Pocket Tutor Ophthalmology Shyamanga Borooah, Mark Wright, Baljean Dhillon, Peng Yong Sim
INDEX
ABCDEFGHIKLMNOPQRSTUVWXZ
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Abdominal symptoms 198, 200, 209
Abducens (sixth nerve) palsy 253–256
Abetalipoproteinaemia 191
Abscess, subperiosteal 80, 81
Acanthamoeba keratitis 134, 135, 136
Accommodation 11, 16
ageing loss 71–72
Acid injury 276
Acquired nasolacrimal duct obstruction (ANDLO) 108–111
Actinic keratosis 92, 92, 105
Adenovirus 117, 134
Adie pupil 33, 73, 245, 262
Age-related macular degeneration (ARMD) 184–187
AION see Anterior ischaemic optic neuropathy
Albinism 19
Alkali injury 276, 279
Allergens 120
Allergic conjunctivitis 120–123
Amaurosis fugax 181
Amblyopia 65, 66, 257, 258, 265–267
Aminoglycosides 136
Amsler chart 23, 24
Anaesthetics, topical 148, 148, 281
ANDLO see Acquired nasolacrimal duct obstruction
Angle closure 207, 208
Anisocoria 30, 99, 244–247, 260
causes 261
clinical scenario 244–247
diagnosis 246, 246–247
diagnostic algorithm 59–60
Anisometropia 266, 267
Ankylosing spondylitis 138
Anterior ischaemic optic neuropathy (AION) 227–232
arteritic 228, 230–231
non-arteritic 229–231
Anterior uveitis 155–158, 261
Antibiotic therapy, 119, 136, 150–151, 278
Antibiotics 48
Anticholinergics 47
Antigens 159
Antihistamines 123
Antivirals 48
Appearance, alteration 19, 29
Aqueous humour 10, 11
Argyll Robertson pupil 245, 261, 262
ARMD see Age-related macular degeneration
Astigmatism 69–71
Astrocytoma 194
Atopic conjunctivitis 120
Autoimmune disease 82, 95, 131
B
B cells 82
Bacterial keratitis 133, 134
Bardet–Biedl syndrome 191
Basal cell carcinoma (BCC) 92, 92, 104
clinical features 91, 106, 107
differential diagnosis 106–107
management 107–108
BCC see Basal cell carcinoma
Bell's palsy 96
Berger's space 12
Beta-blockers 45–46
eye drops 42
Betamethasone 119, 123
Binocular visual symptoms 17
Blepharitis 92, 100–102, 114, 115, 121
Blood tests
dry eye 131
scleritis 139
temporal arteritis/AION 205, 230, 231
Blow-out fracture 286
Blurred vision 18
gradual onset 18, 62–64, 63
Bowen disease 105
Bowman's membrane 7, 127
Brightness, perception of 22
Brow suspension 100
Bruch's membrane 14, 165
C
C-reactive protein (CRP) 230
Canaliculus, common 108
Canthal tendons 87
Carbonic anhydrase inhibitors 46–47
Cataract
causes 144, 144
clinical features 18, 144–145
clinical scenario 141–143
cortical 143
diagnostic approach 142, 143
epidemiology 144
extracapsular extraction 146, 149–151
nuclear sclerotic 145
surgery 147–151
Cefuroxime 136
Cellulitis, orbital/preseptal 77, 79–81, 103
Central vision, tests 22–24
Cephalosporins 136
Chalazion (meibomian cyst) 77, 91, 96, 102–104
causes 102
clinical features 103, 103
management 104
pathogenesis 103
Chemical eye injury 275–279
Chemokines 82
Cherry red spot 181, 183
Children
allergic conjunctivitis 122
amblyopia 65, 257, 258, 265–267
cataract surgery 149
hypermetropia 64–67, 65
myopia 67
optic neuritis 221
orbital cellulitis 79–81
retinoblastoma 270–272
Chlamydial conjunctivitis 117, 118
Chloramphenicol 102, 119, 151, 278
Choroid 2, 3, 8–9, 14, 153
inflammation (choroiditis) 160, 161, 162
melanoma 194
naevus 193, 193–194
rupture 287
Cicatricial disease
ectropion 96, 97
entropion 93, 95
Ciliary body 3, 8, 10, 11, 71, 141, 153, 216
swelling 208, 208
Ciliary muscle 16
Clinical letters 39
Coats’ disease 265, 272
Cognitive decline 41
Coloboma 1, 2, 226, 265
Colour vision
loss 221
testing 22
Commotio retinae 287, 288
Compliance 41
Cones 13, 14
Confrontation visual field testing 24–28, 27, 182, 225, 235
Conjunctiva 6, 6
examination 31
pain 128, 199
scarring 94
Conjunctivitis 77, 116–120, 125, 157
allergic 120–123, 277
infective 113, 116–120, 117, 122
Contact lens wear 61, 128, 129, 131
Cornea 2, 6–8, 16, 127
abrasion 136, 275, 277, 279, 287
anatomy and physiology 6–8
chemical injury 275–279
drug delivery 42
examination 31
foreign body 279–281
haze 277
histology 6–7, 7
infiltrates 129, 130, 133, 134, 137
irregular curvature 70
oedema 31, 200, 209
pain 128, 199
rupture 287
Corneal endothelium 7, 42, 127, 157
Corneal epithelium, punctate defects 44, 277
Corneal topography 71
Corneal ulcer 93, 100, 121, 133
dendritic 135, 135
differential diagnosis 136
Corticosteroid-induced glaucoma 218–219
Corticosteroids
blunt trauma 287
high-dose 140
intravenous 85
oral 50, 140
topical 97, 104, 119, 136, 137, 158, 162
Cotton wool spots 173, 176, 179
Cover test 34
Cranial nerves
abducens (sixth nerve) palsy 253–256
oculomotor (third nerve) palsy 31, 73, 99, 245, 247–250, 248
trochlear (fourth nerve) palsy 250–253
Cross-facial nerve grafting 97
Cyclopentolate 47, 158, 162, 274
Cycloplegic agents 65, 158, 162
Cyst of Moll 91
Cyst of Zeis 91
D
Dacryocystitis 110
Dacryocystorhinostomy 111
Deductive medical reasoning 51
Descemet's membrane 7, 127
Dexamethasone 49, 151, 158, 162, 275, 283
Diabetic retinopathy 170–175
clinical features 171
clinical scenario 165–168
diagnostic criteria 171–172, 172, 173, 174
management 174–175
pathogenesis 171
Diagnostic algorithms 51
anisocoria 60
double vision (diplopia) 56–57
epiphora 58–59
red eye 52–53
visual loss 54–55
Diagnostic pitfalls 39
Diplopia see Double vision
Distance vision 21
Distichiasis 94
Double vision (diplopia) 18–19, 239
binocular 19, 242
clinical scenario 240–244
diagnostic algorithm 56–57
horizontal 242, 255
monocular 19
third nerve palsy 248
vertical 242, 252
Doxycycline 279
Drug delivery
barriers 41
cornea 42
eye drops and ointments 42, 43
intravitreal 49
oral 50
periocular 49, 148
Drug formulation 42
Drug side-effects 42–43
Drusen 15, 226, 237
Dry eye 130–133, 132
E
Ectropion 30, 87, 95–97, 96
Edinger–Westphal nucleus 240, 241
Emmetropisation 68
Endophthalmitis 150
Enophthalmos 30
Entropion 30, 87, 93, 93–95
Epiblepharon 94
Epiphora 19–20, 30
causes 89
clinical scenario 88–90
diagnostic algorithm 58–59
ophthalmic examination 90
Episcleritis 115, 137–140
Erythrocyte sedimentation rate (ESR) 139, 230
Ethnic factors 93, 207, 211, 224
Examination
common signs 20
external eye 29–32
sequence 20–21
visual acuity 21–24
visual fields 24–29
Exophthalmos 82, 83
Extraocular muscles 3, 4, 5, 83, 98
Eye–blood barrier 156
Eye, development of 1, 1–2, 263
Eyedrop bottle 41
Eye drops
beta-blocker 42–43
open angle glaucoma 215
patient compliance 41
toxicity 43, 44
Eyelashes
examination 31
in-turning 94, 94
Eyelids
anatomy and physiology 87, 88, 90–91
causes of swelling 77
examination 30
inflammation (blepharitis) 100–102
laxity 96
lump 90–92
malpositions (see Ectropion; Entropion)
pain 199
rapid swelling 76–79
tumours 104–108, 105, 106
Eye movements 239–240
Eye pain
angle closure glaucoma 197–201
characteristics and location 19, 128, 199
clinical scenarios 128–129, 197–201
keratitis 134
scleritis 138
F
Facial appearance, assessment 29
Facial nerve (CN VII) palsy 96, 96, 97
Far-sightedness see Hypermetropia
Flashing lights 18, 169, 187, 194, 235
Floaters 18, 160, 169, 187
Fluorescein angiography 172, 180, 185, 191
Fluorescein dye 31, 37, 44, 101
Fluorometholone 123
Flurbiprofen 139
Follicles, conjunctiva 117, 118
Foreign body, cornea 279–281
Foreign body sensation 20, 30, 88, 94, 101, 134
Fovea 15, 15
avascular zone 15
examination 37
Foveola 15
Fucithalmic 19
Fundoscopy 34–37, 36
cataract 142
hypertensive retinopathy 176
leukocoria 271, 271
optic atrophy 225–226, 226
optic neuritis 222, 222
papilloedema 233, 233
posterior uveitis 160, 160
pupil dilation 34
retinal artery occlusion 182, 183
retinal detachment 170, 188
retinitis pigmentosa 190, 190
retinopathy of prematurity 268
temporal arteritis 206
Fundus fluorescein angiogram (FFA) 38–39
Fundus, vasculitis 160, 160
Fungal keratitis 133, 134
G
Gaze abnormalities 99, 250
Gentamicin 136
Gland of Krause 130
Gland of Wolfring 130
Glare 18, 142, 144
Glaucoma
acute angle closure 197–201
angle closure 34, 206–210
corticosteroid-induced 218–219
inflammatory 209–210
neovascular 210, 218–219, 220
normal tension 211, 214, 217
open angle 211–217
phacomorphic 209
secondary 217–220, 218–219
Globe see also Enophthalmos; Exophthalmos; Proptosis
blunt injury 273–275, 286
causes of displacement 29–30
examination 29–30
penetrating injury 281–283
Goblet cells, conjunctiva 113, 130
Gonioscope 209, 212
Gonococcal 117, 120
Gorlin syndrome 105
Graves disease 82
Growth factors 268
H
Haemangioma, retinal 194
Haemophilus spp. 117, 134
Haemorrhage, subconjunctival 115, 123–124
Hallucinatory images 18
Hemianopia
bitemporal 5, 25, 26, 236
heteronymous 26
homonymous 25, 26, 236, 237
Herpes simplex 117, 134, 138
Herpes zoster 134
Herpetic keratitis 133, 135, 135, 137
History taking 17–20
Hordeolum (stye) 77
Horner's syndrome 30, 98, 99, 246, 261, 262
investigations 262
signs and symptoms 262
Human leukocyte antigen (HLA)-B27 156
Hyaloid canal 12
Hydroxyamphetamine 246
Hypermetropia 64–67, 65
Hypertension
intracranial 232, 232, 234, 235
intraocular 200, 209, 211–212, 215, 216
systemic 175, 178, 215
Hyperthyroidism 82
Hyphaema 274, 274, 286, 287
Hypopyon 134, 135, 157
I
Ice pack test 99
Imaging 38–39
Immunosuppression 85, 95, 159, 163
Indomethacin 139
Infections
anterior uveitis 156
causing blepharitis 100
causing cataract 144
cornea (keratitis) 133–137
nasolacrimal duct blockage 109
orbital cellulitis 79
posterior uveitis 159
Inferior nasal meatus 108
Infraorbital nerves 285
Intracranial hypertension 232, 232, 234–235
Intracranial mass 27, 234, 234
Intraocular lenses 150
Intraocular pressure 12, 200
angle closure glaucoma 209, 208
lowering 215
measurement 212
open angle glaucoma 211
raised 156, 210, 212, 217
Intravitreal injection 49
Investigations 37–39
Iridotomy 209, 210
Iris
pain 199
plateau 207
transillumination 33, 217
Iris bombé 210
Iritis 19, 245
Ishihara plate 22
Itch 88
K
Kearns–Sayre disease 191, 191
Keratitis 31, 115
infectious 133–137, 134
marginal 136
symptoms 19
Keratoacanthoma 105
Keratoconus 123
Keratometry 71
Keratopathy
punctuate 277
toxic 43, 43
L
Lacrimal glands 130
Lacrimal system 8
Lacrimation, reflex 7, 8
Lagophthalmos 30, 87
Laser treatments
diabetic retinopathy/maculopathy 172
glaucoma 210, 215
Lateral geniculate nucleus (LGN) 25, 196
Lens 9, 10
anatomy and physiology 141
trauma 287
zonules 10, 11
Leukocoria 263, 271, 271
differential diagnosis 265
Levator palpebrae superioris 87, 88
weakness 98
Lid crease, height 98, 99
Lidocaine 148
Light–near dissociation 34
Limbal ischaemia 277
Local anaesthetics 44–45
Lubricants 43–44
Lung tumour, 262
Luteal pigment 15
Lymphadenopathy, preauricular 115, 117
Lymphoma 193, 195
M
Macula 15, 15
cherry red 181, 183
physiology 15
Macular degeneration 69, 184–187
Macular disease, differentiation from optic nerve disease 23
Mast cell stabilisers 123
Mast cells 121
Medicolegal issues 282
Meibomian cyst see Chalazion
Meibomian glands 88, 91
inflammation 101
Melanoma
choroidal 194
eyelid 106
Merkel cell tumour 104, 106
Metamorphopsia 18, 23
Methylprednisolone 140
Miosis 30
Mohs surgery 107
Monocular visual symptoms 17
Moraxella 134
Mucocele 109
Müller muscle 87, 88, 98
Multiple sclerosis (MS) 221, 224, 224
Myasthenia gravis 98, 99, 243
Mydriasis 31, 286
Mydriatic agents 34
Myopia 67–69
risks 68
severity classification 68
Myotonic dystrophies 98
N
Nasal meatus, inferior 108
Nasolacrimal duct
obstruction 90, 108–111
wash-out 110
Near-reading chart 22, 23, 24
Nedocromil sodium 123
Neisseria spp. 117, 134
Nephrotic syndrome 77
Non-steroidal anti-inflammatory drugs (NSAIDs) 139
Nutritional disorders 225, 226
Nystagmus 258–260
O
Oculomotor (third nerve)
anatomy 247, 248
palsy 31, 73, 99, 245, 247–250, 248
Oculomotor nuclei 240
Oculovagal response 209
Ointments, ocular 42
Ophthalmoplegia, chronic progressive external 98, 256
Ophthalmoscope 34
colour of light beam 37
direct 31, 36
Optical coherence tomography (OCT) 38, 172, 180, 213–214
Optic atrophy 224–227
Optic chiasm 5, 17, 24, 25, 198, 201, 203
Optic disc 2, 14, 36
cupping 202, 204, 213
drusen 226, 237
pale 225, 226, 229, 231
pit 226
swelling 176, 205, 206, 221, 229, 231, 233
Optic nerve 3, 3, 12
swelling 222
tests of function 33–34
trauma 225, 287
Optic nerve head, swelling 232–235
Optic neuritis 203, 221–224
Optic neuropathy
anterior ischaemic 223, 227–232
compressive 215, 223
inflammatory 223
temporal arteritis 202–206
thyroid eye disease 76, 77
toxic/nutritional 225
Optics 16
Optic vesicle 1, 1
Orbicularis oculi 88, 94, 96, 97
Orbit 3, 4, 75, 75
anatomy 284–285
blunt trauma 283–288
Orbital cellulitis 77, 79–81
classification 81
management 81
prognosis 81
Orbital septum 75, 79
Oscillopsia 259
Ostia 79
P
Pachymetry 212
Pain see Eye pain
Pan-uveitis 158, 160, 162
Papillae, eyelids 121, 122
Papilloedema 177, 232–235
Parafovea 15
Parasympathomimetics 47–48
Pemphigoid 94, 95
Penetrating injuries 281–283
Perifovea 15
Perilimbal injection 155, 156
Perimetry, automated 24, 26
Periocular injection 40, 49
Peripheral vision 21, 24, 25
loss of 201–202
Persistent hyperplastic primary vitreous 265
Phacodonesis 287
Phacoemulsification 148–149, 150
Pharmacology 40–49
Photophobia 19, 119, 128–129, 153–155
causes 154
eye examination 129
Photopsia 169, 187, 235
Photoreceptors 12, 13, 165, 175, 197, 235
Pigment dispersion syndrome 217, 218–219
Pinhole 21, 22, 65, 71, 142
Platelet count 205, 230
Plus disease 269
Pollen 121
Polyarteritis nodosa 138, 159, 227
Prednisolone 49, 140, 158, 163, 278
Premature infant 267–270
Presbyopia 10, 62–63, 71–73
Preseptal cellulitis 77, 79–81, 103
Prisms 237, 253, 256, 260
Proptosis 29–30
axial 29
non-axial 29, 80
orbital cellulitis 80
thyroid orbitopathy 83
Prostaglandin analogues 45
Pseudoexfoliation syndrome 218–219, 220, 220
Pseudomonas aeruginosa 134
Psychiatric disease 18
Ptosis 30, 31, 97–100, 242, 243, 246, 247
aponeurotic 99, 99
causes 98, 98
Puncti, plugs 42, 43
Pupil 9
constriction 9, 9, 240, 241
dilation 9, 9, 240, 241, 260
examination 30–31
fixed mid-dilated 200, 209
Horner syndrome 99, 262
pharmacological dilatation 34, 142
size difference (see Anisocoria)
Pupillary block 207–208, 208
Pyrexia 77, 115
Q
Quinolones 136
R
Red eye
causes 115, 124, 125, 138, 157
conjunctivitis 114, 117
diagnostic algorithm 52–53
Redness/brightness perception 23
Red reflex 35, 142
absent 263–265, 271, 271
Red targets, sensitivity of central field 28–29
Referral 39
Refracting elements 16
Refraction 61
Refractive errors 61
astigmatism 69–71
eliminating 21–22
hypermetropia 64–67
myopia 67–69
presbyopia 62–64, 71–73
Relative afferent pupil defect (RAPD) 32, 33
Retina 2, 12–15, 165
adult tumours 192–195, 193
examination 37
structure 12, 13
tears 187–189
Retinal artery occlusion 181–184
Retinal degeneration 63
Retinal detachment 170, 187–189
clinical scenario 168–170
management 188–189
risk factors 69, 187
traumatic 287, 288
Retinal ganglion cells 14, 32, 127
Retinal haemorrhages 176
Retinal nerve fibres, myelinated 226
Retinal pigment epithelium (RPE) 14, 14
congenital hypertrophy 193, 194
Retinal vein occlusion 177–181
Retinitis 160, 162
exudative (Coats’ disease) 265, 272
Retinitis pigmentosa 189–192
Retinoblastoma 265, 270–272, 271
Retinopathy
diabetic 170–175, 180
hypertensive 175–177, 180
Retinopathy of prematurity (ROP) 267–270
Retinoschisis 188, 237
Rheumatoid arthritis 138, 139
Rods 13, 14
Roper-Hall classification 277, 278
S
Sac wash-out (SWO) 89, 90, 110, 110
Sarcoidosis 138, 156, 157, 215
SCC see Squamous cell carcinoma
Scheie classification 176, 177
Schirmer tear test 131–132
Sclera 7–8, 8, 127
examination 31
pain 128, 199
Scleritis 125, 127, 137–140, 157
anterior 137
associated conditions 138
classification 137
necrotising anterior 140
posterior 137, 139, 140
Scotoma 17–18, 23, 160
Screening
childhood 267, 268
glaucoma 212, 215
retinoblastoma 272
Sebaceous cell carcinoma 104
Sebaceous cyst 91
Seborrhoeic keratosis 91
Sexually-transmitted diseases 119, 120
Shared eye care 39
Short-sightedness see Myopia
Signs 20
Sinuses, paranasal 79, 80
Sjögren's syndrome 131
Skull 75, 253
SLE see Systemic lupus erythematosus
Slit lamp examination 32
Smoking 82
Snellen chart 21, 65
Sodium cromoglycate 123
Spectacles
myopia 69
presbyopia 73
Squamous cell carcinoma (SCC) 91, 104–108, 106, 107
management 107–108
Squash ball injury 273–275
Squint see Strabismus
Staphylococcus aureus 80, 103, 134
Staphylococcus epidermidis 80
Staphylococcus spp. 117, 134
Stem cells, limbal 279
Stereovision 239
Steroids 48–49
Strabismus (squint) 239
concomitant (non-paralytic) 239, 256–258
cranial nerve palsies 247–256
esodeviation 257
exodeviatio 257
incomitant 239, 242
Streptococcus pneumoniae 134
Streptococcus pyogenes 80
Subconjunctival haemorrhage 123–125, 124
Sun exposure 77, 105
Surgery 20, 38, 40
ectropion 97
entropion 94–95
eyelid tumours 107–108
glaucoma 210, 216, 217
nasolacrimal duct obstruction 110
ptosis 100
Swinging flashlight test 33–34
Symmetry, facial 29
Sympathomimetics 46
Symptoms, common 17–20
Synechiae 31, 33, 47, 156, 157, 158, 209
Syphilis 138, 162, 215, 225
Systemic disease 50, 94, 144, 156, 175
associated with optic neuropathy 215
associated with retinal tumours 194
associated with scleritis 138
Systemic lupus erythematosus (SLE) 138, 159, 162, 215, 225
Systemic treatments 40
T
T cells 82, 159
‘T’ sign 139
Tarsal glands 91
Tear film 3, 5, 130–131
Tears
excessive (epiphora) 19–20
production and drainage 42, 108
Temporal arteritis 202–207, 227
investigations 230, 230
Temporal vascular arcades 25
Tenon capsule 139
Tetracyclines, oral 132
Thyroid eye disease 30, 76, 77, 81–85, 256
Tonometer, Goldman 212
Toxicity
eye drops 43, 44
optic nerve 224, 225
Toxocara 265, 272
Trabecular meshwork 10, 11
Trabeculectomy 216, 216
Trantas’ dots 121
Trauma
anisocoria 245
blunt orbital 283–288
chemical injury 275–279
corneal foreign body 279–281
double vision 243
enophthalmos 30
optic nerve 225, 287
penetrating 281–283
squash ball injury 273–275
subconjunctival haemorrhage 123
Treatment 40–50
compliance 41
intervention 40
observation 40
Trichiasis 94
Trigeminal nerve 7, 8
Trochlear (fourth nerve) palsy 250–253
Tropicamide 34, 142
Tumours
adult retinal 192–195, 193
causing lid swelling 77
eyelids 104–108
intracranial 27, 234, 232
lung 246, 247, 262
retinoblastoma 270–272
U
Ultrasound 38, 139
Usher's syndrome 191
Uvea 8–9, 153
Uveitis
anterior 155–158, 261
posterior and intermediate 158–163
symptoms and signs 115
treatment 49
V
Vagal response 200, 209
Varicella 138
Vasculitis 160, 227
Vertigo 259
Viral conjunctivitis 114, 115
Viral keratitis 134
Visual acuity, assessment 21–24
Visual field defects 25, 235–238
AION 231
altitudinal 25–26
binocular 25, 26
peripheral 201–202
Visual field testing 24–29, 235, 236
confrontation 24–25, 27
peripheral 27, 27
sensitivity of central field to red targets 28
Visual loss
AION 231
anterior uveitis 156, 7
cataract 142, 144
diagnostic algorithm 54–55
gradual 141–143, 168–170
gradual blurring 62–64
papilloedema 232, 235
peripheral 201–202, 204
retinal detachment 187
retinitis pigmentosa189–192, 190
sudden 165–170
sudden and complete 202–206
unilateral 25, 203
Visual pathways 24, 25, 198, 235, 236
defects 235–238
Vitamin C 278
Vitrectomy 189
Vitreous base 12, 12
Vitreous detachment, posterior 169,187, 188
Vitreous haemorrhage 166, 168, 287
Vitreous humour 12, 12
Vomiting 209
W
Watery eye see Epiphora
X
Xeroderma pigmentosum 105
Z
Zonules 10, 11, 16, 71–72, 141
×
Chapter Notes

Save Clear