Clinical Ophthalmology: A Systematic Approach

942 Pages·2007·629.76 MB·English

by  Jack J. Kanski

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Dedication
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SIXTH EDITION
Clinical Ophthalmology
A SYSTEMATIC APPROACH
Jack J Kanski
MD, MS, FRCS, FRCOphth
Honorary Consultant Ophthalmic Surgeon
Prince Charles Eye Unit
King Edward VII Hospital
Windsor, UK
Artists
Terry RTarrant
Phil Sidaway
ELSEVIER
EDINBURGH lONDON NEWYORK OXFORD PHILADELPHIA ST lOUIS SYDNEYTORONTO 2007
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ELSEVIER \... ,1
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First published 1984
Second edition 1989
Reprinted 199() (twire). 1992. 1993
Third edition 1994
Reprinted 199:;. 19%. 1997. 1998
Fourth edition 1999
Reprinted 2000. 20m
Filth edition 2()()\
Reprinted 20m. 20()6
ISBN-I 3:978-()-08-()44%9-2
ISBN-I():()-08-()44%9-7
British Library Cataloguing in Publication Data
Acatalogue record I<)rthis book isavailable from the British Library.
Library of Congress Cataloging in Publication Data
Acatalog record for this book isavailable from the Library of Congress.
Note
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experience broaden our knowledge. changes inpractice. treatment and drug therapy
may become necessary or appropriate. Readers arc advised tocheck the most current
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P.ublish.er nor the Author assumes any liability forany injury and/or damage to
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Contents
Preface to the Sixth Edition .VIII Evaluation ...........................152
Acknowledgements .ix Acquired obstruction. .......................156
Congenital obstruction .158
Ocular Examination Techniques 1 Lacrimalsurgery. ...........................160
Slit-lampbiomicroscopy of the anterior Chronic canaliculitis .........................162
segment 1 Dacryocystitis. .............................163
Fundus examination ... ........................2
Tonometry 8 6 Orbit .165
Gonioscopy .11 Introduction .165
Psychophysicaltests ..........................15 Thyroid eye disease .170
Electrophysical tests ..........................20 Infections .175
Perimetry .24 Inflammatory disease .177
Vascularmalformations .180
2 Imaging Techniques .33 Cystic lesions .. ............................185
Cornea .. ..................................33 Tumours .............................189
Fundus angiography .35
Ultrasonography. ............................44 7 Dry Eye Disorders .205
Optical coherence tomography. ................47 Definitions .205
Imaginginglaucoma ..........................48 Physiology. ................................205
Neuroimaging ...............................52 Classification. ..............................206
Clinicalfeatures .207
3 Developmental Malformations and Specialinvestigations .208
Anomalies. . . . . .. . .. . . . . . . . . . .. . . .. . . . .59 Treatment. ................................211
Eyelids.....................................60
Craniosynostoses ............................64 8 Conjunctiva .215
Mandibulofacialdysostoses .66 Introduction. ..............................215
Cornea. ...................................67 Bacterial conjunctivitis .219
Lens 70 Viralconjunctivitis .226
Iridocorneal dysgenesis 72 Allergicconjunctivitis. .......................229
Globe 78 Cicatrizing conjunctivitis .235
Retina and choroid. ..........................79 Miscellaneous conjunctivitis. ..................239
Optic nerve .82 Degenerations .242
Vitreous .89 Benignpigmented lesions. ....................245
4 Eyelids .93 9 Cornea .249
Introduction .94 Introduction .250
Benign nodules and cysts. .....................95 Bacterial keratitis .. .........................254
Benign tumours .98 Fungalkeratitis ... ..........................260
Malignant tumours ......................109 Viralkeratitis .262
Disorders of lashes .119 Interstiti keratitis .270
Allergic disorders. ..........................123 Protozoan keratitis. .........................270
Bacterial infections ..........................124 Bacterial hypersensitivity-mediated corneal
Viral infections .126 disease .274
Blepharitis. ................................128 Rosacea keratitis .277
Ptosis .133 Severe peripheral corneal ulceration .277
Ectropion .140 Neurotrophic keratitis. ......................280
Entropion .145 Exposure keratitis .281
Miscellaneous acquired disorders .146 Miscellaneous keratitis. ......................283
Corneal ectasias ............................288
5 lacrimal Drainage System .151 Corneal dystrophies. ........................290
Anatomy. .................................151 Corneal degenerations .303
Physiology .................................151 Metabolic keratopathies ......................308
Causes of awatering eye. ....................152 Contact lenses ... ..........................310
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vi Contents
10 Corneal and Refractive Surgery .313 Uveitis in bowel disease. .....................462
Keratoplasty. ..............................313 Uveitis in renal disease .462
Keratoprostheses ...........................317 Sarcoidosis .462
Refractive surgery .317 Beh~et syndrome ...........................465
Vogt-Koyanagi-Harada syndrome. .............466
11 Episclera and Sclera ....................323 Parasitic uveitis .............................468
Anatomy..................................323 Viral uveitis. ...............................477
Episcleritis.................................324 Fungal uveitis .483
Scleritis ...................................325 Bacterial uveitis .485
Scleraldiscoloration. ........................334 Primary idiopathic inflammatory
choriocapillaropathies (white dot
12 Lens .337 syndromes) ................................492
Introduction .337 Miscellaneous anterior uveitis ............501
Acquired cataract. ..........................337 Miscellaneous posterior uveitis ............504
Management ofage-related cataract ............343
Congenital cataract .361 15 Ocular Tumours and Related Conditions. . .509
Ectopia lentis .367 Benign conjunctival tumours ..................510
Malignant conjunctival tumours ................514
13 Glaucoma .371 Iris tumours .518
Basic sciences. .............................372 Iris cysts .523
Optic nerve head ...........................376 Ciliary body tumours ........................524
Ocular hypertension .380 Tumours of the choroid. .....................527
Primary open-angle glaucoma .382 Tumours of the retina .542
Normal tension glaucoma .380 Tumours of the retinal pigment epithelium. ......557
Primary angle-closure glaucoma .391 Paraneoplastic syndromes .561
Pseudoexfoliation ...........................397
Pigment dispersion ..........................400 16 Retinal Vascular Disease .565
Neovascular glaucoma .......................402 Retinal circulation .566
Inflammatory glaucoma .404 Diabetic retinopathy .566
Lens-related glaucoma .......................408 Retinal venous occlusive disease ...............584
Traumatic glaucoma. ........................411 Retinal arterial occlusive disease. ..............591
Iridocorneal endothelial syndrome 412 Ocular ischaemic syndrome .597
Glaucoma in intraocular tumours ..............414 Hypertensive disease ........................598
Glaucoma in epithelial ingrowth .415 Sickle-cell retinopathy .601
Glaucoma in iridoschisis .415 Retinopathy of prematurity .. .................605
Primary congenital glaucoma. .................417 Retinal artery macroaneurysm .610
Phacomatoses ..............................420 Primary retinal telangiectasis. .................612
Glaucoma medications. ......................421 Eales disease ...............................620
Laser therapy .427 Radiation retinopathy. .......................621
Trabeculectomy .430 Purtscher retinopathy .622
Non-penetrating surgery. ....................437 Benign idiopathic haemorrhagic retinopathy. .....622
Antimetabolites infiltration surgery ............438 Valsalva retinopathy .622
Drainage implants .439 Lipaemia retinalis .622
Takayasu disease. ...........................623
14 Uveitis .441 High-altitude retinopathy. ....................624
Introduction .442 Retinopathy in blood disorders. ...............624
History ...................................443
Specialinvestigations .443 17 Acquired Macular Disorders and Related
Clinicalfeatures .447 Conditions. . . .. . . .. . . .. . . . . .. . . .. . . .. .627
Treatment. ................................451 Introduction .627
Intermediate uveitis ...................456 Age-related macular degeneration .629
Uveitis inspondyloarthropathies ...............459 Polypoidalchoroidal vasculopathy ..............644
Uveitis injuvenilearthritis. ...................459 Age-related macular hole. ....................644
Contents vii
Central serous retinopathy .647 21 Neuro-ophthalmology .785
Cystoid macular oedema. ....................651 Optic nerve disease .........................786
Macular epiretinal membrane .654 Pupillaryreactions .802
Degenerative myopia ... .....................654 Chiasm .807
Angioid streaks. ............................656 Optic tract ..812
Choroidal folds. ............................659 Optic radiations ............................813
Hypotony maculopathy .659 Striate cortex ..............................815
Vitreomacular traction syndrome ..............660 Higher visualfunction .815
Idiopathic choroidal neovascularization .661 Third nerve .816
Solar retinopathy .662 Fourth nerve .820
Sixth nerve ................................822
18 Fundus Dystrophies .663 Supranuclear disorders of ocular motility. .......825
Retinal dystrophies. .........................663 Chronic progressive external ophthalmoplegia .. .827
Vitreoretinopathies .684 Intracranial aneurysms. ......................828
Choroidal dystrophies ..............690 Nystagmus .830
Migraine .833
19 Retinal Detachment. . . . . . .. . . . . . .. . . . . .695 Facialspasm .836
Introduction .695
Pathogenesis of rhegmatogenous retinal 22 Drug-induced disorders ... . . . . .. . .. . . . . .839
detachment. ...............................701 Keratopathy .839
Pathogenesis of tractional retinal detachment ... .708 Cataract .840
Pathogenesis of exudative retinal detachment 710 Uveitis. ...................................841
Diagnosis of rhegmatogenous retinal detachment .710 Retinopathy .841
Diagnosis of tractional retinal detachment. ......712 Optic neuropathy. ..........................845
Diagnosis of exudative retinal detachment. ......714
Differential diagnosis of retinal detachment ......714 23 Trauma .847
Prophylaxis of rhegmatogenous retinal Eyelid trauma .847
detachment. ...............................717 Orbital fractures .848
Surgery of rhegmatogenous retinal Trauma to the globe .852
detachment. ...............................720 Chemical injuries .864
Pars planavitrectomy ........................726
........... ... ........869
24 Systemic diseases
20 Strabismus 735 Connective tissue diseases .870
Introduction .735 Spondyloarthropathies ............ ...........882
Amblyopia. ................................746 Inflammatory bowel disease .884
Clinicalevaluation .746 Non-infectious multisystem diseases. ...........885
Heterophoria and vergence abnormalities .766 Systemic infections and infestations .889
Esotropia .767 Mucutaneous diseases .902
Exotropia 772 Metabolic diseases .907
Specialsyndromes .774 Myopathies. ...............................911
Alphabet patterns .778 Neurology .915
Surgery. ..................................780 Leukaemia. ................................921
Index .923
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Preface to the sixth edition
Four years have elapsed since the publication of the nfth processes and forthe nrst time descriptions of histology have
edition of ClilliCll/Opl1t1w/IIIO/0!l!/. Sincethen many advances been included.
have occurred in the speciality including the discovery of The aim of this book is not to replace the many excellent
new disease processes as well as treatment modalities and encyclopaedic multi-author texts and exhaustive bibliogra-
diagnostic methods. This edition has therefore been phies that are readily available in other publications but to
completely revised and expanded to include much new provide the trainee with asystematic. concisely written. well-
material. The number of illustrations has been considerably illustrated and easily assimilated single-volume text that
increased so that the vast majority of clinical conditions are provides basic knowledge and acts as a stepping-stone from
illustrated. The number of chapters has been increased from which the reader can further expand his knowledge of
20 to 24 with new chapters on examination. imaging opht halmology.
techniques. congenital anomalies and drug-induced conditions. JJK
Emphasis isplaced on understanding pathogenesis of disease Windsor 2007
Acknowledgements
I am greatly indebted to many colleagues and ophthalmic ONCOLOGY
photographic departments forsupplying images forthis book. Bertil Damato, PhD.FRCS.FRCOphth
The source of each image is acknowledged in the legend. I Professor of Ophthalmology. Director Ocular Oncology
would also thank my publishers. Caroline Makepeace in Service. Royal Liverpool University Hospital. Liverpool. UK
particular. for their support and encouragement over the
years. I am very grateful to the following colleagues for
NEUROIMAGING
reviewing the manuscript and providing many helpful
Naomi Sitbain, MRCP,FRCR
suggestions:
Consultant Radiologist. St.Thomas' and King's College
Hospitals. London. UK
PATHOLOGY
john Harry, FRCPath,FRCOphth CATARACT
Honorary Consultant Ophthalmic Pathologist. Academic
Richard Packard, MD.FRCS,FRCOphth
Unit of Ophthalmology. Birmingham and Midland Eye
Consultant Ophthalmic Surgeon. Prince Charles EyeUnit.
Centre. Birmingham. UK
Windsor. UK
ADNEXAL DISEASE
PAEDIATRIC OPHTHALMOLOGY
Andrew Pearson, MRCp,FRCOphth
Ken Nischal, FRCOphth
Consultant Ophthalmic Surgeon. Prince Charles EyeUnit.
Consultant Ophthalmic Surgeon. Creat Ormond Street
Windsor. and Royal Berkshire Hospital. Reading. UK
Hospital forChildren. London. UK
STRABISMUS
NEURO-OPHTHALMOLOGY
john Sloper, D.Phil,FRCS,FRCOphth
Ben Burton, MA.MRCP,FRCOphth
Consultant Ophthalmic Surgeon. Moorl1elds EyeHospital.
Fellow in Neuro-ophthalmology. King's College Hospital.
London. UK
London. UK
Ann Mcintyre, DBO.T,BA(Hens)
REFRACTIVE SURGERY
Former Principal Orthoptist. Moorllelds EyeHospital.
Paul Rosen, FRCOphth
London. UK
Consultant Ophthalmic Surgeon. OxfordEyeHospital.
Oxford.UK
EXTERNAL DISEASE
Stephen Tuft, MA.MChir,MD,FRCOphth
GLAUCOMA
Consultant Ophthalmic Surgeon. Moorllelds EyeHospital.
john Salmon, MD,FRCS,FRCOphth
London. UK
Consultant Ophthalmic Surgeon. Oxford EyeHospital.
Oxford. UK
UVEITIS AND SCLERITIS
Carlos Pavesio, MD,FRCOphth
OVERALL REVIEWER
Consultant Ophthalmic Surgeon. Moorllelds EyeHospital.
Aasheet Desai, DOMS.FRCS(Ed)
London. UK
Ophthalmic Surgeon. Prince Charles EyeUnit. Windsor. UK
RETINAL DISEASE
Vaughan Tanner, BSc,FRCOphth
Consultant Ophthalmic Surgeon. Prince Charles EyeUnit.
Windsor. and Royal Berkshire Hospital. Reading. UK