Ophthalmology Shyamanga Borooah, Mark Wright, Baljean Dhillon
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s1Ophthalmologys2
s3Ophthalmology
Shyamanga Borooah BSc(Hons) MBBS MRCP(UK) MRCSEd FRCOphth Honorary Ophthalmic Registrar NHS Lothian Wellcome Trust Clinical Research Training Fellow Scottish Translational Medicine and Therapeutics Initiative Princess Alexandra Eye Pavilion Edinburgh, UK Mark Wright MBChB (Aberdeen) FRCSEd Consultant Ophthalmologist Princess Alexandra Eye Pavilion Edinburgh, UK Baljean Dhillon BMedSci (Hons) BM BS (Nottingham) FRCSEd FRCPS(Glasg) FRCOphth Honorary Professor of Ophthalmology University of Edinburgh SBE Visual Impairment Studies Heriot-Watt University Consultant Ophthalmologist Princess Alexandra Eye Pavilion Edinburgh, UK
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© 2012 JP Medical Ltd.
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Reprinted 2013
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9781907816215
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s5Foreword
Pocket Tutor Ophthalmology continues the tradition of ophthalmology teaching in Edinburgh, established in 1883 when Douglas Argyll Robertson was appointed the first lecturer in diseases of the eye at the university.
For doctors not in the specialty, ophthalmology too often appears a mysterious subject with many acronyms, unpronounceable terms, and innumerable syndromes. In reality, and as this book emphasises, ophthalmology has the advantages that the eye is (mostly) visible and the diseases that affect it can be diagnosed logically, if an ordered approach to history taking and examination is adopted. For instance, patients with a vague complaint of visual blurring may harbour a potentially blinding condition that may be missed if the simple tests of pupillary function and visual field examination are omitted. For those in hospital practice, the importance of eye examination in relation to extraocular disease cannot be overemphasised. For example, a young patient with a headache may be harbouring a brain tumour, with the only sign being papilloedema seen on fundoscopy.
I confidently recommend Pocket Tutor Ophthalmology as an easily accessible guide to diagnosis and management for clinical students, trainee ophthalmologists, emergency doctors, general practitioners and anyone involved in the management of patients suffering from diseases of the central nervous system.
James F Cullen FRCS FRCSEd
Former Consultant Ophthalmologist, Edinburgh
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s7Preface
Eye diseases are amongst the most common conditions seen in hospital, contributing to approximately ten percent of all outpatient appointments. The majority of these eye conditions are often easily treatable once they have been diagnosed. In addition, a large number of systemic diseases have ocular manifestations.
Correct diagnosis and management can mean sight is saved, or even restored. Consequently, a sound understanding of the eye and its surrounding structures in health and disease is widely relevant in medicine. Pocket Tutor Ophthalmology aims to provide a concise and accessible reference to aid understanding and diagnosis of common ophthalmological diseases.
Ophthalmology is often perceived as being difficult to access due to not only the specialised nature of the eye itself, but also the specialist terminology and equipment. This book helps simplify the approach to ocular examination by providing a sound platform of relevant anatomy and physiology. Chapter 2 takes the reader through the important examination techniques and investigations to assist diagnosis. Chapter 3 contains a series of algorithms, developed specifically for this book, which help make clinical diagnosis easier.
The clinical chapters are divided on an anatomical basis and although not exhaustive cover the most common conditions. Each chapter starts with a series of clinical scenarios that provide examples of how these conditions present in the clinical setting. The wonderful thing about ophthalmology is that most conditions can be diagnosed visually so the chapters contain many high-quality colour photographs of pathology.
This book has been written for for medical students, trainees, primary care practitioners and optometrists, to assist in the diagnosis of eye disease. The handy pocket size ensures s8portability and ease of use. We have made every effort to make Pocket Tutor Ophthalmology simple, clear and up-to-date and hope you will find it both enjoyable to read and clinically useful.
Shyamanga Borooah
Mark Wright
Baljean Dhillon
January 2012
s12Acknowledgements
We thank the following authors for their kind permission to reproduce figures from their books, published by Jaypee Brothers Medical Publishers (P) Ltd:
Agarwal S, Apple DJ, Agarwal A, Buratto L, Alió JL, Pandey SK, Agarwal A. Textbook of Ophthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2002. Figures 1.16, 1.17.
Basak SK. Atlas on Clinical Ophthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2006. Figures 2.9, 6.5, 7.17.6, 8.18.3, 10.210.4, 11.2, 11.10, 11.14, 12.12, 12.13, 12.14, 12.17, 13.3.
Bijlani RL. Understanding Medical Physiology: A Textbook for Medical Students (3rd Edition). New Delhi: Jaypee Brothers Medical Publishers, 2004. Figure 12.1.
Datta H. Strabismus. New Delhi: Jaypee Brothers Medical Publishers, 2004. Figure 1.2.
Garg A, Rosen E, Crouch ER, Oleszczynska-Prost E. Instant Clinical Diagnosis in Ophthalmology strabismus. New Delhi: Jaypee Brothers Medical Publishers, 2009. Figures 13.5, 13.7, 13.9.
Garg A, Rosen E, Melamed S, Dada T, Khalil AK. Instant Clinical Diagnosis in Glaucoma. New Delhi: Jaypee Brothers Medical Publishers, 2009. Figures 12.3, 12.9.
Garg A, Fry LL, Tabin G, Gutiérrez-Carmona FJ, Pandey SK. Clinical Practice in Small Incision Cataract Surgery (Phaco Manual). New Delhi: Jaypee Brothers Medical Publishers, 2004. Figure 1.18.
Garg A, Mortensen J, Marchini G. Mastering the Techniques of Glaucoma Diagnosis and Management. New Delhi: Jaypee Brothers Medical Publishers, 2006. Figure 12.10.
Garg A, Rosen E, Lee SH, Crouch ER, Oleszczynska-Prost E, Trivedi RH. Instant Clinical Diagnosis in Ophthalmology Pediatric s13Ophthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2009. Figures 14.1, 14.2.
Garg A, Rosen E, Mortensen J, El Toukhy E, Dhaliwal RS. Instant Clinical Diagnosis in Ophthalmology: Oculoplasty & Reconstructive Surgery. New Delhi: Jaypee Brothers Medical Publishers, 2008. Figures 6.3, 6.8b.
Garg A, Rosen E, Pérez-Arteaga A, Goyal JL. Instant Clinical Diagnosis in Ophthalmology: Neuro-ophthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2009. Figure 12.4.
Garg A, Rosen E, Pérez-Arteaga A, Sharma A. Instant Clinical Diagnosis in Ophthalmology: Anterior Segment Diseases. New Delhi: Jaypee Brothers Medical Publishers, 2009. Figures 1.4, 15.1.
Garg A, Sheppard JD, Donnenfeld ED, Friedlaender M. Clinical Applications of Antibiotics & Anti-inflammatory Drugs in Ophthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2007. Figure 6.6.
Garg A, Sheppard JD, Donnenfeld ED, Meyer D, Mehta CK. Clinical Diagnosis and Management of Dry Eye and Ocular Surface Disorders (Xero-Dacryology). New Delhi: Jaypee Brothers Medical Publishers, 2006. Figure 2.8.
Gupta AK, Choudhry RM, Tandon C. Step by Step Visual Field Examination. New Delhi: Jaypee Brothers Medical Publishers, 2007. Figure 12.8.
Gupta AK, Mazumdar S, Choudhry S. Practical Approach to Ophthalmoscopic Retinal Diagnosis. New Delhi: Jaypee Brothers Medical Publishers, 2010. Figure 1.19.
Mukherjee PK. Essentials of Neuro-Opthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2010. Figures 1.3, 1.7.
Nema HV, Nema N. Textbook of Ophthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2008. Figures 1.6, 1.8, 1.9, 1.11, 1.12, 4.14.3, 6.1, 6.2, 6.4, 12.5, 12.7b, 12.11, 12.18.
Pandey SK. Dry Eye & Ocular Surface Disorders. New Delhi: Jaypee Brothers Medical Publishers, 2006. Figure 1.15.
s14Rani PK, Lingam G, Sharma T. The Sankara Nethralaya Atlas of Retinal Diseases. New Delhi: Jaypee Brothers Medical Publishers, 2008. Figure 1.5.
Saxena S. Clinical Practice in Ophthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2003. Figure 1.14.
Singh I. Textbook of Human Histology. New Delhi: Jaypee Brothers Medical Publishers, 2007. Figures 1.10a, 1.10b, 1.20.
Singh I. Textbook of Human Osteology. New Delhi: Jaypee Brothers Medical Publishers, 2009. Figure 1.1.
Subrahmanyam M. Surgical Atlas of Orbital Diseases. New Delhi: Jaypee Brothers Medical Publishers, 2009. Figures 15.2, 15.3.