet Khanduja, Dr. Reena
Gupta and Dr. Jitender Phogat.
Te love and moral support, in addition to the editorial help, rendered by my daughter Dr. Arushi,
University of Connecticut, USA, and my wife Dr. Indu Khurana, Senior Professor, Physiology made my task
untiring.
Te enthusiastic cooperation received from Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group
President), Mr Tarun Duneja (Director–Publishing), Ms. Sunita Katla (Publishing Manager), Mr. Rajesh
Sharma (Author Coordinator), and Mr. Sumit Kumar (Graphic Designer), Ms. Seema Dogra (Cover
Designer), Ms. Geeta Srivastava and Geeta Barik (Proof Readers) and Mr. Kapil Dev Sharma (DTP Operator)
of Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, needs special acknowledgement.
Sincere eforts have been made to verify the correctness of the text. However, in spite of best eforts, ventures
of this kind are not likely to be free from human errors, some inaccuracies, ambiguities and typographic
mistakes. Users are therefore requested to send their feedback and suggestions. Te importance of such
views in improving the future editions of the book cannot be overemphasized. Feedbacks received will be
highly appreciated and duly acknowledged.
A K Khurana
viii Comprehensive Ophthalmology
Contents
Preface vi
Section I Anatomy and Physiology of Eye
1. Anatomy and Development of Eye 3
2. Physiology of Eye and Vision 14
Section II Optics and Refraction
3. Elementary and Physiological Optics 23
4. Errors of Refraction and Accommodation 34
Section III Diseases of Eye
5. Diseases of Conjunctiva 59
6. Diseases of Cornea 95
7. Diseases of Sclera 140
8. Diseases of Uveal Tract 146
9. Diseases of Lens 179
10. Glaucoma 219
11. Diseases of Vitreous 257
12. Diseases of Retina 263
13. Neuro-ophthalmology 310
14. Disorders of Ocular Motility 336
15. Disorders of Eyelids 362
16. Diseases of Lacrimal Apparatus 386
17. Diseases of Orbit 401
18. Ocular Injuries 426
Section IV Ocular Therapeutics
19. Ocular Pharmacology 443
20. Lasers and Cryotherapy in Ophthalmology 461
Section V Systemic and Community Ophthalmology
21. Systemic Ophthalmology 467
22. Community Ophthalmology 475