Practical Ophthalmology: A Manual for Beginning Residents PDF
Preview Practical Ophthalmology: A Manual for Beginning Residents
Practical Ophthalmology: A Manual for Beginning Residents Seventh Edition Preston H. Blomquist, MD Executive Editor American Academy of Ophthalmology 655 Beach Street P.O. Box 7424 San Francisco, CA 94120-7424 Clinical Education Secretaries Louis B. Cantor, MD Senior Secretary for Clinical Education Christopher J. Rapuano, MD Secretary for Ophthalmic Knowledge Ophthalmology Liaisons Committee Samuel P. Solish, MD, Chair Richard C. Allen, MD, PhD, FACS Humeyra Karacal, MD Joseph T. Nezgoda, MD, MBA Martha P. Schatz, MD Diana J. Shamis, COMT Howard S. Weiss, MD Academy Staff Dale E. Fajardo, EdD, Vice President, Education Beth Wilson, Director, CME & Programs Susan R. Keller, Acquisitions Editor Kimberly Torgerson, Publications Editor D. Jean Ray, Production Manager Denise Evenson, Design Daniel Mummert, Director, Online Education and the ONE Network Jasmine Chen, Manager, E-Learning Eric Gerdes, Interactive Designer Donna Scism, E-Editor/Proofreader Debra Marchi, CCOA, Administrative Assistant The Academy provides this material for educational purposes only. It is not intended to represent the only or best method or procedure in every case, nor to replace a physician’s own judgment or give specific advice for case management. Including all indications, contraindications, side effects, and alternative agents for each drug or treatment is beyond the scope of this material. All information and recommendations should be verified, prior to use, with current information included in the manufacturers’ package inserts or other independent sources, and considered in light of the patient’s condition and history. Reference to certain drugs, instruments, and other products in this publication is made for illustrative purposes only and is not intended to constitute an endorsement of such. Some materials may include information on applications that are not considered community standard, that reflect indications not included in approved FDA labeling, or that are approved for use only in restricted research settings. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use, and to use them with appropriate patient consent in compliance with applicable law. The Academy specifically disclaims any and all liability for injury or other damages of any kind, from negligence or otherwise, for any and all claims that may arise out of the use of any recommendations or other information contained herein. The following contributors state that within the past 12 months, they have had the following financial relationships: JoAnn A. Giaconi, MD: (C) Allergan. Diana J. Shamis, COMT: (L) Florida State College Jacksonville, University of Florida, Department of Ophthalmology; (C) Touchstone Certification, Vanderbilt University, Department of Ophthalmology. (C=Consultant/advisor, L=lecture fees.) The following contributors who contributed to the development of this product state that within the past 12 months, they have had no financial interest in or other relationship with any entity discussed in this book that produces, markets, resells, or distributes ophthalmic health care goods or services consumed by or used in patients, or with any competing commercial product or service: Richard C. Allen, MD, PhD, FACS; Preston H. Blomquist, MD; Amy S. Chomsky, MD; Humeyra Karacal, MD; Susan R. Keller; Joseph T. Nezgoda, MD, MBA; Samuel P. Solish, MD; Kimberly Torgerson; Howard S. Weiss, MD. AAO, American Academy of Ophthalmology, BCSC, The Eye M.D. Association, OPHTHALMOLOGY, ONE, The Ophthalmic News & Education Network, Preferred Practice Pattern, are, among other marks, the registered trademarks and trademarks of the American Academy of Ophthalmology. ® Copyright© 2015 American Academy of Ophthalmology . All rights reserved. Library of Congress Cataloging-in-Publication Data Practical ophthalmology : a manual for beginning residents / Preston H. Blomquist, executive editor.—Seventh edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-61525-614-3 Blomquist, Preston H., editor. II. American Academy of Ophthalmology, issuing body. [DNLM: 1. Eye Diseases—diagnosis. 2. Diagnostic Techniques, Ophthalmological. 3. Ophthalmology—methods. WW 141] RE75 617.7′15—dc23 2015019491 Printed in the United States of America 19 18 17 16 15 1 2 3 4 Contents Preface Acknowledgments 1 Introduction to the Practice of Ophthalmology Practicing Ophthalmology Responsibilities of the Resident Stress During Residency Training Recognizing Stress and Its Sources Dealing With Early Discouragement Ethical Considerations Education and Training Pitfalls and Pointers Suggested Resources 2 Overview of the Ophthalmic Evaluation History Examination Ophthalmic Equipment Ancillary Equipment Physician Demeanor and Approach to the Patient Pediatric Patients Elderly Patients Medical Record Keeping Pitfalls and Pointers Suggested Resources 3 History Taking Goals of the History Methods of Recording the History Components of the History Chief Complaint History of the Present Illness Past Ocular History Ocular Medications General Medical and Surgical History Systemic Medications Allergies Social History Family History Review of Systems Pitfalls and Pointers Suggested Resources 4 Visual Acuity Examination Testing Conventions and Materials Measurement Notation Test Targets Standard Abbreviations Testing Procedures Distance Acuity Test Pinhole Acuity Test Near Acuity Test Other Tests of Near Vision Acuity Tests for Special Patients Low-Vision Testing Testing Children and Special Adults Variables in Acuity Measurements Uncorrectable Visual Acuity Amblyopia Other Tests of Sensory Visual Function Pitfalls and Pointers Suggested Resources 5 Refraction Overview of Refraction Overview of Ophthalmic Optics Principles of Vergence Types of Lenses Refractive States of the Eye Lens Notation Lens Transposition Spherical Equivalent Lensmeter Retinoscopy and Refinement Instrumentation Retinoscopy Technique Neutralization With a Retinoscope Determining Cylinder Summary of Retinoscopy Steps Refinement Cycloplegic Refraction Duochrome Test Binocular Balancing Near Point and Reading Add Guidelines for Prescribing Glasses General Prescribing Guidelines Prescriptions for Myopia Prescriptions for Hyperopia Prescriptions for Astigmatism Prescriptions for Presbyopia Optical Fitting Considerations Pantoscopic Tilt Interpupillary Distance Pitfalls and Pointers Suggested Resources 6 Ocular Motility Examination Strabismus Terminology Motility Terminology Function of the Extraocular Muscles Ocular Motility Examination Overview of Examination Evaluation of Eye Movements Tests of Alignment Red Reflex Test Corneal Light Reflection Test Cover Tests Other Considerations with Alignment Tests Tests of Binocularity and Fusion Stereopsis Other Tests of Binocular Status Pitfalls and Pointers Suggested Resources 7 Pupillary Examination Anatomy of Pupillary Pathways Parasympathetic Pathway (Light-Reflex Pathway) Near-Reflex Pathway Sympathetic Pathway Examination of the Pupils General Pupillary Observation Light-Reflex Test Swinging Flashlight Test Near-Reflex Test Abnormal Pupils Iris Abnormalities Relative Afferent Pupillary Defect Light–Near Dissociation Horner Syndrome The Fixed and Dilated Pupil Pitfalls and Pointers Suggested Resources 8 Visual Field Examination The Visual Field Screening Tests Confrontation Fields Testing Amsler Grid Test Special Situations Manual Perimetry Automated Perimetry Test Targets and Strategies Interpretation of a Computerized Printout Common Visual Field Defects Localizing Visual Field Defects Progression Pitfalls and Pointers Suggested Resources 9 External Examination Situating the Patient General Observation Inspection Head and Face Orbit Eyelids Lacrimal System Globe Palpation Head and Face Orbit Eyelids Lacrimal System Globe Auscultation Pitfalls and Pointers Suggested Resource 10 Slit-Lamp Biomicroscopy Uses of the Slit Lamp Parts of the Slit Lamp The Viewing Arm The Illumination Arm The Patient-Positioning Frame The Base Other Attachments Preparing and Positioning the Patient Principles of Slit-Lamp Illumination Diffuse Illumination Direct Focal Illumination Specular Reflection Transillumination Indirect Lateral Illumination Sclerotic Scatter Oscillatory Illumination Special Techniques The Slit Lamp as a Measuring Device Gonioscopy Fundus Examination With the Slit Lamp Goldmann Tonometry Slit-Lamp Photography Pitfalls and Pointers 11 Anterior Segment Examination Overview of the Anterior Segment Examination Lacrimal Gland and Skin Eyelid and Eyelashes Tumors Blepharitis Conjunctiva Palpebral Conjunctiva Limbal Conjunctiva Bulbar Conjunctiva Other Conjunctival Abnormalities Episclera and Sclera Episcleritis Scleritis Pigmentations Involutional Hyaline Plaques Tear Film Overall Wetness Tear Meniscus
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