The Best Hits Bookshelf Volume 2: Popular Tutorials First Edition March 2018 copyright 2018. The University of Iowa Department of Ophthalmology & Visual Sciences Iowa City, Iowa ii About this Book Think before you act… This first edition book is a compilation of 50 case and tutorial articles featured on our website, EyeRounds. Disclaimer org. These articles have the most online “hits” and were Content is made available for review purposes only. hand-selected for their popularity and impact. They are Much of the material from EyeRounds.org is gathered among some of our most recent and high-yield content. from Grand Rounds presentations. Popularity will, of course, change over time so future editions will likely contain a different mixture of articles. The intent of Grand Rounds is to initiate discussion and stimulate thought, as a result, EyeRounds articles The content is arranged first by type (case or tutorial) may contain information that is not medically and then subspecialty (Cornea and External Disease, proven fact and should not be used to guide treat- Cataract, Glaucoma, Neuro-Ophthalmology, Oculoplas- ment. tics, Pediatrics and Strabismus, Retina and Vitreous, and Opinions expressed are not necessarily those of the On-Call and Trauma.) University of Iowa, the Carver College of Medicine, nor the Department of Ophthalmology and Visual Sciences. About EyeRounds.org For more details, see our terms of use at EyeRounds. Ophthalmology Grand Rounds and EyeRounds.org is a org/TOS.htm website of the University of Iowa Department of Oph- thalmology and Visual Sciences in Iowa City, Iowa. On Funding Support EyeRounds.org, you will find case reports from our EyeRounds.org is partially supported by unrestricted funds daily morning rounds, high-quality atlas images, videos, from The University of Iowa Department of Ophthalmology and online tutorials. EyeRounds.org is an ever-growing and Visual Sciences and from The Iowa Eye Association, resource for students, residents, physicians, and patients. neither of whom have influence on the content of this site. Over time, EyeRounds has gained momentum, now impacting learners all over the globe. Daily, the website receives thousands of hits from over 40 countries. March 8, 2018 EyeRounds.org Content The content on EyeRounds.org is produced by our physi- cians and is intended for medical students, residents, and physicians. What is not in this book? EyeRounds.org atlas images and videos, though very popular with our users, have been excluded from this compilation due to their nature. We invite you to explore the EyeRounds atlas at EyeRounds.org/atlas where you will find hundreds of pages of interesting and educational short items with images of interest. EyeRounds videos can be found at EyeRounds.org/video. Videos have been collected from a variety of sources created over the years by residents, faculty, and fellows of the University of Iowa Department of Ophthalmology & Visual Sciences. iii Dedication of this Work Patricia (Trish) Duffel has a B.S. in Pharmacy from the University of Texas, Austin (1976) and an M.A. in Library and Information Science from the University of Iowa (1991). Having earned her pharmacy degree in the days before the Pharm D degree became generally accepted, Trish is a registered pharmacist (RPh). Since 1991, she has been the solo librarian for the Department of Ophthalmology and Visual Sciences at the University of Iowa and the Executive Director and Editor of EyeRounds.org since 2007. In her almost 27 years in the department, she has held many roles including library manager, literature searcher, information chaser, newsletter writer/editor, copy editor, webmaster, and educator. Trish goes above and beyond, working tirelessly to support and see to the success of residents, fellows, scientists and physicians in the department. Her powerful work ethic, contagious energy, can-do attitude, and unwavering devotion to those around her has made her a favorite among faculty and trainees. She is a treasure trove of knowledge, a forever learner, and a truly incredible human being. For all that she has done for education at the University of Iowa Department of Ophthalmology and Vision Sciences and EyeRounds.org, we dedicate this work to Trish. iv EyeRounds Board 2017-2018 Lorraine A. Provencher, MD Patricia G. (Trish) Duffel, RPh, MA Chief Medical Editor, June 2017 - present Executive Director and Editor, EyeRounds.org Editorial Board Member, July 2016 - present University of Iowa University of Iowa Department of Ophthalmology and Visual Sciences Department of Ophthalmology and Visual Sciences Librarian Ophthalmology Resident Kelsey Hunold, BFA Lindsay M. DeAndrade, MD Assistant Director and Editor, EyeRounds.org Editorial Board Member, July 2016 - present University of Iowa University of Iowa Department of Ophthalmology and Visual Sciences Department of Ophthalmology and Visual Sciences Web and Social Media Coordinator Ophthalmology Resident Benjamin J. Janson, MD Editorial Board Member January 2018 - present Advisory Members University of Iowa Andrew Doan, MD, PhD Department of Ophthalmology and Visual Sciences Co-Founder EyeRounds.org Ophthalmology Resident Comprehensive Ophthalmology & Ocular Pathology San Diego, California Brittni Scruggs, MD, PhD Editorial Board Member, July 2017 - present Jordan M. Graff, MD University of Iowa Editorial Board Member Department of Ophthalmology and Visual Sciences Alumnus, Resident (2007), Vitreoretinal Fellow (2009) Ophthalmology Resident Arizona Heather A. Stiff, MD Matthew C. Weed, MD Editorial Board Member January 2018 - present Editorial Board Member University of Iowa Alumnus, Resident (2014), Ophthalmic Genetics Fellow Department of Ophthalmology and Visual Sciences (2015), Pediatric Ophthalmology Fellow (2016) Ophthalmology Resident Pediatric Ophthalmologist Spokane, WA Daniel Terveen, MD Editorial Board Member, July 2017 - present Thomas A. Weingeist, MD, PhD University of Iowa Editor and Co-Founder, EyeRounds.org Department of Ophthalmology and Visual Sciences University of Iowa Ophthalmology Resident Department of Ophthalmology and Visual Sciences Emeritus Head Thomas A. Oetting, MD Professor of Ophthalmology Editor and Co-Founder, EyeRounds.org University of Iowa Department of Ophthalmology and Visual Sciences Professor of Clinical Ophthalmology Wallace L.M. Alward, MD Editorial Board Member University of Iowa Department of Ophthalmology and Visual Sciences Professor of Ophthalmology Mark Greiner, MD Editorial Board Member University of Iowa Department of Ophthalmology and Visual Sciences Assistant Professor of Ophthalmology Pavlina Kemp, MD Editorial Board Member University of Iowa Department of Ophthalmology and Visual Sciences Assistant Professor of Clinical Ophthalmology v Contents Volume 1: CASE PRESENTATIONS ......................................................................................1-142 Cornea and External Disease ...........................................................................................................................1-18 Salzmann’s Nodular Corneal Degeneration .......................................................................................... 2-8 Treatment of Epithelial Basement Membrane Dystrophy with Manual Superficial Keratectomy ...... 9-13 Acute Corneal Hydrops ..................................................................................................................... 14-18 Cataract ......................................................................................................................................................... 19-33 Marfan Syndrome ............................................................................................................................ 20-23 Posterior Polar Cataract ................................................................................................................... 24-28 True Exfoliation Syndrome ............................................................................................................... 29-33 Glaucoma ...................................................................................................................................................... 34-59 Aphakic Glaucoma ............................................................................................................................ 35-39 Uveitis Glaucoma Hyphema (UGH) Syndrome ................................................................................. 40-44 Aqueous Misdirection ...................................................................................................................... 45-49 Hypotony: Late hypotony from trabeculectomy & Ahmed Seton .................................................... 50-55 Posner-Schlossman Syndrome (Glaucomatocyclitic Crisis) .............................................................. 56-59 Neuro-Ophthalmology ................................................................................................................................... 60-82 Functional Visual Loss ...................................................................................................................... 61-65 Ocular Tilt Reaction .......................................................................................................................... 66-70 Ethambutol Toxicity and Optic Neuropathy ..................................................................................... 71-76 Optic Neuritis ..................................................................................................................................