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Ophthalmology RAPID Ophthalmology mage i b e a in l n k n o Zahir Mirza Editorial Advisor: Andrew Coombes Rapid Ophthalmology To my supportive and ever thoughtful wife. Zahir Mirza Rapid Ophthalmology Dr Zahir Mirza, BSc, MBChB Ophthalmic Specialist Trainee Western Eye Hospital, Imperial NHS Trust London, UK Editorial Advisor Mr Andrew Coombes, BSc, MBBS FRCOphth Consultant Eye Surgeon Barts and the London NHS Trust London, UK A John Wiley & Sons, Ltd., Publication This edition first published 2013 C John Wiley & Sons, Ltd Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data Mirza, Zahir. Rapid ophthalmology / Zahir Mirza ; editorial advisor, Andrew Coombes. p. ; cm. – (Rapid series) Includes bibliographical references and index. ISBN 978-0-470-65691-4 (softback : alk. paper) I. Coombes, Andrew. II. Title. III. Series: Rapid series. [DNLM: 1. Eye Diseases–Handbooks. 2. Diagnostic Techniques, Ophthalmological–Handbooks. WW 39] RE720 617.7–dc23 2013003061 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover image: C Pasieka/Science Photo Library Cover design by Visual Philosophy Set in 9.5/11.5pt Frutiger by AptaraR Inc., New Delhi, India 1 2013 v Contents Preface, x Acknowledgements, xi Abbreviations, xii About the companion website, xiv Basic anatomy and physiology Osteology of the orbit, 3 Orbital fissures, 3 Superior orbital fissure, 3 Inferior orbital fissure, 3 Optic canal, 3 The globe, 3 Cornea, 3 Anatomical terms, 5 Retinal overview, 6 Layers of the retina, 6 Blood supply to the eye, 7 Ciliary body and lens, 7 Trabecular meshwork, 7 Aqueous humour flow, 7 Tears, 8 Vitreous humour, 8 Ocular muscles (origin / insertion / primary actions), 8 Superior rectus (SR), 8 Inferior rectus (IR), 8 Medial rectus (MR), 8 Lateral rectus (LR), 8 Superior oblique (SO), 9 Inferior oblique (IO), 9 The visual pathway, 9 Pupillary reflexes, 11 Direct and consensual light reflex, 11 Accommodation, 11 vi Contents Pupil defects, 12 Holmes-Adie pupil, 12 Essential anisocoria, 12 Argyll Robertson pupils, 12 Horner’s syndrome, 12 Cranial nerve III palsy (complete), 12 Relative afferent pupillary defect (RAPD) or Marcus Gunn pupil, 12 Myopia, hypermetropia and astigmatism, 14 Ophthalmological assessment History taking, 17 Examination, 17 Examination techniques, 18 Colour vision, 18 Pupil reflexes, 18 Visual fields by confrontation, 18 Eye movements, 19 Objective structured clinical examination (OSCE) section, 20 Visual acuity, 20 Ophthalmoscopy, 21 Differentials Watery eye, 25 Proptosis, 25 Optic disc atrophy, 25 Toxic optic neuropathy, 25 Swollen optic discs, 26 Ptosis, 26 The red eye, 26 Classic presentations of a red eye and associated conditions, 26 Differentials – classified anatomically (from anterior to posterior), 27 Differential flow charts, 27 Contents vii Diseases Age-related macular degeneration (AMD), dry, 37 Age related macular degeneration, wet ,39 Amaurosis fugax ,41 Amblyopia, 43 Blepharitis, 44 Cataract, age-related, 46 Cataract, congenital, 48 Cavernous sinus syndrome ,49 Cellulitis, orbital ,51 Cellulitis, preseptal, 52 Chemical injury to the eye ,53 Conjunctivitis, bacterial and chlamydial, 55 Conjunctivitis, other (including ophthalmia neonatorum) ,57 Allergic conjunctivitis, 57 Ophthalmia neonatorum ,57 Conjunctivitis, viral, 58 Cranial nerve III (CNIII) palsy ,60 Cranial nerve IV (CNIV) palsy ,62 Cranial nerve VI (CNVI) palsy ,63 Cytomegalovirus (CMV) retinitis ,65 Dacrocystitis ,66 Diabetic retinopathy, 67 Ectropion, 69 Endophthalmitis ,70 Entropion, 71 Episcleritis, 72 Exposure keratopathy, 73 Eye trauma ,74 Eyelid lacerations/cuts, 74 Corneal foreign bodies, 74 Corneal abrasion, 74 Hyphaema, 74 Iris mydriasis, 74 Lens subluxation/dislocation, 74 Vitreous haemorrhage, 75 Retinal detachment, 75 viii Contents Traumatic optic neuropathy, 75 Globe rupture/penetrating eye injury, 75 Orbital fractures, 75 Retrobulbar haemorrhage, 75 Eye tumours ,76 Primary choroidal melanoma, 76 Secondary (metastatic) choroidal, 76 Retinal haemangioma, 76 Ocular non-Hodgkin lymphoma, 76 Giant cell arteritis (GCA) ,77 Wegener’s granulomatosis, 78 Behc¸et’s disease, 78 Glaucoma, acute primary angle-closure ,79 Glaucoma, chronic open angle, 81 Herpes zoster ophthalmicus (HZO) ,83 Horner’s syndrome ,85 Hypertensive retinopathy, 87 Keratitis, bacterial ,89 Keratitis, herpetic ,91 Keratoconjunctivitis sicca, 93 Keratoconus, 95 Lid lumps, basal cell carcinoma, 97 Lid lumps, chalazion, 99 Lid lumps, other (benign), 100 Cyst of Zeiss, 100 Cyst of Moll, 100 Molluscum contagiosum, 100 Stye (external hordeolum), 100 Squamous cell papilloma, 100 Xanthelasma, 100 Lid lumps, other (malignant), 101 Squamous cell carcinoma (SCC), 101 Melanoma, 101 Merkel cell carcinoma, 101 Keratocanthoma, 101 Migraine, 102 Multiple sclerosis (MS), 104 Contents ix Pinguecula, 106 Posterior vitreous detachment (PVD), 107 Pterygium, 108 Retinal artery occlusion , 109 Retinal detachment , 110 Retinal vein occulsion , 112 Retinitis pigmentosa and other inherited retinal dystrophies, 114 Retinitis pigmentosa, 114 Albinism, 114 Leber congenital amaurosis, 114 Stargardt’s disease, 114 Retinoblastoma , 115 Retinopathy of prematurity (ROP) , 117 Sarcoidosis (and Tuberculosis), 119 Note on tuberculosis (TB), 121 Scleritis , 122 Squint (strabismus), childhood, 124 Thyroid eye disease, 126 Uveitis, anterior , 128 Uveitis, intermediate , 129 Uveitis, posterior , 130 Glossary, 131 Index, 133 x Preface Rapid Ophthalmology is crafted to offer a concise, clear and accessible overview of ophthalmology. Primarily, the book is aimed at medical students, especially to complement ophthalmology firms and exam revision. It is not designed to be a textbook but rather a source for quickly finding facts about ophthalmology. For example, one could easily have a copy in clinic and look up a disease using a patient’s presenting symptoms. Whilst revising for exams the book provides an extremely efficient resource with sections tailored specifically towards differential diagnosis, assessment and OSCE exams. This book, however, has a value beyond most revision textbooks. It is a book that will not be defunct on the shelves of a junior doctor or even a general practitioner. I have intended this book to be such that it that contains the information needed for the nonspecialist to diagnose, manage and
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