Series Editors Ashok Garg MS PhD FIAO (Bel) FRSM FAIMS ADM FICA
International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre 235-Model Town, Dabra Chowk Hisar-125 005 (India)
Emanuel Rosen MD
Medical Director Rosen Eye Associates Harbour City, Salford Quays M50 3 BH UK
Editors Arturo Perez Arteaga MD
Medical Director Centro Oftalmologico Tlalnepantla Dr Perez-Arteaga Vallarta No. 42 Tlalnepantla, Centro Estado de Mexico 54000, Mexico
Ashok Sharma MD
Medical Director Dr Ashok Sharma's Corneal Centre, SCO 833-834 (2nd floor) Sector 22-A Chandigarh, India
Foreword Boris Malyugin
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Instant Clinical Diagnosis in Ophthalmology (Anterior Segment Diseases)
© 2009, Editors
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2009
9788184484847
Typeset at JPBMP typesetting unit
Printed at Ajanta Press
4Dedicated to
– My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his Blessings and Motivation
– My Respected Parents, Teachers, My Wife Dr Aruna Garg, Son Abhishek and Daughter Anshul for their Constant Support and Patience during all these days of Hard Work
– My Dear Friend Dr Amar Agarwal, a Renowned International Ophthalmologist for his Constant Support, Guidance and Expertise
— Ashok Garg
The Memory of My Step Daughter Nicola Ross Who Enjoyed Benefits from Refractive Surgery was Cut Short by a Tragic Fatal Illness
— Emanuel Rosen
I dedicate my work to all the people in the world with ophthalmic diseases, with the best wish that we can improve with this kind of material our quality of care. I also dedicate this opus to Prof Ashok Garg, because he has trusted in my work many times
— Arturo Perez Arteaga
I thank my wife Sushma, my sons Rajan and Raghav who graciously allowed me to contribute to this project
— Ashok Sharma
5Contributors
- Abhiyan Kumar md
- Consultant, Refractive Surgery
- Dr. Pattnaik' Laser Eye Institute
- New Delhi
- India
- Anita Panda md
- Professor and Head
- Department of Cornea Services
- Dr RP Centre for Ophthalmic Sciences
- AIIMS
- Ansari Nagar
- New Delhi 110 029
- India
- Arif Adenwala ms dnb frcs ico
- Consultant Ophthalmologist
- P. Box No. 457
- Zulekha Hospital
- Sharjah (UAE)
- Arturo Perez Arteaga md
- Medical Director
- Centro Oftalmologico Tlalnepantla
- Dr Perez-Arteaga Vallarta No. 42
- Tlalnepantla, Centro
- Estado de Mexico
- 54000, Mexico
- Ashok Garg ms phd frsm
- Chairman and Medical Director
- Garg Eye Institute and Research Centre
- 235-Model Town
- Dabra Chowk
- Hisar 125 005
- India
- Ashok Sharma md
- Director
- Dr Ashok Sharma' Corneal Centre
- SCO 833-834 (2nd Floor)
- Sector 22-A
- Chandigarh 160 022
- India
- Belquiz A Nassaralla md phd
- Goiania Eye Institute
- Department of Cornea and Refractive
- Surgery, Goiania
- GO
- Brazil
- David Meyer mb chb mmed FCoph
- Professor and Head
- Department of Ophthalmology
- Faculty of Health Sciences
- University of Stellenbosch
- South Africa
- Earl R Crouch md
- Eastern Virginia Medical School
- 880, Kemphsville Road
- Suite 2500, Norflock, Virginia 23502
- USA
- Eric Crouch md
- Assistant Professor of Pediatric
- Ophthalmology
- Eastern Virginia Medical School
- 880, Kemphsville Road
- Suite 2500, Norflock
- Virginia 23502
- USA
- Eric D Donnenfeld md facs
- Ophthalmic Consultants of Long Island
- Suit 402
- 2000 North Village Ave
- Rockville Centre
- NY 11570
- USA
- Emanuel Rosen md
- Medical Director
- Rosen Eye Associates
- Harbour City
- Salford Quays
- M50 − 3 BH
- Flavio A Marigo md
- Consultant Ophthalmologist
- New York Ophthalmic Oncology
- Centre, 5th Floor, 115-East, 61st Street
- New York, NY
- USA
- Geeta Behera md
- Department of Cornea Services
- Dr RP Centre for Ophthalmic Sciences
- AIIMS
- Ansari Nagar
- New Delhi 110 029
- India
- Hala M Elhilaly md
- Profesor of Ophthalmology
- Department of Ophthalmology
- Cairo University, Cairo
- Egypt
- Henry D Perry md facs
- Chief of Corneal Services
- Nassau University Medical Center
- East Meadow, New York
- 2000 North Village Ave
- Rockville Centre
- NY 11570
- USA
- Hoda M Mostafa md
- Lecturer of Ophthalmology
- Department of Ophthalmology
- Cairo University
- Cairo
- Egypt
- Joao J Nassaralla md phd
- Rua L n° 53 # 12° andar, Setro Oeste
- Goiania, Goias
- Brazil, ZC : 74.120-050
- John D Sheppard md mmsc
- Associate Professor of Ophthalmology
- Microbiology and Immunology
- Clinical Director, Thomas R Lee
- Centre for Ocular Pharmacology
- Eastern Virginia Medical School
- Norfolk, Virginia 23501
- USA
- Mahesh Dalvi ms
- Consultant
- Pediatric Ophthalmology
- Tejomay Eye Hospital
- Kohlapur
- Maharashtra
- India
- Paul T Finger md
- Consultant Ophthalmologist
- New York Ophthalmic Oncology
- Centre, 5th Floor, 115-East, 61st Street
- New York-NY
- USA
- Rania EI Essawy md
- Department of Ophthalmology
- Cairo University
- Cairo
- Egypt
- Sandeep Kumar md
- Associate Professor
- Subharati Medical College, Meerut
- India
- Shibal Bhartiya md
- Pool Officer
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, Ansari Nagar
- New Delhi 110 029
- India
Nowadays we face the dramatic changes in many diagnostic and treatment modalities of the eye anterior segment diseases. New technologies utilizing high frequency ultrasound, wave front analysis, optical coherence tomography and other sophisticated equipment became routine and indispensable tools.
But their availability has not eliminated the need of classical principles of diagnostics and management of ocular pathology and even underscored the role of physician in establishing the correct diagnosis. In many cases the latter can save precious time and allows prescribing the correct and timely treatment.
This book is new, comprehensive and clinically relevant with in-depth focus on anterior segment diseases. Among the latter the authors concentrated on the vital areas of the eye surface abnormalities including pathology of tear film, diseases of conjunctiva, eyelids, cornea and sclera, developmental abnormalities and tumors.
The majority of the book chapters follow the template including: introduction; clinical signs and symptoms; investigations; differential diagnosis; general principles of treatment and prognosis.
This advanced book has a primary goal on presenting the updated guidelines that I consider extremely valuable for the ophthalmologists.
In realization of this ambitious project the works of the editors Dr A Garg and Dr E Rosen and Section Authors have been essential in achieving the goal for it, namely “establishing the instant and correct clinical diagnosis”.
Boris Malyugin
md phd
Department of Cataract and Implant Surgery, Chief
Deputy Director General
S. Fyodorov Eye Microsurgery Complex State Institution
127486, Beskudnikovsky blvd 59 A
Moscow, Russia.
Tel: +7 (495) 488-8511
Tel/Fax: +7 (495) 905-8051
E-mail: boris.malyugin@gmail.com
8Preface
The modern day busy and fast life ophthalmologists are glued to their clinical and surgical practice and have little time to read large volume books. The need of hour is to have pocket size ready recokner enriched with complete and up-to-date information of the diseases in a most comprehensive manner. At present very few Quality Ready Reference books are available at an International level.
After detail research and need of ophthalmologists we have developed a series of 10 Volume Ready Reference Books termed as Instant Clinical Diagnosis in Ophthalmology. This series covers Oculoplastic and Reconstructive Surgery, Retina, Lens, Glaucoma, Refractive Surgery, Pediatric Ophthalmology, Strabismus, Anterior Segment Diseases, Cornea and Neuro-ophthalmology. Present series has been designed to provide up-to-date information of concerned disease in a comprehensive and a lucid manner along with high quality clinical photographs in an easy to read format. International Masters of concerned subject have contributed chapters in this series covering pathophysiology, clinical signs and symptoms, investigations, differential diagnosis, treatment and prognosis in a simplified manner.
Present volume deals with all types of anterior segment diseases specially congenital and developmental anomalies, tear film disorders specially dry eye, various conjunctival and corneal diseases (infectious, inflammatory, neoplastic, degenerative and trauma), sclera and episclera, iris and ciliary body and finally keratoplasty in a comprehensive manner. Anterior segment diseases are clinically very significant specially corneal diseases which are one of the major causes of irreversible blindness worldwide. Proper and intime diagnosis of corneal diseases is very crucial. This volume shall help the ophthalmologists achieve this goal.
We are highly thankful to our publisher M/s Jaypee Brothers Medical Publishers Pvt. Ltd. specially Sh. Jitendar P Vij (CEO), Mr. Tarun Duneja (Director, Publishing) and all staff members for their dedication and hard efforts put in the preparation of High Quality Series of Instant Clinical Books.
We hope this 10 volume set of ready reference pocket size books shall provide complete and useful clinical information to ophthalmologists all around the world and shall help them accurately and precisely diagnose, treat and manage their clinical case confidently to the satisfaction and expectations of their valued patients. We also hope this ready reckoner shall serve as useful companion on to every clinician desk.
Editors