Ophthalmology at a Glance Ophthalmology at a Glance Jane Olver BSc(Hons), MB BS, DO, FRCS, FRCOphth Consultant Ophthalmic, Oculoplastic and Orbital Surgeon Western Eye and Charing Cross Hospitals Imperial College Healthcare NHS Trust; Director Clinica London London, UK Lorraine Cassidy MB, DO, FRCSI, FRCOphth Professor of Ophthalmology Trinity College, Dublin; Consultant Ophthalmologist, Neuro-ophthalmologist and Oculoplastic Surgeon The Royal Victoria Eye and Ear Hospital; The Adelaide and Meath Hospital, incorporating the National Childrens’ Hospital Dublin, Ireland Gurjeet Jutley BM, BSc(Hons) Specialist Registrar Moorfields Eye Hospital London, UK Laura Crawley BSc(Hons), MB, ChB(Hons), MRCP, FRCOphth Glaucoma Fellow Imperial College Healthcare NHS Trust London, UK Second Edition This edition first published 2014 © Jane Olver, Lorraine Cassidy, Gurjeet Jutley and Laura Crawley First edition published 2005 by Blackwell Science Ltd Registered Office John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 350 Main Street, Malden, MA 02148-5020, USA 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK For details of our global editorial offices, for customer services, and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. 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Limit of Liability/Disclaimer of Warranty: While the publisher and author(s) have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging-in-Publication Data Olver, Jane, author. Ophthalmology at a glance / Jane Olver, Lorraine Cassidy, Gurjeet Jutley, Laura Crawley.—Second edition. p. ; cm.—(At a glance) Includes bibliographical references and index. ISBN 978-1-4051-8473-1 (paper) I. Cassidy, Lorraine, author. II. Crawley, Laura, active 2014, author. III. Jutley, Gurjeet, author. IV. Title. V. Series: At a glance series (Oxford, England) [DNLM: 1. Eye Diseases–Examination Questions. 2. Ophthalmology–methods–Examination Questions. WW 18.2] RE50 617.7–dc23 2013038050 A catalogue record for this book is available from the British Library. Cover image: Courtesy of Jane Olver, Lorraine Cassidy, Gurjeet Jutley and Laura Crawley Cover design by Meaden Creative Set in 9/11.5 pt Times by Toppan Best-set Premedia Limited 1 2014 Contents Preface to second edition 7 29 Basic orbital assessment 72 Preface to first edition 7 30 Orbit disease, thyroid eye disease and facial palsy 74 Acknowledgements 7 31 Ocular oncology 76 Contributors 8 How to use your textbook 9 Part 9 Sub-specialty—External eye disease About the companion website 13 32 Common conditions affecting the external eye 78 33 Common conditions affecting the cornea 81 Part 1 Principles of ophthalmology 34 Medical uses of contact lenses 84 1 Introduction: what is ophthalmology? 14 2 Medical student aims 16 Part 10 Sub-specialty—Corneal, refractive and  3 Social and occupational aspects of vision 18 cataract surgery 35 Corneal and laser refractive surgery 86 Part 2 Ophthalmic history and examination 36 Cataract assessment 89 4 Taking the history and recording the findings 20 37 Cataract surgery 92 5 Visual acuity in adults 22 38 Cataract surgery postoperative care 94 6 Examination of visual fields 24 7 Other visual functions 26 Part 11 Sub-specialty—Glaucoma 39 Glaucoma: the basics 96 Part 3 Correction of refractive errors 40 Detecting glaucoma 98 8 Basic optics and refraction 28 41 Medical and surgical treatment of glaucoma 100 9 Glasses, contact lenses and low-vision aids 30 Part 12 Sub-specialty—Vitreo-retinal Part 4 Basic eye examination 42 Retinal detachment 102 10 External eye and anterior segment 32 43 Retinal and choroidal anatomy and imaging 104 11 Posterior segment and retina 34 44 Inherited retinal disorders and age-related macular 12 Use of eye drops 36 degeneration 106 45 Diabetic retinopathy classification and typical lesions 108 Part 5 Acute ophthalmology 46 Diabetic retinopathy treatment 110 13 Red eye: the conjunctiva 38 47 Retinal artery obstruction 112 14 Red eye: the cornea 40 48 Retinal vein occlusion 114 15 Red eye: the sclera and episclera 42 49 HIV infection and AIDS 117 16 Ophthalmic trauma principles and management of chemical 50 Tropical ophthalmology: tropical eye disease 120 injuries 44 51 Tropical ophthalmology: global eye health 122 17 Specific features of blunt and sharp injuries 46 18 Loss of vision in the inflamed eye 48 Part 13 Sub-specialty—Neuro-ophthalmology 19 Sudden painful loss of vision in a non-inflamed eye 50 52 Pupil abnormalities 124 20 Sudden painless loss of vision 52 53 Optic nerve disease 126 54 Cranial nerve palsies and eye movement disorders 128 Part 6 Gradual loss of vision 55 Visual field defects 130 21 Gradual loss of vision 55 56 Giant cell arteritis 132 Part 7 Sub-specialty—Paediatric ophthalmology Appendix 1: Red eye—signs and symptoms of different 22 Visual acuity in children 58 causes 134 23 Strabismus (squints) 60 Appendix 2: The layers of the retina 135 24 Neonates 62 Appendix 3: Pharmacological intraocular pressure (IOP)- 25 Infants and older children 64 lowering agents—mechanism of action and side effects 136 Appendix 4: Optical coherence tomography (OCT) Part 8 Sub-specialty—Eyelid, lacrimation and orbit reports 137 26 Common eyelid lumps 66 Appendix 5: Important clinical trials in AMD 138 27 Common eyelid malpositions 68 28 Lacrimation (tearing) 70 Index 139 Contents  5 Preface to the second edition Ophthalmology at a Glance is aimed at the medical student, special- edition has been expanded to include chapters on tropical ophthalmol- ist trainee or general practitioner. It is a great pleasure to write the ogy by Sophia Pathai. second edition of Ophthalmology at a Glance and introduce the We have also introduced a new chapter dedicated to ocular oncology reader to the many advances that have occurred in ophthalmology by Mandeep Sagoo and Karim Hammamji, an area that medical stu- since 2004, not least with the training syllabus, corneal refractive dents, newly-trained doctors and GPs should be aware of. It is exciting surgery and cataract surgery, and in the treatment of medical retinal in this second edition to have two new co-authors: Gurjeet Jutley, disorders. We hope that you find all of these advances reflected in Specialist Trainee, and Laura Crawley, Glaucoma Fellow, who have this new edition. both worked extremely hard to update many of the chapters, provide We aim to provide the fundamentals of ophthalmology, starting with new images and write the case studies for the website. the basics of how to take a history, how to correct refractive errors, We hope that the reader will find this book helpful for their studies, do the eye examination, the management of acute eye problems, and when seeing patients in clinic and to help increase their interest in causes of gradual loss of vision in Parts 1 to 5. We will then discuss ophthalmology. the areas of the eye and visual disturbance in more detail in the latter parts 6–13. The largest subspecialty part is vitreo-retinal, which in this Jane Olver, London 2014 Preface to first edition This book is intended primarily for medical students and junior doctors of Ophthalmology. Slowly, we gathered together a team of colleagues preparing for examinations (regardless of whether they are medical or and friends who over 2–3 years all pulled together—were cajoled?— surgical). In addition, we hope that general practitioners and non- into writing this book. As editors, we have knitted together our own ophthalmic consultants who care for patients with eye diseases will and their contributing work. We are incredibly grateful to everyone find this book invaluable in its simplicity and clarity. We have tried to who made this book a reality. create a balanced, up-to-date, practical book. Blackwell’s have sup- ported our need for the extensive colour pictures and diagrams which Jane Olver and Lorraine Cassidy characterize this ‘visual’ subject. London and Dublin, 2004 Ophthalmology at a Glance took form in London around the time that Lorraine Cassidy was about to go to Dublin to become Professor Acknowledgements Thanks to Ingrid Hurtado, the Clinica London Nurse, for taking A special thank you to Mr Nigel Davies, Consultant Ophthalmic many of the pictures for this second edition (with the three Surgeon Chelsea and Westminster Hospital, and Michel Michaelides, authors) at Clinica London on 1 September 2012. We also acknowl- Consultant Ophthalmologist and Clinica Senior Lecturer, Moorfields edge Susan Downes for her contributory photos in Chapters 45 Eye Hospital and UCL Institute of Ophthalmology, for editing the and 46. Medical Retina chapters. Preface to the second edition  7 Contributors Contributors to the second edition Sanjay Gautama, MB, BS Karim Hammamji, MD, FRCSC, DipABO Consultant Anaesthetist Fellow in Ocular Oncology St Mary’s Hospital NHS Trust Moorfields Eye Hospital and St. Bartholomew’s Hospital London, UK London, UK Anthony Kwan Sophia Pathai, MBBS, BSc(Hons), MRCOphth, MSc, PhD Vitreoretinal Fellow Clinical Research Fellow Moorfields Eye Hospital International Centre for Eye Health London, UK London School of Hygiene & Tropical Medicine London, UK Jane Leach, FRCOphth Consultant Ophthalmologist Mandeep S. Sagoo, MB, PhD, MRCOphth, FRCS(Ed) The Royal Victoria Eye & Ear Hospital Senior Lecturer and Consultant Ophthalmic Surgeon Dublin, Ireland UCL Institute of Ophthalmology, Moorfields Eye Hospital and St. Bartholomew’s and the Royal London Hospitals Damien Louis London, UK Staff Ophthalmologist Melbourne, Australia With thanks Nigel Davies, MA, MB, BS, PhD, FRCOphth Raj Maini, FRCOphth Consultant Ophthalmic Surgeon Consultant Ophthalmologist Chelsea and Westminster Hospital Department of Ophthalmology London, UK Charing Cross Hospital London, UK Michel Michaelides, BSc, MB, BS, MD(Res), FRCOphth, FACS Consultant Ophthalmic Surgeon Raman Malhotra, FRCOphth Moorfields Eye Hospital; Consultant Ophthalmic Surgeon Clinical Senior Lecturer Corneoplastic Unit UCL Institute of Ophthalmology Queen Victoria Hospital London, UK East Grinstead, Sussex, UK Bernadette McCarry, DBO Contributors to the first edition Teaching Orthoptist Jonathan Barnes, BSc, FRCOphth Moorfields Eye Hospital Consultant Ophthalmic Surgeon London, UK Luton and Dunstable Hospital Lewsey Road Suzanne Mitchell, FRCOphth Luton, UK Consultant Ophthalmic Surgeon Chelsea and Westminster Hospital Anne Bolton London, UK Head of Ophthalmic Imaging Oxford Eye Hospital Jugnoo Rahi Woodstock Road The Royal Victoria Eye and Ear Hospital Oxford, UK Dublin, Ireland Susan Downes, MD, FRCOphth Dilani Siriwardena, FRCOphth Consultant Ophthalmic Surgeon Consultant Ophthalmic Surgeon Oxford Eye Hospital Moorfields Eye Hospital Woodstock Road London, UK Oxford, UK Ursula Vogt, MD Veronica Ferguson, FRCS, FRCOphth Director Consultant Ophthalmic Surgeon Contact Lens Department Charing Cross Hospital Western Eye Hospital London, UK London, UK 8  Contributors