1 General Topics in Ophthalmology
2 Orbit, Eyelids, and Ocular Adnexa
3 Cornea and Conjunctiva
4 Glaucoma
5 Uveal Tract and Ocular Inflammation
6 Lens
7 Retina and Vitreous
8 Neurologic
9 Pediatrics and Strabismus
10 Medications
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
OPHTHO NOTES
The Essential Guide
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
OPHTHO NOTES
The Essential Guide
Randall L. Goodman, M.D.
Chief of Ophthalmology
Mike O’Callaghan Federal Hospital
Las Vegas, Nevada
Thieme
New York Stuttgart
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Thieme New York
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Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error by the authors, editors, or publisher of the work herein, or changes in medical knowledge, neither the authors, editors, or publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
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TNY ISBN 1-58890-171-8
GTV ISBN 3-13-135781-9
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Contents
FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
xi |
PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
xii |
LIST OF ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . |
xv |
CHAPTER 1: GENERAL TOPICS IN OPHTHALMOLOGY . . . . . |
1 |
Approach to the Patient: Exam and History . . . . . |
1 |
Embryology and Development. . . . . . . . . . . . . . . |
1 |
Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . |
2 |
Epidemiology/Statistics. . . . . . . . . . . . . . . . . . . . |
3 |
Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
3 |
Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
10 |
Immune System/Inflammation. . . . . . . . . . . . . . . |
13 |
Optics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
13 |
Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
19 |
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
22 |
Radiation/Laser . . . . . . . . . . . . . . . . . . . . . . . . . |
23 |
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
24 |
CHAPTER 2: ORBIT, EYELIDS, AND OCULAR ADNEXA . . . . . |
28 |
Anatomy and Physiology . . . . . . . . . . . . . . . . . . |
28 |
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . |
42 |
Exam and Imaging. . . . . . . . . . . . . . . . . . . . . . . |
49 |
Congenital and Genetic Disease . . . . . . . . . . . . . |
53 |
Infectious Disease . . . . . . . . . . . . . . . . . . . . . . . |
56 |
Neoplastic Disease . . . . . . . . . . . . . . . . . . . . . . . |
59 |
Metabolic and Degenerative Disease . . . . . . . . . . |
74 |
Systemic and Vascular Disease. . . . . . . . . . . . . . . |
75 |
Physical Disease. . . . . . . . . . . . . . . . . . . . . . . . . |
75 |
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
viii CONTENTS |
|
Inflammatory and Immune Disease . . . . . . . . . . . |
77 |
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
82 |
CHAPTER 3: CORNEA AND CONJUNCTIVA . . . . . . . . . . . . . |
92 |
Anatomy and Physiology . . . . . . . . . . . . . . . . . . |
92 |
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . |
96 |
Exam and Imaging. . . . . . . . . . . . . . . . . . . . . . . |
104 |
Congenital and Genetic Disease . . . . . . . . . . . . . |
105 |
Infectious Disease . . . . . . . . . . . . . . . . . . . . . . . |
111 |
Neoplastic Disease . . . . . . . . . . . . . . . . . . . . . . . |
117 |
Metabolic and Degenerative Disease . . . . . . . . . . |
121 |
Physical Disease. . . . . . . . . . . . . . . . . . . . . . . . . |
126 |
Inflammatory and Immune Disease . . . . . . . . . . . |
129 |
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
136 |
CHAPTER 4: GLAUCOMA. . . . . . . . . . . . . . . . . . . . . . . . . 143
Anatomy and Physiology . . . . . . . . . . . . . . . . . . 143
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . 147
Exam and Imaging. . . . . . . . . . . . . . . . . . . . . . . 149
Infantile and Pediatric Glaucoma. . . . . . . . . . . . . 155
Primary Open-Angle Glaucoma . . . . . . . . . . . . . 157
Secondary Open-Angle Glaucoma . . . . . . . . . . . . 159
Primary Angle-Closure Glaucoma . . . . . . . . . . . . 163
Secondary Angle-Closure Glaucoma . . . . . . . . . . 164
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
CHAPTER 5: UVEAL TRACT AND OCULAR
INFLAMMATION. . . . . . . . . . . . . . . . . . . . . . 172
Iris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Uveitis Introduction . . . . . . . . . . . . . . . . . . . . . . 174
Uveitis Signs and Symptoms . . . . . . . . . . . . . . . . 176
Anterior Uveitis . . . . . . . . . . . . . . . . . . . . . . . . . 184
Intermediate Uveitis . . . . . . . . . . . . . . . . . . . . . . 188
Posterior Uveitis . . . . . . . . . . . . . . . . . . . . . . . . 190
Panuveitis/Diffuse Uveitis . . . . . . . . . . . . . . . . . . 194
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
CONTENTS ix
CHAPTER 6: LENS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Anatomy and Physiology . . . . . . . . . . . . . . . . . . 201
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . 203
Congenital and Genetic Disease . . . . . . . . . . . . . 204
Metabolic and Degenerative Disease . . . . . . . . . . 208
Systemic and Vascular Disease. . . . . . . . . . . . . . . 210
Physical Disease. . . . . . . . . . . . . . . . . . . . . . . . . 210
Inflammatory and Immune Disease . . . . . . . . . . . 212
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
CHAPTER 7: RETINA AND VITREOUS. . . . . . . . . . . . . . . . . 219
Anatomy and Physiology . . . . . . . . . . . . . . . . . . 219
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . 225
Exam and Imaging. . . . . . . . . . . . . . . . . . . . . . . 231
Congenital and Genetic Disease . . . . . . . . . . . . . 235
Infectious Disease . . . . . . . . . . . . . . . . . . . . . . . 247
Neoplastic Disease . . . . . . . . . . . . . . . . . . . . . . . 252
Metabolic and Degenerative Disease . . . . . . . . . . 262
Systemic and Vascular Disease. . . . . . . . . . . . . . . 271
Physical Disease. . . . . . . . . . . . . . . . . . . . . . . . . 282
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
CHAPTER 8: NEUROLOGIC . . . . . . . . . . . . . . . . . . . . . . . 293
Anatomy and Physiology . . . . . . . . . . . . . . . . . . 293
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . 303
Exam and Imaging. . . . . . . . . . . . . . . . . . . . . . . 310
Congenital and Genetic Disease . . . . . . . . . . . . . 314
Infectious Disease . . . . . . . . . . . . . . . . . . . . . . . 317
Neoplastic Disease . . . . . . . . . . . . . . . . . . . . . . . 318
Metabolic and Degenerative Disease . . . . . . . . . . 319
Systemic and Vascular Disease. . . . . . . . . . . . . . . 319
Physical Disease. . . . . . . . . . . . . . . . . . . . . . . . . 321
Inflammatory and Immune Disease . . . . . . . . . . . 323
Selected Cranial Nerve Abnormalities . . . . . . . . . 328
Gaze Abnormalities . . . . . . . . . . . . . . . . . . . . . . 332
Nystagmus . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
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x CONTENTS
CHAPTER 9: PEDIATRICS AND STRABISMUS . . . . . . . . . . . 338
Anatomy and Physiology . . . . . . . . . . . . . . . . . . 338
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . 346
Exam and Imaging. . . . . . . . . . . . . . . . . . . . . . . 347
Congenital and Genetic Disease . . . . . . . . . . . . . 352
Esotropia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Exotropia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Vertical Deviations. . . . . . . . . . . . . . . . . . . . . . . 365
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
CHAPTER 10: MEDICATIONS . . . . . . . . . . . . . . . . . . . . . . 373
Antibacterials. . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Antifungals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Anti-inflammatories . . . . . . . . . . . . . . . . . . . . . . 377
Antiseptics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Antivirals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Glaucoma Medications . . . . . . . . . . . . . . . . . . . . 381
Immunosuppressives . . . . . . . . . . . . . . . . . . . . . . 388
Miotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390
Mydriatics and Cycloplegics . . . . . . . . . . . . . . . . 390
Neurologic Medications . . . . . . . . . . . . . . . . . . . 391
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
Goodman, Ophtho Notes © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.