Ophthalmology Second Edition
Ophthalmology Second Edition
Shyamanga Borooah BSc (Hons) MBBS MRCP (UK) MRCSEd PhD FRCOphth
Fulbright Fight for Sight Scholar Shiley Eye Institute University of California San Diego
San Diego, USA
Peng Yong Sim BMedSci (Hons) MBChB (Hons) PGCert Clin Ed
Foundation Doctor Royal Free London NHS Foundation Trust
London, UK
Mark Wright MBChB FRCSEd FRCOphth
Consultant Ophthalmologist Princess Alexandra Eye Pavilion, NHS Lothian
Edinburgh, UK
Baljean Dhillon BM BS FRCSEd FRCPEd
FRCPS (Glasg) FRCOphth Professor of Clinical Ophthalmology University of Edinburgh Consultant Ophthalmologist Princess Alexandra Eye Pavilion, NHS Lothian
Edinburgh, UK
© 2018 JP Medical Ltd.
First edition 2012.
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The rights of Shyamanga Borooah, Peng Yong Sim, Mark Wright and Baljean Dhillon to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
9781909836617
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A catalogue record for this book is available from the British Library
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A catalog record for this book is available from the Library of Congress
Publisher: Richard Furn
Development Editor: Thomas Banister-Fletcher
Design: Designers Collective Ltd
Many diseases are restricted to the eye, but the eye and the visual system are also affected by many general disorders. Thus the recognition of ocular abnormalities can be crucial to the diagnosis and monitoring of systemic diseases such as diabetes and hypertension. In addition, any lesion of the central nervous system above the foramen magnum may present with ophthalmic changes.
Despite this, the training of medical and paramedical practitioners has very little ophthalmological content. This lack of dedicated training led the authors to write the first edition of Pocket Tutor Ophthalmology, in the hope it would be an instructive guide for non-ophthalmic medical practitioners, medical students, nurses and those in paramedical practice.
Its success has encouraged the production of this second edition. The book has been revised in response to feedback on the first edition, with the addition of new photographs, a pharmacology section and new full colour artworks. As before, common ophthalmic disorders are described by anatomical region, except for those chapters devoted to paediatrics and trauma. The case presentations in each chapter are particularly helpful, giving a step by step guide to the process of making a diagnosis.
Pocket Tutor Ophthalmology is accessible, well-illustrated and ideal for use in clinical practice. I am confident it will be a constant companion to all those involved in medical care, demystifying ophthalmology and aiding in disease management across all clinical settings.
Alan Bird MD FRCS FMedSci
Emeritus Professor of Clinical Ophthalmology
University College London
London, UK
Foreword to the first edition
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 MD FRCS FRCSEd
Former Consultant Ophthalmologist
Edinburgh, UK
Preface
Pocket Tutor Ophthalmology provides a concise and accessible reference to aid understanding and diagnosis of common ophthalmological diseases.
Ophthalmology is often perceived as being a difficult subject. But a sound understanding of the eye and its surrounding structures can mean sight is saved or even restored. A correct diagnosis may even make the difference between life and death. This book helps make ophthalmology accessible.
Pocket Tutor Ophthalmology opens with a chapter that provides the relevant anatomy and physiology. Chapter 2 takes the reader through the important examination techniques and investigations used to assist diagnosis. Chapter 3 comprises a series of algorithms which help make clinical diagnosis easier. These algorithms have been published widely and have been shown to significantly improve diagnostic accuracy.
The remaining chapters are arranged by anatomical region and cover the most common conditions. In addition to discussion of diagnosis and management, each chapter contains one or more clinical scenarios demonstrating how conditions present in the clinical setting. Most conditions can be diagnosed visually so the chapters contain many high-quality colour photographs as well.
Pocket Tutor Ophthalmology has been written for medical students, medical trainees, primary care practitioners and optometrists, to assist in the understanding of eye disease. We have made every effort to make the book simple, clear and up-to-date. We hope you will find it both enjoyable to read and clinically useful.
Shyamanga Borooah, Peng Yong Sim,
Mark Wright, Baljean Dhillon
November 2017
Acknowledgements
Our thanks to Colin Goudie and the Medical Photography Department, Princess Alexandra Hospital for providing Figures 11.2 and 12.6a, to Chua Chung Nen, Universiti Malaysia Sarawak, for providing Figure 10.1 and to Colin Smith, Neuropathology Unit, Western General Hospital, Edinburgh for providing Figure 12.14.
SB, PS, MW, BD