Common Eye Diseases and their Management

Preface to the Second Edition
Preface to the Third Edition
Preface to the Fourth Edition
Preface to the Fifth Edition
Acknowledgements
Contents
Part I: Introducing the Eye
1: The Scope of Ophthalmology
Patient Communication
Historical Background
Making a Career in Ophthalmology
2: Basic Anatomy and Physiology of the Eye
Introduction
Basic Structure of the Eye and Supporting Structures
The Globe
The Outer Layer of the Eye
The Middle Layer
The Inner Layer
Blood Supply
The Optic Nerve
The Visual Pathway
The Eyelids
The Lacrimal Apparatus
The Extraocular Muscles
Physiology of the Eye
The Eyelids
The Tear Film
The Cornea
The Aqueous Humour
The Vitreous Body
The Lens
The Ciliary Body
Accommodation
The Retina
Summary
3: Examination of the Eye
How to Find Out What a Patient Can See
Visual Acuity
Visual Field
Colour Vision
Spectacles
How to Start Examining an Eye
Evaluating the Pupil
External Eye and Lids
The Globe
How to Use the Ophthalmoscope
Other Tests Available in an Eye Department
Part II: Primary Eye Care Problems
4: Long Sight, Short Sight
5: Common Diseases of the Eyelids
The Watering Eye
Impaired Drainage of Tears
The Lacrimal Passageway
Acute Dacryocystitis
Excessive Secretion of Tears
The Dry Eye
Causes of Dry Eye
Signs
Slit Lamp Examination
Schirmer’s Test
Tear Film Break-Up Time
Management of the Dry Eye
Deformities of the Eyelids
The Normal Eyelid
Epicanthus
Entropion
Ectropion
Lagophthalmos
Blepharospasm
Redundant Lid Skin
Ptosis
Causes of Ptosis
Ingrowing Eyelashes (Trichiasis)
Infections of the Eyelids
Meibomian Gland Infection
Styes
Blepharitis
Molluscum Contagiosum
Orbital Cellulitis
Allergic Disease of the Eyelids
Lid Tumours
Benign Tumours
Malignant Tumours
Lid Injuries
6: Common Diseases of the Conjunctiva and Cornea
Subconjunctival Haemorrhage
Conjunctivitis
Symptoms
Signs
Microscopy
Conjunctival Culture
Causes
Bacterial Conjunctivitis
Chlamydia Conjunctivitis
Trachoma
Adenoviral Conjunctivitis
Herpes Simplex Conjunctivitis
Acute Haemorrhagic Conjunctivitis
Other Infective Agents
Allergic Conjunctivitis
Hay Fever Conjunctivitis
Atopic Conjunctivitis
Vernal Conjunctivitis (Spring Catarrh)
Secondary Conjunctivitis
Corneal Foreign Body
Signs and Symptoms
Treatment
Corneal Ulceration
Types of Corneal Ulcer
Due to Direct Trauma
Due to Bacteria
Due to Acanthamoeba
Due to Viruses
Treatment of Herpes Simplex Keratitis
Due to Damage to the Corneal Nerve Supply
Due to Exposure
Corneal Dystrophies
Corneal Degenerations
Corneal Oedema
Absent Corneal Sensation
Herpes Zoster Ophthalmicus (Shingles of the Eye)
7: The Red Eye
Red Eye Which Is Not Painful and Sees Normally
Subconjunctival Haemorrhage
Conjunctivitis
Acute
Chronic
Checklist of Causes
Episcleritis
Red Painful Eye Which May See Normally
Scleritis
Red Painful Eye Which Cannot See
Acute Glaucoma
Acute Iritis
Acute Keratitis
Neovascular Glaucoma
8: Failing Vision
Failing Vision in Eyes Which Look Normal
When the Fundus Is Normal
When the Fundus Is Abnormal
In Relation to Systemic Disease
Sudden Loss of Vision in One Eye
Treatable Causes of Failing Vision
Untreatable Causes of Failing Vision
9: Headache
History
Classification
Cerebrospinal Fluid
Blood Vessels
Blood
Nerves
Bones
Meninges
The Eyes
Pain Referred from Other Sites
Drugs
Post-traumatic Headache
10: Contact Lenses
Types
Side-Effects
Indications
Cosmetic
Therapeutic
Part III: Problems of the Eye Surgeon
11: Cataract
The Lens
Aetiology
Age
Diabetes
Secondary
Trauma
Congenital Factors
Toxicity
Symptoms
Signs
Reduced Visual Acuity
Findings of Ophthalmoscopy
Findings on Slit Lamp Microscopy
Other Important Signs
Management
When to Operate
Age of the Patient
Traumatic Cataract
The Cataract Operation
Time Spent in Hospital
Convalescence
Summary
12: Glaucoma
Normal Intraocular Pressure
Maintenance of Intraocular Pressure
Measurement of Intraocular Pressure
Clinical Types of Glaucoma
Primary Open Angle Glaucoma
Pathogenesis and Natural History
Symptoms
Signs
Treatment
Normal Pressure Glaucoma (NPG)
Management
Acute Angle Closure Glaucoma
Pathogenesis and Natural History
Symptoms
Signs
Treatment
Secondary Glaucoma
Secondary to Vascular Disease in the Eye
Secondary to Uveitis
Secondary to Tumours
Secondary to Trauma
Drug-Induced Glaucoma
Secondary to Abnormalities in the Lens
Congenital or Developmental Glaucoma
13: Retinal Detachment
Incidence
Pathogenesis
Classification
Rhegmatogenous Retinal Detachment
Tractional Retinal Detachment
Exudative Retinal Detachment
Rhegmatogenous Retinal Detachment
The Presence of Breaks in Retinal Detachment
Retinal Degeneration
The Vitreous
Posterior Vitreous Detachment
Retinal Breaks Formation
Mechanism of Rhegmatogenous Retinal Detachment
Rhegmatogenous Retinal Detachment Associated with Trauma
Signs and Symptoms of Retinal Tear and Retinal Detachment
Flashes (‘Photopsiae’)
Floaters
Shadow
Traction Retinal Detachment
Exudative Retinal Detachment
Management of Rhegmatogenous Retinal Detachment
Prophylaxis
Retinal Surgery
Cryobuckle
Vitrectomy
Prognosis
14: Squint
Types of Squint
Squint in Childhood
Amblyopia of Disuse
Causes of Squint in Childhood
Refractive Error
Opaque Media
Disease of the Retina or Optic Nerve
Congenital or Acquired Muscle Weakness
Abnormalities of Facial Skeleton
Diagnosis
Management of Squint in Childhood
Squint in Adults
Anatomy of the Extraocular Muscles
Causes of Adult Squint
Diagnosis
Hess Screen
Treatment
Ocular Muscle Imbalance
Summary
15: Tumours of the Eye and Adnexae
The Globe
Choroidal Melanoma
Choroidal Metastases
Retinoblastoma
Melanoma of the Iris
The Eyelids
Benign Tumours
Malignant Tumours of the Eyelids
The Conjunctiva
Benign Lesions
Benign Pigmented Lesions of the Conjunctiva
Non-Pigmented Lesions
Malignant Lesions
The Orbit (see Table 15.1)
Exophthalmos and Proptosis
Causes of Proptosis (see Table 15.2)
Assessment of Proptosis
Summary
16: Ocular Trauma
Injuries to the Globe
Contusion
Perforation
Intraocular Foreign Body
Sympathetic Ophthalmia
Injuries to the Eyelids
Injuries to the Orbit
Radiational Injuries
Chemical Injuries
Summary
Part IV: Problems of the Medical Ophthalmologist
17: Testing Visual Acuity
Introduction
Measuring for Spectacles
Objective Refraction
Subjective Refraction
Automated Refraction
Summary
18: The Inflamed Eye
The Role of Autoimmunity in Uveitis
Anterior Uveitis
Symptoms
Signs
Complications
Causes
Management
Heterochromic Iridocyclitis (Fuch’s)
Intermediate Uveitis (Pars Planitis)
Treatment and Management
Posterior Uveitis
Symptoms
Signs
Causes
Management
Specific Uveitis Entities
Toxoplasmosis
Toxocariasis
Tuberculosis
Presumed Ocular Histoplasmosis
Syphilis
Sarcoidosis
Behcet’s Disease
Birdshot chorioretinopathy
Sympathetic Ophthalmia
Other Causes
Endophthalmitis and Panophthalmitis
Episcleritis and Scleritis
Summary
19: The Ageing Eye
Changes in the Eyes with Age
The External Eye
The Globe
Eye Disease in the Elderly
Age Related Macular Degeneration
Management
Cataract
Glaucoma
Deformities of the Eyelids
Temporal Arteritis
Stroke
Summary
20: The Child’s Eye
How the Normal Features Differ from Those in an Adult
How to Examine a Child’s Eye
Screening of Children’s Eyes
Congenital Eye Defects
Lacrimal Obstruction
Epicanthus
Ptosis
Congenital Nystagmus
Structural Abnormalities of the Globe
Other Eye Conditions in Childhood
Abnormalities of Refraction
Squint
Amblyopia of Disuse
Leucocoria
Retinopathy of Prematurity
Ophthalmia Neonatorum
Uveitis
Optic Atrophy
Juvenile Retinal and Macular Degenerations
The Phakomatoses
Summary
21: Systemic Disease and the Eye
Introduction
Diabetes Mellitus
Eyelids
Ocular Movements
Cornea and Conjunctiva
Anterior Chamber
Iris
Lens
Retina and Vitreous
Background Retinopathy
The Pre-Proliferative Stage
Proliferative Retinopathy
Diabetic Maculopathy
Treatment
Treatments for DMO
Treatments for Proliferative Diabetic Eye Disease
Prognosis
Thyroid Eye Disease
Management
Hypertension
The Effect of Age on the Retinal Blood Vessels
The Effects of Raised Blood Pressure on the Retinal Vessels
‘Malignant’ Hypertension
Retinal Vascular Occlusions
Management
Retinal Artery Occlusions
Ischaemic Optic Neuropathy
Anaemia
The Leukaemias
Sickle Cell Disease
Onchocerciasis
Extraocular Features
Ocular Features
Management
Acquired Immune Deficiency Syndrome (AIDS)
Ocular Manifestations of Coronavirus (Covid-19)
Ocular Manifestations of Ebola Virus Disease
Connective Tissue Disease
Mucocutaneous Diseases
Summary
22: Neuro-Ophthalmology
The Optic Disc
Normal Disc
Congenital Disc Anomalies
Pale Disc
Optic Atrophy
Swelling of the Optic Disc
Apparent Swelling
Vascular
Postoperative
Papilloedema (‘True Papilloedema’)
Optic Neuritis
Other Causes
Multiple Sclerosis
Ocular Findings
Optic or Retrobulbar Neuritis
Nystagmus
Internuclear Ophthalmoplegia
Other Features
Defects in the Visual Fields
Abnormalities of the Pupil
The Abnormally Dilated Pupil
The Abnormally Constricted Pupil
Double Vision
Assessment of Eye Movements in Diplopia
Causes of Diplopia
Summary
23: Genetics and the Eye
Basic Genetic Mechanisms
Autosomal Recessive Inheritance
Autosomal Dominant Inheritance
Sex-Linked Recessive Inheritance
Retinitis Pigmentosa
Mitochondrial Inheritance
Leber’s Hereditary Optic Neuropathy (LHON)
Digenic or Polygenic Inheritance
Chromosomal Abnormalities
Multifactorial Diseases
Gene Therapy
Summary
24: Drugs and the Eye
Introduction
Treatment of Infection
Drops Which Widen the Pupil
Parasympathetic Antagonists
Sympathetic Agonist
Indications, Effects and Adverse Events for Mydriatics
Drops Which Constrict the Pupil
Drugs in the Treatment of Open Angle Glaucoma
Drugs in the Treatment of Acute Angle Closure Glaucoma
Drugs in the Treatment of Allergic Eye Disease
Local Anaesthesia in Ophthalmology
Drugs and Contact Lenses
Artificial Tears
Anti-Inflammatory Drugs and the Eye
Diagnostic Agents Used the Eye
Corneal Protection in Unconscious Patients or Patients with Exposed Eyes
Retinal Pharmacotherapy: Anti-Angiogenic Drugs and the Eye, and Intraocular Steroids
Vitreomacular Traction
Damage to the Eyes by Drugs Administered Systemically
Summary
Part V: Visual Impairment
25: Blindness
Definition
Benefits for the Visually Handicapped
Standards of Vision for Various Occupations
Colour Blindness
Incidence and Cause of Blindness
Aids for the Visually Impaired
Artificial Eyes
Further Reading
Index