- •Foreword
- •Erratum
- •Preface
- •The Physical Examination of the Eye
- •The orbit
- •The external eye
- •The eyeball
- •The conjunctiva
- •Tenon’s capsule
- •The sclera and episclera
- •The cornea
- •The anterior chamber
- •The uvea
- •The iris
- •The ciliary body
- •The choroid
- •The lens
- •The retina
- •The vitreous
- •The extraocular muscles
- •The rectus muscles
- •The oblique muscles
- •Innervation of the eye
- •The optic nerve (II)
- •The oculomotor nerve (III)
- •The trochlear nerve (IV)
- •The trigeminal nerve (V)
- •The abducens nerve (VI)
- •The blood supply of the eye
- •Physical examination of the eye
- •Vision
- •External examination
- •Extraocular movements
- •Examination of the conjunctiva
- •Examination of the sclera and episclera
- •Examination of the uvea
- •Intraocular pressure
- •Examination of the cornea
- •Examination of the pupils
- •Examination of the anterior chamber
- •Ophthalmoscopy
- •Summary
- •References
- •Visual acuity testing
- •Slit lamp examination
- •Flourescein examination
- •Tonometry
- •Lid eversion
- •Foreign body removal
- •Contact lens removal
- •Eye irrigation
- •Paracentesis
- •Lateral canthotomy
- •Ocular ultrasonography
- •Summary
- •References
- •Conjunctivitis
- •Subconjunctival hemorrhage
- •Episcleritis
- •Scleritis
- •Uveitis
- •Acute angle-closure glaucoma
- •Summary
- •References
- •Conjunctivitis
- •Viral conjunctivitis
- •Bacterial conjunctivitis
- •Neonatal conjunctivitis
- •Episcleritis
- •Keratitis
- •Viral keratitis
- •Bacterial keratitis
- •Keratitis due to light exposure
- •Uveitis
- •Anterior uveitis
- •Intermediate uveitis
- •Posterior uveitis and retinitis
- •Hordeolum and chalazion
- •Dacryocystitis
- •Periorbital and orbital cellulitis
- •References
- •Acute Monocular Visual Loss
- •Temporal arteritis
- •Epidemiology
- •Etiology
- •Clinical features
- •Diagnosis and treatment
- •Optic neuritis
- •Epidemiology
- •Etiology
- •Clinical features and diagnosis
- •Treatment
- •Central retinal artery occlusion
- •Epidemiology
- •Etiology
- •Cardiogenic embolism
- •Other causes
- •Clinical features
- •Diagnosis and treatment
- •Central retinal vein occlusion
- •Epidemiology
- •Etiology
- •Clinical features
- •Diagnosis and treatment
- •Retinal detachment
- •Epidemiology
- •Etiology
- •Clinical features
- •Diagnosis and treatment
- •Retinal vasculitis
- •Epidemiology and etiology
- •Clinical characteristics
- •Diagnosis and treatment
- •Summary
- •References
- •Trauma to the Globe and Orbit
- •History and physical examination
- •Imaging techniques
- •CT scan
- •Ultrasound
- •Blunt trauma to the orbit
- •Periorbital tissues
- •Orbital fractures
- •Retrobulbar hemorrhage
- •Anterior chamber
- •Traumatic hyphema
- •Subconjunctival hemorrhage
- •Injury to the iris and ciliary body
- •Traumatic iridocyclitis (uveitis)
- •Traumatic mydriasis and miosis
- •Iridodialysis
- •Acute glaucoma
- •Injury to the lens
- •Subluxation and dislocation
- •Cataract formation
- •Globe injury
- •Globe rupture
- •Globe luxation
- •Posterior segment
- •Vitreous hemorrhage
- •Chorioretinal injury
- •Commotio retina
- •Penetrating ocular injury
- •Periorbital tissues
- •Conjunctival lacerations
- •Laceration of the eyelid
- •Globe injury
- •Corneoscleral laceration and puncture wounds
- •Intraocular foreign body
- •Orbital foreign body
- •Delayed complications
- •Endophthalmitis
- •Sympathetic ophthalmia
- •Burns
- •Acid and alkali exposure
- •Miscellaneous irritants, solvents, and detergents
- •Thermal burns
- •UV keratitis
- •Prevention
- •Acknowledgment
- •References
- •Chemical burns
- •Pathophysiology
- •Alkali injury
- •Acid injury
- •Cyanoacrylate exposure
- •Treatment
- •Thermal injuries
- •Radiation injuries
- •Treatment
- •Biologic exposures
- •Treatment
- •Disposition
- •References
- •Neuro-Ophthalmology
- •Neuroanatomy and neuro-ophthalmologic examination
- •The visual pathway
- •The cranial nerves
- •Neuro-ophthalmologic examination
- •Visual acuity
- •Funduscopic examination
- •Testing ocular motility
- •Pupillary disorders
- •Pupil size and reactivity
- •Anisocoria
- •Horner syndrome
- •Tonic (Adie) pupil
- •Pharmacotherapy and pupils
- •Traumatic optic neuropathy
- •Optic neuritis
- •Oculomotor nerve palsy
- •Extraocular movement disorders
- •Cranial nerve palsies and binocular diplopia
- •Cranial nerve III
- •Cranial nerve IV
- •Cranial nerve VI
- •Nystagmus
- •Peripheral nystagmus
- •Central nystagmus
- •Myasthenia gravis
- •Multiple sclerosis
- •Stroke syndromes and gaze palsies
- •Stroke syndromes and the visual system
- •Anterior cerebral artery
- •Internal carotid artery
- •Middle cerebral artery
- •Posterior cerebral artery
- •Basilar artery
- •Vertebal arteries
- •Gaze palsies/conjugate gaze deviation
- •Hemispheric lesions
- •Midbrain lesions
- •Pontine lesions
- •Summary
- •References
- •Visual development
- •The eye examination in a child
- •Examination of the newborn and young infant
- •Older infants and preverbal children
- •Verbal children
- •Conjunctivitis
- •Ophthalmia neonatorum (neonatal conjunctivitis)
- •Childhood conjunctivitis
- •Orbital and periorbital cellulitis
- •Lacrimal system infections
- •Congenital
- •Nasal lacrimal duct obstruction
- •Congenital cataracts
- •Congenital glaucoma
- •Misalignment
- •Oncology
- •References
- •The Painful Eye
- •Acute angle closure glaucoma
- •Scleritis
- •Anterior uveitis (iritis)
- •HLA-B27-associated uveitis
- •Other noninfectious etiologies
- •Infectious etiologies
- •Treatment of anterior uveitis
- •Optic neuritis
- •Keratitis
- •Noninfectious keratitis
- •Ulcerative keratitis
- •Infectious keratitis
- •Bacterial
- •Viral
- •Fungal
- •Amoebic
- •Corneal abrasion
- •References
- •Acquired syphilis
- •Varicella-zoster virus infection
- •Lyme disease
- •Reiter’s syndrome
- •Infectious endocarditis
- •Kawasaki’s disease
- •Temporal arteritis
- •Hypertension
- •Diabetes
- •Summary
- •References
- •Emergency ophthalmology consultation caveats
- •Emergency diagnoses requiring emergency ophthalmology consultation
- •Trauma
- •Endophthalmitis
- •Acute angle closure glaucoma
- •Severe uveitis
- •Corneal ulceration
- •Acute visual loss
- •Optic neuritis
- •Central retinal artery occlusion
- •Retinal detachment
- •Orbital cellulitis
- •References
6 |
ROBINETT & KAHN |
zonule connects to the ciliary body. As one ages, the lens becomes larger and less flexible. The lens contains no nerves or blood vessels [6].
The lens may be dislocated in the setting of trauma. Also, trauma may cause cataract formation. See the article by Bord and Linden elsewhere in this issue.
The retina
The specialized neural tissue lining the posterior, inner part of the globe is the retina. It is semitransparent and multilayered. It is composed of ten layers containing nervous tissue, pigmented epithelial cells, and photoreceptors. The retina is easily detached from its epithelium, except at the optic disk [4–6].
Retinal detachment, a vision-threatening ophthalmologic surgical emergency, can be recognized by historical features (visual loss, floaters, flashing lights) and on physical examination (elevated portion of retina on fundoscopic examination). This will be discussed in detail in the by Vortmann and Schneider found elsewhere in this issue.
The vitreous
Making up two thirds of the volume and weight of the eye, the vitreous fills the space between the lens and retina. It is clear and gelatinous. It is composed of collagen and hyaluronic acid but is 99% water [4–6].
Vitreous floaters are defined as dots or spots floating in the field of vision that change position when the patient shifts his or her gaze to a di erent direction [10]. They may be from blood or debris in the vitreous fluid. They may be caused by retinal detachment or hemorrhage.
The extraocular muscles
The extraocular muscles control the movements of the eye. There are six extraocular muscles.
The rectus muscles
The eye has four rectus muscles that are named by their insertion: medial, lateral, superior, and inferior. They originate from a common site, a ring shaped tendon called the annulus of Zinn. These muscles adduct, abduct, elevate, and depress the eye [4–6].
The oblique muscles
There are two oblique muscles of the eye. They provide some upward and downward movement of the eye but primarily provide rotational movement. These muscles are the superior oblique and the inferior oblique [4–6].
Disorders of upward gaze in a traumatized eye may be caused by orbital floor fracture with inferior rectus entrapment. This will be discussed in detail