Ophthalmology: lecture notes

253 Pages·126.859 MB·English

by  Bron, Anthony J., James, Bruce, Parulekar, Manoj V

Ophthalmology
Lecture Notes
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Ophthalmology
Lecture Notes
Twelfth Edition
Bruce James
MA,DM,FRCS(Ed),FRCOphth
ConsultantOphthalmologist
DepartmentofOphthalmology
StokeMandevilleHospital
Buckinghamshire
andSchoolofMedicine,St.George’sUniversity,Grenada,WestIndies
Anthony Bron
BSc,FRCOphth,FARVO,FMedSci
ProfessorEmeritus
NuffieldLaboratoryofOphthalmology
UniversityofOxford,Oxford
ProfessorofExperimentalOphthalmology,
VisionandEyeResearchUnit,
AngliaRuskinUniversity,Cambridge
Manoj V. Parulekar
MS,FRCS(Ed),FRCOphth
ConsultantOphthalmologist
BirminghamChildren’sHospital
andOxfordUniversityHospitalsNHSTrust
Thiseditionfirstpublished20172017byBruceJames,AnthonyBronandManojVParulekar
Previouseditions1960,1965,1968,1971,1974,1980,1986,1997,2003,2007,2011
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LibraryofCongressCataloging-in-PublicationData
Names:James,Bruce,1957-author.|Bron,AnthonyJ.,author.|Parulekar,
ManojV.,author.
Title:Lecturenotes.Ophthalmology/BruceJames,AnthonyBron,ManojV.
Parulekar.
Othertitles:Ophthalmology
Description:12thedition.|Chichester,WestSussex;Hoboken,NJ:John
Wiley&Sons,Inc.,2017.|Includesbibliographicalreferencesandindex.
Identifiers:LCCN2016026509(print)|LCCN2016027367(ebook)|ISBN
9781119095903(pbk.)|ISBN9781119095927(pdf)|ISBN9781119095941(epub)
Subjects:|MESH:EyeDiseases|Handbooks|ProblemsandExercises
Classification:LCCRE50(print)|LCCRE50(ebook)|NLMWW39|DDC
617.7–dc23
LCrecordavailableathttps://lccn.loc.gov/2016026509
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Setin8.5/11ptUtopiaStd-RegularbyThomsonDigital,Noida,India
1 2017
Contents
Prefacetotwelfthedition, vii
Prefacetofirstedition, ix
Acknowledgements, xi
Abbreviations, xiii
Aboutthecompanionwebsite, xv
1 Anatomy, 1
2 History,symptomsandexamination, 19
3 Clinicaloptics, 44
4 Theorbit, 50
5 Theeyelids, 56
6 Thelacrimalsystem, 63
7 Conjunctiva,corneaandsclera, 69
8 Thelensandcataract, 84
9 Uveitis, 92
10 Glaucoma, 102
11 Retinaandchoroid, 116
12 Retinalvasculardisease, 133
13 Thepupilanditsresponses, 145
14 Disordersofthevisualpathway, 150
15 Eyemovementsandtheirdisorders, 161
16 Trauma, 175
17 Tropicalophthalmology:eyediseasesinthedevelopingworld, 184
18 Eyediseasesinchildren, 195
19 Servicesforthevisuallyhandicapped, 205
20 Clinicalcases, 208
Usefulreferences, 217
Appendix1:Conversiontableforrepresentationofvisualacuity, 219
Appendix2:Drugsavailableforophthalmicuse, 220
Index, 223

Preface to
twelfth edition
WelcometothetwelftheditionofOphthalmologyLec­ astigmatismandrestoringnearanddistancevisionin
tureNotes!Asinthepast,ouraimhasbeentomakethe somepatientswithouttheneedforglasses.Vitreor­
diagnosisandmanagementofeyediseaseapalatable etinalsurgeryemploysinertgasesandsiliconeoilto
processandonceagainwestressthevalueofagood flatten the detached retina and endoscopic probes
historyandcarefulclinicalexaminationoftheeye. whichallowmanipulationsinthevitreousspaceand
Theeyeisremarkablyaccessible.Opticalanddigital the dissection of microscopic membranes from the
techniques continue to develop giving increasingly retinalsurface.Glaucomasurgeryisdevelopingtiny
detailedaccesstothestructuresoftheeyeatcellular drainageimplantstoreduceintraocularpressure.
level. Specular microscopy can image the corneal Despite these advances, most ophthalmic diag­
endothelial cells which regulate corneal hydration noses can still be made from a good history and
and transparency; optical coherence tomography clinical examination of the eye. This book aims to
allows the layers of the retina to be dissected and teachskillswhichwillbeusefultoanyoneengagedin
recently allowsthe retinalvasculature to beimaged medicalpractice.Manysystemicdisordershaveocu­
withouttheneedforinjectionoffluorescein.Confocal larfeatureswhicharecriticalindiagnosis.Thisbook
microscopyprovidesathree-dimensionalviewofthe covers the ophthalmic features of systemic hyper­
optic nerve head. The shape of the cornea can be tension,diabetes,sarcoidosis,endocarditis,demyeli­
plotteddigitallyand,outsidetheglobe,orbitalstruc­ nating disease and space-occupying lesions of the
tures and the visual pathway can be viewed by brain.Italsoexplainshowtorecognizeiritis,distin­
neuroimaging. guishvariousformsofretinopathyandunderstandthe
Therapeutically, lasers are used to relieve acute, differencebetweenpapilloedemaandpapillitis.
angleclosureglaucoma,tolowerocularpressurein Asintheeleventhedition,eachchapterprovidesa
chronicglaucoma,toopenupanopaquelenscapsule setoflearningobjectivesandasummaryofkeypoints,
following cataract surgery and to seal retinal holes. aswellasbulletlistsforemphasis.Youcantestyour
Theyhaveanestablishedroleinreshapingthecornea understandingwiththequestionsandpicturequizzes
totreatrefractiveerrorsoftheeyeandtheirroleisnow atthe end of each chapter. In thisedition, wehave
extendingtouseincataractsurgeryitself.Sight-threat­ updatedallthechaptersandaddedtotheextended
eningdiabeticretinopathycanbetreatedeffectively matching questions (EMQs) and multiple choice
byretinalphotocoagulation,toremovetheangiogenic questionstobringthissmallvolumeuptodate.
stimulus to vasoproliferation. More recently, it has Chapter20offersclassicalcasehistories,whichwill
become possible to inhibit new vessel formation in letyoutestyourdiagnosticskills.Thefinalsectionof
diabeticretinopathy,maculardegenerationandother the book provides a list of further reading and the
retinalvasculardisordersbyintravitrealinjectionsof detailsofattractivewebsiteswhichofferanexpanded
antiangiogenicdrugs.Rolesforthesedrugsintreating viewofthespeciality.Trysomeoftheseout.
oedemaoftheretina,seeforexampleindiabetes,are We hope that you will have as much fun reading
alsobecomingestablished. theseLectureNotesaswedidputtingthemtogether.
These techniques are matched by technological
innovationsinmicrosurgery,responsiblefordramatic BruceJames
advancesincataractandvitreoretinalsurgery.Optical AnthonyBron
functionincataractsurgeryisrestoredbyinsertionof ManojV.Parulekar
alenswhichunfoldswithintheeye.Thesearebecom­
ingincreasinglycomplexallowingforthetreatmentof