Ординатура / Офтальмология / Английские материалы / Pocket Textbook Atlas Of Ophthalmology_Lang, Thieme_2000
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I
Ophthalmology
A Short Textbook
Gerhard K. Lang, M. D.
Professor and Chairman
Department of Ophthalmology and
University Eye Hospital Ulm
Germany
With contributions by
J. Amann, M. D.
O.Gareis, M. D. Gabriele E. Lang, M. D. Doris Recker, M. D.
C.W. Spraul, M. D.
P.Wagner, M. D.
305 Illustrations
Thieme
Stuttgart · New York 2000
Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
II
Library of Congress Cataloging-in-Publica- tion Data
Lang, Gerhard K.
[Augenheilkunde. English] Ophthalmology : a short textbook / Gerhard K. Lang ; with contributions by
J. Amann... [et al.]. p. ; cm. Includes bibliographical references and index.
ISBN 3131261617
1. Eye-Diseases. 2. Ophthalmology. I. Amann, J. (Josef) II. Title. [DNLM: 1. Eye Diseases.
WW 40 L269a 2000a] RE46.L3413 2000 617.7–dc21
Student contributors:
Christopher Dedner, Tübingen
Uta Eichler, Karlsruhe
Heidi Janeczek, Göttingen
Beate Jentzen, Husberg
Mathis Kayser, Freiburg
Kerstin Lipka, Kiel
Maren Molkewehrum, Kiel
Alexandra Ogilvie, Munich
Patricia Ogilvie, Würzburg
Stefan Rose, Oldenburg
Translated by John Grossman, Berlin, Germany
This book is an authorized translation of the German edition published and copyrighted 1998 by Georg Thieme Verlag, Stuttgart, Germany.
Drawings by Markus Voll, Fürstenfeldbruck
! 2000 Georg Thieme Verlag Rüdigerstraße 14
D-70469 Stuttgart, Germany
Thieme New York, 333 Seventh Avenue New York, N. Y. 10001 U.S.A
Typesetting by Druckhaus Götz GmbH, Ludwigsburg
Printed in Germany by Appl, Wemding
ISBN 3-13-126161-7 |
(GTV) |
ISBN 0-86577-936-8 |
(TNY) 1 2 3 4 5 |
Important Note: Medicine is an everchanging science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.
Nevertheless this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect of any dosage instructions and forms of application stated in the book.
Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed.
Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.
This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage.
Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
III
The Concept of the Book in Brief . . .
Definition: The concept behind this book was to organize content and layout according to a uniform structure. This enhances the clarity of the presentation and allows the reader to access information quickly. Each chapter has its own header icon, which is shown on every page of the chapter.
Figure headings summarize the key information presented in the respective figure, eliminating the need for the reader to read through the entire legend.
Epidemiology: In the absence of precise epidemiologic data, the authors state whether the disorder is common or rare wherever possible.
Etiology: This section usually combines information about the etiology and pathogenesis of a disorder and in so doing helps to illuminate important relationships.
Symptoms and diagnostic considerations: These items are usually discussed separately. The section on symptoms includes only the phenomena with which the patient presents. How and by which methods the examiner proceeds from these symptoms to a diagnosis is only discussed under diagnostic considerations.
Sections highlighted with an exclamation mark contain important facts. These may be facts that one is often required to know for examinations, or they may be practical tips that are helpful in diagnosing and treating the disorder.
Differential diagnosis: Wherever possible, this section discusses not only other possible diagnoses but also important criteria for differentiating the disorder from others.
Treatment: This section goes beyond merely documenting all possible therapeutic options. It also explains which therapeutic measures are advisable and offer a prospect of success. The discussion of medical treatment occasionally includes dosage information and examples of preparations used. This is done where such information is relevant to cases students will encounter in practice. The trade names specified do not represent a comprehensive listing.
Prognosis and clinical course: The further development of the book depends in no small measure on your criticism. We are happy to receive any suggestions for improvements as this will help us tailor the next edition to better suit yor needs. Please use the enclosed postcard.
Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
IV
Authors
Gerhard K. Lang, M. D.
Professor and Chairman, University Eye Hospital, Ulm,
Germany
J. Amann, M. D.
Research assistant, University Eye Hospital, Ulm
O. Gareis, M. D.
Senior physician, University Eye Hospital, Ulm
Gabriele E. Lang, M. D.
Director, Department of Medical Retina and Laser Surgery, University Eye Hospital, Ulm
Doris Recker
Orthoptist, University Eye Hospital, Ulm
C. W. Spraul, M. D.
Senior physician, University Eye Hospital, Ulm
P. Wagner, M. D.
Chief of medical staff, University Eye Hospital, Ulm
Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
V
Preface
When my coworkers and I first took up the task of writing a textbook of ophthalmology that was aimed at medical students but would also be suitable for interns and ophthalmology residents, we did not know exactly what we were getting ourselves into. The next four years were devoted to intensive study of this subject. We did not merely intend to design a book according to the maxims “understand it in medical school,” “learn it for the examination,” and “use it during your internship.” Our broader goal was to give students a textbook that would kindle their interest and indeed their enthusiasm for a “small” specialty like ophthalmology and that would sustain this enthusiasm all the way through a successful examination. In an age in which teaching is undergoing evaluation, we felt this was particularly important. In pursuing this admittedly ambitious goal, we were able to draw upon many years of teaching experience. This experience has shaped the educational concept behind this book and manifests itself in details such as the layout, which is characterized by numerous photographs and illustrative drawings. We have placed special emphasis on the figures in particular. These illustrations make ophthalmology come alive and hopefully will be able to imbue the reader with some of the enthusiasm that the authors themselves have for their specialty.
I would like to take this opportunity to offer my heartfelt thanks to my teacher, Prof. Dr. Dr. hc G. O. H. Naumann, Erlangen, Germany, for his suggestions and for the slides from the collection of the Department of Ophthalmology and University Eye Hospital, Erlangen. I would also like to offer special thanks to my coauthors, Dr. Josef Amann, Dr. Oskar Gareis, Prof. Dr. Gabriele E. Lang, Doris Recker, Dr. Christoph Spraul, and Dr. Peter Wagner for their harmonious cooperation and exceptional initiative in writing this book. I also thank Dr. Eckhard Weingärtner for his assistance in compiling the Appendix.
I would also like to extend special thanks to Dr. Jürgen Lüthje and Sabine Bartl of Georg Thieme Verlag, whose professionalism and active and tireless support were a constant source of inspiration to us all. I would again like to thank Markus Voll, Fürstenfeldbruck, Germany, for his splendid illustrations.
Ulm, Germany, Summer 2000 |
Gerhard K. Lang |
Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
VI
Table of Contents
1The Ophthalmic Examination ... 1
(Gabriele E. Lang, Gerhard K. Lang)
1.1Equipment ... 1
1.2History ... 3
1.3Visual Acuity ... 4
1.4Ocular Motility ... 5
1.5Binocular Alignment ... 6
1.6Examination of the Eyelids and Nasolacrimal Duct ... 7
1.7Examination of the Conjunctiva ... 7
1.8Examination of the Cornea ... 10
1.9Examination of the Anterior Chamber ... 11
1.10Examination of the Lens ... 12
1.11Ophthalmoscopy ... 13
1.12Confrontation Field Testing ... 14
1.13Measurement of Intraocular Pressure ... 15
1.14Eyedrops, Ointment, and Bandages ... 15
2The Eyelids ... 17
(Peter Wagner, Gerhard K. Lang)
2.1 |
Basic Knowledge ... 17 |
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2.2 |
Examination Methods ... 19 |
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2.3 |
Developmental Anomalies |
... 20 |
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2.3.1 |
Coloboma ... 20 |
... 21 |
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2.3.2 |
Epicanthal Folds |
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2.3.3 |
Blepharophimosis |
... 21 |
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2.3.4 |
Ankyloblepharon |
... 22 |
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2.4 |
Deformities ... 22 |
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2.4.1 |
Ptosis ... 22 |
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2.4.2 |
Entropion |
... 24 |
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2.4.3 |
Ectropion |
... 28 |
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2.4.4 |
Trichiasis |
... 30 |
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Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Table of Contents |
VII |
2.4.5Blepharospasm ... 30
2.5 Disorders of the Skin and Margin of the Eyelid ... 30
2.5.1 |
Contact Eczema ... 30 |
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2.5.2 |
Edema ... 31 |
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2.5.3 |
Seborrheic Blepharitis ... 33 |
... 34 |
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2.5.4 |
Herpes Simplex of the Eyelids |
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2.5.5 |
Herpes Zoster Ophthalmicus ... |
35 |
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2.5.6 |
Eyelid Abscess ... 36 |
... 37 |
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2.5.7 |
Tick Infestation of the Eyelids |
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2.5.8 |
Louse Infestation of the Eyelids |
... 37 |
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2.6 |
Disorders of the Eyelid Glands ... 38 |
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2.6.1 |
Hordeolum |
... 38 |
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2.6.2 |
Chalazion |
... 39 |
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2.7 |
Tumors ... 40 |
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2.7.1 |
Benign Tumors ... 40 |
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2.7.1.1 |
Ductal Cysts ... |
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2.7.1.2 |
Xanthelasma |
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2.7.1.3 |
Molluscum Contagiosum |
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2.7.1.4 |
Cutaneous Horn |
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2.7.1.5 |
Keratoacanthoma |
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2.7.1.6 |
Hemangioma |
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2.7.1.7 |
Neurofibromatosis (Recklinghausen’s Disease) ... 44 |
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2.7.2 |
Malignant Tumors ... 45 |
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2.7.2.1Basal Cell Carcinoma 45
2.7.2.2Squamous Cell Carcinoma ... 47
2.7.2.3Adenocarcinoma ... 47...
3 |
Lacrimal System ... 49 |
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(Peter Wagner, Gerhard K. Lang) |
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3.1 |
Basic Knowledge ... 49 |
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3.2 |
Examination Methods ... 52 |
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3.2.1 |
Evaluation of Tear Formation ... 52 |
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3.2.2 |
Evaluation of Tear Drainage ... 53 |
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3.3 |
Disorders of the Lower Lacrimal System ... 57 |
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3.3.1 |
Dacryocystitis ... 57 |
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3.3.1.1 |
Acute Dacryocystitis ... 57 |
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3.3.1.2 |
Chronic Dacryocystitis ... 60 |
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3.3.1.3 |
Neonatal Dacryocystitis ... |
60 |
3.3.2 |
Canaliculitis ... 61 |
... 61 |
3.3.3 |
Tumors of the Lacrimal Sac |
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3.4 |
Lacrimal System Dysfunction ... 62 |
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3.4.1 |
Keratoconjunctivitis Sicca ... 62 |
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Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
VIII Table of Contents
3.4.2Illacrimation ... 64
3.5 Disorders of the Lacrimal Gland ... 64
3.5.1 |
Acute Dacryoadenitis ... 64 |
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3.5.2 |
Chronic Dacryoadenitis ... 65 |
... 66 |
3.5.3 |
Tumors of the Lacrimal Gland |
4 |
Conjunctiva ... 67 |
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(Gerhard K. Lang, Gabriele E. Lang) |
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4.1 |
Basic Knowledge ... 67 |
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4.2 |
Examination Methods ... 68 |
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... 69 |
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4.3 |
Conjunctival Degeneration and Aging Changes |
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4.3.1 |
Pinguecula |
... 69 |
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4.3.2 |
Pterygium |
... 69 |
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4.3.3 |
Pseudopterygium ... 71 |
... 72 |
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4.3.4 |
Subconjunctival Hemorrhage |
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4.3.5 |
Calcareous Infiltration ... 72 |
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4.3.6 |
Conjunctival Xerosis ... 72 |
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4.4 |
Conjunctivitis ... 74 |
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4.4.1General Notes on the Causes, Symptoms, and Diagnosis of Conjunctivitis ... 74
4.4.2Infectious Conjunctivitis ... 82
4.4.2.1 |
Bacterial Conjunctivitis ... |
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4.4.2.2 |
Chlamydial Conjunctivitis |
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4.4.2.3 |
Viral Conjunctivitis |
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4.4.2.4 |
Neonatal Conjunctivitis |
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4.4.2.5 |
Parasitic and Mycotic Conjunctivitis ... 98 |
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4.4.3 |
Noninfectious Conjunctivitis ... 98 |
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4.5 |
Tumors ... 104 |
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4.5.1 |
Epibulbar Dermoid ... 104 |
... 104 |
4.5.2 |
Conjunctival Hemangioma |
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4.5.3 |
Epithelial Conjunctival Tumors ... 105 |
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4.5.3.1 |
Conjunctival Cysts ... 105 |
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4.5.3.2 |
Conjunctival Papilloma ... |
106 |
4.5.3.3 |
Conjunctival Carcinoma ... 107 |
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4.5.4 |
Melanocytic Conjunctival Tumors ... 108 |
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4.5.4.1 |
Conjunctival Nevus ... 108 |
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4.5.4.2 |
Conjunctival Melanosis ... |
108 |
4.5.4.3 |
Congenital Ocular Melanosis ... 112 |
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4.5.5 |
Conjunctival Lymphoma ... 113 |
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4.5.6 |
Kaposi’s Sarcoma ... 113 |
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4.6 |
Conjunctival Deposits ... 114 |
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Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Table of Contents |
IX |
5Cornea ... 117
(Gerhard K. Lang)
5.1 |
Basic Knowledge ... 117 |
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5.2 |
Examination Methods |
... 120 |
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5.2.1 |
Slit Lamp Examination |
... 120 |
... 120 |
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5.2.2 |
Dye Examination of the Cornea |
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5.2.3 |
Corneal Topography ... 121 |
... 121 |
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5.2.4 |
Determining Corneal Sensitivity |
... 121 |
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5.2.5 |
Measuring the Density of the Corneal Epithelium |
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5.2.6 |
Measuring the Diameter of the Cornea ... 124 |
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5.2.7 |
Corneal Pachymetry ... 125 |
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5.2.8 |
Confocal Corneal Microscopy ... 125 |
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5.3 |
Developmental Anomalies ... 125 |
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5.3.1 |
Protrusion Anomalies ... 125 |
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5.3.1.1 |
Keratoconus |
... 125 |
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5.3.1.2 |
Keratoglobus |
... 127 |
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5.3.2 |
Corneal Size Anomalies (Microcornea and |
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Megalocornea) ... 127 |
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5.4 |
Infectious Keratitis ... 127 |
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5.4.1 |
Protective Mechanisms of the Cornea ... 127 |
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5.4.2 |
Corneal Infections: Predisposing Factors, Pathogens, and |
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Pathogenesis |
... 128 |
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5.4.3 |
General Notes on Diagnosing Infectious Forms of |
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Keratitis ... 130 |
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5.4.4 |
Bacterial Keratitis ... 130 |
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5.4.5 |
Viral Keratitis ... 132 |
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5.4.5.1 |
Herpes Simplex Keratitis ... 132 |
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5.4.5.2 |
Herpes Zoster Keratitis |
... 134 |
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5.4.6 |
Mycotic Keratitis ... 134 |
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5.4.7 |
Acanthamoeba Keratitis ... 136 |
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5.5 |
Noninfectious Keratitis and Keratopathy ... 137 |
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5.5.1 |
Superficial Punctate Keratitis ... 138 |
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5.5.2 |
Exposure Keratitis ... 140 |
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5.5.3 |
Neuroparalytic Keratitis ... 141 |
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5.5.4 |
Problems with Contact Lenses ... 141 |
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5.5.5 |
Bullous Keratopathy ... 143 |
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... 145 |
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5.6 |
Corneal Deposits, Degenerations, and Dystrophies |
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5.6.1 |
Corneal Deposits ... 145 |
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5.6.1.1Arcus Senilis
5.6.1.2Corneal Verticillata
5.6.1.3Argyrosis and Chrysiasis 146
5.6.1.4Iron Lines ... 146
5.6.1.5Kayser-Fleischer Ring ... 146... 145 ... 145...
Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.
X |
Table of Contents |
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5.6.2 |
Corneal Degeneration ... 146 |
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5.6.2.1 |
Calcific Band Keratopathy ... 146 |
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5.6.2.2 |
Peripheral Furrow Keratitis ... 147 |
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5.6.3 |
Corneal Dystrophies ... 148 |
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5.7 |
Corneal Surgery ... 150 |
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5.7.1 |
Curative Corneal Procedures ... 152 |
... 152 |
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5.7.1.1 |
Penetrating Keratoplasty (Fig. 5.18a) |
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5.7.1.2 |
Lamellar Keratoplasty (Fig. 5.18b) |
... 153 |
... 154 |
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5.7.1.3 |
Phototherapeutic Keratectomy (Fig. 5.18c) |
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5.7.2 |
Refractive Corneal Procedures ... |
155 |
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5.7.2.1Photorefractive Keratectomy (Fig. 5.18d)
5.7.2.2Radial Keratotomy (Fig. 5.18e)
5.7.2.3Photorefractive Keratectomy Correction of Astigmatism ... 156
5.7.2.4Holmium Laser Correction of Hyperopia ... 156
5.7.2.5Epikeratophakic Keratoplasty (Epikeratophakia) ... 156
5.7.2.6Excimer Laser In Situ Keratomileusis (LASIK) ... 156...
6Sclera ... 157
(Gerhard K. Lang)
6.1 |
Basic Knowledge ... 157 |
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6.2 |
Examination Methods |
... 157 |
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6.3 |
Color Changes ... 157 |
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... 158 |
6.4 |
Staphyloma and Ectasia |
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6.5 |
Trauma ... 158 |
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6.6 |
Inflammations ... 158 |
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6.6.1 |
Episcleritis ... 159 |
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6.6.2 |
Scleritis ... 161 |
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7Lens ... 165
(Gerhard K. Lang)
7.1 |
Basic Knowledge ... 165 |
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7.2 |
Examination Methods ... 168 |
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7.3 |
Developmental Anomalies of the Lens ... 169 |
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7.4 |
Cataract ... 170 |
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7.4.1 |
Acquired Cataract ... 173 |
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7.4.1.1 |
Senile Cataract ... 173 |
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7.4.2 |
Cataract in Systemic Disease ... |
179 |
7.4.3 |
Complicated Cataracts |
... 180 |
7.4.4 |
Cataract after Intraocular Surgery |
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Lang, Ophthalmology © 2000 Thieme
All rights reserved. Usage subject to terms and conditions of license.