(c) 2015 Wolters Kluwer. All Rights Reserved. Harley’s Pediatric Ophthalmology Sixth Edition (c) 2015 Wolters Kluwer. All Rights Reserved. 72836_fm_pi-xi.indd i 28/06/13 12:50 PM iii Harley’s Pediatric Ophthalmology Sixth Edition Editors Leonard B. Nelson, MD, MBA Director, The Wills Eye Strabismus Center Co-Director, Department of Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital Associate Professor of Ophthalmology and Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania Scott E. Olitsky, MD Professor of Ophthalmology Children’s Mercy Hospitals and Clinics University of Missouri - Kansas City School of Medicine Kansas City, Missouri (c) 2015 Wolters Kluwer. All Rights Reserved. 72836_fm_pi-xi.indd iii 28/06/13 12:50 PM Acquisition Editor: Ryan Shaw Product Manager: Kate Marshall Vendor Manager: Alicia Jackson Senior Manufacturing Coordinator: Beth Welsh Marketing Manager: Alexander Burns Designer: Joan Wendt Production Service: Integra Software Services Pvt. Ltd. © 2014 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com Fifth Edition © 2005 by Lippincott Williams & Wilkins Fourth Edition © 1998 by W.B. Saunders Third Edition © 1991 by W.B. Saunders Second Edition © 1983 by W.B. Saunders First Edition © 1975 by W.B. Saunders All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Harley’s pediatric ophthalmology. -- Sixth edition / editors, Leonard B. Nelson, Scott E. Olitsky. p. ; cm. Pediatric ophthalmology Preceded by Harley’s pediatric ophthalmology / editors, Leonard B. Nelson, Scott E. Olitsky. 5th ed. c2005. Includes bibliographical references and index. ISBN 978-1-4511-7283-6 I. Nelson, Leonard B., editor of compilation. II. Olitsky, Scott E., editor of compilation. III. Title: Pediatric ophthalmology. [DNLM: 1. Eye Diseases. 2. Child. 3. Infant. WW 600] RE48.2.C5 618.92'0977--dc23 2013020629 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health-care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10 9 8 7 6 5 4 3 2 1 (c) 2015 Wolters Kluwer. All Rights Reserved. 72836_fm_pi-xi.indd iv 28/06/13 12:50 PM This book is dedicated to our wives, Helene and Andrea, for their unending understanding patience, support, and love in pursuit of our academic endeavors. This book is also dedicated to the memory of Robison D. Harley, MD, who we will forever owe a debt of profound gratitude for his leadership and mentorship, and for giving us the opportunity to continue to provide the pediatric ophthalmology community an outstanding treatise in the specialty. (c) 2015 Wolters Kluwer. All Rights Reserved. 72836_fm_pi-xi.indd v 28/06/13 12:50 PM Contributors Nagham Al-Zubidi, MD David K. Coats, MD Andrew G. Lee, MD Neuro-Ophthalmology Fellow Associate Professor of Ophthalmology and Professor of Ophthalmology, Neurology, Department of Ophthalmology Pediatrics and Neurosurgery The Methodist Hospital Baylor College of Medicine Department of Ophthalmology Department of Ophthalmology Texas Children’s Hospital Weill Cornell Medical College Well Cornel Medical College Houston, Texas Chair Houston, Texas Department of Ophthalmology Forrest J. Ellis, MD The Methodist Hospital J. Bronwyn Bateman Assistant Professor of Pediatrics and Houston, Texas Clinical Professor of Ophthalmology Ophthalmology David Geffen School of Medicine Case Western Reserve University Alex V. Levin, MD, MHSc University of California School of Medicine Pediatric Ophthalmology and Ocular Los Angeles, California Co-Director of Pediatric Ophthalmology Genetics and Strabismus Wills Eye Institute William E. Benson, MD Rainbow Babies and Children’s Hospital Thomas Jefferson University Professor of Ophthalmology Consultant for Ophthalmic Plastic and Philadelphia, Pennsylvania Jefferson Medical College Orbital Surgery Thomas Jefferson University University Hospitals of Cleveland Timothy P. Lindquist, MD Attending Surgeon Cleveland, Ohio Department of Ophthalmology Wills Eye Hospital University of Kansas Medicine Philadelphia, Pennsylvania Sharon F. Freedman, MD Children’s Mercy Hospitals and Clinics Professor of Ophthalmology Kansas City, Missouri Gary C. Brown, MD, MBA Professor of Pediatrics Professor of Ophthalmology Duke Eye Center Grace T. Liu, MD Jefferson Medical College Durham, North Carolina Pediatric Ophthalmic Consultants Thomas Jefferson University Department of Pediatric Ophthalmology Director of Retina Service Nandini G. Gandhi, MD New York University Wills Eye Hospital Assistant Professor of Ophthalmology New York, New York Co-Director of Center for Value-Based University of California Medicine Davis, Sacramento, California David B. Lyon, MD, FACS Adjunct Senior Fellow Associate Professor Leonard Davis Institute of Health Kammi B. Gunton, MD Department of Ophthalmology Economics Assistant Surgeon of Pediatric Ophthalmology Eye Foundation of Kansas City Philadelphia, Pennsylvania Wills Eye Hospital Vision Research Center, University Philadelphia, Pennsylvania of Missouri-Kansas City School of Melissa M. Brown, MD, MN, MBA Medicine Adjunct Professor of Ophthalmology Denise Hug, MD Kansas City, Missouri University of Pennsylvania Assistant Professor of Ophthalmology Director of Center for Value-Based University of Missouri Leonard B. Nelson, MD Medicine Children’s Mercy Hospitals and Clinics Director Adjunct Senior Fellow Kansas City, Missouri The Wills Eye Strabismus Center Leonard Davis Institute of Health Co-Director Economics Leila M. Khazaeni, MD Department of Pediatric Philadelphia, Pennsylvania Department of Ophthalmology Ophthalmology and Ocular Loma Linda University Health Genetics Robert A. Catalano, MD, MBA Loma Linda, California Wills Eye Hospital Associate Professor of Ophthalmology Associate Professor of Ophthalmology and Albany Medical College Laura Kirkeby, CO Pediatrics Medical Director of Albany Medical Orthoptist Jefferson Medical College Center Hospital Scripps Clinic Thomas Jefferson University Albany, New York San Diego, California Philadelphia, Pennsylvania vi (c) 2015 Wolters Kluwer. All Rights Reserved. 72836_fm_pi-xi.indd vi 28/06/13 12:50 PM CONTRIBUTORS vii Scott E. Olitsky, MD James D. Reynolds, MD William Tasman, MD Professor of Ophthalmology Professor and Chairman of Ophthalmology Professor and Chairman of Ophthalmology Children’s Mercy Hospitals and University at Buffalo School of Medicine Thomas Jefferson Medical College Clinics Department of Ophthalmology Ophthalmologist-in-Chief University of Missouri - Kansas City Ross Eye Institute Wills Eye Hospital School of Medicine Buffalo, New York Philadelphia, Pennsylvania Kansas City, Missouri Donald P. Sauberan, MD James F. Vander, MD Eye Surgical Associates Clinical Professor of Ophthalmology Gregory Ostrow, MD Lincoln, Nebraska Jefferson Medical College Director Thomas Jefferson University Pediatric Ophthalmology and Adult Bruce M. Schnall, MD Attending Surgeon for Retina Service Strabismus Associate Surgeon- Pediatric Ophthalmology Wills Eye Hospital Scripps Clinic Wills Eye Institute Philadelphia, Pennsylvania San Diego, California Philadelphia, Pennsylvania Rudolph S. Wagner, MD Evelyn A. Paysse, MD Carol L. Shields, MD Clinical Professor of Ophthalmology Professor of Ophthalmology and Associate Director University of Medicine and Dentistry Pediatrics Ocular Oncology Service of New Jersey Baylor College of Medicine Wills Eye Hospital Director of Pediatric Ophthalmology Physician Professor of Ophthalmology Institute of Ophthalmology and Visual Pediatric Ophthalmology Jefferson Medical College Science Texas Children’s Hospital Thomas Jefferson University University Hospital Houston, Texas Consultant Newark, New Jersey Ocular Oncology Christopher J. Rapuano, MD Children’s Hospital of Philadelphia Eric D. Weichel, MD Professor of Ophthalmology Philadelphia, Pennsylvania Director of Vitreoretinal Surgery Jefferson Medical College Department of Ophthalmology Jerry A. Shields, MD Thomas Jefferson University Walter Reed Army Medical Center Director Director and Attending Surgeon Washington, District of Columbia Ocular Oncology Service Cornea Service Wills Eye Hospital Avery H. Weiss, MD Co-Director Refractive Surgery Department Professor of Ophthalmology Associate Professor of Ophthalmology Wills Eye Institute Jefferson Medical College Affi liate Professor of Pediatrics Philadelphia, Pennsylvania Thomas Jefferson University University of Washington School of Consultant in Ocular Oncology Medicine Children’s Hospital of Philadelphia Chief of Division of Ophthalmology Jagadesh C. Reddy, MD Philadelphia, Pennsylvania Children’s Hospital and Regional Consultant Medical Center Cornea, Anterior and Refractive Arielle Spitze, MD Seattle, Washington Surgery Services Department of Ophthalmology LV Prasad Eye Institute The Methodist Hospital Sushma Yalamanchili, MD Hyderabad, India Houston, Texas Department of Ophthalmology The Methodist Hospital Michael X. Repka, MD, MBA Mitchell B. Strominger, MD Houston, Texas Professor of Ophthalmology and Associate Professor of Ophthalmology Pediatrics and Pediatrics Terri L. Young, MD Wilmer Eye Institute Tufts University School of Medicine Professor of Ophthalmology, Johns Hopkins University School of Chief of Pediatric Ophthalmology and Pediatrics, and Medicine Medicine Ocular Motility Service Duke Center for Human Genetics Johns Hopkins Hospital Floating Hospital for Children Duke University Medical Center Baltimore, Maryland Boston, Massachusetts Durham, North Carolina (c) 2015 Wolters Kluwer. All Rights Reserved. 72836_fm_pi-xi.indd vii 28/06/13 12:50 PM Foreword HARLEY’S PEDIATRIC OPHTHALMOLOGY is an essential Dr Harley was the consummate clinician and teacher. All resource for all pediatric caregivers to provide them with a com- of us privileged to learn from him and to contribute to this prehensive source of information about children’s eye problems textbook have felt the responsibility to meet his expectations to enable understanding and excellent clinical care. When first for excellence and his desire to give back in a meaningful published 38 years ago, it filled a void that was recognized by way to our colleagues and to our patients. Dr Harley and Dr Marshall Parks and immediately it became I was asked recently how I became an ophthalmologist. the Bible for their disciples and many trainees who followed It is of importance to me to acknowledge that I am indebted these visionary physicians. Writing in the second edition Mar- completely to Dr Harley for the opportunity and a lifetime shall Parks noted, “Robison Harley has made his mark in medi- of professional and personal fulfillment. I was led by his cine through this monumental work, and for this we pediatric humanity, love of life, beautiful surgery, humility, tolerance ophthalmologists are eternally grateful.” Dr Harley recognized of others less skilled than himself, and constant giving to the rapid development of new information and procedures in others. This treasured textbook, Pediatric Ophthalmology, has pediatric ophthalmology and encouraged frequent updating been preserved and rewritten by its very capable and expe- of his original classic textbook. He encouraged frequent revi- rienced editors Dr Nelson and Dr Olitsky and their carefully sions and would be so delighted with this sixth edition with all selected contributors. Dr Harley gathered and inspired us its new information and informative illustrations which are so to fulfill his uncompromising expectations for his Pediatric well presented. He recognized the importance of specialization Ophthalmology and we are collectively rewarded by this within pediatric ophthalmology and encouraged contributions unique and unrivaled resource to assist all who care for the from many to his book. In the Foreword of the fifth edition, he health of children’s eyes. expressed gratitude “for the expertise of the contributors, the I am personally very grateful for their work which has editors, and the publisher for bringing this splendid volume to made this updated and expanded sixth edition a reality, and our profession…” which honors Dr Harley and gives back for him a work that Dr Robison D. Harley died 6 years ago. When I last vis- I know he would appreciate most in return for his lifetime ited with him shortly before his passing, we discussed cases of mentoring and gifts to each of us. and this textbook, the goals for which he was passionate. David S. Walton, MD viii (c) 2015 Wolters Kluwer. All Rights Reserved. 72836_fm_pi-xi.indd viii 28/06/13 12:50 PM Preface THE SIXTH EDITION of Harley’s Pediatric Ophthalmology contributors include a number of outstanding Wills faculty, brings a number of changes to the textbook which has served previous fellows, and residents. In particular, the Pediatric as a benchmark in the subject for more than three decades. Ophthalmology and Ocular Genetics Department at Wills, Since the publication of the first edition, edited by the late which cares for thousands of children each year, provides a Dr Robison D. Harley in 1975, the field of pediatrics oph- rare opportunity for the study of an extremely wide variety thalmology and strabismus has changed markedly. Initially of pediatric ocular disorders. regarded as an unnecessary subspecialty within the field of We thank all of our contributing authors for their ophthalmology, pediatric ophthalmology eventually gained knowledge and assistance in the preparation of this book. acceptance as a fundamental component of the field due to In addition, we are grateful to the publishers at Lippincott the efforts of early visionaries such as Dr Parks, Dr Costen- Williams & Wilkins who are participating in the fifth decade bader, and Dr Harley. Today, it is regarded as an essential of a tradition begun by Dr Harley. This textbook, which was and vital part of both clinical and academic ophthalmology. one of the first extensive books in pediatric ophthalmology, The latest edition reflects our desire to create the best would not have been possible if it was not for the efforts of educational and teaching treatise in pediatric ophthalmol- Dr Harley, who passed away shortly after the last edition was ogy. With that in mind, the chapters are revised, several pre- published. His insight in the ocular problems that occur in vious chapters were eliminated, and all figures are in color. children as well as his unique ability to teach those insights New contributors represent some of the recent leaders in to others have benefitted generations of ophthalmologists as the field and symbolize a “passing of the torch” from one well as the patients we treat. generation of pediatric ophthalmologists to another. Since the first edition, Wills, a rich storehouse of clinical material, Leonard B. Nelson, MD, MBA has provided a major background for this book. Many of the Scott E. Olitsky, MD ix (c) 2015 Wolters Kluwer. All Rights Reserved. 72836_fm_pi-xi.indd ix 28/06/13 12:50 PM