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Eye Diseases in Hot Climates
John Sandford-Smith, Saul Rajak
1:
Introduction
WHAT IS SPECIAL ABOUT EYE DISEASES IN HOT CLIMATES?
TERMINOLOGY
EYE DISEASES THAT ARE MORE COMMON IN HOT CLIMATES AND POOR COUNTRIES
DEFINITIONS OF VISUAL LOSS AND VISUAL IMPAIRMENT
THE PREVALENCE OF VISUAL LOSS AND BLINDNESS: EYE DISEASE IS VERY COMMON
MOST BLINDNESS IN POOR COUNTRIES IS PREVENTABLE OR TREATABLE
INADEQUATE HEALTHCARE RESOURCES
PLANS AND STRATEGIES FOR COMBATING AVOIDABLE VISUAL LOSS
VISION 2020
VISION 2020 Action Plan 2006–2011
VISION 2020, where are we now?
Integrating eye care into general health services: Universal Eye Health
LINKS BETWEEN EYE UNITS IN POOR COUNTRIES AND RICH COUNTRIES
THE CAUSES OF BLINDNESS WORLDWIDE AND THE DISEASES TARGETED BY VISION 2020
Easily preventable diseases
Easily treatable diseases
Refractive error
The surgical treatment of cataract and the cataract surgical rate
Non-ophthalmologist cataract surgeons
Less easily preventable and treatable diseases
Glaucoma
Diabetic retinopathy
Age-related macular degeneration (AMD)
Diseases that cannot be prevented or treated
THE ‘COST’ OF VISUAL LOSS
HUMAN RESOURCE DEVELOPMENT
PREVENTION, COMMUNITY HEALTH AND HEALTH EDUCATION
Health education
INFRASTRUCTURE AND THE DEVELOPMENT OF APPROPRIATE TECHNOLOGY
Infrastructure
Mobile services: campaigns and outreach surgery
Technology
COST EFFECTIVENESS
GEOGRAPHICAL VARIATIONS IN DISEASE
REHABILITATION
Examples of aids and support for people with visual impairment
RELATIONSHIPS WITH TRADITIONAL HEALERS
THE HUMAN FACTOR
2:
Basic anatomy and physiology of the eye
THE EYEBALL
The outer layer: the sclera and cornea
THE MIDDLE LAYER – THE IRIS, CILIARY BODY AND CHOROID
The iris
The ciliary body
The choroid
THE INNER LAYER – THE RETINA
THE LENS AND THE VITREOUS BODY
THE AQUEOUS FLUID AND THE INTRAOCULAR PRESSURE
THE VISUAL PATHWAYS
THE PROTECTION OF THE EYEBALL
THE CONJUNCTIVA
THE EYELIDS
THE LACRIMAL APPARATUS
THE EXTRAOCULAR MUSCLES
THE ORBIT
THE BLOOD AND NERVE SUPPLY AND LYMPHATIC DRAINAGE OF THE EYE AND ORBIT
3:
Clinical methods: history taking and eye examination
HISTORY-TAKING
Present complaint
Loss or alteration of vision
Discomfort or pain in the eye
Other symptoms
Personal medical history and medication
Family history
Social history: diet, alcohol, smoking and occupation
EXAMINATION
Testing the vision
Visual acuity
The interpretation of the Snellen visual acuity chart
The pinhole test
Testing the visual acuity in children
‘Normal’ and driving vision
Blindness and low vision
The visual field
Confrontation visual field testing (Figure 3.5)
The Bjerrum screen (Figure 3.6)
Automated tests
Colour vision
Examining the eye
The direct ophthalmoscope
How to use the ophthalmoscope
Other filters and light beams on the ophthalmoscope
The indirect ophthalmoscope
The slit lamp
Methods of magnification for examining the front of the eye
The ophthalmoscope
Handheld magnifying lens
Binocular telescopic spectacles (Figure 3.12a and b)
Principles of illumination
Systematic examination of the eyes
The eyelids
The conjunctiva
The cornea
The anterior chamber
The iris
The pupil
The lens
The vitreous body
The fundus
Examining the eyes of young children
The intraocular pressure
Digital tonometry
The Schiotz tonometer (Figures 3.17 and 3.18)
The applanation tonometer
Other parts of the examination
Mobile phone technology
Other tests
Fundus fluorescein angiogram (FFA) (Figure 13.11)
Ocular coherence tomography (OCT) (Figure 2.4)
Ocular ultrasound scan
Electroretinograms and electro-oculograms
Visual evoked response
CT scan and MRI (Figure 21.18)
APPROPRIATE MANAGEMENT OF THE PATIENT
4:
Principles of treatment
MEDICAL TREATMENT AND OCULAR PHARMACOLOGY
TOPICAL TREATMENT
Drops
Ointments
Side effects of topical treatment
SYSTEMIC TREATMENT
INJECTIONS IN AND AROUND THE EYE
Subconjunctival injections
Intravitreal injections
Endophthalmitis: choice of medication
Endophthalmitis: method of injection
Endophthalmitis: vitreous samples
COMMONLY USED DRUGS IN OPHTHALMOLOGY
Antibiotics
ANTIVIRAL AND ANTIFUNGAL DRUGS
ANTI-INFLAMMATORY AGENTS
Steroids
Topical and subconjunctival steroids
The side effects of topical and subconjunctival steroids
Systemic steroids
Topical non-steroidal anti-inflammatory drugs, mast cell stabilisers and anti-histamines
Antihistamines
Mast cell stabilisers
Prostaglandin inhibitors (topical non-steroidal anti-inflammatory drugs)
Systemic ‘steroid-sparing’ immunosuppressive drugs
MYDRIATICS
DRUGS USED IN THE TREATMENT OF GLAUCOMA
TEAR SUBSTITUTES (ARTIFICIAL TEARS)
LOCAL ANAESTHETICS
OTHER MEDICATIONS USED FOR THE EYES
PROBLEMS WITH MEDICATIONS
EYE COMPLICATIONS FROM SYSTEMIC DRUGS
PRINCIPLES OF OPHTHALMIC SURGERY
Extraocular surgery
Intraocular surgery
Anaesthetising an eye for intraocular surgery
Prevention of intraocular infection
Prevention of physical or chemical damage inside the eye
Careful wound closure
Padding/shielding the eye
The treatment of painful blind eyes
Surgery in poor countries
5:
Ophthalmic optics and the correction of refractive errors
BASIC OPHTHALMIC OPTICS
THE OPTICS OF THE EYE
ACCOMMODATION
REFRACTIVE ERRORS
CORRECTING REFRACTIVE ERROR WITH SPECTACLES
REFRACTING A PATIENT
Objective refraction
Subjective refraction
STEPS OF SUBJECTIVE REFRACTION
OTHER WAYS OF CORRECTING REFRACTIVE ERRORS
Contact lenses
Refractive surgery
AIDS FOR PATIENTS WITH LOW VISION
SELF-ADJUSTING SPECTACLES
6:
The eyelids and the lacrimal apparatus
INFLAMMATIONS AND INFECTIONS OF THE EYELIDS
Styes
Inflammation or infection of the meibomian glands
Inflammatory and allergic swelling of the eyelids
Blepharitis
Treatment
Ophthalmic herpes zoster (ophthalmic shingles)
Treatment
Acute complications
Long-term complications
Molluscum contagiosum
Infections of the eyelids caused by ‘tropical’ diseases
Cutaneous leishmaniasis
Cancrum (noma)
Leprosy
Other tropical infections
ABNORMALITIES OF THE FUNCTION AND POSITION OF THE EYELIDS
Facial palsy
The anatomy of the facial nerve
Ptosis
Ptosis caused by disorders of the muscle
Ptosis caused by problems with the nerve supply to the muscle
Ptosis caused by excess weight, volume or thickening of the upper lid
Management of ptosis
Eyelid retraction
Ectropion
Entropion
TUMOURS
Benign tumours and cysts of the eyelid
Malignant tumours of the eyelid
Basal cell carcinomas (BCC) (rodent cell ulcers)
Other malignant tumours of the eyelids
The treatment of eyelid tumours
Eyelid trauma
Problems with the lacrimal apparatus
The lacrimal gland and lacrimal accessory glands
The nasolacrimal passages
7:
Diseases of the conjunctiva, episclera and sclera
CONJUNCTIVITIS
THE SYMPTOMS OF CONJUNCTIVITIS
Discomfort
Vision
Time course
THE SIGNS OF CONJUNCTIVITIS
CAUSES OF CONJUNCTIVITIS
DIAGNOSIS OF CONJUNCTIVITIS
ACUTE BACTERIAL CONJUNCTIVITIS
CHLAMYDIAL INFECTION
Trachoma
Adult inclusion body conjunctivitis
OPHTHALMIA NEONATORUM (NEONATAL CONJUNCTIVITIS)
Gonococcus
Chlamydia
Others infections
Treatment
Prevention
VIRAL CONJUNCTIVITIS
Adenovirus conjunctivitis
Treatment
Measles
Molluscum contagiosum
Herpes simplex virus
GRANULOMATOUS CONJUNCTIVITIS (PARINAUD'S OCULOGLANDULAR CONJUNCTIVITIS)
IMMUNE RESPONSE (INFLAMMATORY) CONJUNCTIVITIS
CONJUNCTIVITIS FROM TYPE 1 (ALLERGIC) HYPERSENSITIVITY REACTIONS
Vernal keratoconjunctivitis (VKC)
The symptoms and signs of VKC
The treatment of vernal conjunctivitis
Seasonal and perennial allergic conjunctivitis (hay fever)
Giant papillary conjunctivitis (GPC)
CONJUNCTIVITIS FROM TYPE 2 HYPERSENSITIVITY REACTIONS
Mucous membrane pemphigoid
CONJUNCTIVITIS FROM TYPE 3 HYPERSENSITIVITY REACTIONS
Sjögren syndrome
CONJUNCTIVITIS FROM TYPE 4 HYPERSENSITIVITY REACTIONS
Contact (irritant) conjunctivitis
Phlyctenular conjunctivitis and keratoconjunctivitis
Erythema multiforme, Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)
OTHER CAUSES OF CONJUNCTIVITIS
Rosacea
Traumatic conjunctivitis (see Chapter 21)
Chemical conjunctivitis
Psychological causes of conjunctivitis
DEGENERATIVE CHANGES IN THE CONJUNCTIVA
Pinguecula (plural pingueculae)
Pterygium
Concretions (Figure 7.25)
CONJUNCTIVAL TUMOURS
Conjunctival carcinoma
Other conjunctival cysts and tumours
SCLERITIS AND EPISCLERITIS
Episcleritis
Scleritis
8:
Trachoma
SYMPTOMS AND SIGNS OF TRACHOMA
Acute infective trachoma
Scarring trachoma
Trichiasis
Corneal scarring
The classification of trachoma
TRACHOMA BLINDNESS IN THE COMMUNITY
RISK FACTORS FOR TRACHOMA
DIFFERENTIAL DIAGNOSIS
Differential diagnosis for active trachoma
Differential diagnosis for scarring trachoma
ASSESSING A TRACHOMA PATIENT
THE LABORATORY DIAGNOSIS OF ACTIVE TRACHOMA
Sensitivity
Specificity
THE TREATMENT OF TRACHOMA
Environmental improvements
Face washing
Antibiotics
Surgery
Eyelash removal
Surgical procedures to correct entropion
Corneal scarring and corneal blindness
9:
The cornea
PATTERNS OF CORNEAL DISEASE
TERMINOLOGY
THE PRINCIPLES OF DIAGNOSIS OF CORNEAL ULCERS
CORNEAL INFECTIONS
SYMPTOMS OF CORNEAL ULCERS
SIGNS OF A CORNEAL ULCER
VIRAL INFECTIONS
Herpes simplex corneal disease
HSV epithelial keratitis
Stromal inflammation and disciform keratitis
Anterior uveitis and secondary glaucoma
Perforation
Longer term - sequelae
The treatment of herpetic corneal ulcers
The treatment of stromal keratitis
Treatment of chronic infections
Treatment of inactive scars
SUPPURATIVE KERATITIS: BACTERIAL AND FUNGAL INFECTIONS
Risk factors for suppurative keratitis
Position
Appearance
Other clinical consequences of suppurative keratitis
Iritis and secondary glaucoma
Perforation and endophthalmitis
Long-term sequelae of suppurative keratitis
Corneal scars
Staphyloma
Distinguishing bacterial and fungal keratitis
Bacterial keratitis
Fungal keratitis
Diagnosis and identification of the organism
Direct examination with the microscope
Culture
Treatment of suppurative keratitis
Treatment of bacterial ulcers
Additional treatment
The treatment of fungal ulcers
Suppurative keratitis and HIV infection
Surgical treatment for suppurative keratitis
Charting the progress of an ulcer
ACANTHAMOEBA
Diagnosis
Clinical history
Clinical appearance (Figure 9.11)
Microbiological
Treatment
INFLAMMATORY CORNEAL DISEASE
Peripheral corneal inflammatory ulcers
Blepharitis
Phlyctens
Stromal keratitis
Peripheral ulcerative keratitis (PUK) (Figure 9.15)
Mooren ulcer or ring ulcer
Surgical treatment of peripheral inflammatory ulcers
OTHER CAUSES OF CORNEAL ULCERS
SUPERFICIAL PUNCTATE KERATITIS
DEGENERATIVE CORNEAL DISEASE
Ageing and sunlight associated corneal degeneration
Solar keratopathy
Corneal dystrophies
Keratoconus
Fuchs endothelial dystrophy (Figure 9.23)
CORNEAL OEDEMA
PTERYGIUM
Symptoms of a pterygium
Treatment of pterygium
BAND KERATOPATHY
CORNEAL SCARS
Vascularisation
Opacification
THE TREATMENT OF CORNEAL SCARS
COSMETIC TREATMENT OF CORNEAL SCARS
10:
Xerophthalmia and nutritional corneal ulceration
TERMINOLOGY
THE EPIDEMIOLOGY OF XEROPHTHALMIA
THE BIOCHEMISTRY AND PHYSIOLOGY OF VITAMIN A
Dietary sources of retinol
International units
Absorption and storage
Transport from the liver to the tissues
Functions of vitamin A
The maintenance of healthy epithelial tissues
Formation of rhodopsin (visual purple)
MEASURING VITAMIN A LEVELS
VITAMIN A DEFICIENCY IN YOUNG CHILDREN
THE SIGNS AND SYMPTOMS OF VITAMIN A DEFICIENCY IN THE EYE
Classification
Conjunctival xerosis – XIA
Dryness
Increased pigmentation
Creamy, white debris
Bitot spot – XlB
Night blindness – XN
Corneal xerosis – X2
Corneal ulceration – X3A
Keratomalacia – X3B
Xerophthalmic corneal scars – XS
Xerophthalmia fundus – XF
Geographic patterns in xerophthalmia
OTHER CAUSES OF CORNEAL ULCERS IN XEROPHTHALMIA
Exposure ulcers
Herpes simplex virus (HSV)
‘Treatment’ by traditional healers
OTHER SYSTEMIC FACTORS IN PATIENTS WITH VITAMIN A DEFICIENCY
Protein energy malnutrition
Infection
Measles
Intestinal parasites
THE TREATMENT OF XEROPHTHALMIA
Nutritional and general treatment
Topical treatment to the eye
Antibiotics
Antiviral agents
Closing the eyes
Padding an eye
Mydriatics
Steroids
Surgery
COMMUNITY TREATMENT: THE PREVENTION OF BLINDNESS FROM XEROPHTHALMIA
11:
Diseases of the uvea
UVEITIS
Acute anterior uveitis (AAU)
Symptoms and signs
The course of the disease
Chronic anterior uveitis (CAU)
Complications of anterior uveitis
Secondary glaucoma
Reduced intraocular pressure
Cataract
Iris atrophy
Band degeneration (Figure 9.26)
Posterior uveitis (choroiditis)
Symptoms and signs
Old, inactive choroiditis
Course of the disease
Intermediate uveitis (pars planitis)
Causes of uveitis (Table 11.2)
Infective causes of uveitis
Inflammatory causes of uveitis
The management and treatment of uveitis
UVEAL TUMOURS
Uveal melanomas
Uveal metastases
DEGENERATIVE CHANGES
TUBERCULOSIS
TB epidemiology
TB infection
TB and the eye
The symptoms and signs of ocular TB
The treatment of TB
SYPHILIS AND THE EYE
Ocular complications of syphilis
Leptospirosis
12:
Diseases of the lens
AGEING AND THE LENS
THE CAUSES AND THE EPIDEMIOLOGY OF CATARACT
Cataract and age
Cataract and a tropical environment and poor countries
Episodes of severe dehydration in early life
Solar radiation
Diet
Heat
Cataract, and systemic and ocular disease
Eye diseases and cataract
Protective factors
The symptoms of cataract
CLINICAL EXAMINATION OF A CATARACT
Examination of the lens
Type of cataract
Examination of the retina
THE ASSESSMENT OF CATARACT IN EYES WITH OTHER PATHOLOGY
Visual acuity
Reading vision
Pinhole vision
The pupil light reflex
Projection of light
Intraocular pressure
COMPLICATIONS OF CATARACT
Phacomorphic glaucoma and phacolytic uveitis and glaucoma
Lens subluxation and dislocation
APHAKIA AND THE APHAKIC EYE
The optical correction of aphakia
Spectacles (Figure 12.17)
Contact lenses (Figure 12.18)
Intraocular lens implants
THE TREATMENT OF CATARACT
Intra-capsular cataract extraction (ICCE)
Extra-capsular cataract extraction with lens implantation
Femtosecond laser cataract extraction
POSTOPERATIVE CARE
COMPLICATIONS OF MODERN CATARACT SURGERY
Long-term complications
Posterior capsular opacification (PCO)
COUCHING OF CATARACTS
WORLD CATARACT BLINDNESS AND ITS ERADICATION
CONGENITAL AND CHILDHOOD CATARACT
Diagnosis and examination of congenital cataract
Clinical appearance of congenital cataract
Causes of congenital cataract
Cause of paediatric cataract
Management of congenital cataract
Management challenges
Surgery for congenital cataract
LENS SUBLUXATION AND DISLOCATION
The treatment of subluxed and dislocated lenses
13:
Diseases of the retina
VASCULAR RETINAL DISEASE
Retinal examination in vascular disease
Systemic examination in vascular disease
Hypertensive retinopathy
Mild hypertensive retinopathy
Moderate hypertensive retinopathy
Severe hypertensive retinopathy
The treatment of hypertensive retinopathy
Retinal vessel occlusions
Retinal artery occlusions
Retinal vein occlusions
Diabetic retinopathy
Epidemiology
Diagnosis and symptoms of diabetes
Classification of diabetes
Pathological changes in diabetic retinopathy
Risk factors for diabetic retinopathy
Investigation of diabetic retinopathy
Preventing blindness from diabetic retinopathy
Treatment of diabetic retinopathy
Diabetic screening in the community
Sickle cell disease
Diagnosis
Ophthalmic signs of sickle cell disease
The management of sickle cell disease
Retinal vasculitis
Signs and symptoms of retinal vasculitis
Classification and causes of retinal vasculitis
Important causes of retinal vasculitis
Treatment
Other causes of retinal vascular disease
RETINAL DEGENERATIVE DISEASE
Age-related macular degeneration (AMD)
Pre-AMD changes
Wet AMD
Dry AMD
Other conditions associated with choroidal neovascularisation
Myopic retinal degeneration
Angioid streaks (Figure 13.29)
Treatment
Hereditary chorioretinal disease
Retinitis pigmentosa (RP)
Albinism
Juvenile macular dystrophies
Onchocerciasis
RETINAL DETACHMENTS
Posterior vitreous detachment and asteroid hyalosis
Causes of retinal detachment
Risk factors for retinal detachment
Symptoms and natural history of a retinal detachment
Floaters
Flashing lights
Visual field loss
Natural history
Examination of retinal tears and detachment
Treatment of retinal holes, tears and rhegmatogenous retinal detachment
Retinal holes and tears
Retinal detachment
Results of surgery
RETINOBLASTOMA
Symptoms and signs of retinoblastoma
Other causes of an absent red reflex in children
Treatment of retinoblastoma
RETINAL INFECTIONS
Retinitis
Toxoplasmosis
Life cycle
Congenital infection
Symptoms and signs
Diagnosis
Treatment
TOXIC RETINOPATHY
Chloroquine retinopathy
Other drugs
14:
Diseases of the optic nerve and visual pathways
DISEASES OF THE OPTIC NERVE
OPTIC NEURITIS
Papillitis
Retrobulbar neuritis
Disease course
Treatment of optic neuritis
OPTIC DISC SWELLING AND PAPILLOEDEMA
Papilloedema
Severe (malignant) hypertension
OPTIC ATROPHY
CAUSES OF OPTIC NEUROPATHY, OPTIC NEURITIS AND OPTIC ATROPHY
Malnutrition
Toxins
Treatment of nutritional, tobacco, alcohol and cassava optic neuropathies
Drugs
Infections
Vascular diseases
Artertitic anterior ischaemic optic neuropathy: giant cell arteritis (temporal arteritis, cranial arteritis)
Non-arteritic anterior ischaemic optic neuropathy
Head injuries
Demyelinating diseases
Tumours or other space-occupying intraorbital or intracranial lesions
Orbital lesions
Chiasmal lesions
Raised intracranial pressure
Retinal disease
Inherited optic atrophy
Glaucoma
DIAGNOSIS OF OPTIC NERVE DISEASE
URGENT TREATMENT OF OPTIC NERVE DAMAGE
CONGENITAL ABNORMALITIES OF THE OPTIC DISC
Optic nerve hypoplasia
Coloboma
Optic disc pit
Persistent fetal vasculature of the optic disc
DISEASES OF THE POSTERIOR VISUAL PATHWAYS AND CORTICAL BLINDNESS
15:
Glaucoma
PRIMARY OPEN ANGLE GLAUCOMA (CHRONIC SIMPLE GLAUCOMA)
Risk factors
Age
Families
Race
The signs and symptoms of open angle glaucoma
Gradual loss of the field of vision
Changes in the appearances of the optic disc
Increased intraocular pressure
Other changes
Pigment dispersion syndrome and pseudoexfoliation
Pseudoexfoliation
Pigment dispersion syndrome
The diagnosis of open angle glaucoma
Management principles for open angle glaucoma
Treatment of open angle glaucoma
Medical treatment
Surgical treatment
Uncomplicated glaucoma drainage surgery
Complications of drainage operations
Glaucoma surgery follow-up
Other surgical procedures
Laser treatment of POAG
ANGLE CLOSURE GLAUCOMA
The risk factors for angle closure
General risk factors
Risk factors for precipitating an acute attack
Examination of the anterior chamber
The signs and symptoms of acute angle closure glaucoma
Symptoms
Signs
Self-resolving episodes of angle closure
The treatment of AACG
Medical treatment for acute angle closure glaucoma
Treatment with corneal indentation
Iridectomy/iridotomy
Chronic angle closure glaucoma
SECONDARY GLAUCOMA
Neovascular glaucoma
Glaucoma secondary to intraocular inflammation
Glaucoma secondary to trauma
Ghost cell glaucoma
Malignant glaucoma (ciliary block glaucoma)
Steroid induced glaucoma
Paediatric glaucoma
Primary congenital glaucoma
Secondary childhood glaucoma
THE PREVENTION OF BLINDNESS FROM GLAUCOMA
16:
Onchocerciasis and other parasitic diseases
ONCHOCERCIASIS
THE LIFE CYCLE OF ONCHOCERCA VOLVULUS IN MAN AND THE SIMULIUM FLY (FIGURE 16.2)
EPIDEMIOLOGY OF ONCHOCERCIASIS
CLINICAL SIGNS AND SYMPTOMS
Skin changes
Nodules
Lymphadenopathy
The brain
Systemic
EYE CHANGES FROM ONCHOCERCIASIS
The cornea
The anterior chamber
The iris and ciliary body and lens
The back of the eye
The retina and choroid
The optic nerve
Visual loss
DIAGNOSIS
Slit lamp examination
A ‘skin snip’ examination
Looking for skin nodules
Other tests
The Mazzotti test
Antibody and DNA tests
IMMUNOLOGY
TREATMENT
LOIASIS
TOXOPLASMOSIS
TOXOCARA
Treatment
OTHER PARASITIC INFECTIONS
Thelazia
Gnathostomiasis and angiostrongyliasis
Trichinosis
Cysticercosis
Hydatid disease
Sparganosis
Myiasis
Conjunctival myiasis
Orbital myiasis
Intraocular myiasis
Other ocular parasitic infections
DIFFUSE UNILATERAL SUBACUTE NEURORETITINIS (DUSN)
17:
Leprosy and the eye
THE DIFFERENT CLINICAL TYPES OF LEPROSY
Multibacillary (MB) leprosy
Paucibacillary (PB) leprosy
Other clinical scenarios
Leprosy reactions: reversal, downgrading and erythema nodosum leprosum
TREATMENT FOR LEPROSY
Leprosy reactions
LEPROSY CONTROL
EYE DISEASE IN LEPROSY
The cornea
Primary changes
Secondary changes
Iris and anterior chamber
Chronic anterior uveitis
Acute anterior uveitis
Conjunctiva, sclera and episclera
The lens
BLINDNESS FROM LEPROSY
TREATMENT OF THE COMPLICATIONS OF OCULAR LEPROSY
Uveitis
Cataracts
Damage to the corneal protective reflex
Facial palsy
Madarosis
18:
Squint and other disorders of eye movement
THE EXTRAOCULAR MUSCLES
HOW DOES A SQUINT DEVELOP?
THE EFFECTS OF A SQUINT
Adult onset squints
Child onset squints
AMBLYOPIA
Diagnosing amblyopia
Problems of having amblyopia
Treatment of amblyopia
CLASSIFICATION OF SQUINT
Comitance
Eye position
Alternating or non-alternating
Manifest or latent
Constant or intermittent
Classification by underlying pathology
THE CAUSES OF SQUINT
Disorders of vision
Central disorders of the eye movements
Disorders of the extraocular muscles
The cranial nerves
Refractive errors
Other causes of squint
CLINICAL EXAMINATION AND ASSESSMENT OF SQUINTS
The corneal light reflex test
The cover-uncover-alternate cover test
The cover test (Figure 18.8)
The uncover test (Figure 18.9)
The alternate cover test (Figure 18.10)
Testing the ocular movements
Versions
Convergence
Assessing squints in children
Prominent epicanthal folds
THE MANAGEMENT AND TREATMENT OF SQUINTS
Squints in children
Assess and treat the cause of the visual impairment or squint
Correct refractive errors with spectacles (see Chapter 5)
Treat amblyopia (see above)
Straighten the eyes with surgery
Treatment of squints in adults
NYSTAGMUS
Classification
Types of nystagmus
Sensory deprivation nystagmus (SDN)
Congenital Idiopathic nystagmus (CIN)
Up and downbeat nystagmus *
Spasmus mutans Brief*
19:
Orbital diseases
SPACE-OCCUPYING LESIONS IN THE ORBIT
Differential diagnosis of space-occupying orbital lesions
Tumours
Cysts
Inflammatory orbital masses
Vascular lesions
The treatment of space-occupying lesions in the orbit
Does the disease originate in the nasal sinuses?
Does the disease originate in the orbit itself?
Is the orbital lesion part of a systemic disease?
ACUTE ORBITAL CELLULITIS AND PRE-SEPTAL CELLULITIS
Symptoms and signs
Disease course
THYROID EYE DISEASE
Symptoms and signs
Treatment of thyroid eye disease
20:
Human immunodeficiency virus and the eye
EPIDEMIOLOGY
Prevalence and incidence
HIV TRANSMISSION
HIV PATHOPHYSIOLOGY
LABORATORY TESTS AND THE DEFINITION OF AIDS
TREATMENT AND PREVENTION OF HIV
Anti-retroviral therapy (ART)
Health education
Needlestick injuries
HIV COUNSELLING
HIV DISEASE EPIDEMIOLOGY
OPHTHALMIC COMPLICATIONS OF HIV/AIDS
THE EYELIDS AND CONJUNCTIVA
Herpes zoster ophthalmicus (HZO, ophthalmic shingles)
Molluscum contagiosum (Figure 20.4)
Kaposi sarcoma
Ocular surface squamous neoplasia (OSSN)
Dilated conjunctival blood vessels (conjunctival microvasculopathy)
Trichomegaly (eyelash growth and thickening)
THE ORBIT
THE CORNEA
Infectious keratitis
Dry eyes
INTRAOCULAR INFLAMMATION
Uveitis
Immune recovery uveitis (IRU)
RETINA
HIV retinopathy
Viral retinal infection
Acute retinal necrosis and progressive outer retinal necrosis
Cytomegalovirus retinitis (CMV)
Treatment of viral retinal infection
Other retinal infections
Bacteria
Others infections
NEURO-OPHTHALMIC COMPLICATIONS
OPHTHALMIC SIDE EFFECTS OF ARTS
21:
Eye injuries
EXAMINATION AND ASSESSMENT
CORNEAL AND CONJUNCTIVAL FOREIGN BODIES AND CORNEAL ABRASIONS
Corneal foreign body
Conjunctival foreign body
A corneal abrasion
Treatment of corneal abrasions
Recurrent erosion (abrasion) syndrome
BURNS AND CHEMICAL INJURIES
Treatment of eyelid burns
Corneal and conjunctival chemical injuries
Emergency treatment of chemical burns to the conjunctiva and cornea
Long term treatment of eyes that have had severe chemical injuries
NON-PENETRATING, OR BLUNT INJURIES TO THE EYEBALL
Complications of blunt injuries
Bleeding into the anterior chamber (hyphaema)
Angle recession
Rupture of the suspensory ligament
Delayed cataract
Peripheral retinal tear
Retinal oedema (commotio retinae)
Choroidal tear
Rupture of the eyeball
Treatment of blunt injuries
PENETRATING INJURIES TO THE EYE
Signs of a corneal or scleral penetration
Complications of penetrating injuries
Treatment of penetrating eye injuries
Surgical treatment
How recent was the injury?
How extensive is the injury?
What facilities and equipment are available?
Medical treatment
Treatment of retained foreign bodies
INJURIES TO THE EYELIDS
ORBITAL INJURIES
Orbital margin fractures
Orbital floor fractures
CRANIAL NERVE INJURIES
PREVENTION OF EYE INJURIES
22:
Eye disease and visual impairment in children
CHILDHOOD BLINDNESS ACCORDING TO THE TIME OF ONSET
Disease starting at conception or in the embryo
Disease starting during pregnancy
Congenital infections
Diseases starting at birth
Ophthalmia neonatorum
Retinopathy of prematurity (ROP)
Birth injuries
Herpes simplex virus (HSV) keratitis
Diseases starting in infancy and childhood
Refractive error
Corneal disease
Optic nerve and cerebral disease
Trauma
VISION TESTING IN CHILDREN
THE GLOBAL DISTRIBUTION OF CHILD BLINDNESS
PROBLEMS AND CHALLENGES IN THE CLINICAL CARE OF CHILDREN WITH EYE DISEASE
Taking the history and assessing the vision
Examining the eyes of children
Making the diagnosis
Refracting young children
Treatment
THE EYE IN SYSTEMIC DISEASE
Cerebral malaria
Miliary tuberculosis
LOW VISUAL AIDS EDUCATION AND REHABILITATION
23:
Diagnosis of common eye conditions
LOSS OF VISION
REFRACTIVE ERRORS
OPACITIES IN THE OCULAR MEDIA
DISEASES OF THE RETINA AND OPTIC NERVE
THE IRRITABLE OR PAINFUL RED EYE
Pain and photophobia
Vision
Redness
Fluorescein staining of the cornea
Anterior chamber inflammation and keratic precipitates
Corneal haziness
The pupil
Discharge
One or both eyes affected
DISORDERS AT THE LIMBUS
Limbal inflammation
Excessive limbal pigmentation
Degenerative changes
Other disorders located at the limbus
FUNCTIONAL VISUAL LOSS (HYSTERICAL/MALINGERING)
Appendix
FURTHER RESOURCES
Eye care and eye disease information and training materials
Books, teaching aids and tools for clinical and surgical ophthalmology
INDEX
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