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Fundamentals of Clinical Ophthalmology

Cornea

Fundamentals of Clinical Ophthalmology

Cornea

Douglas J Coster

Lions Professor of Ophthalmology,

Flinders University of South Australia,

Flinders Medical Centre, Adelaide, Australia

Series Editor

Susan Lightman

Professor of Clinical Ophthalmology

Institute of Ophthalmology and

Moorfields Eye Hospital, London

© BMJ Books 2002

BMJ Books is an imprint of the BMJ Publishing Group

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 and/or otherwise, without the prior written permission of the publishers.

First published in 2002

by BMJ Books, BMA House, Tavistock Square, London WC1H 9JR

www.bmjbooks.com

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 0–7279–1557–6

Typeset by Newgen Imaging Systems (P) Ltd, Chennai

Printed and bound in Malaysia by Times Offset

Contents

Preface to the Fundamentals of Clinical

 

Ophthalmology series

vii

Preface

ix

Acknowledgements

xi

1

Foundations of keratology

1

2

The cornea and inflammation: diagnosing the red eye

35

3

Corneal ulceration

41

4

Superficial keratopathy

65

5

Corneal complications of contact lens wear

74

6

Interstitial keratitis

83

7

Proliferative lesions

88

8

Corneal ectasia: acquired abnormalities of corneal shape

93

9

Herpes simplex virus keratitis

102

10

Corneal trauma

108

11

Corneal dystrophies

119

12

Corneal transplantation

128

v

CONTENTS

 

13

Medical therapy for corneal disease

137

14

Procedures

147

15

Therapy of corneal disorders

167

Index

180

vi

Preface to the

Fundamentals of Clinical Ophthalmology series

This book is part of a series of ophthalmic monographs, written for ophthalmologists in training and general ophthalmologists wishing to update their knowledge in specialised areas. The emphasis of each is to combine clinical experience with the current knowledge of the underlying disease processes.

Each monograph provides an up to date, very clinical and practical approach to the subject so that the reader can readily use the information in everyday clinical practice. There are excellent illustrations throughout each text in order to make it easier to relate the subject matter to the patient.

The inspiration for the series came from the growth in communication and training opportunities for ophthalmologists all over the world and a desire to provide clinical books that we can all use.This aim is well reflected in the international panels of contributors who have so generously contributed their time and expertise.

Susan Lightman

vii

Preface

This book is intended to provide a coherent description of disorders of the cornea and their management. Emphasis is placed on diagnosis and, in particular, on the diagnostic process, because accurate diagnosis is essential for effective management.

Although an apparently simple structure, with limited but important functions, the cornea is prone to a wide range of pathological processes. Attention has been directed to the common and important conditions which afflict the cornea. Some less common and perhaps less important conditions are discussed where relevant to the general theme.

This book is intended to be concise. Its aim is to provide an overview, with emphasis on how various conditions relate to one another and on identifying common principles of treatment. For a more detailed discussion of particular conditions there are many monographs and larger textbooks, most of which are disease based and therefore particularly useful after a diagnosis has been made.

Because the cornea is an integral part of the ecosystem of the outer eye, it is unwise to consider it in isolation. The cornea is affected by changes in the conjunctiva, eyelids, tear film and commensal organisms and, conversely, other entities may be affected by changes in the cornea. However, here it has been necessary to consider primarily the cornea and to mention other disorders of the external eye only in passing.

Clinical management implies diagnosis and treatment. Treatment is discussed in general terms in the body of the text and the specifics of treating particular conditions are set out in tabular form in Chapter 15.

Solitary authorship facilitates coherence but increases the threat of personal bias. I have tried to minimise this by basing my views on the evidence provided in the published literature. As with all clinical medicine, however, there are large gaps in the justification of common clinical practices. In such cases, I have had no choice but to present a more personal view but in doing so, I have attempted to present the collective view of experienced clinicians in the field.

Douglas Coster

ix