Corneal Emergencies PDF
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Corneal Emergencies Bhavana Sharma Jeewan S. Titiyal Editors 123 Corneal Emergencies Bhavana Sharma • Jeewan S. Titiyal Editors Corneal Emergencies Editors Bhavana Sharma Jeewan S. Titiyal Department of Ophthalmology Cornea, Cataract and Refractive Surgery All India Institute of Medical Sciences Services Bhopal, India Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India ISBN 978-981-16-5875-4 ISBN 978-981-16-5876-1 (eBook) https://doi.org/10.1007/978-981-16-5876-1 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Foreword The contemporary medical literature affirms that the most common ophthalmic diagnoses addressed in emergency departments are problems related to the anterior structures of the eye, including the lids, cornea and conjunctiva. For this reason, both the ophthalmologist and the emergency medicine physician must be able to recognize, triage and manage these disorders effectively. In this volume, Profs Sharma and Titiyal and their colleagues have compiled a truly comprehensive trea- tise on urgent and emergent disorders of the cornea and external eye. Beginning with the basic pathophysiology of corneal injuries and the requisites for diagnosis and treatment, this book progresses from minor corneal injuries to severe trauma, corneal infections, management of perforations, chemical injuries, postsurgical complications, contact lens-associated emergencies, peripheral ulcer- ative keratitis, complications of ectatic diseases, systemic inflammatory diseases affecting the ocular surface, keratomalacia and the medicolegal aspects of corneal emergencies. In the setting of a busy emergency department, ocular emergencies are often deemed less urgent, even when permanent vision loss may be the result. The reason for this, in part, is the press of potentially life-threatening emergencies that may preempt attention to other ‘less immediate’ issues. However, the downgrading of urgency may also be the result of lack of familiarity with the nature of corneal emer- gencies. For this reason, it is even more important that the emergency medicine physician understand the degree of urgency that accompanies corneal disease and trauma in the emergency department. Enlisting a group of experienced clinicians as contributors, the editors provide us with a book that is a truly comprehensive resource for the corneal specialist, the general ophthalmologist and the emergency medicine physician. Both a scholarly text and a useful ‘manual’, this volume will be an important clinical opus in our field. Mark J. Mannis, MD, FACS Fosse Endowed Chair in Vision Science Research Professor and Chair Department of Ophthalmology and Vision Science University of California Davis Eye Center Davis, Sacramento, CA, USA v Preface Corneal emergencies are one of the most common ocular emergencies. They may be accidental or iatrogenic in nature and encompass a plethora of conditions including trauma, infections, chemical injuries and postsurgical complications. Together, they constitute a significant burden of avoidable corneal blindness and warrant immedi- ate intervention to prevent sight-threatening sequelae. This book is a comprehensive compilation of the various corneal emergencies encountered by ophthalmologists in their day-to-day practice. The chapters system- atically cover the basic pathophysiology, clinical examination, essential investiga- tions and treatment algorithms for the different corneal emergencies. Special attention has been paid to incorporate the recent advances in the diagnosis and treat- ment of emergencies associated with ocular surface disorders, corneal ectasia and microbial keratitis. The written material is structured in a lucid fashion with numer- ous tables, flowcharts and colour illustrations to help the readers understand and assimilate the information easily. The highlights of each chapter are summarized at the end as key points in order to provide the important information at a glance. The myriad corneal emergencies may manifest in different forms requiring a good diagnostic acumen and meticulous management approach. The immediate treatment received at the point of first contact is a significant determinant of final visual and anatomical outcomes in any ocular emergency. Ophthalmology, like all of medicine, is increasingly becoming specialized with surgeons mastering specific skill sets; however, a knowledge of corneal emergencies is imperative for all oph- thalmologists regardless of their field of interest. This book provides a comprehen- sive overview of the presentation of various corneal emergencies and details a step-by-step management to enable optimal outcomes. I believe this book would serve as a useful guide and valuable resource not just for the residents and fellows who often handle the emergency department but also for the senior corneal specialists. I would like to express my sincere gratitude to all the authors for their valuable contributions to this book. I would also like to thank Springer publications and their staff for facilitating the publication and distribution of this book. New Delhi, India Jeewan S. Titiyal vii Preface Corneal emergencies are visually debilitating ocular conditions of fairly common occurrence necessitating emergency intervention. Its management has undergone significant transformation with new diagnostic and therapeutic options that have changed the treatment paradigm over the last several decades. The editors and authors have endeavoured to provide the most recent resource for residents, fellows, clinicians and researchers in the management of corneal emergencies. One of the great strengths of this book is the vast experience and clinical expertise of contribu- tors of this book. It gives the distilled experience of the world’s leaders in this field and outlines their approach and justification for the same This book was conceptualized while observing residents as they managed vari- ous emergencies during their training period. I felt that there was a need for a con- cise, informative and practical book on corneal emergencies. Subsequently, I conversed with residents and fellows and also reached out to those who had com- pleted their residency, regarding the need and utility for such a book. The feedback on the need for an authoritative resource in the field of corneal emergencies was unanimous rendering confidence that comprehensive knowledge of corneal emer- gencies can be unravelled through this book. The book deals with an important and yet uncovered subtopic of the cornea through thoughtfully curated chapters, clinical photographs and key points incorpo- rated in the chapters. It intends to provide comprehensive knowledge of corneal emergencies, their risk factors, causative agents, diagnostic pearls, treatment chal- lenges and management options through explanatory flow diagrams and diagnostic and treatment algorithms accompanied by numerous illustrative photographs, dia- grams and sketches. The figures and illustrations have been designed to provide an informative and vivid representation of referenced conditions. Much emphasis is on practical management, supplemented with preferred practice patterns, guidelines and other authoritative sources. Corneal emergencies are an integral part of postgraduate curriculum. This book shall serve as essential reading for postgraduate students, trainees, fellows and oph- thalmic practitioners in addition to supplementary/recommended reading for under- graduate students. Ophthalmic practitioners would immensely benefit from this book by way of its comprehensive approach to the diagnosis and management of corneal emergencies which would further their understanding to better manage such cases and to avoid potential consumer litigations. ix x Preface I am extremely grateful for input, advice and support received from colleagues, staff and students, in particular Dr Deepak Soni who was instrumental in meticulous data curation and overall editing. Dr Sajith Haridas and Dr Ananyan Sampath for their contribution towards skilful sketches and drawings without which many of the images in the book would not have been possible. We thank colleagues From Dr RP Centre AIIMS New Delhi for graciously allowing the use of clinical photographs from their collection. Finally, I would like to acknowledge the support and commit- ment of the staff at Springer Nature in completing the book to perfection. Bringing out a book on a subject like corneal emergencies was enormous and complex and was made possible by the concerted efforts of the contributing authors of this book. I am obliged to all the contributing authors for sharing their knowledge and expertise and the time and effort they have put into the writing of this book. I am extremely grateful to Prof Mark J Mannis for being a source of great inspiration in the field of academics, research and clinical care. He has been kind enough for taking the time to contribute a brilliant foreword for this book. I am indebted to my co-editor Padmashree Prof Jeewan Singh Titiyal for his invaluable help and guid- ance at every step. I would also like to acknowledge my family for their patience and constant support to accomplish this work. We hope this book will benefit students, practising ophthalmologists and thereby the patients for years to come. Happy reading! Bhopal, India Bhavana Sharma About the Editors Bhavana Sharma is currently the Head of Department of Ophthalmology and Dean Examinations at All India Institute of Medical Sciences, Bhopal, India. She completed her graduation and postgraduation from the Regional Institute of Ophthalmology, Bhopal, and was conferred with gold medal for the best outgoing postgraduate student. She further completed her training in cornea and cataract from Dr RP Centre AIIMS, New Delhi. She specializes in Cornea, Cataract and Ocular Surface Diseases. She is presently deliberating her academic, clinical and adminis- trative duties at AIIMS Bhopal in addition to being in charge of cornea clinic and eye bank services. She has numerous publications in international and national jour- nals to her credit, in addition to chapters in various books. She serves as a reviewer for major international and national journals and text books, in addition to being an editorial board member of prestigious international ophthalmology journals. She has been conferred with achievement award of All India Ophthalmological Society for significant contribution towards academics. She has presented more than 150 papers in various conferences and has been awarded best paper awards of cornea, cataract and trauma sessions and the most coveted Best of Best Paper Award. She is frequently invited as guest faculty by various organizations to deliver guest lectures and chair scientific sessions in addition to conducting instruction courses. She has served as vice president, treasurer and general secretary of divisional ophthalmic societies in addition to chair of various institutional and government committees. Jeewan S. Titiyal completed his graduation, postgraduation and training from All India Institute of Medical Sciences (AIIMS), New Delhi, and is presently the chief at Dr Rajendra Prasad Centre For Ophthalmic Sciences, AIIMS New Delhi. His areas of expertise include cataract surgery keratoplasty, refractive surgery, stem cell transplantation, contact lens and low vision aids. He has dedicated his academic career to the pursuit of excellence in the field of Ophthalmology, and this book is a part of his endeavours to transmit knowledge and skills to the generation of Ophthalmologists. He has been invited by various organizations to deliver keynote addresses, orations and guest lectures and chair scientific sessions. Dr Titiyal is the first Indian to perform live surgery at the American Society of Cataract and Refractive Surgery (ASCRS), USA. He has to his credit numerous publications in peer-reviewed journals and various books and chapters as well. He has been awarded xi xii About the Editors the ‘Senior Achievement Award’ by the American Academy of Ophthalmology (2016), the ‘Achievement award’ by the Asia Pacific Academy of Ophthalmology (2015), the APACRS Educator Award (2015), the prestigious RP Dhandha Award and P. Siva Reddy Award by the All India Ophthalmological Society and numerous gold medals. The ‘Padma Shri’, one of the highest civilian awards in 2014, was conferred on him in recognition of his exemplary contributions in the field of medi- cine by the Government of India.
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