THE WILLS EYE MANUAL Offi ce and Emergency Room Diagnosis and Treatment of Eye Disease SIXTH EDITION LLWWBBKK11000000--FFMM..iinndddd ii 2233//1122//1111 88::3333 PPMM LLWWBBKK11000000--FFMM..iinndddd iiii 2233//1122//1111 88::3333 PPMM THE WILLS EYE MANUAL Offi ce and Emergency Room Diagnosis and Treatment of Eye Disease SIXTH EDITION EDITORS Adam T. Gerstenblith Michael P. Rabinowitz ASSOCIATE EDITORS Behin I. Barahimi Christopher M. Fecarotta FOUNDING EDITORS Mark A. Friedberg Christopher J. Rapuano LLWWBBKK11000000--FFMM..iinndddd iiiiii 2233//1122//1111 88::3333 PPMM Senior Executive Editor: Jonathan W. Pine, Jr. Senior Product Manager: Emilie Moyer Vendor Manager: Alicia Jackson Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Lisa Lawrence Art Director: Doug Smock Production Services: Aptara, Inc. © 2012 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com Fifth edition, © Lippincott Williams & Wilkins, 2008 Fourth edition, © Lippincott Williams & Wilkins, 2004 Third edition, © Lippincott Williams & Wilkins, 1999 Second edition, © Lippincott Williams & Wilkins, 1994 First edition, © Lippincott-Raven, 1990 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 offi cial duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data available upon request ISBN 13: 978-1-4511-0938-2 ISBN 10: 1-4511-0938-5 Care has been taken to confi rm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omis- sions or for any consequences from application of the information in this book and make no war- ranty, 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 fl ow 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 LLWWBBKK11000000--FFMM..iinndddd iivv 2233//1122//1111 1111::0066 PPMM CONSULTANTS Contributors CONTRIBUTORS TO THE SIXTH EDITION Andrew Lam, M.D. Katherine A. Lane, M.D. Fatima K. Ahmad, M.D. Michael A. Malstrom, M.D. Christopher J. Brady, M.D. Chrishonda C. McCoy, M.D. Meg R. Gerstenblith, M.D. Jesse B. McKey, M.D. Katherine G. Gold, M.D. Maria P. McNeill, M.D. Sebastian B. Heersink, M.D. Joselitio S. Navaleza, M.D. Suzanne K. Jadico, M.D. Avni H. Patel, M.D. Brandon B. Johnson, M.D. Chirag P. Shah, M.D., M.P.H. Jennifer H. Kim, M.D. Heather N. Shelsta, M.D. Amanda E. Matthews, M.D. Bradley T. Smith, M.D. Melissa D. Neuwelt, M.D. Vikas Tewari, M.D. Anne M. Nguyen, M.D. Garth J. Willis, M.D. Linda H. Ohsie, M.D. Allison P. Young, M.D. Kristina Yi-Hwa Pao, M.D. Mindy R. Rabinowitz, M.D. Vikram J. Setlur, M.D. PHOTO CONTRIBUTORS Gary Shienbaum, M.D. Elizabeth L. Affel, M.S., R.D.M.S. Eileen Wang, M.D. Robert S. Bailey, Jr., M.D. Douglas M. Wisner, M.D. William E. Benson, M.D. Jurij R. Bilyk, M.D. Elisabeth J. Cohen, M.D. CONTRIBUTORS TO THE FIFTH EDITION Justis P. Ehlers, M.D. TEXT CONTRIBUTORS Alan R. Forman, M.D. Paul S. Baker, M.D. Scott M. Goldstein, M.D. Shaleen L. Belani, M.D. Kammi B. Gunton, M.D. Shawn Chhabra, M.D. Becky Killian John M. Cropsey, M.D. Donelson R. Manley, M.D. Emily A. DeCarlo, M.D. Julia Monsonego Justis P. Ehlers, M.D. Christopher J. Rapuano, M.D. Gregory L. Fenton, M.D. Peter J. Savino, M.D. David Fintak, M.D. Bruce M. Schnall, M.D. Robert E. Fintelmann, M.D. Robert C. Sergott, M.D. Nicole R. Fram, M.D. Chirag P. Shah, M.D., M.P.H. Susan M. Gordon, M.D. Heather N. Shelsta, M.D. Omesh P. Gupta, M.D., M.B.A. Carol L. Shields, M.D. Eliza N. Hoskins, M.D. Jerry A. Shields, M.D. Dara Khalatbari, M.D. George L. Spaeth, M.D. Bhairavi V. Kharod, M.D. William Tasman, M.D. Matthew R. Kirk, M.D. v LLWWBBKK11000000--FFMM..iinndddd vv 2233//1122//1111 88::3333 PPMM vi CONTRIBUTORS MEDICAL ILLUSTRATOR CONTRIBUTORS TO THE SECOND EDITION Paul Schiffmacher Mark C. Austin, M.D. Jerry R. Blair, M.D. Benjamin Chang, M.D. CONTRIBUTORS TO THE FOURTH EDITION Mary Ellen Cullom, M.D. Seema Aggarwal, M.D. R. Douglas Cullom, Jr., M.D. Edward H. Bedrossian, Jr., M.D. Jack Dugan, M.D. Brian C. Bigler, M.D. Forest J. Ellis, M.D. Vatinee Y. Bunya, M.D. C. Byron Faulkner, M.D. Christine Buono, M.D. Mary Elizabeth Gallivan, M.D. Jacqueline R. Carrasco, M.D. J. William Harbour, M.D. Sandra Y. Cho, M.D. Paul M. Herring, M.D. Carolyn A. Cutney, M.D. Allen C. Ho, M.D. Brian D. Dudenhoefer, M.D. Carol J. Hoffman, M.D. John A. Epstein, M.D. Thomas I. Margolis, M.D. Colleen P. Halfpenny, M.D. Mark L. Mayo, M.D. ThucAnh T. Ho, M.D. Michele A. Miano, M.D. Stephen S. Hwang, M.D. Wynne A. Morley, M.D. Kunal D. Kantikar, M.D. Timothy J. O’Brien, M.D. Derek Y. Kunimoto, M.D. Florentino E. Palmon, M.D. R. Gary Lane, M.D. William B. Phillips, M.D. Henry C. Lee, M.D. Tony Pruthi, M.D. Mimi Liu, M.D. Carl D. Regillo, M.D. Mary S. Makar, M.D. Scott H. Smith, M.D. Anson T. Miedel, M.D. Mark R. Stokes, M.D. Parveen K. Nagra, M.D. Janine G. Tabas, M.D. Michael A. Negrey, M.D. John R. Trible, M.D. Heather A. Nesti, M.D. Christopher Williams, M.D. Vasudha A. Panday, M.D. MEDICAL ILLUSTRATOR Nicholas A. Pefkaros, M.D. Neal H. Atebara, M.D. Robert Sambursky, M.D. Daniel E. Shapiro, M.D. CONTRIBUTORS TO THE FIRST EDITION Derrick W. Shindler, M.D. Melissa M. Brown, M.D. Catharine J. Crockett, M.D. CONTRIBUTORS TO THE THIRD EDITION Bret L. Fisher, M.D. Christine W. Chung, M.D. Patrick M. Flaharty, M.D. Brian P. Connolly, M.D. Mark A. Friedberg, M.D. Vincent A. Deramo, M.D. James T. Handa, M.D. Kammi B. Gunton, M.D. Victor A. Holmes, M.D. Mark R. Miller, M.D. Bruce J. Keyser, M.D. Ralph E. Oursler III, M.D. Ronald L. McKey, M.D. Mark F. Pyfer, M.D. Christopher J. Rapuano, M.D. Douglas J. Rhee, M.D. Paul A. Raskauskas, M.D. Jay C. Rudd, M.D. Eric P. Suan, M.D. Brian M. Sucheski, M.D. MEDICAL ILLUSTRATOR MEDICAL ILLUSTRATOR Marlon Maus, M.D. Marlon Maus, M.D. LLWWBBKK11000000--FFMM..iinndddd vvii 2233//1122//1111 88::3333 PPMM Consultants CONSULTANTS CORNEA Edward H. Bedrossian, Jr., M.D. Joseph C. Flanagan, M.D. MAJOR CONSULTANT Scott M. Goldstein, M.D. Christopher J. Rapuano, M.D. Ann P. Murchison, M.D., M.P.H. CONSULTANTS Brandon D. Ayers, M.D. ONCOLOGY Elisabeth J. Cohen, M.D. Brad H. Feldman, M.D. MAJOR CONSULTANTS Kristin M. Hammersmith, M.D. Carol L. Shields, M.D. Sadeer B. Hannush, M.D. Jerry A. Shields, M.D. Irving M. Raber, M.D. CONSULTANTS GLAUCOMA Sara A. Lally, M.D. Arman Mashayekhi, M.D. MAJOR CONSULTANTS L. Jay Katz, M.D. PEDIATRICS George L. Spaeth, M.D. CONSULTANTS MAJOR CONSULTANT Mary J. Cox, M.D. Alex V. Levin, M.D. Scott J. Fudemberg, M.D. CONSULTANTS Anand V. Mantravadi, M.D. Brian J. Forbes, M.D. Marlene R. Moster, M.D. Kammi B. Gunton, M.D. Jonathan S. Myers, M.D. Sharon S. Lehman, M.D. Tara H. Uhler, M.D. Leonard B. Nelson, M.D. Jonathan H. Salvin, M.D. NEURO-OPHTHALMOLOGY Bruce M. Schnall, M.D. Barry N. Wasserman, M.D. CONSULTANTS Jennifer K. Hall, M.D. RETINA Mark L. Moster, M.D Peter J. Savino, M.D. MAJOR CONSULTANTS Robert C. Sergott, M.D. William E. Benson, M.D. OCULOPLASTICS Sunir J. Garg, M.D. Jason Hsu, M.D. William Tasman, M.D. MAJOR CONSULTANTS Jurij R. Bilyk, M.D. CONSULTANTS Jacqueline R. Carrasco, M.D. Mitchell S. Fineman, M.D. Robert B. Penne, M.D. Omesh P. Gupta, M.D., M.B.A. Mary A. Stefanyszyn, M.D. Julia A. Haller, M.D. vii LLWWBBKK11000000--FFMM..iinndddd vviiii 2233//1122//1111 88::3333 PPMM viii CONSULTANTS Allen C. Ho, M.D. RADIOLOGY Richard S. Kaiser, M.D. Joseph I. Maguire, M.D. CONSULTANT Carl D. Regillo, M.D. Adam E. Flanders, M.D. Marc J. Spirn, M.D. James F. Vander, M.D. VISUAL PHYSIOLOGY INFECTIOUS DISEASE CONSULTANTS Elizabeth L. Affel, M.S., R.D.M.S. CONSULTANT Julia Monsonego, C.R.A. Joseph A. DeSimone, Jr., M.D. FELLOW CONSULTANTS PATHOLOGY F. Char DeCroos, M.D. Darrell E. Baskin, M.D. CONSULTANT Allen Chiang, M.D. Ralph C. Eagle, Jr., M.D. Paul B. Johnson, M.D. Nikolas J.S. London, M.D Rajiv E. Shah, M.D. GENERAL Chirag P. Shah, M.D., M.P.H. Andre J. Witkin, M.D. CONSULTANTS Vladimir S. Yakopson, M.D. Michael A. DellaVecchia, M.D. Alan R. Forman, M.D. MEDICAL ILLUSTRATOR Edward A. Jaeger, M.D. Bruce J. Markovitz, M.D. Paul Schiffmacher LLWWBBKK11000000--FFMM..iinndddd vviiiiii 2233//1122//1111 88::3333 PPMM Foreword Cornea 4 Wills Eye celebrated its 175th anniversary in 2009 and the Retina Service its 50th anniversary in 2010. Hard to believe. Now, in 2012, we are celebrating the sixth edition of The Wills Eye Manual. Con- ceived by Mark Friedberg and Christopher Rapuano when they were residents in 1990, the manual has had a great track record. To date, 150,000 copies have been sold, and it has been translated into ten languages. It is also now helping to disseminate educational infor- mation to physicians in developing countries, especially through the American Academy of Ophthalmology’s Ophthalmic News & Educa- tion (ONE) network. Adam Gerstenblith and Michael Rabinowitz, the editors of the sixth edition, have been extremely effi cient in revising this latest vol- ume. The previous edition, published in 2007, was the fi rst to have illustrations enhancing the descriptions of various conditions, and the new edition includes additional and revised illustrations, where appropriate, as well as the latest information. In the past few years ophthalmology has taken giant steps forward, notably in the man- agement of wet macular degeneration, use of computer chips for reti- nal function, the role of stem cells, and exponential progress in gene identifi cation of disease entities. Although tomorrow’s future will soon be yesterday’s history, we continue to learn more about the original Wills family. Thanks to the National Park Service, the deed to the original Wills house and gro- cery (which was located behind the house) between Second and Third on Chestnut has surfaced. The most interesting fact we learned was that James Sr. and Hannah Wills bought the property from Benjamin Rush, the renowned physician of the day. It was purchased for 700 pounds gold. Rush was a signer of the Declaration of Independence, and because of his fame, President Thomas Jefferson suggested that Meriwether Lewis pay him a visit before Lewis and William Clark left in 1804–1806 to explore the land acquired in the Louisiana Purchase. So, Wills with its colorful history has grown up and continues to thrive. I am confi dent that it will continue to contribute new and exciting advances, some not yet even conceived. William Tasman, M.D. ix LLWWBBKK11000000--FFMM..iinndddd iixx 2233//1122//1111 88::3333 PPMM