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Atlas of Clinical Ophthalmology
VM Loganathan
CHAPTER 1:
ANATOMY OF EYE
THE EYEBALL OR GLOBE (FIGURES 1.1 TO 1.4)
Outer Coat
Vascular Coat
Inner Coat
Cornea
Anterior Chamber
Lens
Posterior Chamber
Vitreous
Optic Nerve
Eyelids
Conjunctiva
Extraocular Muscles (Figures 1.2 and 1.3)
CHAPTER 2:
DISEASES OF LID
ANATOMY OF LID (FIGURE 2.1)
STYE (FIGURE 2.2)
Symptoms
Signs
Aetiology
Treatment
CHALAZION (FIGURE 2.3A)
Symptoms
Signs
Aetiology
Treatment
BLEPHARITIS (FIGURE 2.4)
Types
Squamous Blepharitis
Symptoms
Signs
Aetiology
Treatment
Ulcerative Blepharitis
Symptoms
Signs
Prognosis
Treatment
ENTROPION (FIGURE 2.5)
Aetiology
Types
Symptoms
Signs
Treatment
ECTROPION (FIGURE 2.6)
Symptoms
Types
Cicatricial
Paralytic
Mechanical
Treatment
PTOSIS (FIGURE 2.7)
Ptosis or Drooping of Upper Lid Occurs as
Treatment
BASAL CELL CARCINOMA OR RODENT ULCER (FIGURE 2.8)
Treatment
SQUAMOUS CELL CARCINOMA
CHAPTER 3:
DISEASES OF LACRIMAL APPARATUS
ANATOMY AND PHYSIOLOGY (FIGURE 3.1)
LACRIMAL GLAND
LACRIMAL PASSAGES
Lacrimal Punctum
CHRONIC DACRYOCYSTITIS (FIGURE 3.2)
Symptoms
Signs
Aetiology and Pathology
Investigation
Syringing
Treatment
ACUTE DACRYOCYSTITIS (FIGURE 3.3)
Symptoms
Signs
AETIOLOGY AND PATHOLOGY
Treatment
Prognosis
Indication for DCR or Dacryocystorhinostomy
LACRIMAL FISTULA (FIGURE 3.4)
Treatment
LACRIMAL GLAND TUMOUR
Treatment
DACRYOADENITIS (FIGURE 3.5)
CHAPTER 4:
DISEASES OF CONJUNCTIVA
ANATOMY OF CONJUNCTIVA (FIGURE 4.1)
ACUTE CATARRHAL OR ACUTE MUCOPURULENT CONJUNCTIVITIS (ACCO) (FIGURE 4.2)
Symptoms
Signs
Aetiopathology
Treatment
Complications
OPHTHALMIA NEONATORUM (FIGURE 4.3)
Signs
Aetiopathogenesis
Treatment
Remember
Complication
Remember
DIPHTHERITIC CONJUNCTIVITIS OR MEMBRANOUS CONJUNCTIVITIS (FIGURE 4.4)
Symptom
Signs
Complication
Treatment
PSEUDOMEMBRANOUS CONJUNCTIVITIS
Clinical Features
TRACHOMA
Symptoms
Signs
WHO Classification of Trachoma
AETIOPATHOGENESIS OF TRACHOMA
How the Infection Spreads?
Conjunctiva Follicles (Stage 2)
Cornea
Investigations and Lab Diagnosis
Note
Treatment
DEGENERATIVE DISEASES OF THE CONJUNCTIVA
Pterygium (Figure 4.6)
Symptom
Signs
Treatment
PINGUECULA (FIGURE 4.7)
Signs
Treatment
CONCRETIONS
Treatment
SUBCONJUNCTIVAL HAEMORRHAGE (FIGURE 4.8)
Symptoms
Signs
Aetiology
Treatment
BITOT'S SPOTS (FIGURE 4.9)
SPRING CATTARH
Signs
PALPEBRAL FORM (FIGURE 4.10)
Symptom
BULBAR FORM (FIGURE 4.11)
Treatment
SIMPLE ALLERGIC CONJUNCTIVITIS
Treatment
PHLYCTENULAR CONJUNCTIVITIS (FIGURE 4.12)
CHAPTER 5:
DISEASES OF CORNEA
ANATOMY OF THE CORNEA (FIGURE 5.1)
PHYSIOLOGY OF THE CORNEA
CORNEAL ULCER (FIGURE 5.2)
Symptoms
Sign
Aetiology
Pathology
HYPOPYON ULCER (FIGURE 5.3)
TREATMENT OF CORNEAL ULCER OR HYPOPYON ULCER OR HYPOPYON CORNEAL ULCER AND BACTERIAL ULCER
Record the Vision
PROGNOSIS
COMPLICATIONS
Treatment of Impending Perforation
Treatment of Perforated Corneal Ulcer
MYCOTIC CORNEAL ULCER (FIGURE 5.4)
Clinical Features
Symptoms
Causative Organisms
Filamentous Fungal Keratitis
Candida Keratitis
Diagnosis
Treatment
PROTOZOAL KERATITIS
Acanthamoeba Keratitis (Figure 5.5)
Aetiology
Mode of Infection
Clinical Features
Diagnosis
Treatment
VIRAL KERATITIS
Herpes Simplex Viral Keratitis
Mode of Infection
Primary Infection
Diagnosis
Treatment
RECURRENT OCULAR HERPES
Epithelial Keratitis
Stromal Keratitis
Treatment
Treatment of Stromal Keratitis
HERPES ZOSTER OPHTHALMICUS (FIGURE 5.7)
Mode of Infection
Clinical Features
Treatment
HOW TO PREVENT CORNEAL ULCER?
INTERSTITIAL KERATITIS (FIGURE 5.8)
Aetiology
Pathology
Symptoms
Sign
Investigations
Treatment
PHLYCTENULAR KERATOCONJUNCTIVITIS (FIGURE 5.9)
Allergic Conjunctivitis
Symptoms
Asymptomatic
Signs
Treatment
KERATOCONUS (FIGURE 5.10)
Differential Diagnosis
Treatment
MOOREN’S ULCER (FIGURE 5.11)
Treatment
KERATOMALACIA (FIGURE 5.12)
Symptoms
Sign
EYE DONATION AND EYE BANK
How the Donated Eyes are Stored and Perserved?
EYE BANK
KERATOPLASTY OR CORNEAL TRANSPLANTATION (FIGURES 5.14 AND 5.15)
Indications for Keratoplasty
Surgical Technique
Recepient Button
Donor Button
Graft Placement and Suturing
Complications
REFRACTIVE CORNEAL SURGERY
LASIK: LASER ASSISTED IN SITU KERATOMILEUSIS
Indications
CHAPTER 6:
DISEASES OF SCLERA
ANATOMY
SCLERA
EPISCLERITIS (FIGURE 6.1)
Signs
Symptoms
Aetiopathology
Treatment
SCLERITIS (FIGURES 6.2 AND 6.3)
Signs
Symptoms
Aetiopathogenesis
SCLEROMALACIA PERFORANS
Treatment
CHAPTER 7:
REFRACTIVE ERRORS
EMMETROPIA (FIGURE 7.1)
HYPERMETROPIA (FIGURE 7.2)
Treatment
MYOPIA (FIGURE 7.3)
Types
Symptoms
Treatment
ASTIGMATISM
Regular Astigmatism
Types
Irregular Astigmatism
Symptoms
Treatment
PRESBYOPIA (FIGURE 7.9)
Symptoms
Treatment
HOW TO FIND OUT A REFRACTIVE ERROR?
Retinoscopy
Method
Neutralisation
CONTACT LENS (FIGURE 7.10)
Types of Contact Lens
Indications for Contact Lens
CHAPTER 8:
DISEASES OF LENS
ANATOMY AND PHYSIOLOGY OF LENS (FIGURE 8.1)
PHYSIOLOGY AND FUNCTION OF LENS
CATARACT
Aetiopathogenesis of Cataract
HOW LENS OPACITIES ARE FORMED IN A SENILE CATARACT?
Senile Cataract
Senile Nuclear Cataract
Senile Cortical Hypermature Cataract or Shrunken Cataract
Symptoms of Cataract
Signs of Cataract
Management of Cataract
Medical Management
Surgical Management
Indications for Cataract Removal
INVESTIGATION BEFORE CATARACT SURGERY
Preoperative Preparation
Anaesthesia
STEPS OF SURGERY (THE SURGERY IS DONE UNDER MICROSCOPE)
Complication During Anaesthesia
PHACOEMULSIFICATION STEPS
Principle
Steps
Complication
Advantages
DEVELOPMENTAL CATARACT (FIGURE 8.5)
Aetiology
Management
APHAKIA (FIGURE 8.8)
Causes
Signs
Treatment
Disadvantages
Traumatic Cataract
Symptom
Sign
Management
Surgery
Complicated Cataract (See Figure 9.5)
Signs
Treatment
Subluxation of Lens (Figure 8.7)
CHAPTER 9:
DISEASES OF UVEAL TRACT
ANATOMY OF UVEAL TRACT (FIGURE 9.1)
Iris
Ciliary Body
Choroid
ACUTE IRIDOCYCLITIS (FIGURE 9.2)
Symptoms
Signs
Pathogenesis of Acute Iridocyclitis (Relation of signs to pathological changes)
Aetiology
Differential Diagnosis
Investigations
Treatment
Prognosis
CHRONIC IRIDOCYCLITIS OR GRANULOMATOUS FORM (FIGURES 9.5 AND 9.6)
Signs
Management
Differentiating Features
POSTERIOR UVEITIS (CHOROIDITIS, CHORIORETINITIS)
Symptoms
Signs
Aetiology
Course of Pathological Events
Treatment
Complication and Defective or Loss of Vision in Uveitis due to
COMMON SYSTEMIC INFECTION AND UVEITIS
Tuberculosis (Figure 9.9)
Leprosy
Toxoplasmosis (Figure 9.8)
Treatment
SYNDROMES ASSOCIATED WITH UVEITIS
CHAPTER 10:
INTRAOCULAR TUMOURS
RETINOBLASTOMA
Symptoms
Signs
Proptosis
Signs of Uveitis
Squint
Pathology
Management
Treatment
MELANOMA (FIGURE 10.3)
Stage of Melanoma
Symptoms
Signs
Treatment
CHAPTER 11:
GLAUCOMA
DEFINITION
Normal Anatomy of Angle of Anterior Chamber (Figure 11.1)
Pathophysiology of Glaucoma
Symptoms
PRIMARY OPEN ANGLE GLAUCOMA
Symptom
Signs
Note
Fundus (Figure 11.7)
Triad Of POAG
Investigation
Treatment
Medical Management
Medical Treatment
Topical Beta-blockers
Surgical Management
Indication
Types of Surgery
Trabeculectomy Operation
General Features
Prodromal Stage
Stage of Contant Instability or Subacute Angle Closure
Mechanism of Angle Closure (Figure 11.8B)
Acute Congestive Glaucoma (Figure 11.8A)
Symptoms
Signs
Treatment
Medical Treatment
Surgical Treatment
Chronic Angle Closure Glaucoma (Figure 11.9)
Sign
Absolute Glaucoma
Sign
Secondary Glaucoma
CAUSES OF SECONDARY GLAUCOMA
Lens Induced Glaucoma
Mechanism of Glaucoma
Sign
Sign and Symptom
Treatment
Dislocation or Subluxation
Marchesani Syndrome
Treatment
Iridocyclitis and Secondary Glaucoma
Intraocular Tumour
Neovascular Glaucoma (Figure 11.10)
Management
INFANTILE GLAUCOMA OR BUPHTHALMOS (FIGURE 11.11)
Mechanism of Glaucoma
Sign and Symptom
Management
CHAPTER 12:
DISEASES OF RETINA
ANATOMY AND PHYSIOLOGY
RETINAL DISEASES (GENERAL SIGNS AND SYMPTOMS OF RETINAL DISORDERS)
Symptoms
Signs
NORMAL FUNDUS (FIGURE 12.2)
Pathological Fundus
DIABETIC RETINOPATHY
Global Burden of Diabetes
Diabetic Retinopathy
Classification of Diabetic Retinopathy
Background Diabetic Retinopathy (Figure 12.7)
Proliferative Diabetic Retinopathy (Figure 12.8)
Diabetic Maculopathy (Figures 12.4 and 12.9)
PATHOGENESIS OF DIABETIC RETINOPATHY
Investigations
Medical Treatment
Surgical Treatment
Role of Physician and how to Prevent Diabetic Retinopathy?
HYPERTENSIVE RETINOPATHY
Pathogenesis of Hypertension
In Younger Patients
In Older Patients
Classification of Hypertensive Retinopathy (Figures 12.10 and 12.11)
Fundus Changes in Hypertensive Retinopathy
EALES’ DISEASE
Symptoms
Signs (Figure 12.12)
Management in Acute Stage
CENTRAL RETINAL ARTERY OCCLUSION
Fundus Appearance (Figure 12.13)
Site of Obstruction in CRAO
Treatment
CENTRAL RETINAL VEIN OCCLUSION
Predisposing Factors
Pathology of Obstruction
Fundus Appearance (Figure 12.14)
Management
RETINITIS PIGMENTOSA
Symptoms
Signs
Pathology
Syndromes Associated
Investigations
Treatment
MACULA DISORDERS: CENTRAL SEROUS RETINOPATHY
Aetiology
Pathology
Symptoms
Signs (Figure 12.16)
Investigation
Treatment
AGE RELATED MACULAR DEGENERATION
WET ARMD
Symptoms
Sign (Figure 12.18)
Pathology
Management
DRY ARMD
MACULAR DYSTROPHY (STARGARDT'S DYSTROPHY) (FIGURE 12.20)
LEUKAEMIA AND ANAEMIA
Fundus Appearance (Figures 12.21 and 12.22)
HIV AND AIDS (FIGURE 12.23)
RETINAL DETACHMENT
Symptoms of RD
Signs of RD (Figure 12.24)
Aetiopathogenesis of Retinal Detachment
Pathology of Rhegmatogenous RD
Management of RD
Anaesthesia
Principle of RD Surgery
CHAPTER 13:
DISEASES OF VITREOUS
ANATOMY
DISEASES OF VITREOUS
VITREOUS HAEMORRHAGE (FIGURE 13.1)
Symptoms
Signs
Aetiology: Common Causes
Treatment
Vitrectomy
Three Port Vitrectomy (Figure 13.2)
Indication for Vitrectomy
Opacites in Vitreous
Synchysis Scintillans
CHAPTER 14:
DISEASES OF OPTIC NERVE and VISUAL PATHWAY
ANATOMY OF OPTIC NERVE AND VISUAL PATHWAY (FIGURES 14.1 AND 14.2)
BLOOD SUPPLY OF VISUAL PATHWAY
Optic Nerve
Optic Chiasma
DISEASES OF OPTIC NERVE
Optic Neuritis
Investigation
Treatment
Retrobulbar Neuritis
Trauma to Optic Nerve and Sequelae
PAPILLOEDEMA (FIGURE 14.4)
Causes of Bilateral Papilloedema
Unilateral Papilloedema
Signs
Symptoms
Optic Atrophy
Primary Optic Atrophy (Figure 14.5)
Secondary Optic Atrophy
Consecutive Optic Atrophy (Figure 14.6)
Glaucomatous Optic Atrophy
DISEASES OF VISUAL PATHWAY (FIGURE 14.7)
CHAPTER 15:
DISEASES OF ORBIT
ANATOMY OF ORBIT (SEE FIGURES 1.1 TO 1.4)
ORBITAL CELLULITIS (FIGURE 15.1)
Signs
Predisposing Factors
Sequelae and Complication
Treatment
PANOPHTHALMITIS (FIGURE 15.2)
Aetiology
Symptoms
Sign
Treatment
CAVERNOUS SINUS THROMBOSIS
Symptoms
Signs
Management
Proptosis and Exophthalmos
Common Causes of Unilateral Proptosis
Signs and Symptoms
Glioma of Optic Nerve
Signs and Symptoms
Pseudotumour of Orbit (Figure 15.3)
Signs and Symptoms
Lymphoma of Orbit (Figure 15.4)
Management
Leukaemia
Extension of Intraocular Tumour
Extension of Intraocular Tumour
Tumours of Lacrimal Gland
Exophthalmos
Treatment
CHAPTER 16:
STRABISMUS (SQUINT)
ANATOMY OF EXTRAOCULAR MUSCLES AND MOVEMENTS OF EYE (SEE FIGURES 1.1 TO 1.4)
Eye Movements
Normal Eye Movements
Disjunctive Movements
Concomitant Strabismus (Nonparalytic Squint)
Aetiology of Concomitant Strabismus
Sensory Obstacles (Hinder the Formation of Clear Image)
Motor Obstacles (Hinder the Maintenance of Two Eye in Primary Gaze)
Central Obstacles
CONVERGENT SQUINT (ESOTROPIA) (FIGURES 16.1 AND 16.2)
Accommodative Esotropia
DIVERGENT SQUINT (FIGURES 16.3 AND 16.4)
EVALUATION OF A CASE OF STRABISMUS
Treatment
PARALYTIC SQUINT
Trauma
Isolated IIIrd Cranial Nerve or Oculomotor Nerve Palsy (Figure 16.5)
Symptoms
Signs
Isolated 6th Nerve Palsy
Aetiology
Combined III, IV and VI Nerve Palsy Total Ophthalmoplegia
Signs and Symptoms
Aetiology
CHAPTER 17:
EYE INJURIES
SIDEROSIS
Copper
Sympathetic Ophthalmia
Cause
Clinical Features
Management
CHAPTER 18:
PREVENTION OF BLINDNESS
BACKLOG OF CATARACT
World Bank Assisted Cataract Blindness Control Project
Role of Eye Camp in Eradicating Cataract Blindness
District Blindness Control Society
Other Activities Under NPCB
Eye Bank and Eye Donation
Vision Screening in School Children
INDEX
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