SUPPLEMENT TO April 15, 2010 www.revoptom.com Twelfth Edition Joseph W. Sowka, O.D., FAAO, Dipl. Andrew S. Gurwood, O.D., FAAO, Dipl. Alan G. Kabat, O.D., FAAO 001_ro0410_hndbkv7.indd 1 4/5/10 8:47 AM TABLE OF CONTENTS Eyelids & Adnexa Conjunctiva & Sclera Cornea Uvea & Glaucoma Vitreous & Retina Neuro-Ophthalmic Disease Oculosystemic Disease EYELIDS & ADNEXA VITREOUS & RETINA Floppy Eyelid Syndrome ...................................... 6 Macular Hole .................................................... 35 Herpes Zoster Ophthalmicus ................................ 7 Branch Retinal Vein Occlusion .............................37 Canaliculitis ........................................................ 9 Central Retinal Vein Occlusion............................. 40 Dacryocystitis .................................................... 11 Acquired Retinoschisis ........................................ 43 CONJUNCTIVA & SCLERA NEURO-OPHTHALMIC DISEASE Acute Allergic Conjunctivitis ................................ 13 Melanocytoma of the Optic Disc ..........................45 Pterygium .......................................................... 16 Demyelinating Optic Neuropathy (Optic Neuritis, Subconjunctival Hemmorrhage ............................ 18 Retrobulbar Optic Neuritis) ................................. 47 Traumatic Optic Neuropathy ...............................50 CORNEA Pseudotumor Cerebri .......................................... 52 Corneal Abrasion and Recurrent Corneal Erosion ..20 Craniopharyngioma ........................................... 54 Dry Eye Syndrome ............................................. 22 Thygeson’s Superficial Punctate Keratopathy .........26 OCULOSYSTEMIC DISEASE Cat Scratch Disease ........................................... 56 UVEA & GLAUCOMA Sjögren’s Syndrome ........................................... 57 Anterior Uveitis .................................................. 28 Hypertension ..................................................... 60 Iridocorneal Endothelial Syndromes (ICE) .............. 30 Diabetes Mellitus ................................................ 62 Phacolytic Glaucoma .......................................... 31 Primary Chronic Angle Closure Glaucoma ............33 A Peer-Reviewed Supplement The articles in this supplement were subjected to Review of Optometry ’s peer-review process. The maga- zine employs a double-blind review system for clinical manuscripts. Two referees review each manuscript before publication. This supplement was edited by the editors of Review of Optometry . ©2010. Reproducing editorial content and photographs require permission from Review of Optometry. 001_ro0410_hndbkv7.indd 4 4/5/10 8:47 AM FROM THE AUTHORS To Our Colleagues: The publication of the Twelfth edition of The Handbook of Ocular Disease Management coincides with many changes within the profession of optometry. Optometry has evolved from what was once a purely visual correction and refractive profession to an integrated member of the healthcare team. There has been increased specialization within optometry to the point that optometrists now utilize intra-professional referrals rather than strictly using inter-professional referrals. We need to embrace the concept that eye care, patient care, and optometry have become so advanced that it is difficult for any single practitioner to be everything to every patient. Optometric societies have developed to cater to and foster interest in specialized areas of optometry. Sub-specialization has become a real part of optometry. Referral to optometric colleagues for glaucoma and ocular disease management, vision therapy, low vision, and specialty contact lens fittings is now common place. Common to all of these changes is the need for optometrists to remain current and enhance their knowledge and education. Optometrists must commit to lifelong learning. Reading high quality peer-reviewed publications is necessary. Attending continuing education conferences that are free of commercial bias allows optometrists to keep current and interact, both socially and professionally, with colleagues. We have always felt that the best way to begin this commitment to lifelong learning is through the completion of an accredited residency. Residency training not only provides increased clinical experience, it opens doors and initiates the lifelong learning process. To all optometry stu- dents (and practitioners) reading this manuscript, we strongly encourage you to pursue residency training. Joe Andy Al Joseph W. Sowka, O.D., F.A.A.O., Dipl., is a professor of optometry at Nova Southeastern University College of Optometry, where he teaches Glaucoma and Retinal Disease. He is the director of the Glaucoma Service and chief of the Advanced Care Service. He is a diplomate of the Disease Section of the American Academy of Optometry (Glaucoma Subsection) and a founding member of the Optometric Glaucoma Society and the Optometric Retina Society. He can be reached at (954) 262-1472 or at [email protected]. Andrew S. Gurwood, O.D., F.A.A.O., Dipl., is a member of the attending staff of The Albert Einstein Medical Center Department of Ophthalmology. Involved in direct patient care, he also precepts students and medical residents teaching clinical practice, clinical The authors have medicine and its relationship to the eye and ocular urgencies and emergencies. He is a diplomate of the American Academy of Optometry’s Primary Care Section, a found- no financial inter- ing member of the Optometric Retina Society, a member of the Optometric Glaucoma est in any product Society and a member of the Optometric Dry Eye Society. He serves on the American Academy of Optometry’s Program Committee and is the Chairperson of the American mentioned. Academy of Optometry’s Disease Section Written Examination for Retinal Disease Diplomate. He can be reached at (215) 276-6134 or at [email protected] . Alan G. Kabat, O.D., F.A.A.O., is an associate professor at Nova Southeastern University College of Optometry where he teaches several didactic courses and serves as an attending physician in The Eye Care Institute. He is a founding member of the Optometric Dry Eye Society and the Ocular Surface Society of Optometry. Dr. Kabat is also the newly appointed Diplomate Chair for the Disease Section (Anterior Segment ] Disease Subsection) of the American Academy of Optometry. He can be reached at (954) 262-1440 or at [email protected]. APRIL 15, 2010 REVIEW OF OPTOMETRY 5A 001_ro0410_hndbkv7.indd 5 4/5/10 8:47 AM EYELIDS AND ADNEXA FLOPPY EYELID SYNDROME Pathophysiology surface. Others have suggested that the The exact etiology of FES is not underlying mechanism is simply poor Signs and Symptoms thoroughly understood. Research has apposition of the upper eyelid to the Floppy eyelid syndrome globe, instigating an inadequate (FES), first described in 1981 tear distribution and subsequent by Culbertson and Ostler, is a desiccation of the ocular surface relatively uncommon ocular tissues.9 condition characterized by flac- cid, easily everted upper lids.1 Management It is usually seen in overweight, In the majority of cases, middle-aged males, although it diagnosis is made by the clas- may occasionally be encountered sic appearance and effortless or in women, children and non- spontaneous eversion of the eye- obese individuals. A fair per- lids. There are few ancillary tests centage of patients with FES to consider beyond the normal also suffer from obstructive sleep ocular evaluation, though vital apnea (OSA), a disorder marked Floppy eyelid syndrome. dye staining (e.g., sodium fluo- by partial collapse of the phar- rescein, rose bengal and/or lis- ynx during inspiration while sleeping, demonstrated that tarsal elastin is sig- samine green) may help to assess the resulting in loud snoring and gasping nificantly diminished in these patients, severity of any associated keratopathy. for air.2-4 such that the tarsal plate of the eye- Treatment for FES consists primar- Symptoms generally consist of ocular lid no longer displays its customary ily of lubricating the ocular surface and irritation, itching and stringy mucous rigidity.6 A recent study of patients safeguarding the eye from nocturnal discharge, particularly upon awaken- with FES identified elevated matrix damage. Artificial tears, used liberally ing.1-4 The symptoms may appear to metalloproteinase (MMP) activity in throughout the day, help to eliminate be largely unilateral or asymmetric. subjects’ eyelids; MMPs in these cases mucous debris and promote corneal Patients with OSA characteristical- have been shown to degrade local elas- healing. In cases of moderate or pro- ly complain of erratic sleep patterns, tin fibers and may ultimately lead to found epitheliopathy, consider more chronic somnolence, fatigue and morn- eyelid laxity and instability in this dis- enduring lubricants such as Systane ing headaches. ease process.7 The authors postulated Ultra (Alcon Laboratories) or Blink Examination of patients with FES that nocturnal mechanical factors may Tears (Abbott Medical Optics) on a typically reveals chronic papillary con- result in local eyelid ischemia, which q.i.d. basis. At bedtime, the patient junctivitis with mild to moderate bul- upregulates these elastin-degrading should instill either a bland ophthal- bar hyperemia, often lateralizing to the enzymes to produce the tissue laxity.7 mic ointment (e.g., Systane Nighttime, patient’s habitual sleeping side (i.e., Another publication suggested that from Alcon Laboratories or Refresh if