Ophthalmology

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Long considered one of ophthalmology’s premier texts, this award-winning title by Drs. Myron Yanoff and Jay S. Duker remains your go-to reference for virtually any topic in this fast-changing field. In a single, convenient volume, it offers detailed, superbly illustrated guidance on nearly every ophthalmic condition and procedure you may encounter, making it a must-have resource no matter what your level of experience. Extensive updates throughout keep you current with all that’s new in every subspecialty area of the field. Offers truly comprehensive coverage, including basic foundations through diagnosis and treatment advances across all subspecialties: genetics, optics, refractive surgery, lens and cataract, cornea, retina, uveitis, tumors, glaucoma, neuro-ophthalmology, pediatric and adult strabismus, and oculoplastics. Features streamlined, templated chapters, a user-friendly visual layout, and key features boxes for quick access to clinically relevant information and rapid understanding of any topic. Contains nine brand-new chapters covering OCT angiography and optical coherence tomography, small incision lenticule extraction (SMILE), corneal imaging, electrophysiology in neuro-ophthalmology, glaucoma drainage implants, thyroid eye disease, orbital infections, and aesthetic fillers and botulinum toxin for wrinkle reduction. Covers new imaging techniques including wide-field imaging, anterior segment OCT (AS-OCT), and high definition OCT, as well as two completely reorganized sections on optics and refraction and intraocular tumors that provide a more logical and user-friendly approach for enhanced understanding. Includes more than 2,000 high-quality illustrations (most in full color) and an expanded video library with 50 clips of diagnostic and surgical techniques. New videos cover refractive surgery advances, phakic intraocular lenses, combined cataract procedures, nystagmus, eye movement examinations, and more. Expert Consult™ eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

Author(s): Jay S. Duker MD, Myron Yanoff MD
Edition: 5
Publisher: Elsevier
Year: 2020

Language: English
Pages: 1440

Ophthalmology
Copyright Page
User Guide
Color Coding
ExpertConsult Website
Video Contents
Preface
Preface to First Edition
List of Contributors
Acknowledgments
Dedication
1.1 Fundamentals of Human Genetics
Key Features
DNA and the Central Dogma of Human Genetics
Human Genome
Mitosis and Meiosis
Basic Mendelian Principles
Mutations
Genes and Phenotypes
Patterns of Human Inheritance
Autosomal Dominant
Autosomal Recessive
X-Linked Recessive
Mitochondrial Inheritance
Pseudodominance
X-Linked Dominant Inheritance
Digenic Inheritance and Polygenic Inheritance
Imprinting
Molecular Mechanisms of Disease
Autosomal Dominant
Haploinsufficiency
Gain-of-Function Dominant Negative Effect
Autosomal and X-Linked Recessive
Gene Therapy
Key References
References
1.2 Molecular Genetics of Selected Ocular Disorders
Key Features
Introduction
Dominant Corneal Dystrophies
Aniridia, Peter’s Anomaly, Autosomal Dominant Keratitis
Rieger’s Syndrome
Juvenile Glaucoma
Congenital Glaucoma
Nonsyndromic Congenital Cataract
Retinitis Pigmentosa
Stargardt Disease
X-Linked Juvenile Retinoschisis
Norrie’s Disease
Sorsby’s Macular Dystrophy
Gyrate Atrophy
Color Vision
Retinoblastoma
Albinism
Leber’s Optic Neuropathy
Congenital Fibrosis Syndromes and Disorders of Axon Guidance
Autosomal Dominant Optic Atrophy
Complex Traits
Key References
References
1.3 Genetic Testing and Genetic Counseling
Key Features
Genetic Testing
Role of Genetic Testing in the Clinic
Methods for DNA-Based Genetic Testing
Current Recommendations for Genetic Testing for Ophthalmic Diseases
CLIA Laboratories
Genetic Reports
Genetic Counseling
Clinical Evaluation and Family History
Risk Prediction Based on Inheritance
Indications to Refer for Genetic Counseling
Known Inherited Condition
Ocular and Systemic Congenital Anomalies
Specific Eye Diseases
Ocular Defects Associated With Genetic Diseases
Confidentiality
Key References
References
2.1 Light
Key Features
Introduction
Geometrical Optics
Basic Stigmatic Optics
Astigmatic Optics
Wave Properties of Light
Interference
Diffraction
Polarization
Dispersion
Quantum Effects
Fluorescence and Phosphorescence
Lasers
Key References
References
2.2 Optics of the Human Eye
Key Features
Introduction
Cornea
Pupil
Lens
Accommodation
Range and Amplitude
Scattering
Aberrations
Monochromatic Aberrations
Chromatic Aberrations
Retina
Resolution and Focal Length
Refractive Errors
Change in Size or Position or Absence of Optical Elements
Change in the Shape of Optical Elements
Change in Refractive Indexes
Myopia
Hypermetropia
Astigmatism
Presbyopia
Key References
References
2.3 Clinical Refraction
Key Features
Introduction
History
Visual Acuity
Testing Distance
Other Considerations
Contrast Sensitivity
Contrast
Targets
Sine Waves
Recording Contrast Sensitivity
Spherical Equivalent
Detecting Astigmatism
Utility of the Test
Procedure
Instrumentation
Determination of the Cylinder Axis
Determination of Cylinder Power
Rechecking the Sphere
Final Checks
Accommodation
Binocular Balance
Refracting at Near
Additional Subjective Techniques
Retinoscopy
Retinoscope
Optics of Retinoscopy
Neutrality
With and Against Motion
Other Clues
Myopia Estimation
Astigmatism
Key References
References
2.4 Correction of Refractive Errors
Key Features
Introduction
Spectacle Correction
Spectacle Material
Monofocal Spectacles
Bifocals
Progressive Spectacles
Occupational Bifocals
Pantoscopic Tilt and Wrap Angle
Base Curve and Center Thickness
Contact Lenses
Vertex Correction
Rigid Contact Lenses
Special Purpose Contact Lenses
Contact Lens Complications
Soft Contacts
Contact Lens Correction of Presbyopia
Orthokeratology
Intraocular Lenses
Monofocal Intraocular Lenses
Toric IOLs
Presbyopia Correcting Intraocular Lenses
Keratorefractive Surgery
Corneal Inlays
Key References
References
2.5 Ophthalmic Instruments
Key Features
Introduction
Direct Ophthalmoscope
Binocular Indirect Ophthalmoscope
Illumination System
Observation System
Contrast
Inverted Image
Field of View
Magnification
Stereopsis
Fundus Camera
Lighting
Reducing Reflections From the Cornea and Instrument
The Observation System
Field of View
Optical Coherence Tomography
Slit-Lamp Biomicroscope
Illumination
Improving Tissue Contrast
Observation System
Slit-Lamp Fundus Lenses
Goldmann Applanation Tonometer
Specular Microscope
Operating Microscope
Keratometer and Corneal Topographer
Lensmeter
Automated Refractor
Magnifying Devices
Angular Magnification
Magnifying Glass
Galilean Telescope
Simple Microscope (Operating Loupe)
Key References
References
2.6 Wavefront Optics and Aberrations of the Eye
Key Features
Introduction
Ray Aberrations
The Wavefront Approach to Aberrations
Spherical Aberration
Coma
Distortion
Field Curvature (FC)
Oblique Astigmatism (OA)
Higher-Order Aberrations (HOA)
Chromatic Aberration
Measurement of Ocular Aberrations
Mathematical Considerations
An Overall Perspective on Aberration Theory
Key References
References
3.1 Current Concepts, Classification, and History of Refractive Surgery
Key Features
Associated Features
Introduction
Excimer Laser and Ablation Profiles
Laser Ablation Profiles
Munnerlyn’s Formula
Wavefront-Guided Ablation
Topography-Guided Ablation
Wavefront-Optimized/Aspherical/ Q-Factor-Adjusted Laser Profiles
Presbyopia Correction
Concepts in Development
Classification of Refractive Procedures
Cornea
Central Cornea
Corneal Surface: Addition
Epikeratophakia.
Corneal Surface: Subtraction
Photorefractive Keratectomy.
Laser Subepithelial Keratomileusis.
EpiLASIK.
Epi-Bowman Keratectomy (EBK).
Corneal Stroma: Subtraction
Keratomileusis.
Laser-Assisted in situ Keratomileusis.
Femto-LASIK.
Intrastromal Laser Ablation.
Intrastromal Lenticule Extraction.
Corneal Stroma: Addition
Keratophakia.
Intracorneal Inlays.
Corneal Stroma: Relaxation
Lamellar Keratotomy (Hyperopic Automated Lamellar Keratoplasty).
Peripheral Cornea
Peripheral Cornea: Addition
Intracorneal Rings.
Intracorneal Ring Segments.
Peripheral Cornea: Subtraction
Wedge Resection.
Peripheral Cornea: Relaxation
Radial Keratotomy.
Hexagonal Keratotomy.
Astigmatic Keratotomy.
Peripheral Cornea: Coagulation–Compression
Thermokeratoplasty.
Microwave-Induced Thermokeratoplasty: Keraflex Procedure.
Circular Keratorrhaphy.
Peripheral Cornea: Oppression
Orthokeratology.
Intraocular Lenses and Refractive Lensectomy
Refractive Lens Exchange
Toric Intraocular Lenses
Multifocal Intraocular Lenses
Potentially Accommodative Intraocular Lenses
Light-Adjustable Intraocular Lenses
Phakic Intraocular Lenses
Add-on Intraocular Lenses in Pseudophakic Eyes
New or Alternative Approaches
Photorefractive Intrastromal Cross-Linking (PiXL)
LASIK Extra
Prophylactic
IntraCor
Ciliary Muscle–Zonular Complex
Axial Length
Refractive Indexes
Summary
Key References
References
3.2 Preoperative Evaluation for Refractive Surgery
Key Features
Introduction
General Considerations
Age
Degree of Correction
Patient Expectations
Systemic Contraindications to Keratorefractive Surgery
Diabetes Mellitus
Pregnancy and Lactation
Autoimmune Diseases
Dermatological Keloid
Human Immunodeficiency Virus
Medications
Ophthalmic Diseases
Corneal Dystrophy
Corneal Curvature
Ocular Surface Disease
Herpes Reactivation
Glaucoma
Other Considerations
Ophthalmic Examination
Ancillary Testing
Wavefront Measurement (Aberrometry)
Computerized Videokeratography
Pachymetry
Counseling
Key References
References
3.3 Excimer Laser Surface Ablation
Key Features
Introduction
Ablation Profiles
Indications
Preoperative Evaluation
PRK Surgical Technique
Patient Preparation and Epithelial Removal
Stromal Ablation
LASEK Surgical Technique (see Fig. 3.3.3)
Epi-LASIK Surgical Technique (Fig. 3.3.4)
Surface Ablation With Mitomycin-C
Wavefront-Guided Surface Ablation
Results
Photorefractive Keratectomy for Myopia and Astigmatism
Photorefractive Keratectomy for Hyperopia
Wavefront-Guided PRK
Complications
General Complications for All Surface Ablation Procedures
Undercorrection or Overcorrection
Epithelial Problems
Corneal Haze/Scar Formation
Dry Eyes
Infectious Keratitis
Specific Intraoperative Complications Related to LASEK
Alcohol Leakage During Surgery
Incomplete Epithelial Detachment
Specific Intraoperative Complications Related to Epi-LASIK
Conclusions
Key References
References
3.4 LASIK
Key Features
Associated Features
Historical Review
LASIK
Excimer Lasers
Patient Selection
Preoperative Evaluation and Diagnostic Approach
Limitations and Contraindications
Microkeratomes and Femtosecond Lasers
Operative Technique
Microkeratome Surgical Technique
Femtosecond Laser Flap Creation
Excimer Laser Ablation
Postoperative Care
Complications
Intraoperative Complications
Ablation Complications
Postoperative Complications
Keratectasia
Results
LASIK Enhancements
LASIK in Complex Cases
LASIK After Radial Keratotomy
LASIK After Photorefractive Keratectomy
LASIK After Penetrating Keratoplasty
LASIK After Intraocular Lens Implantation and Bioptics
Intraocular Lens Calculations After LASIK
Summary
Key References
References
3.5 Small Incision Lenticule Extraction (SMILE)
Key Features
Introduction
Femtosecond Laser System
Treatment Range for SMILE
Patient Evaluation
Surgical Procedure
Femtosecond Laser Application
Lenticule Removal
Postoperative Management
Complications
Perioperative Complications
Postoperative Complications
Higher-Order Aberrations
Biomechanical Stability
Refractive and Visual Outcome
Retreatments
Conclusions
Key References
References
3.6 Wavefront-Based Excimer Laser Refractive Surgery
Key Features
Introduction
Wavefront Optics
Higher-Order Aberrations
Ideal Corneal Shape
Measurements of Wavefront Aberrations
Quality of Vision and Measures of Optical Quality
Wavefront-Measuring Devices
Wavefront-Based Surgery
Results
Wavefront Platforms (Table 3.6.1)
Conclusions
Key References
References
3.7 Phakic Intraocular Lenses
Key Features
Associated Features
Introduction
History of Phakic Lenses
Indications of Phakic Lenses
Moderate and High Myopia
High Hyperopia
High Astigmatism
Advantages and Disadvantages of Phakic Iols
Intraocular Lens Power Calculation
Sizing the Phakic IOLs
Visual Outcomes
Anterior Chamber Angle-Supported Phakic Intraocular Lenses
Complications
Pupillary Ovalization
Endothelial Damage
Elevation of Intraocular Pressure
Uveitis
Cataract
Iris-Fixated Phakic Intraocular Lenses
Surgical Procedure
Complications
Glare and Halos
Anterior Chamber Inflammation/Pigment Dispersion
Endothelial Cell Loss
Glaucoma
Iris Atrophy or Dislocation
Cataract
Other Complications
Posterior Chamber Phakic Intraocular Lenses
Surgical Technique
Complications
Cataract
ICL Replacement
Pigmentary Dispersion and Elevated Intraocular Pressure
Endothelial Cell Damage
Bioptics
Conclusion
Key References
References
3.8 Astigmatic Keratotomy
Key Features
Historical Review
Incisional Keratotomy
Surgical Techniques for Astigmatic and Radial Keratotomy
Preoperative Considerations
Patient Selection
Visual Axis Determination and Marking
Intraoperative Corneal Pachymetry
Incision Technique
Diamond Blade–Assisted AK
Full Penetrating Femtosecond AK
Femtosecond Intrastromal Astigmatic Keratotomy (ISAK)
Wedge Resection Using Laser Arcuate Resection (LAR)
Surgical Protocol
Axis of Astigmatism
Postoperative Protocol
Outcome Comparison for Various Astigmatism Correction Methods
Complications and Management of Astigmatism Correction Methods
Complications Related to Corneal Incisions
Incision Beyond Clear Cornea
Optical Zone Invasion
Complications Related to Corneal Perforations
Postoperative Complications
Progressive Hyperopia
Induced Astigmatism
Contact Lens Intolerance
Stromal Melting
Infectious Keratitis
Conclusions
Key References
References
3.9 Intrastromal Corneal Ring Segments and Corneal Cross-Linking
Key Features
Introduction
Intracorneal Ring Segments
Corneal Cross-Linking (CXL)
CXL Plus
Surgical Procedure: ICRS
Patient Selection
Preoperative Considerations
ICRS Selection
Single Versus Paired ICRS
ICRS Surgical Technique
Clinical Outcomes
Postoperative Complications
Surgical Procedure: CXL
CXL Clinical Outcomes
Postoperative Complications
Combining ICRS With CXL
Conclusions
Key References
References
3.10 Surgical Correction of Presbyopia
Key Features
Introduction
Presbyopia Correction at the Corneal Level
Monovision
Presby-LASIK
Central Presby-LASIK
Laser Blended Vision
Intracorneal Inlays
Historical Background
Corneal Reshaping Inlay
Raindrop
Refractive Inlays
Presbia Flexivue Microlens
Icolens (Neoptics AG)
Small Aperture Inlays
KAMRA
Presbyopic IOLs
Multifocal IOLs
Rotationally Symmetrical
Diffractive IOLs.
Refractive IOLs.
Rotationally Asymmetrical IOLs (Varifocal)
Patient Selection Criteria
AcrySof Restor SN6AD3 (Alcon Laboratories, Inc.)
Lentis Mplus LS-313 (Oculentis GmbH)
Symfony (Abbott Medical Optics, Inc.)
AT LISA tri 839 MP (Carl Zeiss Meditec AG)
Fine Vision Micro F (Physiol)
Panoptix (Alcon)
Clinical Outcomes and Quality of Life
Complications
Accommodating IOLs
1) IOLs With Change in Axial Position, Single Optic
Crystalens HD (Bauch & Lomb)
1CU (Human Optics AG)
Tetraflex (Lenstec Inc)
2) IOLs With Change in Axial Position, Dual Optic
Synchrony (Visiogen Inc.)
3) IOLs With Change in Shape or Curvature
FluidVision (Powervision, Inc).
Nulens (DynaCurve).
4) IOL With Change in Refractive Index or Power
Lumina (Akkolens).
Comments.
Other Treatments
Scleral Expansion Bands
Topical Treatment
FOV Tears
Liquid Vision
EV06 (Encore Vision)
Key References
References
4.1 Corneal Anatomy, Physiology, and Wound Healing
Key Features
Introduction
Embryology, Anatomy, and Physiology of the Cornea
Epithelium
Stroma
Endothelium
Endothelial Responses to Stress
Corneal Wound Healing
Epithelial Injury
Stromal Injury
Endothelial Injury
Key References
References
4.2 Anterior Segment Imaging Modalities
Key Features
Introduction
Anterior Segment Optical Coherence Tomography
Clinical Applications
Tear Film Evaluation
Refractive Surgery and Ectasia-Related Disorders
Penetrating and Endothelial Keratoplasty–Related Procedures
Ocular Surface Tumors
Cataract Surgery and Intraocular Lens Implantation
Keratitis
Miscellaneous Uses
Limitations
Specular Microscopy
Clinical Applications
Corneal Dystrophies
Intraocular Surgery Evaluation
Donor Cornea Evaluation
Limitations
Ultrasound Biomicroscopy
Clinical Applications
Ocular Masses
Glaucoma
Ocular Trauma
Limitations
Meibography
Clinical Applications
Meibomian Gland Dysfunction
Limitations
In vivo Confocal Microscopy
Clinical Applications
Dry Eye Disease and Neuropathic Corneal Pain
Infectious Keratitis and Demodex
Corneal Deposits and Corneal Dystrophies
Limitations
Topography and Tomography
Clinical Applications
Refractive Surgery
Ectasia-Related Disorders
Astigmatism
Wavefront Analysis
Clinical Applications
Refractive Surgery
Limitations
Summary
Key References
References
4.3 Congenital Corneal Anomalies
Key Features
Introduction
Size and Shape Anomalies
Microcornea
Epidemiology, Pathogenesis, and Ocular Manifestations
Treatment
Megalocornea
Epidemiology, Pathogenesis, and Ocular Manifestations
Treatment
Corneal Absence
Congenital Anterior Staphyloma
Anomalies of Corneal Clarity
Anterior Embryotoxon
Posterior Embryotoxon
Corneal Keloids
Dermoids
Axenfeld’s Anomaly and Rieger’s Syndrome
Peters’ Anomaly
Ocular Manifestations
Systemic Associations
Pathology
Treatment and Outcome
Sclerocornea
Congenital Hereditary Endothelial Dystrophy and Congenital Stromal Corneal Dystrophy
Key References
References
4.4 Blepharitis
Key Features
Associated Features
Introduction
Epidemiology
Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Treatment
Key References
References
4.5 Herpes Zoster Ophthalmicus
Key Features
Associated Features
Epidemiology and Pathogenesis
Ophthalmic Herpes Zoster
Clinical Manifestations
Postherpetic Neuralgia
Herpes Zoster Ophthalmicus in Acquired Immune Deficiency Syndrome
Diagnosis
Management
Management of Ocular Manifestation
Postherpetic Neuralgia
Prevention
Key References
References
4.6 Conjunctivitis
Key Features
Infectious Conjunctivitis
Bacterial Infections
Acute Bacterial Conjunctivitis
Hyperacute Bacterial Conjunctivitis
Chronic Bacterial Conjunctivitis
Adenoviral Conjunctivitis
Follicular Conjunctivitis
Pharyngoconjunctival Fever
Epidemic Keratoconjunctivitis
Acute Hemorrhagic Conjunctivitis
Herpes Simplex Conjunctivitis
Other Causes of Viral Conjunctivitis
Chronic Follicular Conjunctivitis
Trachoma
Adult Inclusion Conjunctivitis
Neonatal Conjunctivitis (Ophthalmia Neonatorum)
Chlamydial Infections
Neisserial Infections
Other Bacterial Infections
Viral Infections
Fungal and Parasitic Conjunctivitis
Microsporidial Keratoconjunctivitis
Loiasis
Parinaud’s Oculoglandular Syndrome
Noninfectious Conjunctivitis
Toxic Follicular Conjunctivitis
Erythema Multiforme Major (Stevens–Johnson Syndrome) and Toxic Epidermal Necrolysis
Epidermolysis Bullosa
Graft-versus-Host Disease
Xeroderma Pigmentosa
Kawasaki Disease
Ligneous Conjunctivitis
Key References
References
4.7 Allergic Conjunctivitis
Key Features
Acute Allergic Conjunctivitis: Seasonal/Perennial
Chronic Atopic Keratoconjunctivitis
Vernal Conjunctivitis
Treatment of Allergic/Atopic Keratoconjunctivitis
Allergic Dermatoconjunctivitis
Microbial Allergic Conjunctivitis
Giant Papillary Conjunctivitis
Key References
References
4.8 Tumors of the Conjunctiva
Key Features
Conjunctival Malignant Neoplasms
Ocular Surface Squamous Neoplasia
Conjunctival Melanoma
Conjunctival Lymphoma
Benign Conjunctival Neoplasms and Neoplasias
Conjunctival Nevus
Benign Acquired Melanosis of Conjunctiva
Conjunctival Hemangioma
Conjunctival Squamous Papilloma
Conjunctival Lymphangioma
Conjunctival Choristomas
Limbal Dermoid
Conjunctival Solid Dermoid
Conjunctival Dermolipoma
Conjunctival Osteoma
Nonneoplastic Lesions and Disorders Simulating Malignant Conjunctival Neoplasms and Neoplasias
Lesions Simulating Ocular Surface Squamous Neoplasms and Neoplasias
Conjunctival Hyperplasia
Conjunctival Keratosis/Hyperkeratosis/Dyskeratosis
Inflamed Pinguecula/Hypertrophic Pterygium
Inflammatory Granuloma of Conjunctiva
Viral Papilloma of Conjunctiva
Lesions Simulating Conjunctival Melanoma and Malignant Primary Acquired Melanosis
Posterior Uveal Melanoma With Anterior Transcleral Extension
Occult Eyewall Laceration With Incarceration of Uveal Tissue
Nodular Anterior Scleritis
Ciliary Body Staphyloma
Conjunctival Argyrosis
Lesions Simulating Conjunctival Lymphoma
Benign Reactive Lymphoid Hyperplasia of the Conjunctiva
Inflammatory Granulomas of Conjunctiva
Management of Conjunctival Tumors Suspected of Being Malignant Neoplasms or Neoplasias
Key References
References
4.9 Pterygium and Conjunctival Degenerations
Key Features
Associated Features
Introduction
Pinguecula
Pterygium
Senile Scleral Plaques
Conjunctival Amyloid
Conjunctival Melanosis
Key References
References
4.10 Ocular Cicatricial Pemphigoid/Mucous Membrane Pemphigoid
Key Features
Associated Features
Introduction
Pathogenesis
Clinical Findings
Diagnosis
Treatment
Conclusions
Key References
References
4.11 Episcleritis and Scleritis
Key Features
Associated Feature
Key Features
Associated Features
Introduction
Inflammatory Diseases
Episcleritis
Epidemiology and Pathogenesis
Diagnosis and Ocular Manifestations
Differential Diagnosis
Systemic Associations
Treatment
Scleritis
Epidemiology and Pathogenesis
Ocular Manifestations
Differential Diagnosis
Diagnosis and Ancillary Testing
Systemic Associations
Pathology
Treatment
Medical Treatment
Surgical Treatment
Course and Outcome
Key References
References
4.12 Bacterial Keratitis
Key Feature
Associated Features
Introduction
Epidemiology and Pathogenesis
Clinical Features
Gram-Positive Cocci
Staphylococcus
Streptococcus
Gram-Positive Bacilli
Bacillus
Corynebacterium
Listeria
Clostridium
Propionibacterium acnes
Filamentous Bacteria
Actinomyces and Nocardia
Gram-Negative Rods
Pseudomonas
Serratia
Escherichia, Klebsiella, and Proteus
Moraxella
Haemophilus
Gram-Negative Cocci
Neisseria
Moraxella (Branhamella) catarrhalis
Mycobacteria
Nontuberculous Mycobacteria
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Outcome
Key References
References
4.13 Fungal Keratitis
Key Feature
Associated Features
Introduction
Epidemiology and Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Outcome
Key References
References
4.14 Parasitic Keratitis
Key Feature
Associated Features
Introduction
Acanthamoeba Keratitis
Epidemiology and Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Pathology
Treatment
Outcome
Microsporidiosis
Epidemiology and Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Systemic Associations
Treatment
Outcome
Onchocerciasis
Epidemiology and Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Outcome
Key References
References
4.15 Herpes Simplex Keratitis
Key Features
Associated Features
Epidemiology
Herpes Simplex Virus
Life Cycle of HSV
Primary HSV Infection
Recurrent HSV Infections
Epithelial Keratitis
Dendritic Ulcer
Geographical Ulcer
Marginal Keratitis
Metaherpetic (Trophic) Ulcer
Stromal/Endothelial Keratitis
Endotheliitis
Localized Endotheliitis
Diffuse and Linear Endotheliitis
Necrotizing Keratitis
Immune Stromal Keratitis
Lipid Keratopathy
Keratouveitis
Miscellaneous Syndromes
Diagnosis
Culture
DNA Testing
Fluorescent Antibody Testing
Tzanck’s Smear
Serum Antibody Testing
Herpetic Eye Disease Study
Treatment
Infectious Epithelial Keratitis
Stromal Keratouveitis
Metaherpetic Keratitis
Medications
Antivirals
Corticosteroids
Surgery
Penetrating Keratoplasty
Conjunctival Flap
Amniotic Membrane Transplantation
Future Directions
Key References
References
4.16 Peripheral Ulcerative Keratitis
Key Features
Associated Features
Introduction
Anatomy and Pathogenesis
Ocular Manifestations
Systemic Associations
Differential Diagnosis
Diagnostic and Ancillary Testing
Treatment
Medical Treatment
Surgical Treatment
Course and Outcome
Key References
References
4.17 Noninfectious Keratitis
Key Feature
Associated Feature
Introduction
Thygeson’s Superficial Punctate Keratitis
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Superior Limbic Keratoconjunctivitis of Theodore
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Mooren’s Ulcer
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Neurotrophic Keratitis
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Terrien’s Marginal Degeneration
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Lax Eyelid Condition, Lax Eyelid Syndrome, and Floppy Eyelid Syndrome
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Key References
References
4.18 Keratoconus and Other Ectasias
Key Features
Associated Features
Keratoconus
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Pellucid Corneal Degeneration
Keratoglobus
Epidemiology and Pathogenesis
Ocular Manifestations
Pathology
Treatment
Posterior Keratoconus
Post–Refractive Surgery Corneal Ectasia
Key References
References
4.19 Anterior Corneal Dystrophies
Key Features
Associated Features
Introduction
Anterior Basement Membrane Dystrophy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Pathology
Treatment
Meesmann’s Epithelial Dystrophy
Reis–Bückler Dystrophy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Pathology
Treatment
Thiel–Behnke Dystrophy
Key References
References
4.20 Stromal Corneal Dystrophies
Key Features
Associated Features
Introduction
Gelatinous Drop-Like Dystrophy
Lattice Dystrophy Type I
Genetics
Ocular Manifestations
Clinical Presentation
Pathology
Treatment
Systemic Amyloidosis With Corneal Lattice
Genetics
Ocular Manifestations
Patient Presentation
Pathology
Treatment
Other Lattice Dystrophies
Granular Corneal Dystrophy Type I
Genetics
Ocular Manifestation
Patient Presentation
Pathology
Treatment
Granular Corneal Dystrophy Type 2
Genetics
Ocular Manifestations
Patient Presentation
Pathology
Treatment
Macular Corneal Dystrophy
Genetics
Ocular Manifestations
Patient Presentation
Pathology
Treatment
Schnyder’s Corneal Dystrophy
Genetics
Ocular Manifestations
Patient Presentations
Pathology
Treatment
Central Cloudy Dystrophy
Genetics
Ocular Manifestations
Patient Presentations
Pathology
Treatment
Fleck Dystrophy
Genetics
Ocular Manifestations
Patient Presentation
Pathology
Treatment
Posterior Amorphous Corneal Dystrophy
Genetics
Ocular Manifestations
Patient Presentation
Pathology
Treatment
Congenital Stromal Corneal Dystrophy
Genetics
Ocular Manifestations
Differential Diagnosis
Pathology
Treatment
Key References
References
4.21 Diseases of the Corneal Endothelium
Key Features
Associated Features
Introduction
Fuchs’ Dystrophy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Congenital Hereditary Endothelial Dystrophy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Posterior Polymorphous Corneal Dystrophy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Key References
References
4.22 Corneal Degenerations
Key Features
Associated Features
Introduction
Corneal Arcus (Arcus Senilis)
Lipid Keratopathy
Vogt’s White Limbal Girdle
Senile Corneal Furrow Degeneration
Terrien’s Marginal Corneal Degeneration
Peripheral Corneal Guttae
Calcific Band Keratopathy
Spheroidal Degeneration
Iron Deposition
Crocodile Shagreen
Cornea Farinata
Salzmann’s Corneal Degeneration
Corneal Keloids
Corneal Amyloid Degeneration
Key References
References
4.23 Dry Eye Disease
Key Features
Associated Features
Introduction
Epidemiology
Pathogenesis
Normal Physiology
Pathophysiology
Diagnosis and Classification
Aqueous Tear-Deficient Dry Eye
Non-Sjögren’s Tear Deficiency
Sjögren’s Syndrome Tear Deficiency
Evaporative Dry Eye Disease
Meibomian Gland Disease and Blepharitis
Exposure
Mucin Deficiency
Extrinsic Causes
Ocular Manifestations
Diagnosis and Ancillary Testing
Diagnostic Dye Evaluation
Tear Film Stability
Measurement of Tear Production
Other Tests
Treatment
Aqueous Tear Deficiency
Evaporative Dry Eye Disease
Ocular Surface Inflammation
Key References
References
4.24 Complications of Contact Lens Wear
Key Features
Introduction
Toxic, Allergic and Mechanical Reactions
Solutions
Giant Papillary Conjunctivitis
Superior Limbic Keratoconjunctivitis
Conditions Reflecting Metabolic Challenge
Corneal Hypoxia and Edema
Neovascularization
Limbal Stem Cell Deficiency
Abrasions
Corneal Inflammatory Events and Microbial Keratitis
The Role of Lens Care Systems
Corneal Inflammatory Events
Microbial Keratitis
Fungal Keratitis
Acanthamoeba Keratitis
Unsupervised Lens Wear
FDA and CDC Recommendations
Conclusions
Key References
References
4.25 Corneal and External Eye Manifestations of Systemic Disease
Key Feature
Associated Feature
Introduction
Congenital Disorders
Chromosomal Disorders
Inherited Connective Tissue Disorders
Metabolic Disorders
Protein and Amino Acid Metabolic Disorders
Mucopolysaccharidoses
Sphingolipidoses
Dyslipoproteinemias
Mucolipidoses
Other Oculosystemic Disorders
Conclusions
Key References
References
4.26 Acid and Alkali Burns
Key Features
Associated Feature
Introduction
Alkali Injuries
Acid Injuries
Pathophysiology
Clinical Course
Therapy
Immediate Phase
Acute and Reparative Phases
Surgical Therapy
Key References
References
4.27 Corneal Surgery
Key Features
Associated Feature
Keratoplasty
Introduction
Historical Review
Anesthesia
Specific Techniques
Penetrating Keratoplasty
Preoperative Evaluation and Diagnostic Approach
Donor Selection
Surgical Techniques
Complications and Postoperative Management
Wound Leak.
Flat Anterior Chamber With Increased Intraocular Pressure.
Endophthalmitis.
Persistent Epithelial Defect.
Primary Graft Failure.
Suture-Related Problems.
Graft Rejection.
Treatment for Astigmatism.
Corneal Ulcers.
Recurrence of Diseases.
Anterior Lamellar Keratoplasty
Preoperative Evaluation and Diagnostic Approach
Donor Selection
Donor Preparation.
Surgical Techniques
Anterior Lamellar Dissection of the Host Tissue.
Complications and Postoperative Management
Perforation of Descemet’s Membrane.
Pseudo-Anterior Chamber.
Triple Procedure (Combined Procedure)
Preoperative Evaluation and Diagnostic Approach
Surgical Techniques
Open Sky Cataract Extraction.
Artificial Cornea (Keratoprosthesis)
Boston K-Pro
AlphaCor
Modified Osteo-Odonto-Keratoprosthesis
Outcome
Superficial Corneal Procedures
Historical Review
Anesthesia
Specific Techniques
Superficial Keratectomy
Preoperative Evaluation and Diagnostic Approach
Surgical Techniques
Complications and Postoperative Management
Corneal Biopsy
Preoperative Evaluation and Diagnostic Approach
Surgical Techniques
Complications and Postoperative Management
Outcome
Phototherapeutic Keratectomy
Preoperative Evaluation and Diagnostic Approach
Surgical Techniques
Corneal Dystrophies, Scars, and Elevated Opacities
Postoperative Care
Complications
Hyperopia
Myopia/Myopic Astigmatism
Irregular Astigmatism and Decentration
Pain
Delayed Epithelization
Bacterial Keratitis
Viral Keratitis
Recurrence and Haze
Graft Rejection
Outcome
Key References
References
4.28 Conjunctival Surgery
Key Features
Associated Feature
Historical Review
Anesthesia
Specific Techniques
Conjunctival Flap
Preoperative Evaluation and Diagnostic Approach
Surgical Techniques
Complications and Postoperative Management
Pterygium Surgery
Preoperative Evaluation and Diagnostic Approach
Surgical Techniques
Bare Sclera Technique/Simple Closure
Autograft
Amniotic Membrane
Other Techniques.
Recurrent Pterygium Excision.
Antimetabolites and Radiation
Fibrin Glue
Complications and Postoperative Management
Conjunctivochalasis Management
Surgical Techniques
Complications
Key References
References
4.29 Endothelial Keratoplasty
Key Feature
Associated Features
Introduction
Evolution of EKP Techniques
Indications
Surgical Technique
Anesthesia and Recipient Preparation
Donor Tissue Preparation and Insertion
Descemet’s Stripping With Endothelial Keratoplasty
Descemet’s Membrane Endothelial Keratoplasty
Combined Procedures
Outcomes
Visual Acuity
Refractive Changes
Graft Survival
Complications
Graft Detachment
Immunological Rejection
Postkeratoplasty Intraocular Pressure Elevation
Infrequent Complications
Outlook
Key References
References
4.30 Surgical Ocular Surface Reconstruction
Key Features
Associated Features
Introduction
Historical Perspectives
General Concepts
Preoperative Considerations
Operative Procedures
Unilateral Disease
Partial Stem Cell Deficiency
Mechanical Debridement
Amniotic Membrane Grafting
Autologous Limbal Stem Cell Transplantation
Total Stem Cell Deficiency
Autologous Limbal Stem Cell Transplantation
Bilateral Disease
Keratolimbal Allograft and Allogeneic SLET
Ex Vivo Expanded Limbal Stem Cells and Nonocular Tissue
Special Considerations in Ocular Surface Reconstruction
Ocular Surface Optimization
Corneal Transplantation
Conclusions
Key References
References
4.31 Management of Corneal Thinning, Melting, and Perforation
Key Features
Associated Features
Introduction
Corneal Thinning From Noninflammatory Disorders
Corneal Thinning and Melting From Inflammatory Disorders
Surgical Treatment of Corneal Perforations
Tissue Adhesives
Penetrating Keratoplasty
Patch Graft
Miscellaneous Treatments
Conclusions
Key References
References
5.1 Basic Science of the Lens
Key Features
Associated Features
Key References
References
5.1 Basic Science of the Lens
Key Features
Introduction
Anatomy of the Lens
Capsule
Epithelial Cells
Lens Substance
Sutures
Growth
Mass
Dimensions
Physiology of the Lens
Permeability, Diffusion, and Transport
Transport of Ions
Amino Acid and Sugar Transport
Biophysics
Light Transmission
Transparency
Refractive Indices
Chromatic Aberration
Spherical Aberration
Accommodation
Biochemistry
Sugar Metabolism
Protein Metabolism
Glutathione
Amino Acid Transport
Antioxidant Mechanisms
Lens Crystallins
Crystallin Structure
Crystallin Gene Expression During Lens Growth
Crystallin Function
Age Changes
Morphology
Physiological Changes
Biophysical Changes
Accommodation Changes
Biochemical Changes
Crystallins
Secondary Cataract
Fibrosis-Type Posterior Capsule Opacification
Pearl-Type Posterior Capsule Opacification
Soemmerring’s Ring
Prevention and Treatment of Posterior Capsule Opacification
Key References
References
5.2 Evolution of Intraocular Lens Implantation
Key Features
Introduction
Lens Design and Fixation
Generation I (Original Ridley Posterior Chamber Lens)
Generation II (Early Anterior Chamber Lenses)
Generation III (Iris-Supported Lenses)
Generation IV (Intermediate Anterior Chamber Lenses)
Generation V (Improved Posterior Chamber Lenses)
Generation VI (Modern Capsular Lenses – Rigid PMMA, Soft Foldable, and Modern Anterior Chamber)
Recent Advances
Key References
References
5.2 Evolution of Intraocular Lens Implantation
Key features
Introduction
Lens Design and Fixation
Generation I (Original Ridley Posterior Chamber Lens)
Generation II (Early Anterior Chamber Lenses)
Generation III (Iris-Supported Lenses)
Generation IV (Intermediate Anterior Chamber Lenses)
Generation V (Improved Posterior Chamber Lenses)
Generation VI (Modern Capsular Lenses—Rigid PMMA, Soft Foldable, and Modern Anterior Chamber)
Recent Advances
Key References
References
5.3 Epidemiology, Pathophysiology, Causes, Morphology, and Visual Effects of Cataract
Key Features
Epidemiology of Cataracts
Pathophysiology of Cataracts
Genetics
Cell Proliferation and Differentiation
Metabolic Disturbance and Osmotic Regulation Failure
Calpains
Protein Modification
Oxidation
Defensive Mechanisms
Other Factors
Cataract Causes, Associations, and Prevention
Age
Sunlight and Irradiation
Smoking and Alcohol
Body Mass Index
Myopia
Trauma
Systemic Disorders
Dermatological Disorders
Central Nervous System Disorders
Ocular Disease and Cataracts
Toxic Causes
Congenital and Juvenile Cataracts
Prevention of Cataracts
Morphology and Visual Effects of Cataract
Morphology
Assessment and Grading of Cataracts
Visual Effects of Cataracts
Visual Acuity
Contrast Sensitivity, Glare, and Wavefront Aberrometry
Other Effects
Anomalies of Lens Growth
Aphakia
Microspherophakia
Lenticonus and Lentiglobus
Lens Coloboma
Ectopia Lentis
Key References
References
5.4 Patient Workup for Cataract Surgery
Key Features
Introduction
Medical History and Current Therapeutic Regimen
General Ophthalmic History and Examination
Assessment of Lens Opacities
Introduction
Diagnosis of Lens Opacities
Classification of Lens Opacities
Nuclear Opacities
Cortical Opacities
Posterior Subcapsular Opacities
Advanced Cataracts
Grading of Lens Opacities
Lens Opacities Classification System III (Fig. 5.4.2)
Effects of Opacities on Vision
Visual Acuity Reduction
Contrast Sensitivity Reduction
Myopic Shift
Monocular Diplopia
Glare
Color Shift
Visual Field Loss
Investigations for Further Surgical Refinement
Corneal Topography
Preoperative Topography
Determination of IOL Type and Power
Planning the Incision
Good Clinical Practice (Social and Legal Aspects)
Key References
References
5.5 Intraocular Lens Power Calculations
Key Features
Introduction
Ocular Biometry
Ultrasound Biometry
Optical Biometry
IOL Power Formulas
Vergence Formulas
Ray Tracing Formulas
Artificial Intelligence Formulas
Combination Formulas
IOL Calculations in Special Eyes
IOL Power Calculation in Short Eyes
IOL Power Calculation in Long Eyes
IOL Power Calculation in Eyes With Previous Corneal Refractive Surgery
Factors Contributing to Challenges in IOL Power Calculation
Methods to Improve the Accuracy of IOL Power Calculations in Postrefractive Eyes
Methods Relying on Prior Clinical Data
Methods Using a Combination of the Surgically Induced Refractive Change (ΔMR) and Current Corneal Power Values
Methods Requiring No Historical Data
Web-Based Post-Refractive IOL Calculator
Radial Keratotomy
IOL Power Calculation in Keratoconic Eyes
IOL Power Calculation in Eyes Following Keratoplasty
Toric IOL Calculation
Impact of Posterior Corneal Astigmatism
Selection of Toric IOL Toricity
Imaging and Guidance Systems for Toric IOL Alignment
Intraoperative Wavefront Aberrometry
Postoperative IOL Adjustment
Conclusion
Key References
References
5.6 Indications for Lens Surgery/Indications for Application of Different Lens Surgery Techniques
Key Features
Introduction
Medical Indications for Lens Surgery
Lenticular Opacification (Cataract)
Cataract in the Presence of Other Ocular Disorders
Lenticular Malposition
Lenticular Malformation
Lens-Induced Ocular Inflammation
Lens-Induced Glaucoma
Inflammatory Glaucoma (Phacolytic Glaucoma)
Pupil Block and Angle Closure (Phacomorphic Glaucoma)
Refractive Indications for Lens Surgery
Indications for Different Lens Surgery Techniques
Intracapsular Cataract Extraction
Extracapsular Extraction (Large-Incision Nuclear Expression Cataract Surgery)
Small-Incision Nuclear Expression Cataract Surgery (“Mini-nuc” and Other Techniques)
Phacoemulsification
Surgery of the Lens Capsule
Zonular Surgery
Surgery for Presbyopia
Monovision
Astigmatism
Key References
References
5.7 The Pharmacotherapy of Cataract Surgery
Key Features
Introduction
Preoperative Medications
Pupil Dilatation
Anti-infective Prophylaxis
Anesthetics
Intraoperative Medications
Additives to Irrigating Solutions, Intracameral Antibiotics, and Other Intraocular Drugs Used During the Surgical Procedure
Irrigating Solutions
Ophthalmic Viscosurgical Devices
Intracameral Medications to Replace Postoperative Drops
Postoperative Medications
Antibiotics
Corticosteroids and Nonsteroidal Anti-inflammatory Drugs
Late Postoperative Medications
Treatment of Endophthalmitis
Treatment of Cystoid Macular Edema
Key References
References
5.8 Anesthesia for Cataract Surgery
Key Features
Introduction
Medical Aspects of Anesthesia for Cataract Surgery
Cataract Type and Associated Medical Conditions
Specific Conditions
Ischemic Heart Disease
Anticoagulants
Diabetes Mellitus
Local Anesthesia
General Considerations
Topical Anesthesia (see Box 5.8.1)
Retrobulbar Block (see Box 5.8.2)
Peribulbar Block (see also Table 5.8.1)
Technique
Local Anesthetic Agent
Complications
Sub-Tenon’s Block (see also Table 5.8.1)
Anatomy
Technique
Sedative Agents
General Anesthesia
Technique
Spontaneous Respiration
Ventilation
Conclusions
Postoperative Care
Key References
References
5.9 Phacoemulsification
Key Features
Introduction
Handpieces and Tips
Power Modulation
Pumps and Fluidics
Flow-Based (Peristaltic)
Vacuum-Based
Anterior Chamber Hydrodynamics
Fluidics of Microincisional Phaco
Postocclusion Surge
Key References
References
5.10 Refractive Aspects of Cataract Surgery
Key Features
Introduction
Value of Corneal Topography
Intraoperative Management of Preoperative Corneal Astigmatism to Prevent Induction of Corneal Astigmatism
Corneal Incisions
To Treat Preoperative Corneal Astigmatism
Astigmatic Incisions
Limbal Relaxing Incisions
Opposite Clear Corneal Incisions
Toric Intraocular Lens Implantation
Postoperative Management of Residual or Induced Corneal Astigmatism
Corneal Laser Ablative Techniques
Post–Cataract Surgery Piggyback IOLs
Light-Adjustable Intraocular Lens Implant
Key References
References
5.11 Small Incision and Femtosecond Laser-Assisted Cataract Surgery
Key Features
Associated Feature
Introduction
Incision Construction and Architecture
Continuous Curvilinear Capsulorrhexis
Hydrodissection and Hydrodelineation
Nucleofractis Techniques
Divide and Conquer
Phaco Chop
Power Modulations
Biaxial Microincision Cataract Surgery
B-MICS Vertical Chop Technique
Femtosecond Laser-Assisted Cataract Surgery
Anterior Capsulectomy
Lens Fragmentation
Corneal Incisions
Conclusions
Key References
References
5.12 Manual Cataract Extraction
Key Features
Introduction
Historical Issues
Manual (Large-Incision) Cataract Surgery
Incision
Wound Closure
Intracapsular Cataract Extraction
General Comments
Specific Techniques
Iris Management
Vitreous Presentation or Prolapse
Intraocular Lenses
Extracapsular Cataract Extraction
Anterior Capsulectomy
“Can Opener” Capsulectomy
Linear Capsulectomy and Intercapsular Techniques
Capsulorrhexis
Size, Type, and Position of Capsulectomy
Nucleus Expression
Cortical Washout
Intraocular Lens Insertion
Mininuc Technique
Anterior Chamber Maintainer
Capsulorrhexis
Sclerocorneal Pocket Tunnel
Nucleus Manipulation
Nucleus Expression
Cortex Removal and Intraocular Lens Implantation
Complications
Discussion
Key References
References
5.13 Combined Procedures
Key Features
Introduction
Combined Glaucoma Surgery
Overview
Trabeculectomy and Cataract Surgery
Nonpenetrating Glaucoma Surgery and Cataract
Minimally Invasive Glaucoma Surgery
Aqueous Shunts
Outcomes
Lens Surgery Combined With Keratoplasty
Historical Review
Surgical Options
Specific Techniques
Complications
Outcomes
Combined Phacovitrectomy
Introduction
Indications and Advantages Over Sequential Noncombined Surgery
Disadvantages
Specific Techniques
Conclusion
Key References
References
5.14 Cataract Surgery in Complex Eyes
Key Features
Associated Features
Introduction
Zonular Instability
Uveitis
Compromised Endothelium
Key References
References
5.15 Pediatric Cataract Surgery
Key Features
Introduction
Historical Review
Preoperative Evaluation and Diagnostic Approach
Alternatives to Surgery
Anesthesia
General Techniques
Specific Techniques
Pars Plana Approach
Corneolimbal Approach
Choices for Correction of Aphakia in Children
Spectacles
Contact Lenses
Intraocular Lenses
Selection of Intraocular Lenses
Implantation in Children Under 2 Years of Age
Implantation in Children Above 2 Years of Age
Postoperative Treatment
Complications
Postoperative Complications
Amblyopia Management
Options to Correct Myopic Shift
Outcome
Key References
References
5.16 Complications of Cataract Surgery
Key Features
Associated Feature
Introduction
Intraoperative Complications
Cataract Incision
Tunnel Perforation
Descemet’s Detachment
Thermal Burns
Anterior Capsulectomy
Preventing Radial Tears in the Anterior Capsule
Excessively Small Capsulorrhexis
Minimizing Complications When Radial Tears Are Present
Nucleus Expression Cataract Extraction
Complications During Phaco
Hydrodissection
Iris Prolapse or Damage
Floppy Iris Syndrome
Trapped Nucleus
Subluxated Lens
Ruptured Posterior Capsule
Before Nucleus Removal
During Cortical Irrigation–Aspiration
Intraocular Lens Insertion
Capsular Bag
Iris Fixated (Retropupillary or Prepupillary)
Ciliary Sulcus
Sutured Posterior Chamber
Anterior Chamber
Dropped Nucleus
Anterior Segment Hemorrhage
Postoperative Complications
Wound Dehiscence
Wound Leakage
Inadvertent Filtering Bleb
Epithelial Ingrowth
Postoperative Astigmatism
Corneal Edema and Bullous Keratopathy
Hyphema
Endocapsular Hematoma
Intraocular Pressure Elevation
Capsular Block Syndrome
Intraocular Lens Miscalculation
Intraocular Lens Decentration and Dislocation
Asymmetrical Haptic Placement
Sunset Syndrome
Lens-Bag Decentration
Pupillary Capture
Sulcus-Fixated Intraocular Lens Dislocation
Posterior and Anterior Dislocation
Intraocular Lens Exchange
Cystoid Macular Edema
Endophthalmitis
Posterior Capsular Opacification
Retinal Detachment
Key References
References
5.17 Secondary Cataract
Key Features
Introduction
Pathogenesis
Treatment and Prevention
Hydrodissection-Enhanced Cortical Cleanup
In-the-Bag IOL Fixation
Capsulorrhexis Size
Biocompatible Intraocular Lens
Contact Between the IOL Optic and the Posterior Capsule
Intraocular Lens Optic Geometry
Intraocular Lenses Maintaining the Capsular Bag Open or Expanded
Key References
References
5.18 Outcomes of Cataract Surgery
Key Features
Introduction
Evaluation of Outcomes
Five Parameters That Describe Visual Function
Visual Acuity Testing
Standardized Visual Acuity Testing
Potential Retinal Acuity Testing
Contrast Sensitivity Testing
Glare Testing
Visual Fields
Color Vision
Objective Findings of Cataract Surgery Outcomes
Best-Corrected Visual Acuity
Uncorrected Visual Acuity
Target Refraction Prediction Error
Contrast Sensitivity
Glare
Visual Fields
Color Vision
Subjective Findings of Cataract Surgery Outcomes
Patients’ Self-Assessment of the Visual Outcome
Cataract Surgery of One or Both Eyes
Cataract Surgery in Eyes With Ocular Comorbidity
Summary
Key References
References
6.1 Structure of the Neural Retina
Key Feature
Introduction
Center of the Macula: Umbo
Foveola
Fovea
Parafovea
Perifovea
Macula, or Central Area
Extra-Areal Periphery
Layers of the Neural Retina
Key References
References
6.2 Retinal Pigment Epithelium
Key Features
Introduction
Structure and Metabolism
Cellular Architecture and Blood–Retinal Barrier
Pigments
Metabolism and Growth Factors
Membrane Properties and Fluid Transport
Ion Channels and Transport Systems
Electrical Activity
Photoreceptor–Retinal Pigment Epithelium Interactions
Visual Pigment Regeneration
Photoreceptor Renewal and Phagocytosis
Retinal Adhesion and Interphotoreceptor Matrix
Repair, Regeneration, and Therapy
References
6.3 Retinal and Choroidal Circulation
Key Features
Introduction
Posterior Segment Vascular Anatomy
Retinal Vascular Anatomy
Choroidal Vascular Anatomy
Blood–Retinal Barrier
Retinal and Choroidal Blood Flow
Retina and Choroidal Circulation Evaluated by OCTA
Regulation of Retinal and Choroidal Blood Flows
Key References
References
6.4 Vitreous Anatomy and Pathology
Key Features
Associated Features
Introduction
Molecular Morphology
Supramolecular Organization
Vitreous Anatomy
Macroscopic Morphology
Microscopic Morphology
Age-Related Changes
Embryology and Postnatal Development
Developmental Anomalies
Aging of the Vitreous Body
Posterior Vitreous Detachment
Anomalous Posterior Vitreous Detachment
Premacular (Epiretinal) Membrane/Macular Pucker
Macular Holes
Diabetic Vitreopathy
Asteroid Hyalosis
Key References
References
6.5 Contact B-Scan Ultrasonography
Key Features
Associated Features
Introduction
Devices
Technique of Examination
Concepts of B-Scan Interpretation
Real Time
Gray Scale
Three-Dimensional Analysis
Display Presentation and Documentation
Normal Vitreous Cavity
Vitreous Hemorrhage
Retinal Detachment
Choroidal Detachment
Tumors
Digital Contact Ultrasonography
What’s New?
Anterior Segment High-Frequency Ultrasonography
Summary
Key References
References
6.6 Camera-Based Ancillary Retinal Testing
Key Features
Key Features
Key Features
Fluorescein Angiography
Introduction
Purpose of the Test
Properties of Sodium Fluorescein Dye
Procedure
Complications
Interpretation of Results
Normal Fluorescein Angiogram
Abnormal Fluorescein Angiography
Indocyanine Green Angiography
Introduction
Properties of Indocyanine Green
Procedure
Complications
Interpretation of Results
Fundus Autofluorescence
Acknowledgments
Key References
References
6.7 Optical Coherence Tomography in Retinal Imaging
Key Features
Associated Features
Introduction
OCT Technology Platforms
Time-Domain OCT
Spectral-Domain OCT
Multifunctional OCT
Time-Encoded Frequency-Domain OCT (Swept-Source OCT)
High-Speed, Ultra-High-Resolution OCT
Adaptive Optics OCT
Anatomical Results
Image Optimization
OCT Image Interpretation
Preretinal
Posterior Vitreous Detachment
Vitreomacular Traction
Epiretinal Membrane
Macular Holes
Lamellar Holes
Pseudo-Hole
Intraretinal
Macular Edema
Irvine–Gass Syndrome: Cystoid Macular Edema After Cataract Surgery
Retinal Exudates
Subretinal
Subretinal Fluid
Pigment Epithelial Detachment
RPE Tear
Choroidal Pathology
Choroidal Neovascularization
OCT Artifacts
Time-Domain OCT
Spectral-Domain OCT
Key References
References
6.8 Optical Coherence Tomography Angiography
Key Features
Introduction
Biological Basis of OCTA
OCTA Versus Dye-Based Angiography Methods
Key Applications of SD-OCTA
Detection of Impaired Perfusion (or “Nonperfusion”)
Detection of Choroidal Neovascularization
Quantification of Vascular Changes
Conclusions
Key References
References
6.9 Retinal Electrophysiology
Key Features
Introduction
Full-Field ERG
Multifocal ERG
Electro-oculography
Key References
References
6.10 Light and Laser Injury
Key Features
Associated Features
Introduction
Light Interaction With the Retina
Photic Retinopathy
Solar Retinopathy
Welding Arc Exposure
Lightning Maculopathy
Retinal Phototoxicity From Ophthalmic Instruments
Light Exposure and Age-Related Macular Degeneration
Laser Injury
Laser Pointers
Complications of Therapeutic Retinal Laser Photocogulation
Key References
References
6.11 Scleral Buckling Surgery
Key Features
Associated Features
Introduction
Historical Review
Preoperative Evaluation and Diagnostic Approach
Differential Diagnosis
Alternatives to Scleral Buckling
Anesthesia
General Techniques
Treatment of Retinal Breaks
Explant Scleral Buckling Techniques
Drainage of Subretinal Fluid
Chandelier-Assisted Scleral Buckling
Closure
Complications
Intraoperative Complications
Scleral Perforation
Drainage Complications
Postoperative Complications
Glaucoma
Infection and Extrusion
Choroidal Effusion
Cystoid Macular Edema and Residual Subretinal Fluid
Macular Pucker
Diplopia
Changes in Refractive Error
Outcome
Key References
References
6.12 Vitrectomy
Key Features
Introduction
Historical Review
Preoperative Evaluation and Diagnostic Approach
Indications and Alternatives to Surgery
Anesthesia
General Techniques
Specific Techniques
Lensectomy
Vitreous Cutters
Epiretinal Membrane Dissection
Intraoperative Tissue Staining
Perfluorocarbon Liquids
Endophotocoagulation
Gas and Silicone Oil Tamponade
Complications
Outcomes
Key References
References
6.13 Intravitreal Injections and Medication Implants
Key Features
Associated Features
Introduction
Preinjection Preparation
Pupillary Dilation
Anesthesia
Antisepsis
Injection
Postinjection
Complications
Endophthalmitis
Hemorrhage
Intraocular Pressure Changes
Retinal Pigment Epithelium Tears
Retinal Tears and Detachments
Other Complications
Other Considerations
Implants
Conclusions
Key References
References
6.14 Progressive and “Stationary” Inherited Retinal Degenerations
Key Features
Associated Features
Key Features
Associated Features
Progressive Diffuse/Panretinal Degenerations
Introduction
Epidemiology and Pathogenesis
Rod-Cone Dystrophy
Cone-Rod Dystrophy
Diagnosis and Ancillary Testing
Electroretinography
Monitoring Disease Progression
Visual Field Testing
Dark Adaptation Testing
Color Vision Tests
Fluorescein Angiography
Fundus Autofluorescence
Optical Coherence Tomography
Electro-oculography
Multifocal Electroretinography
Visual Evoked Cortical Potential
Genetic Testing
Ocular Findings/Manifestations
Typical Retinitis Pigmentosa
X-Linked Retinitis Pigmentosa
Leber’s Congenital Amaurosis
Cone Dystrophy
Genetics and Pathology
Systemic Associations and Differential Diagnosis of Pigmentary Retinopathy
Course and Outcomes
“Stationary” Retinal Disorders
Congenital Stationary Night Blindness
Congenital Stationary Night Blindness With Normal Fundus
Oguchi’s Disease
Fundus Albipunctatus
Congenital Red–Green Color Deficiency
Blue Cone Monochromatism
Achromatopsia
Ocular Albinism
Female Carriers of X-Linked Retinal Degenerations
Treatment of Retinal Degenerations
Vitamin A
Docosahexaenoic Acid
Carbonic Anhydrase Inhibitors for Cystoid Macular Edema
Gene Therapy
Neurotrophic Factors
Stem Cell–Based Therapies
Retinal Prostheses/Implants
References
Key References
6.15 Macular Dystrophies
Key Features
Associated Features
Introduction
Stargardt Disease and Fundus Flavimaculatus
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
Vitelliform Macular Dystrophy (Best Disease)
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
Adult Vitelliform Macular Dystrophy/ Adult-Onset Foveomacular Dystrophy (Pattern Dystrophy)
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
Dominant Drusen (Doyne’s Drusen, Malattia Leventinese)
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
Pattern Dystrophy
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
Dominant Cystoid Macular Edema
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
Sorsby’s Macular Dystrophy
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
North Carolina Macular Dystrophy
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
Atrophia Areata
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Treatment, Course, and Outcome
Cone Dystrophy
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Treatment, Course, and Outcome
Central Areolar Choroidal Dystrophy
Epidemiology and Pathogenesis
Ocular Manifestations and Diagnosis
Pathology
Treatment, Course, and Outcome
Key References
References
6.16 Choroidal Dystrophies
Key Features
Choroideremia
Gyrate Atrophy
Associated Features
Introduction
Choroideremia
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment, Course, and Outcome
Gyrate Atrophy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment, Course, and Outcome
Key References
References
6.17 Hereditary Vitreoretinopathies
Key Features
Associated Features
Introduction
Stickler’s Syndrome
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Systemic Associations
Treatment, Course, and Outcome
X-Linked Juvenile Retinoschisis
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Treatment, Course, and Outcome
Autosomal Dominant Vitreoretinochoroidopathy
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Treatment, Course, and Outcome
Familial Exudative Vitreoretinopathy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Systemic Associations
Treatment, Course, and Outcome
Norrie’s Disease
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Systemic Associations
Treatment, Course, and Outcome
Key References
References
6.18 Hypertensive Retinopathy
Chronic Hypertensive Retinopathy
Key Features
Associated Retinal Findings
Malignant Acute Hypertensive Retinopathy
Key Features
Associated Feature
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Hypertensive Retinopathy
Hypertensive Choroidopathy
Hypertensive Optic Disc Edema
Diagnosis and Ancillary Testing
Treatment and Future Directions
Key References
References
6.19 Retinal Arterial Obstruction
Central Retinal Artery Obstruction
Key Features
Associated Features
Branch Retinal Artery Obstruction
Key Features
Associated Features
Central Retinal Artery Obstruction
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Branch Retinal Artery Obstruction
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Ophthalmic Artery Obstruction
Cilioretinal Artery Obstruction
Combined Artery and Vein Obstructions
Key References
References
6.20 Venous Occlusive Disease of the Retina
Central Retinal Vein Occlusion
Key Features
Associated Features
Branch Retinal Vein Occlusion
Key Features
Associated Features
Introduction
Epidemiology
Central Retinal Vein Occlusion
Pathogenesis
Ocular Manifestations
Ancillary Testing
Differential Diagnosis
Systemic Associations and Laboratory Evaluation
Pathology
Treatment
Neovascular Glaucoma
Macular Edema
Course and Outcome
Branch Retinal Vein Occlusion
Pathogenesis
Ocular Manifestations
Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Key References
References
6.21 Retinopathy of Prematurity
Key Features
Avascular Retina
Associated Features
Introduction
Pathogenesis
Clinical Features and Classification
Diagnosis and Screening
Role of Telemedicine in ROP Screening
Differential Diagnosis
Pathology
Treatment
Ablation of Peripheral Avascular Retina
Role of Anti-VEGF Therapy in ROP Treatment
Surgery in ROP Treatment
Late Complications of ROP
Key References
References
6.22 Diabetic Retinopathy
Key Features
Associated Features
Introduction
Epidemiology
Pathogenesis
Aldose Reductase
Vasoproliferative Factors
Platelets and Blood Viscosity
Ocular Manifestations
Early Nonproliferative Diabetic Retinopathy
Advanced Nonproliferative Diabetic Retinopathy
Proliferative Diabetic Retinopathy
Other Ocular Complications of Diabetes Mellitus
Cornea
Glaucoma
Lens
Optic Neuropathy
Cranial Neuropathy
Diagnosis and Ancillary Testing
Differential Diagnosis
Pathology
Treatment
Medical Therapy
Antiplatelet Therapy
Antihypertensive Agents
Antiangiogenesis Agents
Bevacizumab
Pegaptanib
Aflibercept
Additional Medical Therapies
Pharmacotherapy for Proliferative Diabetic Retinopathy
Corticosteroids
Surgical Therapy
Panretinal Photocoagulation
Peripheral Retinal Cryotherapy
Focal Laser for Macular Edema
Vitrectomy in Diabetic Retinopathy
Conclusions
Key References
References
6.23 Ocular Ischemic Syndrome
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Symptoms
Anterior Segment
Posterior Segment
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment, Course, and Outcome
Key References
References
6.24 Hemoglobinopathies
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Treatment
Course and Outcome
Key References
References
6.25 Coats’ Disease and Retinal Telangiectasia
Key Features
Associated Features
Introduction
Epidemiology
Ocular Manifestations
Diagnosis
Ancillary Testing
Differential Diagnosis
Idiopathic Juxtafoveal Retinal Telangiectasia
Group 1A
Group 1B
Group 2
Group 3
The MacTel Project
Potential Treatments for Idiopathic Juxtafoveal Retinal Telangiectasia
Systemic Associations
Treatment
Complications of Treatment
Course and Outcome
Key References
References
6.26 Radiation Retinopathy and Papillopathy
Key Features
Associated Features
Radiation Retinopathy
Pathology and Pathogenesis
Clinical Features
Diagnostic Studies
Risk Factors
Brachytherapy
Teletherapy
Differential Diagnosis
Treatment
Reducing the Dose of Radiation
Laser Photocoagulation
Intravitreal Anti–Vascular Endothelial Growth Factor Agents
Corticosteroids
Other Treatments
Prognosis
Radiation Papillopathy
Pathology and Pathogenesis
Clinical Features
Diagnostic Studies
Differential Diagnosis
Treatment
Prognosis
Summary
Key References
References
6.27 Proliferative Retinopathies
Key Features
Associated Features
Introduction
Retinal Angiogenesis
Overview of Diagnosing Neovascularization
Overview of Treating Neovascularization
Entities Associated With Retinal Neovascularization
Systemic Diseases
Diabetes Mellitus
Hyperviscosity Syndromes
Aortic Arch Syndromes and Ocular Ischemic Syndromes
Carotid–Cavernous Fistula
Multiple Sclerosis
Retinal Vasculitis
Sarcoidosis
Systemic Diseases That Have a Strong Hereditary Component
Hemoglobinopathies
Incontinentia Pigmenti
Retinal Vascular and Ocular Inflammatory Diseases
Eales’ Disease
Retinal Vein Occlusion
Retinal Embolization
Retinopathy of Prematurity
Uveitis
Acute Retinal Necrosis
Birdshot Chorioretinopathy
Long-Standing Retinal Detachment
Choroidal Melanoma and Hemangioma
Hereditary Retinal Diseases
Familial Exudative Vitreoretinopathy
Inherited Retinal Venous Beading
Retinoschisis
Retinitis Pigmentosa
Autosomal Dominant Vitreoretinochoroidopathy
Key References
References
6.28 Retinal Arterial Macroaneurysms
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment, Course, and Outcome
Key References
References
6.29 Age-Related Macular Degeneration
Key Features
Associated Features
Introduction
Epidemiology
Pathogenesis
Ocular Manifestations
Dry AMD
Drusen and Focal Hyperpigmentation of the RPE
Geographic Atrophy
Neovascular AMD
Detachment of the RPE
Diagnosis and Ancillary Testing
Fundus Autofluorescence
Optical Coherence Tomography
Fluorescein Angiography
Indocyanine Green Angiography
Optical Coherence Tomography Angiography
Differential Diagnosis
Pathology
Natural History and Prognosis
Treatment and Prevention
Dry AMD
Neovascular AMD
Verteporfin Photodynamic Therapy
Anti-VEGF Therapies
Pegaptanib Sodium
Ranibizumab
Bevacizumab
Ranibizumab Versus Bevacizumab
Aflibercept
Anti-VEGF Treatment Regimens
Combination Therapies
Anti-VEGF Therapy Plus PDT
Anti-VEGF Therapy Plus PDGF Inhibitors
Long-Term Outcomes With Anti-VEGF Therapy
Conclusions
Key References
References
6.30 Secondary Causes of Choroidal Neovascularization
Key Features
Associated Feature
Traumatic Ruptures of Bruch’s Membrane
Treatment
Angioid Streaks
Treatment
Pathological Myopia
Treatment
Inflammatory Disorders
Key References
References
6.31 Central Serous Chorioretinopathy
Key Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Key References
References
6.32 Macular Hole
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Gass Stage 1 Macular Hole
Gass Stage 2 Macular Hole
Gass Stage 3 Macular Hole
Gass Stage 4 Macular Hole
Vitreomacular Adhesion
Vitreomacular Traction
Full-Thickness Macular Hole
Lamellar Macular Hole
Pseudo-Macular Hole
“Stage 0” Macular Hole
Diagnosis and Ancillary Testing
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Key References
References
6.33 Epiretinal Membrane
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Pathology
Treatment
Course and Outcomes
Key References
References
6.34 Vitreomacular Traction
Key Features
Associated Features
Introduction
Natural History of Vitreomacular Traction
Diagnosis and Ancillary Testing
Differential Diagnosis
Pathology
Treatment
Vitrectomy
Pharmacological Vitreolysis
Pneumatic Vitreolysis
Conclusions
Key References
References
6.35 Cystoid Macular Edema
Key Features
Associated Features
Introduction
Pathogenesis and Etiology
Vascular
Postoperative
Uveitis-Related
Medication-Related
Retinal Dystrophies
Tractional Causes
Anatomical
Intraocular Neoplasms
Diagnosis and Ancillary Testing
Fundoscopy
Optical Coherence Tomography
Autofluorescence
Fluorescein Angiography
Treatment
Vascular
Diabetic Macular Edema (See Chapter 6.22, Diabetic Retinopathy)
Retinal Venous Occlusive Disease (See Chapter 6.20, Venous Occlusive Disease of the Retina)
Branch Retinal Vein Occlusion
Central Retinal Vein Occlusion
Macroaneurysms (See Chapter 6.28, Retinal Arterial Macroaneurysms)
Juxtafoveal Retinal Telangiectasias (See Chapter 6.25, Coats’ Disease and Retinal Telangiectasia)
Radiation Retinopathy (See Chapter 6.26, Radiation Retinopathy and Papillopathy)
Age-Related Macular Degeneration (See Chapter 6.29, Age-Related Macular Degeneration)
Postoperative
Inflammatory (See Part 7: Uveitis and Other Intraocular Inflammations)
Medication Induced (See Chapter 6.45, Retinal Toxicity of Systemically Administered Drugs)
Retinal Dystrophy (See Chapter 6.14, Progressive and ‘Stationary’ Inherited Retinal Degenerations)
Tractional (See Chapter 6.32, Macular Hole, Chapter 6.33, Epiretinal Membrane, Chapter 6.34, Vitreomacular Traction Syndrome)
Anatomical Abnormalities (See Chapter 6.36, Coexistent Optic Nerve and Macular Abnormalities)
Neoplastic (See Part 8: Intraocular Tumors)
Conclusions
Key References
References
6.36 Coexistent Optic Nerve and Macular Abnormalities
Key Features
Associated Features
Introduction
Congenital Anomalies of the Optic Disc
Congenital Optic Disc Pit
Morning Glory Optic Disc Anomaly
Optic Nerve Coloboma
Treatment of Retinal Detachments Secondary to Congenital Anomalies of the Optic Disc
Other Optic Nerve Abnormalities Associated With Macular Pathology
Optic Nerve Abnormalities Associated With Choroidal Neovascularization
Abnormalities Associated With Exudation
Key References
References
6.37 Peripheral Retinal Lesions
Key Features
Associated Features
Introduction and Anatomy
Ora Serrata
Vitreous Base
Ocular Manifestations and Diagnosis of Peripheral Retinal Lesions
Meridional Folds or Radial Folds
Pars Plana Cysts
Ora Serrata Pearls
Degenerative Adult Retinoschisis
Congenital X-Linked Retinoschisis
Paving Stone Degeneration
Lattice Degeneration and Retinal Breaks
Key References
References
6.38 Retinal Breaks
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Retinal Tears
Round Holes With Opercula
Round Holes Without Opercula (Atrophic Holes)
Traumatic Retinal Breaks
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Treatment of Retinal Breaks
Cryopexy
Photocoagulation
Anesthesia
Course and Outcome
Key References
References
6.39 Rhegmatogenous Retinal Detachment
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Factors Causing Retinal Detachment
Retinal Breaks
Vitreous Liquefaction and Detachment
Traction on the Retina
Liquid Currents
Conditions Predisposing an Eye to Retinal Detachment
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Key References
References
6.40 Serous Detachments of the Neural Retina
Key Features
Associated Features
Introduction
Pathophysiology
Alterations in Choroidal Flow
Idiopathic Central Serous Chorioretinopathy
Tumors of the Choroid and Retina
Systemic Disease With Disrupted Choroidal Blood Flow
Vasculitis and Autoimmune Disease
Poor Scleral Outflow
Nanophthalmos and Uveal Effusion Syndrome
Posterior Scleritis
Breakdown of the RPE and Retina
Vogt–Koyanagi–Harada Disease, Sympathetic Ophthalmia, and Sarcoidosis
Infectious Diseases
Retinal Vascular Diseases
Miscellaneous
Diagnostic and Ancillary Testing
Diagnostic Ultrasonography
Optical Coherence Tomography
Fluorescein Angiography and Indocyanine Green Angiography
Optical Coherence Tomography Angiography
Computed Tomography and Magnetic Resonance Imaging
Differential Diagnosis
Treatment
Course and Outcome
Key References
References
6.41 Choroidal Hemorrhage
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Treatment
Primary Management
Secondary Management
Choroidal Hemorrhage in Trauma
Choroidal Hemorrhage in Other Conditions
Course and Outcome
Key References
References
6.42 Proliferative Vitreoretinopathy
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Key References
References
6.43 Posterior Segment Ocular Trauma
Key Features
Associated Features
Introduction
Ocular Manifestations and Clinical Examination
History
Clinical Examination
Ancillary Testing
Nonpenetrating Trauma
Commotio Retinae
Choroidal Rupture
Traumatic Macular Hole
Chorioretinitis Sclopetaria
Retinal Tear
Retinal Detachment
Retinal Dialysis
Retinal Pigment Epithelium Contusion/Traumatic Choroidopathy
Macular Hemorrhage
Optic Nerve Avulsion
Penetrating Trauma
Initial Closure
Intraocular Foreign Bodies
Metallosis
Secondary Infection
Rehabilitation: Secondary Surgical Timing
Rehabilitation: Surgical Technique
Traumatic Endophthalmitis
Course and Outcome
Prognosis
Sympathetic Ophthalmia
Additional Considerations
Key References
References
6.44 Distant Trauma With Posterior Segment Effects
Terson Syndrome
Key Features
Associated Features
Purtscher Retinopathy
Key Features
Associated Features
Shaken Baby Syndrome
Key Features
Associated Features
Terson Syndrome
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Treatment and Outcome
Purtscher Retinopathy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Systemic Associations
Pathology
Treatment and Course
Shaken Baby Syndrome
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Pathology
Treatment, Course, and Outcome
Miscellaneous Conditions
Whiplash Injury
Fat Embolism Syndrome
Valsalva Retinopathy
Key References
References
6.45 Retinal Toxicity of Systemically Administered Drugs
Key Features
Associated Features
Introduction
Chloroquine and Hydroxychloroquine
Sildenafil
Thioridazine
Niacin
Canthaxanthine
Tamoxifen
Fingolimod
Paclitaxel
Deferoxamine
Didanosine
Clofazimine
Thiazolidinediones
Imatinib
Mitogen-Activated Protein Kinase Inhibitors and Immune Checkpoint Inhibitors
Key References
References
7.1 Anatomy of the Uvea
Key Feature
Associated Features
Introduction
Iris
Ciliary Body
Choroid
Key References
References
7.2 Mechanisms of Uveitis
Key Feature
Associated Features
Introduction
Innate and Adaptive Immunities
Cells of the Immune System
Nonlymphocytic Leukocytes
B Cells
T Cells
Mast Cells
NK and NK T Cells
Antigen-Presenting Cells
Molecules of the Immune System Involved in Uveitis
Antibodies
Cytokines
Chemokines and Chemokine Receptors
Adhesion Molecules
Other Molecules
Tolerance and Autoimmunity
Central Tolerance
Peripheral Tolerance
Ignorance
Mechanisms That Trigger and Promote Uveitogenic Processes
Genetic Background
Trauma
Microbial Infection
Mechanisms of Inflammation
Types of Immunopathogenic Processes
Immunopathogenic Processes of Uveitis in Humans
Mechanisms That Inhibit Inflammation in the Eye
Key References
References
7.3 General Approach to the Uveitis Patient and Treatment Strategies
Key Feature
Associated Features
Introduction
Classification
Epidemiology
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Treatment
Mydriatic and Cycloplegic Agents
Nonsteroidal Anti-inflammatory Drugs
Corticosteroids
Topical
Periocular
Intravitreal
Systemic
Immunosuppressive Therapy
Course and Outcome
Key References
References
7.4 Herpetic Viral Uveitis
Herpes Simplex and Varicella Zoster
Herpetic Anterior Uveitis
Key Features
Associated Features
Varicella-Zoster and Herpes Simplex Virus–Induced Acute Retinal Necrosis
Key Features
Associated Features
Progressive Outer Retinal Necrosis
Key Features
Associated Features
Herpes Simples Virus and Varicella-Zoster Virus
Introduction
Epidemiology and Pathogenesis
Ocular Presentation
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Cytomegalovirus
Cytomegalovirus Retinitis
Key Features
Associated Features
Cytomegalovirus-Associated Anterior Uveitis
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Epstein–Barr Virus
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Treatment and Outcome
Key References
References
7.5 Nonherpetic Viral Infections
Key Features
West Nile Virus
Introduction
Epidemiology
Ocular Manifestations
Diagnosis
Treatment
Chikungunya
Introduction
Epidemiology
Ocular Manifestations
Diagnosis
Treatment
Zika
Introduction
Epidemiology
Ocular Manifestations
Diagnosis
Treatment
Ebola
Introduction
Epidemiology
Ocular Manifestations
Diagnosis
Treatment
Human T-Cell Lymphotropic Virus Type I
Introduction
Epidemiology/Pathogenesis
Ocular Manifestations
Diagnosis
Treatment
Measles Virus
Introduction
Epidemiology/Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Pathology
Treatment
Rubella Virus
Summary
Key References
References
7.6 Syphilitic and Other Spirochetal Uveitis
Syphilitic Uveitis
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Lyme Disease
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Systemic Associations
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Leptospirosis
Key Features
Associated Feature
Introduction
Epidemiology and Pathogenesis
Systemic Manifestations
Ocular Manifestations
Diagnosis
Differential Diagnosis
Treatment
Course and Outcome
Key References
References
7.7 Tuberculosis, Leprosy, and Brucellosis
Key Ocular Features
Tuberculous Uveitis
Leprosy Uveitis
Brucellosis Uveitis
Associated Systemic Features
Tuberculosis
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Anterior Uveitis
Intermediate Uveitis
Posterior and Pan-Uveitis
Diagnosis
Pathology
Treatment
Leprosy
Introduction
Epidemiology
Systemic Manifestations and Pathogenesis of Ocular Disease
Clinical Presentation
Diagnosis
Treatment
Brucellosis
Introduction
Systemic Manifestations
Ocular Manifestations
Diagnosis
Treatment
Acknowledgements
Key References
References
7.8 Bartonella-Related Infectious Uveitis (Cat Scratch Disease) and Whipple’s Disease
Key Features
Cat Scratch Disease
Whipple’s Disease
Introduction
Cat Scratch Disease: Bartonella Henselae–Associated Uveitis
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Imaging
Differential Diagnosis
Pathology
Treatment
Whipple’s Disease: Tropheryma Whipplei–Associated Uveitis
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Key References
References
7.9 Infectious Endophthalmitis
Key Features
Associated Features
Introduction
Epidemiology and Risk Factors
Exogenous Endophthalmitis
Trauma
Cataract Surgery
Penetrating Corneal Surgery
Glaucoma Filtration Procedures
Vitrectomy
Intravitreal Injections
Endogenous Endophthalmitis
Pathology and Pathogenesis
Clinical Presentation and Evaluation
Microbiological Testing
Differential Diagnosis
Treatment
Medications
Surgical Intervention
Outcomes
Conclusions
Key References
References
7.10 Histoplasmosis
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Key References
References
7.11 Fungal Endophthalmitis
Key Features
Associated Features
Candidal Intraocular Infection
Aspergillus Endogenous Endophthalmitis
Coccidioidal Intraocular Inflammation
Candida
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Histopathology
Aspergillus
Epidemiology and Pathogenesis
Ocular Manifestations
Histopathology
Fusarium
Epidemiology and Pathogenesis
Ocular Manifestations
Coccidioides Immitis—Ocular Coccidioidomycosis
Cryptococcal Endophthalmitis
Histoplasma Endophthalmitis
Diagnosis of Fungal Endophthalmitis
Differential Diagnosis
Treatment of Fungal Endophthalmitis
Course and Outcome
Key References
References
7.12 Ocular Toxoplasmosis
Key Features
Associated Features
Introduction
Organism and Life Cycle
Epidemiology
Pathology and Pathogenesis
Clinical Manifestations
Systemic Disease
Ocular Disease
Diagnosis
Differential Diagnosis
Therapy
Course and Prognosis
Key References
References
7.13 Posterior Parasitic Uveitis
Key Features
Introduction
Ocular Cysticercosis
Clinical Presentation
Treatment
Ocular Toxocariasis
Chronic Endophthalmitis
Posterior Pole Granuloma
Peripheral Granuloma
Atypical Presentations
Differential Diagnosis
Ancillary Testing
Treatment
Onchocerciasis
Gnathostomiasis
Diffuse Unilateral Subacute Neuroretinitis
Amebiasis
Giardiasis
Malaria
Leishmaniasis
Ocular Manifestation
Pediatric Presumed Trematode Infection
Ophthalmomyiasis
Acknowledgement
Key References
References
7.14 Uveitis Related to HLA-B27 and Juvenile Idiopathic Arthritis–Associated Uveitis
Uveitis Related to HLA-B27
Key Features
Associated Features
Juvenile Idiopathic Arthritis-Associated UveiTIS
Key Features
Associated Features
Uveitis Related to HLA-B27
Introduction
Pathogenetic Mechanisms
Clinical Features and Laboratory Investigations
Associated Systemic Disease
Treatment and Prevention
Juvenile Idiopathic Arthritis
Introduction
Pathogenetic Mechanisms
Clinical Picture
Uveitis in JIA
Risk Factors
Clinical Picture
Complications and Prognosis
Management
Management of Complications
Outcomes
Screening
Key References
References
7.15 Sarcoidosis
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Key References
References
7.16 Behçet’s Disease
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Corticosteroids
Immunophilin Ligands
Cytotoxic Agents
Biological Agents
Course and Outcome
Key References
References
7.17 Vogt–Koyanagi–Harada Disease
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Prodromal Phase
Uveitic Phase
Chronic and Recurrent Phases
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Auditory Signs
Neurological Signs
Dermal Signs
Other Signs
Pathology
Uveitic Phase
Chronic and Recurrent Phases
Treatment
Course and Outcome
Key References
References
7.18 Phacogenic Uveitis
Key Feature
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcome
Key References
References
7.19 Sympathetic Uveitis
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Prevention
Treatment
Course and Outcome
Key References
References
7.20 Idiopathic and Other Anterior Uveitis Syndromes
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Pathology
Treatment
Fuchs’ Heterochromic Iridocyclitis
Posner–Schlossman Syndrome
Drug-Induced Anterior Uveitis
Schwartz–Matsuo Syndrome
Ellingson Syndrome
Key References
References
7.21 Pars Planitis and Other Intermediate Uveitis
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Findings and Complications
Diagnosis
Management
Medical Management
Surgical Management
Prognosis
Key References
References
7.22 Posterior Uveitis of Unknown Cause—White Spot Syndromes
Key Feature
Associated Features
Introduction
Birdshot Chorioretinopathy
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Treatment
Course and Outcome
Acute Posterior Multifocal Placoid Pigment Epitheliopathy
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcomes
Serpiginous Choroiditis
Epidemiology
Ocular Manifestations
Diagnosis
Differential Diagnosis
Pathology
Treatment
Course and Outcomes
Relentless Placoid Chorioretinitis
Epidemiology
Ocular Manifestations
Diagnosis
Differential Diagnosis
Treatment
Course and Prognosis
Persistent Placoid Maculopathy
Epidemiology and Pathogenesis
Ocular Manifestations
Differential Diagnosis
Treatment
Course and Outcome
Multifocal Choroiditis/Punctate Inner Choroidopathy
Epidemiology
Ocular Manifestations
Diagnosis
Systemic Associations
Course and Outcomes
Differential Diagnosis
Treatment
Multiple Evanescent White Dot Syndrome
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Course and Outcomes
Acute Zonal Occult Outer Retinopathy
Epidemiology
Ocular Manifestations and Diagnosis
Differential Diagnosis
Course and Outcome
Acute Macular Neuoretinopathy
Epidemiology and Pathogenesis
Diagnosis
Differential Diagnosis
Course and Outcomes
Acknowledgment
Key References
References
7.23 Masquerade Syndromes
Key Features
Associated Features
Introduction
Primary Neoplasms
Primary Intraocular (Vitreoretinal) Lymphoma
Diagnosis
Treatment
Primary Choroidal Lymphomas and Lymphoid Hyperplasia
Melanoma
Other Primary Neoplasms
Secondary Neoplasms and Metastases
Lymphoma and Leukemia
Metastatic Carcinoma
Metastatic Melanoma
Paraneoplastic Syndromes
Conclusions
Key References
References
8.1 Malignant Intraocular Neoplasms
Key Features
Introduction
Primary Malignant Intraocular Neoplasms
Retinoblastoma
Primary Uveal Melanoma
Primary Anterior Uveal Melanoma
Primary Posterior Uveal Melanoma
Primary Intraocular Lymphoma
Primary Vitreoretinal Lymphoma
Primary Uveal Lymphoma
Medulloepithelioma
Adenocarcinomas of Intraocular Neuroectodermal Epithelial Layers
Primary Nonophthalmic Malignant Neoplasms Metastatic to the Eye
Secondary Malignant Intraocular Neoplasms
Hematological Neoplasias Involving the Eyes
Key References
References
8.2 Benign Intraocular Neoplasms, Hamartomas, and Choristomas
Key Features
Introduction
Benign Intraocular Neoplasms
Uveal Nevus
Anterior Uveal Nevus
Posterior Uveal Nevus
Retinal Astrocytoma
Retinal Capillary Hemangioma
Uveal Leiomyoma
Uveal Neurilemoma
Adenomas of Intraocular Neuroectodermal Epithelial Tissues
Intraocular Hamartomas
Circumscribed Choroidal Hemangioma
Combined Hamartoma of the Retina
Intraocular Choristomas
Benign Cellular Tumors of Uncertain Category
Choroidal Osteoma
Key References
References
8.3 Non-Neoplastic Intraocular Lesions and Disorders Simulating Malignant Intraocular Neoplasms
Key Features
Introduction
Non-Neoplastic Lesions and Disorders Simulating Malignant Intraocular Neoplasms of the Anterior Ocular Segment
Neuroepithelial Cysts of Iris and Ciliary Body
Epithelial Inclusion Cyst of Iris
Anterior Scleral Staphyloma
Iridocorneal Endothelial Syndrome
Inflammatory Tumor of Iris or Ciliary Body
Iris Foreign Body
Advanced Cataract Simulating Ciliary Body Melanoma on B-Scan Ultrasonography
Non-Neoplastic Lesions and Disorders Simulating Malignant Intraocular Neoplasms of the Posterior Ocular Segment Other Than Retinoblastoma
Congenital Hypertrophy of Retinal Pigment Epithelium
Focal Retinal Pigment Epithelial Hyperplasia
Spontaneous Subretinal Hematomas
Localized Suprachoroidal Hematoma
Acquired Nonfamilial Retinal Hemangiomatous Lesion
Nodular Posterior Scleritis
Bilateral Diffuse Uveal Melanocytic Proliferation Associated With Systemic Carcinoma
Vortex Vein Varicosity
Orbital Tumor Indenting Eye Wall
Sclerochoroidal Calcification
Endogenous Microbial Subretinal Abscess
Atypical Retinal Pigment Epithelial Detachment
Bullous Central Serous Chorioretinopathy
Ciliochoroidal Effusion and Idiopathic Uveal Effusion Syndrome
Multifocal Best Vitelliform Retinal Dystrophy and Vitelliform Paraneoplastic Retinopathy
Massive Gliosis of Retina
Inflammatory Chorioretinal Granuloma
Harada’s Disease
Idiopathic Uveitis in the Elderly
Vitiliginous (Birdshot) Choroiditis
Endogenous Endophthalmitis
Non-Neoplastic Intraocular Lesions and Disorders Simulating Intraocular Retinoblastoma
Non-Neoplastic Lesions and Disorders Simulating Intraretinal Retinoblastoma
Vitreoretinal Toxocara Granuloma
Extensive Myelination of Retinal Nerve Fiber Layer
Chorioretinal Coloboma
Toxoplasmic Retinitis
Focal Retinal Gliosis
Lesions and Disorders Simulating Exophytic Retinoblastoma
Advanced Coats’ Disease
Persistent Hyperplastic Primary Vitreous (Persistent Fetal Vasculature)
Congenital Retinal Dysplasia
Advanced Retinopathy of Prematurity (Retrolental Fibroplasia)
Advanced Familial Exudative Vitreoretinopathy (Fev)
Advanced Incontinentia Pigmenti Retinopathy
Lesions and Disorders Simulating Endophytic Retinoblastoma
Pars Planitis (Intermediate Uveitis)
Endogenous Endophthalmitis Simulating Endophytic Retinoblastoma
Key References
References
8.4 Phakomatoses
Key Features
Introduction
Neurofibromatosis
Epidemiology and Pathogenesis
Extraophthalmic Manifestations
Ocular Manifestations
Systemic Manifestations
Treatment
Course and Outcomes
Tuberous Sclerosis
Epidemiology and Pathogenesis
Extraophthalmic Manifestations
Ocular Manifestations
Systemic Evaluation
Treatment
Course and Outcome
Von Hippel–Lindau Syndrome
Epidemiology and Pathogenesis
Extraophthalmic Manifestations
Ocular Manifestations
Systemic Evaluation
Treatment
Course and Outcomes
Sturge–Weber Syndrome
Epidemiology and Pathogenesis
Extraophthalmic Manifestations
Ocular Manifestations
Systemic Evaluation
Treatment
Course and Outcome
Wyburn–Mason Syndrome
Epidemiology and Pathogenesis
Extraophthalmic Manifestations
Ocular Manifestations
Systemic Evaluation
Treatment
Course and Outcomes
Key References
References
9.1 Principles of Imaging in Neuro-Ophthalmology
Key Features
Introduction
Ophthalmologist’s Role in Neuroimaging
Computed Tomography
Principles
Clinical Applications
Safety
Magnetic Resonance Imaging
Principles
Imaging Parameters
T1 and T2
TR and TE
Special Sequences and Techniques in the Production of an Image
Spin Echo, Gradient-Echo, Fluid-Attenuated Inversion Recovery, and Fat Suppression
Diffusion-Weighted Imaging
Contrast Enhancement
Surface and Head Coils
Magnetization Transfer Imaging
Safety
Angiography
Magnetic Resonance Angiography
Principles
Clinical Applications of MRA
Computed Tomographic Angiography
Principles
Clinical Applications
CTA Versus MRA
Conventional Angiography
Principles
Ultrasonography
Principles
Functional Imaging
Positron Emission Technology and Single-Photon Emission Computed Tomography
Principles
Clinical Applications
Magnetic Resonance Spectroscopy
Principles
Functional Magnetic Resonance Imaging
Principles
Imaging Strategies in Neuro-Ophthalmology
Key References
References
9.2 Optical Coherence Tomography in Neuro-Ophthalmology
Key Features
Introduction
OCT Interpretation
Peripapillar Retinal Nerve Fiber Layer
Macular Ganglion Cells Layer
Microcystic Inner Nuclear Layer Abnormalities
Papilledema
Nonarteritic Ischemic Optic Neuropathy
Compressive Optic Neuropathy
Transsynaptic Retrograde Degeneration in Homonymous Hemianopia
Multiple Sclerosis
OCT and Brain Atrophy
Neuromyelitis Optica
Neurodegenerative Diseases
Parkinson’s Disease
Alzheimer’s Disease
Friedreich’s Ataxia and Other Rare Neurological Syndromes
Hereditary Optic Neuropathies
Leber’s Hereditary Optic Neuropathy
Dominant Optic Atrophy
Nutritional and Toxic Optic Neuropathies
Optical Coherence Tomography Angiography
Key References
References
9.3 Anatomy and Physiology
Key Features
Historical Review
General Anatomy
Constituent Elements
Axons
Glia
Four Portions of the Optic Nerve
Optic Disc
Intraorbital Optic Nerve
Intracanalicular Optic Nerve
Intracranial Optic Nerve
Circulation of the Optic Nerve
Key References
References
9.4 Differentiation of Optic Nerve From Macular Retinal Disease
Key Features
Diagnostic Features
Introduction
Ocular Features
Diagnosis and Ancillary Testing
History
Physical Examination
Ancillary Testing
Key References
References
9.5 Congenital Optic Disc Anomalies
Key Feature
Associated Feature
Introduction
Age Association
Central Nervous System Malformations
Optic Nerve Hypoplasia
Morning Glory Disc Anomaly
Optic Disc Coloboma
Optic Pit
Megalopapilla
Congenital Tilted Disc Syndrome
Congenital Optic Disc Pigmentation
Aicardi Syndrome
Key References
References
9.6 Papilledema and Raised Intracranial Pressure
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Testing
Differential Diagnosis
Compressive Optic Neuropathies
Papillitis
Anterior Ischemic Optic Neuropathy
Central Retinal Vein Occlusion
Diabetic Papillopathy
Optic Disc Vasculitis
Other Causes
Systemic Associations
Pathology
Treatment
Course and Outcome
Key References
Reference
9.7 Inflammatory Optic Neuropathies and Neuroretinitis
Key Features
Associated Feature
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Viral and Postviral Syndromes
Sarcoidosis
Syphilis
Lyme Disease
Cat Scratch Disease
Toxoplasmosis
Optic Neuropathy in HIV Disease
Systemic Lupus Erythematosus and Other Vasculitides
Neuromyelitis Optica
Association With Multiple Sclerosis
Pathology
Treatment
Other Treatments
Management Recommendations
Course and Outcome
Key References
References
9.8 Ischemic Optic Neuropathy
Key Features
Associated Features
Ischemic Optic Neuropathy
Introduction
Anterior Ischemic Optic Neuropathy
Epidemiology and Pathogenesis
Arteritic Anterior Ischemic Optic Neuropathy
Nonarteritic Anterior Ischemic Optic Neuropathy (NAION)
Ocular Manifestations
Arteritic Anterior Ischemic Optic Neuropathy
Nonarteritic Anterior Ischemic Optic Neuropathy
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Treatment
Arteritic Anterior Ischemic Optic Neuropathy
Nonarteritic Anterior Ischemic Optic Neuropathy
Course and Outcome
Arteritic Anterior Ischemic Optic Neuropathy
Nonarteritic Anterior Ischemic Optic Neuropathy
Posterior Ischemic Optic Neuropathy
Diabetic Papillopathy
Pathogenesis and Features
Course and Outcome
Key References
References
9.9 Hereditary, Nutritional, and Toxic Optic Atrophies
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Key References
References
9.10 Prechiasmal Pathways—Compression by Optic Nerve and Sheath Tumors
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Treatment
Optic Nerve Compression by Optic Nerve and Sheath Tumors
Introduction
Gliomas and Malignant Gliomas
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Optic Nerve Sheath Meningiomas
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Pathology
Treatment
Course and Outcome
Other Intracanalicular and Intracranial Compressive Lesions
Key References
References
9.11 Traumatic Optic Neuropathies
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Pathology
Treatment
Key References
References
9.12 Lesions of the Optic Chiasm, Parasellar Region, and Pituitary Fossa
Key Feature
Associated Features
Introduction
Anatomy
Epidemiology and Pathogenesis
Pituitary Adenomas
Meningiomas
Craniopharyngiomas
Optic Gliomas
Other Causes of Chiasmal Syndrome
Ocular Manifestations
Signs and Symptoms of Chiasmal Lesions
Signs and Symptoms of Parasellar Lesions
Diagnosis
Visual Field Testing
Neuroimaging
Other Diagnostic Testing
Differential Diagnosis
Systemic Associations
Pathology
Pituitary Adenomas
Meningiomas
Craniopharyngiomas
Optic Pathway Gliomas
Treatment, Course, and Outcome
Pituitary Adenomas
Surgical Treatment
Radiation Therapy
Meningiomas
Craniopharyngiomas
Optic Gliomas
Key References
References
9.13 Lesions of Retrochiasmal Pathways, Higher Cortical Function, and Nonorganic Visual Loss
Key Features
Retrochiasmal Pathways and Higher Cortical Function
Optic Tracts
Lateral Geniculate Bodies
Optic Radiations
Higher Cortical Function
Topographical Diagnosis of Retrochiasmal Disease
Cortical Representation of Vision
Introduction
Object Identification and Memory
Reading and Dyslexia
Color Perception
Integration of Visual–Auditory Space
Motion Detection
Nonorganic Visual Loss
Key References
References
9.14 Disorders of Supranuclear Control of Ocular Motility
Key Features
Associated Features
Introduction
Anatomy of Eye Movement
Anatomy of Supranuclear Eye Movement Control
Horizontal Eye Movements
Vertical Eye Movements
Slow Eye Movements
Pursuit Eye Movements
Vestibular System
Optokinetic System
Vergence System
Diagnostic Testing
Saccades
Fixation
Pursuit
Vergence Eye Movements
Ocular Alignment
Differentiating Supranuclear From Nuclear and Infranuclear Lesions
Oculocephalic (Doll’s Eyes) Reflex
Vestibulo–Ocular Reflex Testing
Disorders of Supranuclear Ocular Motility
Congenital Gaze Palsies
Acquired Gaze Palsies
Disorders of Pursuit
Internuclear Ophthalmoplegia
Disorders of Vertical Gaze
Ocular Motility Disorders and the Cerebellum
Ocular Motility Disorders and the Vestibular System
Vergence Disorders
Development of the Ocular Motor System
Transient Ocular Motility Abnormalities in Infancy
Key References
References
9.15 Nuclear and Fascicular Disorders of Eye Movement
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Palsies of the Third Cranial Nerve
Third Cranial Nerve Nuclear Lesions
Third Cranial Nerve Fascicular Palsies
Congenital Third Cranial Nerve Palsies
Palsies of the Fourth Cranial Nerve
Fourth Cranial Nerve Nuclear and Fascicular Lesions
Palsies of the Sixth Cranial Nerve
Sixth Cranial Nerve Nuclear Palsies
Sixth Cranial Nerve Fascicular Palsies
Diagnosis
Palsies of the Third Cranial Nerve
Palsies of the Fourth Cranial Nerve
Palsies of the Sixth Cranial Nerve
Treatment, Course, and Outcome
Palsies of the Third Cranial Nerve
Palsies of the Fourth Cranial Nerve
Palsies of the Sixth Cranial Nerve
Key References
References
9.16 Paresis of Isolated and Multiple Cranial Nerves and Painful Ophthalmoplegia
Key Features
Associated Features
Introduction
Anatomy
Ocular Manifestations
General Symptoms
Isolated Cranial Neuropathies
Isolated Sixth Cranial Nerve Palsy
Isolated Fourth Cranial Nerve Palsy
Isolated Third Cranial Nerve Palsy
Divisional Third Cranial Nerve Palsy
Nonisolated Cranial Neuropathies
Multiple Cranial Neuropathies
Bilateral Ophthalmoplegia
Subarachnoid Involvement
Nonisolated Third Cranial Nerve Palsies
Diagnosis
Isolated Cranial Neuropathies
Isolated Sixth Cranial Nerve Palsy
Isolated Fourth Cranial Nerve Palsy
Isolated Third Cranial Nerve Palsy
Nonisolated Cranial Neuropathies
Multiple Cranial Neuropathies
Bilateral Ophthalmoplegia
Differential Diagnosis
Isolated Cranial Neuropathies
Isolated Sixth Cranial Nerve Palsy
Isolated Fourth Cranial Nerve Palsy
Isolated Third Cranial Nerve Palsy
Nonisolated Cranial Neuropathies
Treatment
Nonisolated Cranial Neuropathies
Key References
References
9.17 Disorders of the Neuromuscular Junction
Key Feature
Associated Features
Myasthenia Gravis
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Systemic Associations
Treatment
Course and Outcome
Botulism
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Treatment
Lambert–Eaton Myasthenic Syndrome
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Treatment
Course and Outcome
Key References
References
9.18 Ocular Myopathies
Key Features
Associated Features
Introduction
Mitochondrial Myopathies
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Dystrophic Myopathies
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Inflammatory and Infiltrative Myopathies
Epidemiology and Pathogenesis
Orbital Myositis
Ocular Manifestations
Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Key References
References
9.19 Nystagmus, Saccadic Intrusions, and Oscillations
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Congenital Nystagmus
Latent and Manifest Latent Nystagmus
Spasmus Nutans
Vestibular Nystagmus
Peripheral Vestibular Nystagmus
Central Vestibular Nystagmus
Positional Vestibular Nystagmus
Benign Paroxysmal Positional Nystagmus
Gaze-Evoked Nystagmus
Rebound Nystagmus
Alternating Nystagmus
Upbeat Nystagmus
Downbeat Nystagmus
Dissociated Nystagmus
Acquired Pendular Nystagmus in Adults
Monocular Visual Loss and Bilateral Visual Loss
See-Saw Nystagmus
Abducting Nystagmus in Internuclear Ophthalmoplegia
Ocular Bobbing
Saccadic Intrusions
Superior Oblique Myokymia
Convergence–Retraction Nystagmus and Convergence Nystagmus
Square-Wave Jerks
Macrosquare-Wave Jerks
Macrosaccadic Oscillations
Voluntary “Nystagmus”
Saccadic Pulses
Ocular Flutter
Opsoclonus
Treatment
Drug Treatment
Optical Treatment
Surgical Treatment
Other Treatments
Key References
References
9.20 Pupillary Signs of Neuro-Ophthalmic Disease
Key Features
Associated Features
Introduction
Relative Afferent Pupillary Defects
Efferent Pupillary Defects
Anisocoria
Pupillary Inequality That Increases in the Dark
Physiological Anisocoria
Horner’s Syndrome
Diagnosis of Horner’s Syndrome—Cocaine and Apraclonidine Pharmacological Testing
Location of Damage to the Sympathetic Pathway
Horner’s Syndrome in Children and Infants
Pupillary Inequality That Increases With Light
Slit-Lamp Examination of the Iris
No or Little Residual Light Reaction
Segmental Paralysis of the Iris Sphincter
Pupillary Supersensitivity to Cholinergic Drugs
Pupillary Undersensitivity to a Miotic Dose of Pilocarpine
Tonic Pupil of Adie’s Syndrome
Third Nerve Palsy
Aberrant Regeneration of the Third Cranial Nerve
Poor Pupil Dilation
Retinal Origin of the Pupil Light Reflex—The Melanopsin-Containing Retinal Ganglion Cell
Key References
References
9.21 Presbyopia and Loss of Accommodation
Key Feature
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Treatment
Key References
References
9.22 Headache and Facial Pain
Key Features
Associated Feature
Introduction
The Art and Science of Taking a Headache History
Basic Outline of the Headache History
Date of Onset, Age at Onset, and Frequency of Symptoms
Location
Duration
Predisposing Factors
Preceding Symptoms
Quality and Severity of Pain
Accompanying Symptoms
Differential Diagnosis of Headache Syndromes
Migraine
Epidemiology of Migraine
Clinical Features of Various Migraine Syndromes
Migraine Without Aura (Previously Termed Common Migraine)
Migraine With Aura (Previously Termed Classic Migraine)
Structural Lesions That Mimic Migraine With Aura
Recurrent Painful Ophthalmoplegic Neuropathy (Previously Termed Ophthalmoplegic Migraine)
Retinal Migraine
Pathogenesis of Migraine
Treatment of Migraine With Aura and Migraine Without Aura
Tension-Type Headache
Cluster Headache
Paroxysmal Hemicrania
Temporal Arteritis
Headache as a Result of Intracranial Processes
Differential Diagnosis of Facial Pain
Headache Attributed to Disorders of the Nose or Paranasal Sinuses (Previously Termed Sinus Headache)
Orbital Inflammation and Neoplasia
Classic Trigeminal Neuralgia (Previously Termed Tic Douloureux)
Paratrigeminal Oculosympathetic (Raeder’s) Syndrome
Primary Stabbing Headache (Ice-Pick Headaches, Jabs and Jolts Syndrome)
Key References
References
9.23 Tumors, Infections, Inflammations, and Neurodegenerations
Key Features
Associated Features
Tumors
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Pathology
Treatment
Course and Outcome
Infections
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Testing
Pathology
Treatment
Course and Outcome
Inflammations
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Systemic Necrotizing Vasculitides
Diagnosis and Testing
Pathology
Treatment
Course and Outcome
Neurodegenerations
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Cerebellar Neurodegenerative Diseases
Parkinsonism
Progressive Supranuclear Palsy
Chorea
Dementias With Eye Findings
Alzheimer’s Disease
Charles Bonnet’s Syndrome
Cerebrovascular Diseases
Dementia Complex Associated With HIV
Prion Diseases
Diagnosis and Testing
Pathology
Treatment
Course and Outcome
Key References
References
9.24 Urgent Neuro-Ophthalmic Disorders
Key Features
Introduction
Epidemiology and Pathogenesis
Giant Cell Arteritis
Aneurysm
Cavernous Sinus Thrombosis
Orbital Apex Syndrome
Pituitary Apoplexy
Ocular Manifestations
Giant Cell Arteritis
Aneurysm
Cavernous Sinus Thrombosis
Orbital Apex Syndrome
Pituitary Apoplexy
Diagnosis and Ancillary Testing
Giant Cell Arteritis
Aneurysm
Cavernous Sinus Thrombosis and Orbital Apex Syndrome
Pituitary Apoplexy
Differential Diagnosis
Giant Cell Arteritis
Aneurysm
Cavernous Sinus Thrombosis and Orbital Apex Syndrome
Pituitary Apoplexy
Pathology
Giant Cell Arteritis
Aneurysm
Cavernous Sinus Thrombosis and Orbital Apex Syndrome
Pituitary Apoplexy
Treatment
Giant Cell Arteritis
Aneurysm
Cavernous Sinus Thrombosis and Orbital Apex Syndrome
Pituitary Apoplexy
Course and Outcomes
Giant Cell Arteritis
Aneurysm
Cavernous Sinus Thrombosis
Orbital Apex Syndrome
Pituitary Apoplexy
Key References
References
9.25 Trauma, Drugs, and Toxins
Key Features
Associated Features
Trauma and the Brain
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Drugs, Toxins, and the Brain
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Systemic Associations
Pathology
Treatment, Course, and Outcome
Key References
References
9.26 Vascular Disorders
Key Feature
Associated Features
Introduction
Aneurysms
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Head Pain
Ophthalmoplegia
Pupillary Involvement
Differential Diagnosis
Treatment, Course, and Outcome
Carotid–Cavernous Sinus Fistulas and Dural Shunts
Epidemiology and Pathogenesis
Ocular Manifestations
Differential Diagnosis
Treatment, Course, and Outcome
Arteriovenous Malformations
Transient Visual Loss
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Nature of the Episodes
Type of Visual Loss
Length of Episodes
Frequency of Episodes
Associated Symptoms
Underlying Risk Factors
Treatment, Course, and Outcome
Transient Isolated Bilateral Loss of Vision
Aura Without Headache
Strokes
Epidemiology and Pathogenesis
Transient Ischemic Attacks and Stroke
Carotid–Ophthalmic Ischemic Attacks and Stroke
Ocular Manifestations
Key References
References
9.27 Electrophysiology
Key Features
Introduction
NonOrganic Vision Loss
Optic Nerve Disease
Key References
References
10.1 Epidemiology of Glaucoma
Key Features
Introduction
Prevalence and Rates of Associated Blindness
Primary Open-Angle Glaucoma
Demographic Risk Factors for Primary Open-Angle Glaucoma
Race
Age
Gender
Family History
Ocular Risk Factors for Primary Open-Angle Glaucoma
Intraocular Pressure
Optic Nerve Parameters
Nerve Fiber Layer Imaging
Myopia
Peripapillary Atrophy
Corneal Thickness and Hysteresis
Systemic Risk Factors for Primary Open-Angle Glaucoma
Diabetes
Hypertension
Cigarette Smoking, Alcohol Use, and Caffeine Consumption
Primary Angle-Closure Glaucoma
Demographic Risk Factors for Primary Angle-Closure Glaucoma
Race
Gender
Family History
Ocular Risk Factors for Primary Angle-Closure Glaucoma
Anterior Chamber Depth
Anterior Segment Optical Coherence Tomography
Limbal Anterior Chamber Depth
Axial Length/Refractive Error
Lens Thickness
Radius of Corneal Curvature
Systemic Risk Factors for Primary Angle-Closure Glaucoma
Secondary Glaucomas
Ocular Hypertension
Glaucoma Suspects
Key References
References
10.2 Screening for Glaucoma
Key Features
Introduction
Historical Review
Screening Programs
Prior Glaucoma Screening Efforts
Current Definition of Open-Angle Glaucoma
Purpose of the Test
Utility of the Test and Interpretation of Results
Procedure
Complications
Alternative Tests
Analysis of Tests
Telemedicine and Glaucoma Screening
Marker Testing for Glaucoma
Future Direction of Glaucoma Screening
Key References
References
10.3 Mechanisms of Glaucoma
Key Features
Introduction
Physiology of Aqueous Production
Structural and Functional Overview of Aqueous Humor Formation
Three Steps in Aqueous Secretion
Ion and Fluid Uptake From the Stroma
Fluid Transfer Through Gap Junctions
Fluid Transfer Into the Aqueous Humor
Regulation of Net Aqueous Humor Formation
Conclusions and Future Directions
The Aqueous Humor Outflow Pathway
Pathology of the Glaucomatous Outflow Pathway
Conclusions and Future Directions
Pathophysiology of Glaucomatous Optic Neuropathy
Glaucomatous Neuropathy Occurs in Response to Increased Cell Stress Conditions
Disrupted Axon Transport
Vascular Hypothesis
Excitotoxicity Due to Excessive Glutamate
Oxidative Stress and Free Radical Damage
Inflammatory Cytokines
Aberrant Immunity
Cellular Mechanisms of Apoptosis in Glaucoma
Neurotrophic Factors for Survival and Growth
Central Visual Pathway Degeneration in Glaucoma
Conclusions and Future Directions
Key References
References
10.4 Clinical Examination of Glaucoma
Key Features
Introduction
Obtaining Clinically Relevant Information
Assessing the Patient’s Functional Status
Obtaining the Patient’s History
Medical History
Ocular History
Family History
Ethnicity
Examination Techniques
Visual Acuity Testing
Pupillary Response Testing
Tonometry
The Role of Intraocular Pressure in Glaucoma
Applanation Tonometry
Pachymetry
External Examination
Slit-lamp Examination
Conjunctiva, Sclera, and Episclera
Cornea
Anterior Chamber
Iris
Lens
Gonioscopy
Estimation of the Peripheral Anterior Chamber Angle
Principles of Gonioscopy
Direct Gonioscopy
Indirect Gonioscopy
Gonioscopic Grading Systems
Gonioscopic Anatomy of the Angle
Shaffer System
Spaeth System
Occludable Angles
Specific Findings of the Anterior Chamber Angle
Optic Nerve Examination
Testing for Glaucoma
Key References
References
10.5 Visual Field Testing in Glaucoma
Key Features
Associated Features
Introduction
Standard Automated Perimetry
Testing Algorithms in Standard Automated Perimetry
Visual Field Testing and Glaucoma Diagnosis
Visual Field and Assessing the Severity of Glaucoma
Visual Field and Assessing Progression in Glaucoma
Key References
References
10.6 Advanced Psychophysical Tests for Glaucoma
Key Features
Introduction
Test Strategies
Test Procedures
Analysis Methods
Conclusion
Key References
References
10.7 Optic Nerve Analysis
Key Features
Associated Features
Diagnostic Technologies
Introduction
Normal Anatomy
Clinical Examination: Glaucomatous Features
Disc Cup
Blood Vessels
Peripapillary Atrophy
Imaging
Optic Disc Photography
Confocal Scanning Laser Ophthalmoscopy
Optical Coherence Tomography
Conclusions
Key References
References
10.8 Optic Nerve Blood Flow Measurement
Key Features
Associated Features
Introduction
Applied Anatomy
Physiology
Experimental Investigations
Clinical Studies
Optical Coherence Tomography Angiography
Retinal Oximetry
Ocular Blood Flow and Visual Field Loss
Systemic Vascular Disease and Glaucoma
Pharmacology
Statement of Disclosure
Key References
References
10.9 Ocular Hypertension
Key Features
Introduction
Epidemiology and Pathogenesis
Predictive Factors for Conversion of OHT to POAG
Central Corneal Thickness
Intraocular Pressure
Age
Pattern Standard Deviation
Optic Nerve
Optic Disc Hemorrhage
Other Predictive Factors
Diagnosis
Differential Diagnosis
Treatment
Course and Outcome
Key References
References
10.10 Primary Open-Angle Glaucoma
Key Features
Associated Features
Definition and Classification
Intraocular Pressure, Risk Factors, and Aspects of Molecular Pathogenesis
Diagnosis
Nature of Progressive Visual Loss
Preperimetric Glaucoma
Threshold and Conversion
Critical Phase
Blindness
Treatment and Monitoring
Key References
References
10.11 Normal-Tension Glaucoma
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Treatment
Lower Intraocular Pressure
Course and Outcome
Key References
References
10.12 Angle-Closure Glaucoma
Key Features
Introduction
Epidemiology and Pathogenesis
Prevalence
Incidence
Risk Factors
Pupillary Block
Nonpupillary Block Mechanisms
Plateau Iris Configuration
Aqueous Misdirection
Diagnosis
External Examination
Penlight Examination
Slit-Lamp Examination
Gonioscopy
Other Imaging Techniques
Ultrasound Biomicroscopy
Anterior-Segment Optical Coherence Tomography
Provocative Tests
Differential Diagnosis
Management of Acute Angle Closure
After 1 to 2 Hours
Later
Even Later
Management of Chronic Angle-Closure Glaucoma
Management of Angle-Closure Glaucoma
Medical Treatment
Laser Treatment
Surgical Treatment
Surgical Iridectomy
Lens Extraction
Goniosynechialysis
Trabeculectomy
Glaucoma Drainage Implant
Cyclodestructive Procedures
Micropulse Laser
Prognosis
Acknowledgments
Key References
References
10.13 Glaucoma Associated With (Pseudo)-Exfoliation Syndrome
Key Features
Associated Features
Introduction
Epidemiology and Genetics
Clinical Presentation and Ocular Manifestations
Glaucoma in Exfoliation Syndrome
Systemic Manifestations
Differential Diagnosis
Key References
References
10.14 Pigmentary Glaucoma
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Differential Diagnosis
Treatment
Course and Outcome
Key References
References
10.15 Neovascular Glaucoma
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Treatment
Course and Outcome
Emerging Treatments
Key References
References
10.16 Inflammatory and Corticosteroid-Induced Glaucoma
Key Features
Associated Features
Introduction
Pathophysiology
Mechanisms of Elevated IOP
Secondary Open-Angle Glaucoma
Pre-Existing Open-Angle Glaucoma
Secondary Angle-Closure Glaucoma
Pre-Existing Disposition to Primary Angle Closure
Combined-Mechanism Glaucoma
Principles of Management
Uveitis
Diagnosis
Management
Mydriasis and Cycloplegia
Glaucoma
Medical Management
Surgical Management
Specific Entities
Glaucomatocyclitic Crisis (Posner–Schlossman Syndrome)
Fuchs’ Uveitis Syndrome (Fuchs’ Heterochromic Iridocyclitis)
Key References
References
10.17 Glaucoma Associated With Ocular Trauma
Key Features
Associated Features
Introduction
Immediate or Early-Onset Glaucoma After Ocular Trauma
Contusion
Trabecular Disruption
Hyphema
Massive Choroidal Hemorrhage
Chemical Trauma
Late-Onset Glaucoma After Ocular Trauma
Angle Recession
Peripheral Anterior Synechiae
Ghost Cell (Hemolytic) Glaucoma
Lens-Induced Glaucoma
Lens Dislocation
Phacomorphic Glaucoma
Phacolytic Glaucoma
Phacoantigenic Glaucoma
Lens Particle Glaucoma
Delayed Closure of a Cyclodialysis Cleft
Epithelial Downgrowth
Retained Intraocular Foreign Body
Rhegmatogenous Retinal Detachment
Key References
References
10.18 Glaucoma With Raised Episcleral Venous Pressure
Key Feature
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Treatment
Course and Outcome
Key References
References
10.19 Malignant Glaucoma
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Treatment
Medical
Laser
Surgery
Fellow Eye
Key References
References
10.20 Glaucomas Secondary to Abnormalities of the Cornea, Iris, Retina, and Intraocular Tumors
Key Features
Ghost Cell Hemolytic Glaucoma
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Pathology
Treatment
Schwartz’s Syndrome
Iridocorneal Endothelial Syndrome
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Progressive (Essential) Iris Atrophy
Chandler’s Syndrome
Iris–Nevus Syndrome (Cogan–Reese Syndrome)
Pathology
Treatment
Axenfeld–Rieger Syndrome
Epidemiology and Pathogenesis
Ocular Manifestations
Systemic Associations
Pathology
Treatment
Epithelial Downgrowth and Fibrous Ingrowth (Proliferation)
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Pathology
Treatment
Aniridia
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Systemic Associations
Pathology
Treatment
Tumors and Glaucoma
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Pathology
Treatment
Penetrating Keratoplasty
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Treatment
Alkali Chemical Trauma
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Pathology
Treatment
Key References
References
10.21 Congenital Glaucoma
Key Features
Associated Features
Introduction
Epidemiology and Pathogenesis
Primary Congenital Glaucoma (PCG)
Glaucoma Following Cataract Surgery
Secondary Glaucomas Associated With Ocular Anomalies or Systemic Syndromes
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Classification Schemes
Pathology
Treatment
Course and Outcome
Key References
References
10.22 When to Treat Glaucoma
Key Features
Introduction
Analysis of Risk Factors
Risk Factors
Intraocular Pressure
Optic Disc Characteristics
Central Corneal Thickness and Corneal Hysteresis
Age
Race and Ethnicity
Family History
Principles of Initiation of Therapy
Initiation of Therapy in the Glaucoma Patient
Initiation of Therapy in the Glaucoma Suspect
Conclusions
Key References
References
10.23 Which Therapy to Use in Glaucoma
Key Feature
Introduction
Historical Review
Treatment Modalities
Medical Treatment
Laser Trabeculoplasty
Surgery
Cyclodestructive Procedures
Treatment Algorithms
Conclusions
Key References
References
10.24 Current Medical Management of Glaucoma
Key Features
Introduction
Drugs That Decrease Aqueous Production
Beta-Blockers
Mechanism
Efficacy
Side Effects
Alpha-Adrenergic Agonists
Mechanism
Efficacy
Side Effects
Carbonic Anhydrase Inhibitors
Mechanism
Efficacy
Side Effects
Oral
Topical
Drugs That Increase Aqueous Outflow
Miotics
Mechanism
Efficacy
Side Effects
Prostaglandin Analogues
Mechanism
Efficacy
Side Effects
Systemic Safety
Fixed Combination Medications
Drug Development Pipeline
The Medical Armamentarium for Glaucoma Treatment
Key References
References
10.25 Laser Trabeculoplasty and Laser Peripheral Iridectomy
Key Features
Associated Features: Laser Trabeculoplasty
Associated Features: Laser Peripheral Iridectomy
Laser Trabeculoplasty
Introduction and Historical Review
Preoperative Evaluation and Diagnostic Approach
General Techniques
Patient Preparation
Lens Choice
Equipment Preparation
Treatment Guidelines
Follow-Up
Re-treatment
Complications
Outcome
Laser Peripheral Iridectomy
Introduction and Historical Review
Preoperative Evaluation and Diagnostic Approach
Indications
Contraindications
General Techniques
Argon versus Nd:YAG Laser
Patient Preparation
Lens Choice
Specific Techniques
Argon Laser
Nd:YAG Laser
Combined Argon–Nd:YAG Technique
Second Iridectomy
Complications
Intraocular Pressure Spikes
Laser-Induced Inflammation
Iridectomy Failure
Diplopia
Bleeding
Lens Opacities
Corneal Injury
Other Complications
Outcome
Laser Iridoplasty
Micropulse Laser Trabeculoplasty
Key References
References
10.26 Cyclodestructive Procedures in Glaucoma
Key Features
Associated Features
Introduction
Historical Review
Preoperative Evaluation and Diagnostic Approach
Mechanism of Action
Alternatives to a Cyclodestructive Procedure
Anesthesia
Specific Techniques
Cyclocryotherapy
Transscleral Cyclophotocoagulation
Noncontact and Contact Nd:YAG Laser Cyclophotocoagulation
Semiconductor Diode Laser Transscleral Cyclophotocoagulation
Micropulse Diode Cyclophotocoagulation
Endoscopic Laser Cyclophotocoagulation
Complications
Outcome
Key References
References
10.27 Goniotomy and Trabeculotomy
Key Features
Associated Feature
Introduction
Indications
Instruments
Preoperative Care
Examination Under Anesthesia
Procedures
Goniotomy
Trabeculotomy
Postoperative Care
Results
Complications
Key References
References
10.28 Minimally Invasive and Microincisional Glaucoma Surgeries
Key Features
Introduction
Considerations for Patient Selection
Angle Surgeries
Trabecular Microbypass Stents
Concept
iStent G2 Inject (GTS-400)
Technique
Results
iStent G1
Technique
Results
Hydrus: Ab Interno Schlemm’s Canal Scaffold
Concept
Technique
Results
Laser-Assisted Endoscopic Trabeculotomy
Concept
Endoscopic Excimer Laser Trabeculotomy
Technique
Results
Trabeculectomy Ab Interno: Trabectome
Concept
Technique
Results
Phaco Combined With Trabectome
Trabectome Alone in Pseudo-Phakic and Phakic Eyes
Trabectome and Goniosynechialysis in Narrow Angles and Angle Closure
Trabectome After Failed Trabeculectomy or Tube Shunt Surgery
Adjuvant Trabectome Surgery at the Time of Tube Shunt Surgery
Trabectome Surgery in Severe Glaucoma
Other Ab Interno Trabeculectomy and Trabeculotomy Techniques
Subconjunctival Microshunts
Concept
Technique
Results
Suprachoroidal Drainage Devices
Concept
Ab Externo Suprachoroidal Shunts
SOLX Gold Micro-Shunt
Technique
Results
Ab Interno Suprachoroidal Shunts
CyPass Micro-Stent
Technique
Results
iStent G3 Supra
Conclusions
Key References
References
10.29 Trabeculectomy
Key Features
Associated Features
Introduction
Indications
Surgical Planning
Preoperative Factors to Consider
Patient Counseling
Surgical Techniques
Intraoperative Technique: Limbal-Based Conjunctival Flap
Surgical Technique: Fornix-Based Conjunctival Flap
Avoiding Intraoperative Complications
Postoperative Care
Conclusions
Key References
References
10.30 Antifibrotic Agents in Glaucoma Surgery
Key Features
Associated Features
Introduction
Types of Antifibrotic Agents
Indications for Antimetabolite Use
Patient Groups With a High Risk of Scarring
Patient Groups With an Intermediate or Low Risk of Scarring
Application Techniques
Type and Concentration of Intraoperative Agent and Time of Exposure
Type of Sponge
Larger Areas of Antimetabolite Treatment
Position of Drainage Area Under Eyelid
Closure of Scleral Flap and Associated Surgical Techniques
Postoperative Injections
Complications
Future Strategies to Prevent Fibrosis
Key References
References
10.31 Drainage Implants
Key Feature
Associated Features
Historical Perspective
Basic Concept
Indications
Preoperative Considerations
Implant Selection
Surgical Technique
Anesthesia
Quadrant Selection
Conjunctival Flap and Dissection
Endplate Attachment
Implant Preparation
Tube Insertion
Patch Graft Placement
Conjunctival Closure
Postoperative Management
Complications
Intraoperative
Postoperative
Evidence From Randomized Clinical Trials
Drainage Implants Versus Trabeculectomy
Valved Versus Nonvalved Drainage Implants
Drainage Implants of Different Endplate Sizes
Conclusions
Key References
References
10.32 Complications of Glaucoma Surgery and Their Management
Key Features
Associated Features
Introduction
Trabeculectomy
Intraoperative Complications
Conjunctival Buttonhole
Trabeculectomy Scleral Flap Tear/Disinsertion
Intraoperative Bleeding
Early Postoperative Complications
Shallow Anterior Chamber
Low Filtration
Choroidal Effusion
Late Postoperative Complications
Late Hypotony
Late Bleb Failure
Cataract Formation
Late Bleb Leaks
Blebitis and Endophthalmitis
Glaucoma Drainage Implants
Key References
References
10.33 Genes Associated With Human Glaucoma
Key Features
Associated Feature
Introduction
Congenital Glaucoma
Developmental Glaucoma
Primary Open-Angle Glaucoma: Juvenile Onset
Pigment Dispersion Syndrome and Glaucoma
Adult-Onset Primary Open-Angle Glaucoma
Normal-Tension Glaucoma
Exfoliation Syndrome and Glaucoma
Angle-Closure Glaucoma
Key References
References
10.34 Evidence-Based Medicine in Glaucoma
Key Features
Introduction
Tools of Evidence-Based Medicine
Randomized Clinical Trials
Meta-Analyses and Systematic Reviews
Other Study Designs
Case Reports
Cross-Sectional Studies
Case-Control Studies
Cohort Study
Other Limitations
Selection Bias
Information Bias
Evaluation of Diagnostic Testing in Glaucoma
Examples of Evidence-Based Medicine in Glaucoma Therapy
Barriers to the Practice of Evidence-Based Medicine
Future Directions
Conclusions
Key References
References
11.1 Anatomy and Physiology of the Extraocular Muscles and Surrounding Tissues
Key Features
Embryology
General Structure of Extraocular Muscles
Gross Anatomy of the Extraocular Muscles
Origins of the Extraocular Muscles
Compartments of the Extraocular Muscles
Insertions of the Extraocular Muscles
Paths and Actions of the Extraocular Muscles
Innervation
Blood Supply
The Orbital Infrastructure and Anatomy
Clinical Correlates
Extraocular Muscle Physiology
Hering’s and Sherrington’s Laws
Key References
References
11.2 Evaluating Vision in Preverbal and Preliterate Infants and Children
Key Features
Introduction
Historical and Observational Techniques
Fixation Targets
Optokinetic Nystagmus
Visual Evoked Potentials
Forced-Choice Preferential Looking
Graded Optotypes
Digital Photoscreening
Maturation of Visual Acuity
Key References
References
11.3 Examination of Ocular Alignment and Eye Movements
Key Features
Evaluation of Ocular Alignment
Introduction
Laboratory Methods
Clinical Methods
Objective Clinical Methods
Corneal Light Reflex Tests
Cover Tests
Subjective Clinical Methods
Eye Movement Examinations
Introduction
Mechanical Tests of Eye Movement Limitation
Forced Duction Test
Active Force Generation Test
Key References
References
11.4 Sensory Adaptations in Strabismus
Key Features
Visual Confusion and Diplopia
Introduction
Ocular Manifestations
Treatment, Course, and Outcome
Suppression and Anomalous Retinal Correspondence
Introduction
Ocular Manifestations
Diagnosis and Ancillary Testing
Treatment, Course, and Outcome
Monofixation Syndrome
Introduction
Ocular Manifestations
Diagnosis and Ancillary Testing
Course and Outcome
Key References
References
11.5 Sensory Status in Strabismus
Key Features
Introduction
Sensory Fusion
Depth Perception and Stereopsis
Clinical Testing
Testing for Binocularity (Simultaneous Perception)
Tests of Retinal Correspondence
Stereopsis Tests
Test for Monofixation Syndrome
Key References
References
11.6 Esotropia
Key Features of Infantile Esotropia
Associated Features (Often Appear After the First Year of Life)
Key Features of Accommodative Esotropia
Associated Feature
Key Features of Duane’s Syndrome
Associated Features of Duane’s Syndrome
Introduction
Infantile Esotropia
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Treatment
Course and Outcome
Accommodative Esotropia
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis and Ancillary Testing
Differential Diagnosis
Treatment, Course, and Outcome
Cyclic Esotropia
Moebius’ Sequence
Duane’s Syndrome
Epidemiology and Pathogenesis
Ocular Manifestations
Treatment
Systematic Associations
Strabismus Fixus
Esotropia in the Neurologically Impaired
Esotropia Associated With Visual Deficit (Sensory Esotropia)
The “Heavy Eye Syndrome” and the “Sagging Eye Syndrome”
Key References
References
11.7 Exotropia
Key Feature
Associated Features
Introduction
Epidemiology and Pathogenesis of Intermittent Exotropia
Ocular Manifestations of Intermittent Exotropia
Classification of Intermittent Exotropia According to Distance/Near Angle
Control of Intermittent Exotropia
Complications of Exotropia
Diagnosis and Ancillary Testing for Exotropia
Differential Diagnosis
Treatment
Correction of Refractive Errors
Orthoptic Treatment
Therapeutic Occlusion
Overcorrecting Minus Lenses
Optical Treatment
Pharmacological Treatment
Surgical Treatment
Course and Outcome
Key References
References
11.8 Torsional Strabismus
Key Features
Introduction
Definitions of Inferior Oblique Overaction, Superior Oblique Overaction, A-Pattern, and V-Pattern
The Three Axes of Strabismus
Example: Child With Accommodative Esotropia Who Develops a V-Pattern
Summary of Upcoming Sections
Clinical Observations
Epidemiology
Age of Observation
How to Observe or Measure Torsion
Directly With Fundoscopy or Photography
Correlation of the Appearance of Oblique Overaction, Pattern Strabismus, and Fundus Torsion
Blind Spot Mapping
Location of Rectus Muscle Insertions at Surgery
Forced Ductions
Double Maddox Rod
Lancaster Red-Green Test
Magnetic Resonance Imaging of the Orbits
Parks’ Three-Step Test
Torsion Is Sufficient to Cause the Appearance of Oblique Dysfunction
A- and V-Patterns From Excyclotorsion of the Globe Absent Primary Oblique Dysfunction
The Observation of Normal Version Testing After Denervation and Extirpation (D&E) of the IOs
Etiology
Sensory Torsion
Well-Known Examples of Sensory Esotropia or Sensory Exotropia
Muscle Length Adaptation
Bias
Sensory Deprivation or the Lack of Fusion Leads to Tropia
Pulley Arrays
Other Causes of Oblique Dysfunctions and Pattern Strabismus
Superior Oblique Muscle Palsy
Brown’s Syndrome
Duane’s Syndrome
Dissociated Vertical Deviation
Craniosynostosis
Pseudo-Oblique Overaction Occurs in Patients With a Large Quantity of Exotropia
Management
Observation
Oblique Muscle Surgery
Surgical Variations
Rectus Transpositions
Summary
Key References
References
11.9 Paralytic Strabismus
Key Features
Associated Features
Introduction
Third Nerve Palsy (Oculomotor)
Introduction
Ocular Manifestations
Congenital Third Nerve Palsies
Acquired Third Cranial Nerve Palsies
Nonsurgical Treatment
Surgical Treatment
Fourth Nerve Palsy (Trochlear)
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Nonsurgical Treatment
Surgical Treatment
Sixth Nerve Palsy
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Nonsurgical Treatment
Surgical Treatment
Summary
Key References
References
11.10 Other Vertical Strabismus Forms
Key Features
Introduction
Dissociated Vertical Divergence
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Treatment
Primary Inferior Oblique Muscle Overaction
Epidemiology and Pathogenesis
Ocular Manifestations
Differential Diagnosis
Treatment
Monocular Elevation Deficiency (Previously Termed “Double Elevator Palsy”)
Introduction
Epidemiology and Pathogenesis
Differential Diagnosis
Treatment, Course, and Outcome
Brown’s Syndrome
Introduction
Epidemiology and Pathogenesis
Ocular Manifestations
Treatment
Congenital Fibrosis
Fractures of the Orbital Floor
Ocular Manifestations
Diagnosis
Treatment
Graves’ Ophthalmopathy (Dysthyroid Orbitopathy)
Introduction
Ocular Manifestations
Diagnosis
Treatment
Heavy Eye Syndrome
Key References
References
11.11 Amblyopia
Key Features
Associated Features
Experimental Findings
Introduction
Classification of Amblyopia (the Three Ds)
Strabismic Amblyopia (Deviated Image)
Anisometropic Amblyopia (Defocused Image)
Stimulus-Deprivation Amblyopia (Deprived Image)
Pathophysiology
Diagnosis
Treatment
Occlusion
Atropine Penalization
Optical Penalization
Systemic Pharmacological Treatment
Course and Outcome
Considerations
Key References
References
11.12 Forms of Nonsurgical Strabismus Management
Key Feature
Orthoptics
Prisms
Botulinum Toxin
Bupivicaine
Occlusion
Key References
References
11.13 Techniques of Strabismus Surgery
Key Feature
Introduction
Historical Review
Preoperative Evaluation and Diagnostic Approach
Anesthesia
General Techniques
Specific Techniques
Recession of a Rectus Muscle
Lateral Rectus
Medial Rectus and Vertical Recti
Resection of a Rectus Muscle
Lateral Rectus
Medial Rectus and Vertical Recti
Other Surgical Techniques
Complications
Violation of the Posterior Tenon’s Capsule/Fat Adherence
Anterior Segment Ischemia
Epithelial Cysts/Suture Granulomas
Corneal Dellen
Globe Perforation
Underresponse or Overresponse
Lost or Slipped Muscles/Stretch Scar
Muscle Rupture or Pulled in Two Syndrome (Pits)
Outcomes
Key References
References
12.1 Clinical Anatomy of the Eyelids
Key Features
Introduction
Anatomy of the Eyelids
Orbicularis Muscle
Orbital Septum
Preaponeurotic Fat Pockets
Major Eyelid Retractors
Sympathetic Accessory Retractors
Tarsal Plates
Canthal Tendons
Conjunctiva
Nerves to the Eyelids
Vascular Supply of the Eyelids
Key References
References
12.2 Clinical Anatomy of the Orbit
Key Features
Introduction
General Organization
Osteology of the Orbit
Orbital Roof
Lateral Orbital Wall
Orbital Floor
Medial Orbital Wall
Connective Tissue System
Periorbita
Orbital Septal System
Tenon’s Capsule
Muscles of Ocular Motility
Motor Nerves of the Orbit
Sensory Nerves of the Orbit
Arterial Supply to the Orbit
Venous Drainage From the Orbit
Key References
References
12.3 Orbital Imaging
Key Features
Introduction
Normal Orbital Anatomy in the Axial Plane
Axial Section Through the Lowermost Orbit
Axial Section Through the Inferior Orbit
Axial Section Through the Midorbit
Axial Section Through the Superior Orbit
Axial Section Through the Orbital Roof
Normal Orbital Anatomy in the Coronal Plane
Coronal Section Through the Anteriormost Orbit
Coronal Section Through the Anterior Orbit
Coronal Section Through the Central Orbit
Coronal Section Through the Anterior Orbital Apex
Coronal Section Through the Posterior Orbital Apex
Computed Tomographic Imaging Features of Some Orbital Pathologies
Cavernous Hemangioma
Dermoid Cyst
Thyroid Eye Disease
Optic Nerve Sheath Meningioma
Myositis
Optic Nerve Glioma
Adenoid Cystic Carcinoma
Orbital Mucocele
Key References
References
12.4 Blepharoptosis
Key Features
Introduction
Foundation: A Simplified Classification of Ptosis
Anatomy and Function
Classification Based on Levator Function
Common Ptosis
Acquired Involutional Ptosis
Simple Congenital Ptosis
Differential Diagnosis
Common Ptosis
Unusual Congenital Ptosis
Marcus Gunn Jaw-Winking Syndrome
Blepharophimosis Syndrome
Unusual Acquired Ptosis
Neurogenic Ptosis
Myasthenia Gravis
Third Cranial Nerve Palsy
Horner’s Syndrome
Myogenic Ptosis
Chronic Progressive External Ophthalmoplegias
Oculopharyngeal Dystrophy
Myotonic Dystrophy
Posttraumatic Ptosis
Clinical Evaluation and Preoperative Considerations
History and Examination
Adults
Children
Formulating a Treatment Plan
General Considerations
Surgical Correction of Ptosis
Anesthesia
Levator Aponeurosis Advancement
Frontalis Suspension
Complications
Undercorrection
Overcorrection
Changes in Astigmatism
Outcome
Key References
References
12.5 Entropion
Key Features
Introduction
Preoperative Evaluation and Diagnostic Approach
The Capsulopalpebral Fascia
The Tarsus and Canthal Ligament
Enophthalmos
Orbicularis Muscle
The Posterior Lamella
Other Factors
Differential Diagnosis
Epiblepharon
Trichiasis
Congenital Entropion
Alternatives to Surgery
Quickert–Rathbun Sutures
Botulinum Toxin
Anesthesia
General Technique
Specific Techniques
Retractor Reattachment
Lateral Tarsal Strip Procedure
Transverse Tarsotomy
Hard Palate Mucosal Graft
Complications
Overcorrection
Hematoma
Eyelid Retraction
Exposure Keratopathy
Ptosis
Outcome
Key References
References
12.6 Ectropion
Key Features
Associated Features
Introduction
Preoperative Evaluation and Diagnostic Approach
Eyelid Laxity Evaluation
Medial Canthal Tendon Laxity
Lateral Canthal Tendon Laxity
Lacrimal Puncta Evaluation
Anterior Lamellae Inspection
Orbicularis Oculi Muscle Tone
Eyelid Masses
Lower Eyelid Retractor Dehiscence
Differential Diagnosis
Involutional Ectropion
Cicatricial Ectropion
Paralytic Ectropion
Mechanical Ectropion
Congenital Ectropion
Alternatives to Surgery
Anesthesia
General Techniques
Specific Techniques
Involutional Ectropion
Lateral Tarsal Strip Procedure
Medial Spindle Procedure With Rotational Suture
Lower Eyelid Retractor Advancement
Full-Thickness Pentagonal Block Resection
Cicatricial Ectropion
Local Skin Flaps (Z-Plasty)
Full-Thickness Skin Graft
Paralytic Ectropion
Medial Canthoplasty
Lateral Tarsorrhaphy
Complications
Outcome
Key References
References
12.7 Benign Eyelid Lesions
Key Features
Associated Features
Introduction
Epithelial Tumors
Squamous Papilloma
Cutaneous Horn
Seborrheic Keratosis
Inverted Follicular Keratosis
Keratoacanthoma
Actinic Keratosis
Epidermal Inclusion Cyst
Pilar Cyst
Epidermoid and Dermoid Cysts
Adnexal Tumors
Benign Lesions of Sebaceous Origin
Milia
Sebaceous Adenoma
Benign Lesions of Eccrine Origin
Eccrine Hidrocystoma
Syringoma
Chondroid Syringoma
Benign Lesions of Apocrine Origin
Apocrine Hidrocystoma
Cylindroma
Benign Lesions of Hair Follicle Origin
Trichoepithelioma
Trichofolliculoma
Trichilemmoma
Pilomatrixoma
Vascular Tumors
Capillary Hemangioma
Lymphangioma
Nevus Flammeus
Pyogenic Granuloma
Tumors of Neural Origin
Neurofibroma
Xanthomatous Lesions
Xanthelasma
Juvenile Xanthogranuloma
Pigmented Lesions of Melanocytic Origin
Freckles
Lentigo Simplex
Solar Lentigo
Melanocytic Nevi
Congenital Melanocytic Nevus
Nevus of Ota
Blue Nevus
Inflammatory Lesions
Chalazion
Hordeolum
Infectious Lesions
Molluscum Contagiosum
Verruca Vulgaris
Conclusion
Outcomes
Key References
References
12.8 Eyelid Malignancies
Key Features
Associated Features
Introduction
Basal Cell Carcinoma
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Differential Diagnosis
Systemic Associations
Pathology
Treatment
Surgery
Radiation Therapy
Cryotherapy
Chemotherapy and Photodynamic Therapy
Course and Outcome
Squamous Cell Carcinoma
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Pathology
Treatment
Course and Outcome
Sebaceous Gland Carcinoma
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Pathology
Treatment
Course and Outcome
Malignant Melanoma
Epidemiology and Pathogenesis
Ocular Manifestations
Diagnosis
Systemic Associations
Pathology
Treatment
Course and Outcome
Key References
References
12.9 Evaluation and Management of Periorbital Soft Tissue Trauma
Key Features
Introduction
Preoperative Evaluation and Diagnostic Approach
Systemic Stabilization
Medical History
Examination
Ancillary Testing
Documentation
Infection Prophylaxis
Timing of Repair
Anesthesia
Treatment
General Concepts
Common Patterns of Eyelid Injury
Partial-Thickness Eyelid Injuries and Abrasions
Deep Partial-Thickness and Full-Thickness Eyelid Lacerations
Eyelid Margin Lacerations
Eyelid Injuries With Tissue Loss
Tissue Loss of 0% to 25%
Tissue Loss of 25% to 60%
Full-Thickness Eyelid Injuries With Greater Than 60% Tissue Loss
Lower Eyelid
Upper Eyelid
Postoperative Care
Late Repair of Eyelid Injuries
Dog Bites
Lacrimal Injury
Eyelid Burns
Conclusions
Key References
References
12.10 Orbital Diseases
Key Features
Introduction
Clinical Evaluation
Metastatic Tumors
Introduction
Metastatic Carcinoma
Key Points
Orbital Imaging
Treatment and Prognosis
Lacrimal Gland Lesions
Introduction
Pleomorphic Adenoma (Benign Mixed Cell Tumor)
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Adenoid Cystic Carcinoma
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Mesenchymal Tumors
Introduction
Fibrous Histiocytoma
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Rhabdomyosarcoma
Key Points
Orbital Imaging
Pathology
Staging
Treatment and Prognosis
Neurogenic Tumors
Introduction
Plexiform Neurofibroma
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Schwannoma (Neurilemmoma)
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Malignant Peripheral Nerve Sheath Tumor (Malignant Schwannoma)
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Neuroblastoma
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Optic Nerve Glioma (Pilocytic Astrocytoma of Childhood)
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Optic Nerve Sheath Meningioma
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Lymphoproliferative Diseases
Introduction
Benign Reactive Lymphoid Hyperplasia
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Atypical Lymphoid Hyperplasia
Key Points
Orbital Imaging and Echography
Pathology
Treatment and Prognosis
Malignant Orbital Lymphoma (Lymphosarcoma)
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Histiocytic Tumors
Introduction
Eosinophilic Granuloma (Histiocytosis X)
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Inflammations and Infections
Thyroid Eye Disease
Cystic Lesions
Introduction
Dermoid Cyst
Key Points
Superficial Lesions
Orbital Imaging
Pathology
Treatment and Prognosis
Deep Lesions
Orbital Imaging
Pathology
Treatment and Prognosis
Mucocele
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Microphthalmos With Cyst
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Vascular Neoplastic and Structural Lesions
Introduction
Capillary Hemangioma (Hemangioendothelioma)
Key Points
Superficial Lesions
Treatment and Prognosis
Deep Lesions
Orbital Imaging
Pathology
Treatment and Prognosis
Cavernous Hemangioma
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Lymphangioma
Key Points
Superficial Lesions
Deep Lesions
Orbital Imaging
Pathology
Treatment and Prognosis
Arteriovenous Fistula
Key Points
Low-Flow Type
High-Flow Type
Primary Shunts
Secondary Shunts
Orbital Imaging
Treatment and Prognosis
Varices
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Secondary Tumors
Introduction
Basal Cell Carcinoma
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Malignant Melanoma
Key Points
Orbital Imaging
Pathology
Treatment and Prognosis
Key References
References
12.11 Enucleation, Evisceration, and Exenteration
Key Features
Introduction
Preoperative Evaluation and Diagnostic Approach
Indications for Surgery
Preoperative Counseling
Anesthesia
Specific Techniques
Enucleation
Enucleation With Simple Sphere Implant
Enucleation With Porous Implant
Evisceration
Overview
Surgical Technique
Exenteration
Overview
Surgical Technique
Postoperative Management
Complications
Evisceration
Enucleation
Exenteration
Key References
References
12.12 The Lacrimal Drainage System
Key Features
Associated Features
Introduction
Anatomy and Physiology
Evaluation of Epiphora
Clinical History
Physical Examination
Eyelids
Lacrimal Passages
Nose
Clinical Diagnostic Tests
Tear Tests
Dye Tests
Excretory Tests
Lacrimal Syringing
Jones Fluorescein Dye Test
Endoscopy
Diagnostic Imaging
Nuclear Lacrimal Scan
Dacryocystography
Computed Tomography
Obstructions of the Lacrimal Sac and Duct
Congenital Obstruction
Acquired Obstruction
Nonspecific Acquired Obstruction
Specific Acquired Obstruction
Dacryocystitis
Treatment of Lacrimal Sac and Duct Obstruction
Congenital Nasolacrimal Obstruction
Acquired Nasolacrimal Obstruction
Dacryocystorhinostomy
Endonasal Dacryocystorhinostomy
Tumors of the Lacrimal Sac
Diseases of the Canaliculi
Punctal Stenosis
Useful Lacrimal Tips
Key References
References
12.13 Thyroid Eye Disease
Key Features
Introduction
Epidemiology, Risk Factors, and Associated Conditions
Pathogenesis
Clinical Presentation: Disease Severity and Activity
Diagnosis
Evaluation of Disease Severity and Activity
Quality of Life
Basic Management
Medical Therapy
Orbital Radiotherapy
Surgical Therapy
Management Plan Using the VISA Classification
Key References
References
12.14 Orbital Infection and Inflammation
Key Features
Introduction
General Assessment
Orbital Infection
Orbital Cellulitis
Bacterial Dacryoadenitis
Orbital Tuberculosis
Orbital Viral Infection
Orbital Fungal Infection
Rhino-Orbital-Cerebral Mucormycosis
Orbital Aspergillus Infection
Orbital Parasitical Infection
Noninfectious Orbital Inflammation
Granulomatous Orbital Inflammation
Sarcoidosis
Xanthogranulomatous Disease
IgG4-Related Disease
Orbital Vasculitic Disease
Granulomatosis With Polyangiitis
Sjögren’s Syndrome
Idiopathic Orbital Inflammation
Idiopathic Orbital Myositis
Idiopathic Dacryoadenitis
Tolosa–Hunt Syndrome (Orbital Apex IOI)
Key References
References
12.15 Cosmetic Blepharoplasty and Browplasty
Key Features
Introduction
Anatomical Considerations
Eyelids
Upper Eyelid
Lower Eyelid
Brows
Blepharoplasty
Preoperative Evaluation and Diagnostic Approach
History and Psychological Evaluation
Physical Examination
Anesthesia
General Techniques
Specific Techniques
Upper Lid Blepharoplasty
Lower Lid Blepharoplasty
Skin Approach
Transconjunctival Approach
Other Surgical Techniques
Postoperative Care
Complications
Orbital Hemorrhage and Blindness
Infections
Ptosis
Lagophthalmos, Lower Lid Retraction, Ectropion, and Lateral Canthal Deformities
Other Complications
Outcome
Brow Malposition
Preoperative Evaluation and Diagnostic Approach
Anesthesia
General Techniques
Specific Techniques
The Bicoronal Forehead Lift
The Midfrontal Brow Lift
The Direct Brow Lift
Endoscopic Brow Lift
Transblepharoplasty Brow Fixation
Complications
Excessive Cutaneous Scar and Alopecia
Paresthesia and Hematoma
Overcorrection and Undercorrection
Outcome
Key References
References
12.16 Aesthetic Fillers and Botulinum Toxin for Wrinkle Reduction
Key Features
Introduction
Approach to Periorbital Rejuvenation
Botulinum Toxin
Fillers
Anatomical Considerations
The Brow and Temple
Rhytides in the Upper Face
Shaping the Brow
Temple and Forehead Contouring
The Eye
Widening the Palpebral Aperture
Lid Ptosis, Malposition, and Asymmetry
Orbital Augmentation
Infraorbital Hollow
Adjunctive Therapies
Precautions
Chlorhexidine
Vascular Compromise
Conclusion
Key References
References