The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease Book

Contributors v

Consultants vii

Foreword ix

Preface xi

Preface to the First Edition xiii

Chapter 1 Differential Diagnosis of Ocular Symptoms 1

Chapter 2 Differential Diagnosis of Ocular Signs 6

Chapter 3 Trauma 13

3.1 Chemical Burn 13

3.2 Corneal Abrasion 16

3.3 Corneal and Conjunctival Foreign Bodies 17

3.4 Conjunctival Laceration 19

3.5 Traumatic Iritis 20

3.6 Hyphema and Microhyphema 21

3.7 Iridodialysis/Cyclodialysis 25

3.8 Eyelid Laceration 26

3.9 Orbital Blow-Out Fracture 32

3.10 Traumatic Retrobulbar Hemorrhage 35

3.11 Traumatic Optic Neuropathy 40

3.12 Intraorbital Foreign Body 42

3.13 Corneal Laceration 44

3.14 Ruptured Globe and Penetrating Ocular Injury 46

3.15 Intraocular Foreign Body 48

3.16 Commotio Retinae 49

3.17 Traumatic Choroidal Rupture 50

3.18 Chorioretinitis Sciopetaria 51

3.19 Purtscher Retinopathy 52

3.20 Shaken Baby Syndrome/Inflicted Childhood Neurotrauma 53

Chapter 4 Cornea 55

4.1 Superficial Punctate Keratopathy 55

4.2 Recurrent Corneal Erosion 57

4.3 Dry-Eye Syndrome 59

4.4 Filamentary Keratopathy 61

4.5 Exposure Keratopathy 62

4.6 Neurotrophic Keratopathy 63

4.7 Thermal/Ultraviolet Keratopathy 64

4.8 Thygeson Superficial Puncture Keratopathy 65

4.9 Pterygium/Pinguecula 66

4.10 Band Keratopathy 67

4.11 Bacterial Keratitis 69

4.12 Fungal Keratitis 73

4.13 Acanthamoeba Keratitis 75

4.14 Crystalline Keratopathy 76

4.15 Herpes Simplex Virus 77

4.16 Herpes Zoster Ophthalmicus/Varicella Zoster Virus 81

4.17 Ocular Vaccinia 85

4.18 Interstitial Keratitis 86

4.19 Staphylococcal Hypersensitivity 88

4.20 Phlyctenulosis 89

4.21 Contact Lens-Related Problems 90

4.22 Contact Lens-Induced Giant Papillary Conjunctivitis 94

4.23 Peripheral Corneal Thinning/Ulceration 95

4.24 Dellen 98

4.25 Keratoconus 98

4.26 Corneal Dystrophies 100

4.27 Fuchs Endothelial Dystrophy 102

4.28 Aphakic Bullous Keratopathy/Pseudophakic Bullous Keratopathy 103

4.29 Corneal Graft Rejection 104

4.30 Corneal Refractive Surgery Complications 105

Chapter 5 Conjunctive/Sclera/Iris/External Disease 110

5.1 Acute Conjunctivitis 110

5.2 Chronic Conjunctivitis 116

5.3 Parinaud Oculoglandular Conjunctivitis 118

5.4 Superior Limbic Keratoconjunctivitis 119

5.5 Subconjunctival Hemorrhage 120

5.6 Episcleritis 121

5.7 Scleritis 122

5.8 Blepharitis/Meibomitis 125

5.9 Ocular Rosacea 126

5.10 Ocular Cicatricial Pemphigoid 127

5.11 Contact Dermatitis 129

5.12 Conjunctival Tumors 129

5.13 Malignant Melanoma of the Iris 133

Chapter 6 Eyelid 135

6.1 Ptosis 135

6.2 Chalazion/Hordeolum 137

6.3 Ectropion 139

6.4 Entropion 140

6.5 Trichiasis 140

6.6 Floppy Eyelid Syndrome 141

6.7 Blepharospasm 142

6.8 Canaliculitis 143

6.9 Dacryocystitis/Inflammation of the Lacrimal Sac 144

6.10 Preseptal Cellulitis 146

6.11 Malignant Tumors of the Eyelid 149

Chapter 7 Orbit 153

7.1 Orbital Disease 153

7.2 Inflammatory Orbital Disease 154

7.3 Infectious Orbital Disease 159

7.4 Orbital Tumors 165

7.5 Traumatic Orbital Disease 173

7.6 Lacrimal Gland Mass/Chronic Dacryoadenitis 174

7.7 Miscellaneous Orbital Diseases 176

Chapter 8 Pediatrics 177

8.1 Leukocoria 177

8.2 Retinopathy of Prematurity 179

8.3 Familial Exudative Vitreoretinopathy 182

8.4 Esodeviations in Children 183

8.5 Exodeviations in Children 186

8.6 Strabismus Syndromes 188

8.7 Amblyopia 189

8.8 Congenital Cataract 191

8.9 Ophthalmia Neonatorum (Newborn Conjunctivitis) 193

8.10 Congenital Nasolacrimal Duct Obstruction 195

8.11 Congenital/Infantile Glaucoma 196

8.12 Developmental Anterior Segment and Lens Anomalies/Dysgenesis 198

8.13 Congenital Ptosis 200

8.14 The Bilaterally Blind Infant 201

Chapter 9 Glaucoma 204

9.1 Primary Open-Angle Glaucoma 204

9.2 Low-Pressure Primary Open-Angle Glaucoma (Normal Pressure Glaucoma) 211

9.3 Ocular Hypertention 212

9.4 Acute Angle-Closure Glaucoma 213

9.5 Chronic Angle-Closure Glaucoma 216

9.6 Angle-Recession Glaucoma 217

9.7 Inflammatory Open-Angle Glaucoma 218

9.8 Glaucomatocyclitic Crisis/Posner-Schlossman Syndrome 220

9.9 Steroid-Response Glaucoma 221

9.10 Pigment Dispersion Syndrome/Pigmentary Glaucoma 222

9.11 Pseudoexfoliation Syndrome/Exfoliative Glaucoma 224

9.12 Lens-Induced (Phacogenic) Glaucoma 226

9.13 Plateau Iris 229

9.14 Neovascular Glaucoma 230

9.15 Iridocorneal Endothelial Syndrome 233

9.16 Postoperative Glaucoma 234

9.17 Aqueous Misdirection Syndrome/Malignant Glaucoma 236

9.18 Postoperative Complications of Glaucoma Surgery 237

9.19 Blebitis 240

Chapter 10 Neuro-Ophthalmology 242

10.1 Anisocoria 242

10.2 Horner Syndrome 244

10.3 Argyll Robertson Pupils 246

10.4 Adie (Tonic) Pupil 247

10.5 Isolated Third Nerve Palsy 248

10.6 Aberrant Regeneration of the Third Nerve 251

10.7 Isolated Fourth Nerve Palsy 252

10.8 Isolated Sixth Nerve Palsy 254

10.9 Isolated Seventh Nerve Palsy 256

10.10 Cavernous Sinus and Associated Syndromes (Multiple Ocular Motor Nerve Palsies) 259

10.11 Myasthenia Gravis 263

10.12 Chronic Progressive External Ophthalmoplegia 266

10.13 Internuclear Ophthalmoplegia 267

10.14 Optic Neuritis 268

10.15 Papilledema 271

10.16 Idiopathic Intracranial Hypertension/Pseudotumor Cerebri 273

10.17 Arteritic Ischemic Optic Neuropathy (Giant Cell Arteritis) 274

10.18 Nonarteritic Ischemic Optic Neuropathy 276

10.19 Posterior Ischemic Optic Neuropathy 277

10.20 Miscellaneous Optic Neuropathies 278

10.21 Nystagmus 280

10.22 Transient Visual Loss/Amaurosis Fugax 283

10.23 Vertebrobasilar Artery Insufficiency 284

10.24 Cortical Blindness 285

10.25 Nonphysiologic Visual Loss 286

10.26 Headache 287

10.27 Migraine 289

10.28 Cluster Headache 291

Chapter 11 Retina 293

11.1 Posterior Vitreous Detachment 293

11.2 Retinal Break 294

11.3 Retinal Detachment 295

11.4 Retinoschisis 298

11.5 Cotton-Wool Spot 300

11.6 Central Retinal Artery Occlusion 302

11.7 Branch Retinal Artery Occlusion 303

11.8 Central Retinal Vein Occlusion 304

11.9 Branch Retinal Vein Occlusion 307

11.10 Hypertensive Retinopathy 308

11.11 Ocular Ischemic Syndrome/Carotid Occlusive Disease 309

11.12 Diabetic Retinopathy 310

11.13 Vitreous Hemorrhage 316

11.14 Cystoid Mascular Edema 318

11.15 Central Serous Chorioretinopathy 320

11.16 Nonexudative (Dry) Age-Related Mascular Degeneration 322

11.17 Neovascular or Exudative (Wet) Age-Related Mascular Degeneration 324

11.18 Idiopathic Polypoidal Choroidal Vasculopathy (Posterior Uveal Bleeding Syndrome) 326

11.19 Retinal Arterial Macroaneurysm 327

11.20 Sickle Cell Disease (Including Sickle Cell Anemia, Sickle Trait) 328

11.21 Valsalva Retinopathy 330

11.22 High Myopia 331

11.23 Angioid Streaks 332

11.24 Ocular Histoplasmosis 334

11.25 Macular Hole 336

11.26 Epiretinal Membrane (Macular Pucker, Surface-Wrinkling Retinopathy, Cellophane Maculopathy) 338

11.27 Choroidal Effusion/Detachment 339

11.28 Retinitis Pigmentosa and Inherited Chrioretinal Dystrophies 341

11.29 Cone Dystrophies 345

11.30 Stargardt Disease (Fundus Flavimaculatus) 346

11.31 Best Disease (Vitelliform Macular Dystrophy) 348

11.32 Chloroquine/Hydroxychloroquine Toxicity 349

11.33 Crystalline Retinopathy 350

11.34 Optic Pit 352

11.35 Solar Retinopathy 353

11.36 Choroidal Nervus and Malignant Melanoma of the Choroid 354

Chapter 12 Uveitis 358

12.1 Anterior Uveitis (Iritis/Iridocyclitis) 358

12.2 Intermediate Uveitis 364

12.3 Posterior Uveitis 365

12.4 Human Leukocyte Antigen (HLA)-B27-Associated Uveitis 369

12.5 Toxoplasmosis 369

12.6 Sarcoidosis 372

12.7 BehÇet Disease 374

12.8 Acute Retinal Necrosis (ARN) 375

12.9 Cytomegalovirus Retinitis 377

12.10 Noninfectious Retinal Microvasculopathy/HIV Retinopathy 380

12.11 Vogt-Koyanagi-Harada Syndrome 380

12.12 Syphilis 382

12.13 Postoperative Endophthalmitis 384

12.14 Chronic Postoperative Uveitis 387

12.15 Traumatic Endophthalmitis 388

12.16 Endogenous Bacterial Endophthalmitis 389

12.17 Candida Retinitis/Uveitis/Endophthalmitis 391

12.18 Sympathetic Ophthalmia 392

Chapter 13 General Ophthalmic Problems 394

13.1 Acquired Cataract 394

13.2 Pregnancy 396

13.3 Lyme Disease 397

13.4 Convergence Insufficiency 398

13.5 Accommodative Spasm 399

13.6 Stevens-Johnson Syndrome (Erythema Multiforme Major) 400

13.7 Vitamin A Deficiency 402

13.8 Albinism 403

13.9 Wilson Disease 404

13.10 Subluxed or Dislocated Crystalline Lens 405

13.11 Hypotony Syndrome 407

13.12 Blind, Painful Eye 409

13.13 Phakomatoses 410

Chapter 14 Imaging Modalities in Ophthalmology 416

14.1 Plain Films 416

14.2 Computed Tomography 416

14.3 Magnetic Resonance Imaging 418

14.4 Magnetic Resonance Angiography 420

14.5 Magnetic Resonance Venography 421

14.6 Cerebral Arteriography 421

14.7 Nuclear Medicine 422

14.8 Ophthalmic Ultrasonography 422

14.9 Photographic Studies 424

14.10 Intravenous Fluorescein Angiography 425

14.11 Indocyanine Green Angiography 426

14.12 Optical Coherence Tomography 427

14.13 Confocal Scanning Laser Ophthalmoscopy 428

14.14 Confocal Biomicroscopy 428

14.15 Corneal Topography & Tomography Description 428

14.16 Dacryostography 429

Appendices 430

Appendix 1 Dilating Drops 430

Appendix 2 Tetanus Prophylaxis 431

Appendix 3 Cover/Uncover and Alternate Cover Tests 431

Appendix 4 Amsler Grid 432

Appendix 5 Seidel Test to Detect a Wound Leak 433

Appendix 6 Forced-Duction Test and Active Force Generation Test 433

Appendix 7 Technique for Diagnostic Probing and Irrigation of the Lacrimal System 435

Appendix 8 Corneal Culture Procedure 435

Appendix 9 Fortified Topical Antibiotics/Antifungals 437

Appendix 10 Technique for Retrobulbar/Subtenson/Subconjunctival Injections 438

Appendix 11 Intravitreal Tap and Inject 439

Appendix 12 Intravitreal Antibiotics 440

Appendix 13 Anterior Chamber Paracentesis 440

Appendix 14 Angle Classification 441

Appendix 15 Yag Laser Peripheral Iridotomy 444

Appendix 16 YAG Capsulotomy 445

Ophthalmic Acronyms and Abbreviations 446

Index 451