The Wills Eye Hospital Atlas of Clinical Ophthalmology

495 Pages·2001·50.34 MB·English

by  William Tasman

The Wills Eye Hospital Atlas 
of Clinical Ophthalmology

Second Edition
2001
Lippincott Williams & Wilkins
Philadelphia
530 Walnut Street, Philadelphia, PA 19106 USA, http://www.lww.com/
0-7817-2774-X
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means,
including photocopying, or utilized by any information storage and retrieval system without written permission for the copyright
owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals
as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright.
Printed in China
Library of Congress Cataloging-in-Publication Data
The Wills Eye Hospital atlas of clinical ophthalmology / edited by William Tasman, Edward A. Jaeger; associate editors, James J.
Augsburger … [et al.].—2nd ed.
p.; cm.
Includes bibliographical references and index.
ISBN 0-7817-2774-X
1. Eye—Diseases—Atlases. 2. Ophthalmology—Atlases. I. Title: Atlas of clinical ophthalmology. II. Tasman, William, 1929–III.
Jaeger, Edward A. IV. Wills Eye Hospital (Philadelphia, Pa.)
[DNLM: 1. Eye Diseases—Atlases. WW 17 W741 2001]
RE71.W55 2001
617.7′1—dc21
2001020374
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However,
the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the
information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of
the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the
practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in
accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in
government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to
check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is
particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in
restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device
planned for use in their clinical practice.
10 9 8 7 6 5 4 3 2 1
Dedication
To the past and present members of the Wills Eye Hospital Attending, Resident, and Fellow staffs whose dedication to
patient care, teaching, and sharing of knowledge has been the hallmark of Wills since 1832.
Jefferson Medical College, Thomas Jefferson University;
Director, Cornea Service, Wills Eye Hospital, Philadelphia,
Pennsylvania
Chapter 1
Helen V. Danesh-Meyer F.R.A.C.O.
Discipline of Ophthalmology, University of Auckland, Auckland,
New Zealand

Valsalva induced boat-shaped sub-hyaloid hemorrhage overlying the macula of a Chapter 9
23-year-old lifeguard, sustained while struggling to launch his lifeboat into a
David H. Fischer M.D.
rough Jersey shore surf.
Edited by Associate Professor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University;
Associate Ophthalmologist, Hospital of the University of
William Tasman M.D. Pennsylvania; Associate Surgeon, Director of Uveitis, Retina
Service, Wills Eye Hospital, Philadelphia, Pennsylvania
Professor and Chairman
Department of Ophthalmology, Jefferson Medical College, Chapter 8
Thomas Jefferson University; Ophthalmologist-in-Chief, Wills
Eye Hospital, Philadelphia, Pennsylvania
Joseph C. Flanagan M.D.
Professor of Ophthalmology
Edward A. Jaeger M.D.
Jefferson Medical College, Thomas Jefferson University;
Professor of Ophthalmology Director, Oculoplastic Service, Wills Eye Hospital, Philadelphia,
Jefferson Medical College, Thomas Jefferson University; Pennsylvania
Attending Surgeon, Wills Eye Hospital, Philadelphia,
Chapter 10
Pennsylvania
Associate Editors Peter R. Laibson M.D.
Professor of Ophthalmology
James J. Augsburger M.D. Jefferson Medical College, Thomas Jefferson University; Co-
Director, Cornea Department, Wills Eye Hospital, Philadelphia,
Professor and Chairman
Pennsylvania
Department of Ophthalmology, University of Cincinnati College
of Medicine, Cincinnati, Ohio; Ophthalmologist-in-Chief, The Chapter 1
University Hospital, Cincinnati, Ohio
Robert A. Mazzoli M.D., F.A.C.S.
Chapter 7
Clinical Assistant Professor
Jonathan B. Belmont M.D. Surgery (Ophthalmology), Uniformed Services University of the
Health Sciences; Chairman, Ophthalmology; Director,
Associate Surgeon
Ophthalmic Plastic, Reconstructive, and Orbital Surgery,
Retina Department; Co-Director, Uveitis Service, Retina
Madigan Army Medical Center, Tacoma, Washington
Department, Wills Eye Hospital, Philadelphia, Pennsylvania
Chapter 10
Chapter 8
Christopher J. Rapuano M.D.
William E. Benson M.D.
Associate Professor of Ophthalmology
Professor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University; Co-
Jefferson Medical College, Thomas Jefferson University;
Director, Refractive Surgery, Cornea Service, Wills Eye Hospital,
Director, Retina Service, Wills Eye Hospital, Philadelphia,
Philadelphia, Pennsylvania
Pennsylvania
Chapter 1
Chapter 4
Carl D. Regillo M.D.
Gary C. Brown M.D.
Associate Professor of Ophthalmology
Professor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University;
Jefferson Medical College, Thomas Jefferson University;
Associate Surgeon, Wills Eye Hospital, Philadelphia,
Director, Retina Vascular Unit, Wills Eye Hospital, Philadelphia,
Pennsylvania
Pennsylvania
Chapter 4
Chapter 5
Peter J. Savino M.D.
Joseph H. Calhoun M.D.
Professor of Ophthalmology
Chief
Jefferson Medical College, Thomas Jefferson University;
Pediatric Ophthalmology, Wills Eye Hospital, Philadelphia,
Director, Neuro-Ophthalmology Service, Wills Eye Hospital,
Pennsylvania
Philadelphia, Pennsylvania
Chapter 11
Chapter 9
Elisabeth J. Cohen M.D.
Bruce M. Schnall M.D.
Professor of Ophthalmology
Associate Surgeon
Pediatric Ophthalmology, Wills Eye Hospital, Philadelphia,
Neal H. Atebara M.D.
Pennsylvania
Assistant Clinical Professor
Chapter 11
Department of Surgery, University of Hawaii School of Medicine,
Retina Center of Hawaii; Staff Surgeon, Ophthalmology, Queen's
Carol L. Shields M.D. Medical Center, Honolulu, Hawaii
Associate Professor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University; Augusto Azuara-Blanco M.D., Ph.D.
Attending Surgeon, Ocular Oncology, Wills Eye Hospital,
Consultant Ophthalmic Surgeon
Philadelphia, Pennsylvania
Aberdeen Royal Infirmary, Aberdeen, United Kingdom
Chapter 6
Chapter 3
Jerry A. Shields M.D.
Edward H. Bedrossian Jr. M.D., F.A.C.S.
Professor of Ophthalmology
Assistant Professor
Jefferson Medical College, Thomas Jefferson University;
Department of Ophthalmology, Jefferson Medical College,
Director, Oncology Service, Wills Eye Hospital, Philadelphia,
Thomas Jefferson University; Attending Surgeon, Oculoplastic
Pennsylvania
Surgery Department, Wills Eye Hospital, Philadelphia,
Chapter 6 Pennsylvania
Chapter 10
S. Gregory Smith M.D.
Attending Surgeon Ralph C. Eagle Jr. M.D.
Cataract and Primary Eye Care Services, Wills Eye Hospital,
Director
Philadelphia, Pennsylvania
Department of Pathology; The Noel T. and Sara L. Simmonds
Chapter 2 Professor of Ophthalmic Pathology, Wills Eye Hospital; Professor
of Ophthalmology and Pathology, Jefferson Medical College,
Thomas Jefferson University, Philadelphia, Pennsylvania
George L. Spaeth M.D.
Chapter 2
Louis J. Esposito Glaucoma Research Professor
Jefferson Medical College; Director, Glaucoma Service, Wills
Eye Hospital, Philadelphia, Pennsylvania Jeffrey D. Henderer M.D.
Chapter 3 Assistant Professor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University;
Assistant Surgeon, Wills Eye Hospital, Philadelphia,
Secondary Editors
Pennsylvania
Chapter 3
Jonathan Pine
Acquisitions Editor
Edward A. Jaeger M.D.
Kerry Barrett Professor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University;
Developmental Editor
Attending Surgeon, Wills Eye Hospital, Philadelphia,
Janice Stangel Pennsylvania
Production Editor Chapter 2
Penny Bice
L. Jay Katz M.D.
Production Editor
Professor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University;
Colin Warnock
Attending Surgeon, Wills Eye Hospital, Philadelphia,
Manufacturing Manager Pennsylvania
Mark Lerner Chapter 3
Cover Designer
Marlene R. Moster M.D.
Maryland Composition Professor of Ophthalmology
Compositor Jefferson Medical College, Thomas Jefferson University;
Attending Surgeon, Glaucoma Service, Wills Eye Hospital,
Philadelphia, Pennsylvania
Chapter 3
Jonathan S. Myers M.D.
Instructor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University;
Assistant Surgeon, Wills Eye Hospital, Philadelphia,
Pennsylvania
Two retinal tears in the superior arcade and a macular hole secondary to trauma
Chapter 3
in a mentally challenged 17-year-old with head-banging tendencies.
Contributors
Robert B. Penne M.D.
Instructor
Ophthalmology, Jefferson Medical College, Thomas Jefferson
University; Associate Surgeon, Oculoplastic Department, Wills
Eye Hospital, Philadelphia, Pennsylvania
Chapter 10
Douglas J. Rhee M.D.
Assistant Professor
Department of Ophthalmology, Jefferson Medical College,
Thomas Jefferson University; Assistant Surgeon, Wills Eye
Hospital, Philadelphia, Pennsylvania
Chapter 3
Mary A. Stefanyszyn M.D.
Clinical Instructor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University;
Associate in Surgery, Wills Eye Hospital, Philadelphia,
Pennsylvania
Chapter 10
William Tasman M.D.
Professor and Chairman
Department of Ophthalmology, Jefferson Medical College,
Thomas Jefferson University; Ophthalmologist-in-Chief, Wills
Eye Hospital, Philadelphia, Pennsylvania
Chapters 2 and 5
Annette K. Terebuh M.D.
Private Practice
Bellefontaine, Ohio
Chapter 3
Richard P. Wilson M.D.
Professor of Ophthalmology
Jefferson Medical College, Thomas Jefferson University;
Attending Surgeon, Glaucoma, Wills Eye Hospital, Philadelphia,
Pennsylvania
Chapter 3
Preface

Persistent tunica vasculosis in a premature infant with retinopathy of prematurity.
As this second edition goes to press, Wills is moving to its fourth home during its 168-year history. Thus, it is an exciting time and
perhaps fitting that this second edition is being published as this transition is being made. In the first edition, we pointed out how
many artists have focused on the eye as almost a theme in many of their paintings. Eye disorders, as a matter of fact, can be traced
to artists such as Monet who developed cataracts. During the development of these cataracts, his portrayal, for example, of the
Japanese footbridge at his home in Giverny, changed considerably.
What has not changed, however, is the importance of visual illustrations of eye diseases. Since our first edition, it has now become
quite common to store these images on computer disks, which facilitates storage and organization of the material. As these changes
take place, Wills medical staff continues to contribute to the literature and to the collection of photographs in our archives. The
second edition of this Atlas contains 11 chapters and over 1400 illustrations, which cover ocular conditions from the front of the eye
to the back. As before, we have developed a CD-ROM version of the Atlas complete with animation and voice over, which has been
expanded from the first edition.
We hope that readers will find this second effort a helpful resource.
Acknowledgments

Serpiginous choroiditis in a 49-year-old male who was visually symptomatic for 15 months. Vision in the right eye was 20/200. (Photograph courtesy of Jay Klancnik, M.D.
and Mary Jude Cox, M.D.).
The editors would like to gratefully acknowledge all the individuals who contributed to the initial development of this textbook and
to those who participated in this second edition. This includes members of the Wills Eye Hospital staff as well as members of our
private office staffs. Without their assistance in manuscript preparation, slide discovery, and information gathering, the textbook
would not have been produced in such a timely fashion.
Daniel P. Montzka, M.D., a wizard on the computer, provided invaluable assistance in the initial editing of the printed manuscript
and continues to be extremely in strumental in revising the companion CD-ROM. Ralp h C. Eagle, Jr., M.D., provided many of the
histopathology slides, descriptions, and clinical-pathologic correlations. He has added considerable material to the CD-ROM version
of the second edition. We are also grateful to Neal Atebara, M.D., for providing illustrations throughout the text and coordinating
the optics section in the CD-ROM.
We would esp ecially like to thank Robert E. Curtin II, Jack Sc ully, and Roger Barone of the Wills Eye Hospital Audio Visual
Department for their dedicated efforts in coordinating the illustrations as well as assisting in preparation of the CD-ROM.
Finally, we would like to express our appreciation to the staff of Lippincott, Williams & Wilkins for their invaluable assistance in the
development of this textb ook. Developmental Editor K erry Barrett provided expert edit orial assistance and was always readily
available. Without her pleasant and persistent attention to detail and her editorial expertise, the end product would have been
much more difficult to attain. J. Stuart Freeman, Jr., the irrepressible retiring Senior Editor at Lippincott, originally suggested the
idea of compiling the extensive and varied Wills Eye Hospital Clinical experience in th e form of an atlas. Present Senior Executive
Editor, Jonathan Pine, has c ontinued Stuart's tradition and has been very supportive. We greatly appreciated the encouragement
and direction of these individuals and we hope this second edition continues to justify their confidence.
Contents
Dedication
Authors
Preface
Acknowledgments
Contents
Chapter 1 External Diseases
Chapter 2 Lens
Chapter 3 Glaucoma
Chapter 4 Vitreoretinal Disorders
Chapter 5 Retinal Vascular Disease
Chapter 6 Tumors of the Uveal Tract
Chapter 7 Retinal Tumors
Chapter 8 Intraocular Inflammation
Chapter 9 Neuro-ophthalmology
Chapter 10 Oculoplastics
Chapter 11 Pediatric Ophthalmology
Subject Index
P.1

Chapter 1
External Diseases
Elisabeth J. Cohen
Christopher J. Rapuano
Peter R. Laibson

Recurrent lattice corneal dystrophy in a corneal transplant before (A) and after (B) excimer laser phototherapeutic keratectomy.