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Anterior Segment Diseases
Ashok Garg, Emanuel Rosen, Arturo Perez Arteaga, Ashok Sharma
CHAPTER ONE:
Congential Anomalies of the Anterior Segment
Anophthalmos/Microphthalmos
Prevalence
Mann Classified Anophthalmos into Three Distinct Types
Histologically
Differential Diagnosis
Etiology
Ocular and Systemic Associations
Management
Management of Anophthalmos
Orbital Surgery
Eyelid Surgery
Management of Microphthalmos
Anterior Segment Dysgenesis
Posterior Embryotoxon
Axenfeld-Rieger Syndrome
Peters Anomaly
Histopathology
Differential Diagnosis
Ultrasound Biomicroscopy
Sclerocornea
Histologically
Ultrasound Biomicroscopy
Differential Diagnosis
CHAPTER TWO:
Developmental Abnormalities
Axenfeld Rieger Syndrome
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Peters Anomaly
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Aniridia
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
CHAPTER THREE:
Conjunctival Disorders
Trachoma
Introduction
Clinical Signs and Symptoms
Follicular Inflammation
Intense Inflammation
Eyelid Scarring
Trichiasis Stage
Corneal Clouding
Investigations
Differential Diagnosis
Treatment
Medications
Surgery
Prognosis
Bacterial Conjunctivitis
Introduction
Investigations
Clinical Signs and Symptoms
Differential Diagnosis
Treatment
Prognosis
Adenoviral Keratoconjunctivitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Chlamydial Conjunctivitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Allergic Conjunctivitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Giant Papillary Conjunctivitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Vernal Conjunctivitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Atopic Conjunctivitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Ocular Cicatricial Pemphigoid
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Stevens-Johnson Syndrome
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Superior Limbic Keratoconjunctivitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Phlyctenular Conjunctivitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Lymphoma
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Conjunctival Nevus
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Conjunctival Intraepithelial Neoplasia
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Squamous Cell Carcinoma
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Primary Acquired Melanosis of the Conjunctiva
Introduction
Investigations
Clinical Signs and Symptoms
Differential Diagnosis
Treatment
Prognosis
Conjunctival Melanoma
Introduction
Investigations
Clinical Signs and Symptoms
Differential Diagnosis
Treatment
Prognosis
Limbal Dermoid
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Pingueculae
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Pterygium
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Conjunctivochalasis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
CHAPTER FOUR:
Episclera and Sclera
Episcleritis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Scleritis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
CHAPTER FIVE:
Corneal Disorders
Bacterial Keratitis
Introduction
Clinical Features
Microbiological Diagnosis
Treatment
Fungal Keratitis
Introduction
Clinical Presentation
Microbiological Diagnosis
Treatment
Herpes Simplex Keratitis
Introduction
Clinical Presentation
Microbiological Tests
Treatment
Herpes Zoster Ophthalmicus
Introduction
Treatment
Acanthamoeba Keratitis
Introduction
Clinical Features
Microbiological Tests
Treatment
Atypical Mycobacterium Keratitis
Microbiological Tests
Treatment
Nocardia Keratitis
Marginal Keratitis
Introduction
Clinical Presentation
Differential Diagnosis
Treatment
Vernal Conjunctivitis
Introduction
Clinical Presentation
Treatment
Vernal Ulcer
Etiology
Clinical Features
Treatment
Vitamin a Deficiency
Definition of Xerophthalmia, Keratomalacia
Pathophysiology
Ocular Manifestation
Night Blindness
Conjunctival Manifestations
Bitot's Spots: (X1B)
Corneal Manifestations
Xerophthalmic Fundus
Diagnosis
Treatment
Vitamin A
Prevention
Corneal Edema
Treatment
Numular Corneal Opacities
Dry Eyes
Clinical Presentation
Diagnosis
Treatment
Meibomian Gland Disease
Clinical Presentation
Pathophysiology
Treatment
Neurotrophic Keratitis
Clinical Presentation
Treatment
Ocular Surface Disease and Limbalstem Cell Deficiency
Normal Ocular Surface
Corneal Epithelial Cell Homeostasis
Basic Concept of Stem Cells
Role of Limbal Stem Cells in Ocular Surface Healing
Conjunctival Transdifferentiation, not a Reality
Limbal Stem Cell Deficiency
Limbal Stem Cell Disorders
Clinical Presentation
Diagnosis
Currents in Surgical Management Ofocular Surface Disease
Treatment of Ocular Surface Disorders
Adjunct Treatment
Ocular Surface Reconstruction
Newer Surgical Procedures
Rationale of Newer Surgical Options
Surgical Technique
Limbal Stem Cell Transplant
Preparation of Preserved Human Amniotic Membrane
Amniotic Membrane Transplantations
Mooren's Ulcer
Differential Diagnosis
Treatment
Peripheral Ulcerative Keratitis
Investigations
Treatment
Management of Corneal Injuries
Open-globe Injury Classification
Type
Grade
Pupil
Zone
Principles of Repair: Principles of Surgical Repair
Management of Injury to Lens
Complications of Corneal Injury
Management of Blunt Trauma of Anterior Segment
Closed-globe Injury: Classification
Type
Grade
Pupil
Zone
Birth Trauma
Raised Intraocular Pressure
Secondary Hemorrhage
Medical Management
Surgical Intervention
Corneal Blood Staining
Acute Chemical Eye Injury
Diagnosis
Visual Rehabilitation
Corneal Degenerations
Keratoconus
Clinical Presentation
Pathogenesis
Treatment
Pellucid Marginal Corneal Degeneration
Treatment
Terrien's Marginal Degeneration
Treatment
Salzmann's Nodular Degeneration
Treatment
Climatic Droplet Keratopathy
Treatment
Anterior Corneal Dystrophies
Meesmann's Epithelial Dystrophy
Epithelial Basement Membrane Dystrophy
Reis-Bucklers Dystrophy
Stromal Corneal Dystrophies
Granular Dystrophy
Avellino Dystrophy
Lattice Dystrophy
Macular Dystrophy
Gelatinous Droplike Dystrophy
Endothelial Dystrophies
Fuchs' Endothelial Dystrophy
Congenital Corneal Dystrophies
Congenital Hereditary Endothelial Dystrophy (CHED)
Clinical Features
Differential Diagnosis
Pathogenesis
Treatment
Posterior Polymorphous Dystrophy
Diagnosis
Differential Diagnosis
Pathology
Treatment
CONGENITAL HEREDITARY STROMAL DYSTROPHY
CHAPTER SIX:
Iris and Ciliary Body
Idiopathic Iritis
Introduction
Clinical Signs and Symptoms
Investigation
Differential Diagnosis
Treatment
Prognosis
Sarcoidosis
Introduction
Clinical Signs and Symptoms
Investigation
Differential Diagnosis
Treatment
Prognosis
Fuchs Heterochromic Iridocyclitis
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
Juvenile Idiopathic Arthritis
Introduction
Clinical Signs and Symptoms
Investigation
Differential Diagnosis
Treatment
Prognosis
CHAPTER SEVEN:
Tear Film Disorders
Introduction
Superficial Lipid Layer
Middle Aqueous Layer
Posterior Mucin Layer
Tear Film Formation Dynamics
Normal Tear Drainage
Tear Composition
Physical Properties OF Tears
Tear pH
Osmotic Pressure
Other Physical Properties of Tear
Chemical Composition OF Tear Fluid
Lipids
Cholesterol
Proteins
Tear Albumin
Lysozyme
Lactoferrin
Transferrin
Ceruloplasmin
Immunoglobulins
Complement
Glycoproteins
Antiproteinases
Metabolites
Glucose
Urea
Amino Acids
Lactate
Histamine
Prostaglandins
Catecholamines, Dopamine, Noradrenaline and Dopa
Electrolytes and Hydrogen Ions
Sodium
Calcium
Magnesium
Chloride
Bicarbonate
Enzymes
Enzymes of Energy Producing Metabolisms
Lactate Dehydrogenase
Lysosomal Enzymes
Amylase
Peroxidase
Plasminogen Activator
Collagenase
Drugs Excreted in Tears
Applied Physiology
Hyposecretion of Tears
Diagnostic Tests for Tear Hyposecretions
Tear Film Break-up Time (BUT)
Schirmer's Test
Vital Dye Staining
Lysozyme Assay
Tear Globulin Assay
Tear Osmolarity
Biopsy of the Conjunctiva
Hypersecretion of Tears
Physiological Diagnostic Test for Hypersecretions
Jones I (Primary) Test
Jones II (Secondary Irrigation) Test
Fluorescein Dye Disappearance Test
Special Tests
Intubation Dacryocystography
Scintillography (Radionuclide Testing)
Color Doppler Scanography
Diagnosis
Patient History
How do winds or drafts affect your eyes?
Does reading affect your eyes?
Any problems when you awake at night?
Do your eyes tear when you peel onions? Can you cry when you feel sad or hurt?
What medications do you take?
Can you feel saliva in your mouth? Can you swallow bread without additional fluids?
Do you have any skin problems?
What topical lubricants do you use? Are they preserved or unpreserved? How long and how often do you use them?
Physical Examination
Systemic Examination
Ocular Examination
External Eyelid Examination
Slit-lamp Biomicroscopy (SLB)
Clinical Diagnostic Tests
Tear Film Stability Assessment
Tear Breakup Time
Tear Secretion Assessment
Schirmer and Jones's Tests
Phenol Red Threat Test
Nasal-lacrimal Reflex Tearing
Tear Film and Epithelial Integrity Assessment
Fluorescein Dye
Rose Bengal Dye
Lissamine Green Dye
Laboratory Diagnostic Tests
Serum Antibodies
Conjunctival Impression Cytology
Tests to Demonstrate the Physical Characteristics of the Tear Film
Tear Osmolarity
Ocular Ferning Test
Tear Film Evaporation
Tear Clearance
Tests to Measure the Chemical Composition of the Tear Film
Tear Lysozyme
Tear Lactoferrin
Tear Protein
Tests to Measure Lipid Tear Deficiency
Conclusion
Introduction
Investigations
Clinical Signs and Symptoms
Chronic Dry Eye After Lasik
Risk Factors for Dry Eye After Refractive Surgery
Treatment
Introduction
Pathophysiology
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Preventive Measures
Computer Glasses
Prognosis
Etiology of Pediatric Dry Eye
Riley-Day Syndrome (Familial Dysautonomia)
Management of Severe Dry Eye
Multiple Concomitant Therapies
Pediatric Refractive Surgery
Treatment Persistence
CHAPTER EIGHT:
Hyphema
Introduction
History
Examination
Associated Exam Findings
Prognosis and Treatment of Hyphema
CHAPTER NINE:
Pediatric Iris Abnormalities
Aniridia
Histology
Additional Abnormalities
Typical Clinical Presentation
Cause
Sporadic or Familial
Familial
Sporadic
Coloboma Iris
Typical
Atypical
Common Association
Heterochromia Iridis
Congenital
Involved Iris Dark
Involved Iris Light in Color
Waardenburg Syndrome
Acquired
Involved Iris Dark
Involved Iris Light
William Syndrome
Iris Nodules
Lisch Nodule
Juvenile Xanthogranuloma (JXG)
Primary Iris Cysts
Iris Pigment Epithelium Cysts
Central Cysts (Pupillary)
Cyst Iris Stroma
Brushfield Spots (Wofflin Nodules)
Persistent Pupillary Membrane (PPM)
Treatment
Primary Iris Abnormalities
Rieger's Anomaly
Rieger's Syndrome
CHAPTER TEN:
Anterior Segment Tumors
Introduction
Iris Nevus
Introduction
Diagnosis
Special Forms of Iris Nevus
Iris Freckles
Lisch Nodules
Cogan-Reese Syndrome
Nevus of Ota (Oculodermal Syndrome)
Treatment
Prognosis
Ciliary Body Nevus
Introduction
Diagnosis
Treatment and Prognosis
Iris Melanoma
Introduction
Diagnosis
Treatment
Prognosis
Ciliary Body Melanoma
Introduction
Diagnosis
Treatment
Prognosis
Anterior Segment Cysts
Introduction
Diagnosis
Treatment
Metastasis
Introduction
Diagnosis
Treatment
Prognosis
Tumors of the Non-Pigmented Ciliary Body Epithelium
Medulloepithelioma
Introduction
Diagnosis
Fuchs' Adenoma (Pseudoepitheliomatous Hyperplasia)
Introduction
Diagnosis
Other Tumors of the Nonpigmented Ciliary Body Epithelium
Other Tumors
Leiomyoma
Neurilemmoma (Schwannoma)
Neurofibroma
Hemangioma and Lymphoid Tumors
CHAPTER ELEVEN:
Keratoplasty
Introduction
Visual Assessment
Direct
Indirect
Ocular Examination
Surgical Procedures
Indications
Congenital
Acquired, Non-traumatic
Acquired, Traumatic
Surgical Management
Penetrating Keratoplasty
Disadvantages of Smaller Graft
Concomitant Procedures
Iris Procedures
Peripheral Iridectomy
Anterior Synechiolysis
Pupilloplasty
Lensectomy and Anterior Vitrectomy
Concomitant Retinal Surgery
Postoperative Care
Immediate Postoperative Period
Early Postoperative Care
Postoperative Medications
Suture Removal
Optical Correction and Amblyopia Therapy
Conclusion
Introduction
Review
Eye Banking and Corneal Storage
Lamellar Keratoplasty
Limbal Stem Cell Transplantation
Corneal Collagen Cross Linking
New Technology
Evolution of New Nomenclature in Corneal Transplant Surgery
Evolution of Keratoplasty: Indian Scenario
Introduction
Indications of Penetrating Keratoplasty
Age at the Time of Penetrating Keratoplasty
Evaluation of Infants or Neonates with Congenital Corneal Opacities
Investigations
Pediatric Keratoplasty Constraints
Preparation Before Corneal Transplant Surgery
Donor Tissue
Surgery
Size of the Graft
Alternatives to Penetrating Keratoplasty
High Risk Penetrating Keratoplasty
Perioperative Care
Complications
Early
Intermediate
Late
Allograft Rejection
Glaucoma
Treatment of Amblyopia
Outcome
Repeat Corneal Graft
Keratoprosthesis
Rehabilitation of Blinds Due to Corneal Disease
Summary and Conclusions
INDEX
TOC
Index
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