Table Of ContentOphthalmology
THIRD EDITION
AN ILLUSTRATED COLOUR TEXT
Commissioning Editor: Timothy Horne
Project Editor: Siân Jarman
Project Manager: Alan Nicholson
Design Direction: Kirsteen Wright
Illustration Manager: Bruce Hogarth
Ophthalmology
THIRD EDITION
AN ILLUSTRATED COLOUR TEXT
MARK BATTERBURY
BSc FRCS (Glasg) FRCOphth
Consultant Ophthalmologist, St Paul’s Eye Unit
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Director of Clinical Studies and Honorary Lecturer
Departments of Medicine and Orthoptics
University of Liverpool, Liverpool, UK
BRAD BOWLING
FRCSEd(Ophth) FRCOphth
Consultant Ophthalmic Surgeon
Buckinghamshire Hospitals NHS Trust
Buckinghamshire, UK
CONOR MURPHY
MMedSc FRCOphth PhD
Professor of Ophthalmology
and Consultant Ophthalmic Surgeon
Royal College of Surgeons in Ireland
and Royal Victoria Eye and Ear Hospital
Dublin, Ireland
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2009
iv
First Edition © Harcourt Publishers Limited 1999
Second Edition © Elsevier Limited 2005
Third Edition © 2009 Elsevier Limited. All rights reserved.
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ISBN 978-0-7020-3059-8
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Note
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Printed in China
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Preface to first edition
This introductory text to ophthalmology anatomically-ordered approach. The preceding sections or as a practical
repeats the approach of others in the third section deals with a collection guide in a clinical setting.
Illustrated Colour Text series. Double-page of special topics, some disease related, This book is aimed primarily at
spreads combining simple-to-read text, others covering clinical management. the medical student, but we believe
colour illustrations, tables and ‘key point’ The final section, presented in an it will also be useful to orthoptic and
summaries are used to present each topic innovative format is concerned optometric students and professionals,
as a self-contained educational unit. with decision-making in the clinical to general practitioners and other non-
The contents are divided into four situation. The reader is presented with ophthalmic medical practitioners and
sections. The first contains essential scenarios corresponding to the chief to nurses.
anatomy and physiology, including a clinical problems in ophthalmology.
novel presentation of the mechanism Each scenario can be followed through
of human sight together with an a number of diagnostic paths via 1999 M.B.
introduction to disease processes and a series of questions and answers. Liverpool and Cardiff B.B.
therapy. The second section describes The section may be used for self-
ophthalmic diseases using a traditional assessment following study of the
Preface to second edition
The text has been extensively revised ophthalmology. Some of the spreads disease and a database of organisations
and updated to correct inaccuracies have been expanded, reflecting the and information resources.
to improve clarity and understanding, importance to the reader of the subject
especially in response to feedback matter or the new knowledge. We 2004 M.B.
from helpful students, and to keep have also added a spread about genetic Liverpool and Oxford B.B.
pace with new developments in
Preface to third edition
We welcome the contribution of Dublin, Ireland. His careful review edition incorporates all the latest
Conor Murphy to this edition. of the book has freshened some of advances.
Conor has recently completed his the text, improving clarity as well as
ophthalmic training, has a special accuracy. 2009 M.B.
interest in undergraduate medical Some areas of ophthalmology Liverpool, Buckinghamshire B.B.
teaching and has taken up a post have changed, particularly treatment and Dublin C.M.
as Professor of Ophthalmology in of macular degeneration. This
vi
Acknowledgements
Over the years we have worked with several members of Churchill Livingstone and then Elsevier. They have always been
helpful and tolerant, as well as being able to ensure progress by gently prodding without being impatient! Special thanks go to
Jim Killgore, Mike Parkinson, Lynn Watt, Ailsa Laing, Alan Nicholson and all the artists.
We thank the many people who have helped with the colour photographs for all three editions. In particular Ronnie,
Steve, Karen and Jerry of the St Paul’s Eye Unit Department of Medical Photography; Simon Harding, David Wong, Stephen
Kaye, Debbie Broadbent, Paul Hiscott, Peter Wishart, Chris Lloyd, Brian Leatherbarrow, Steve Charles, Peng Khaw and Jeremy
Butcher, who kindly provided us with photographs from their own collection.
Colin Willoughby, Lecturer in Ophthalmology at the University of Liverpool and expert in ocular genetics, contributed the
genetics spread, giving of his precious time whilst writing up research papers and his MD thesis. Daniel Brotchie, also of the
University of Liverpool, allowed us to use the database of resources and organisations that he has painstakingly constructed
over several years.
We have been heartened by the many people who have commented favourably on the first and second editions and have
tried to assimilate into this third edition their many suggestions for change and improvement.
Brad Bowling thanks his wife, Suzanne, and son, Edward, for their support and encouragement. Conor Murphy would like
to thank Deirdre for all her support during the writing of this book and his other academic endeavours. Mark Batterbury’s
family have grown used to the phrase ‘I’ve got to do some book work’ when the weekend’s activities have to be planned, but
their appreciation of the finished product of the first edition helped them be patient and tolerant for which they are greatly
thanked.
Mark Batterbury
Brad Bowling
Conor Murphy
2009
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Contents
BASIC PRINCIPLES 1
Anatomy and physiology: outer eye 2 Human sight 8 Special investigations 16
Anatomy and physiology: inner eye 4 The ophthalmic history I 10 Ocular pathology 18
Relations and connections: orbit and The ophthalmic history II 12 Ocular microbiology 20
visual pathways 6 The ophthalmic examination 14 Ocular pharmacology 22
DISEASES 25
Eyelids: blepharitis, dermatitis and Iritis 46 Optic disc swelling and optic
lumps 26 Posterior uveitis 48 atrophy 66
Eyelids: abnormalities of position 28 The lens 50 Intraocular tumours 68
Tear secretion and drainage 30 Ocular fundus: diabetic retinopathy 52 Strabismus: childhood 70
Orbital diseases 32 Ocular fundus: retinal vascular Strabismus: adult 72
Conjunctiva: infective inflammation 34 occlusions 54 Unequal and abnormal pupils 74
Conjunctiva: non-infective Ocular fundus: other retinal vascular Trauma: eyelids, orbits and head 76
inflammation 36 disorders 56 Trauma: the eyeball 78
Cornea: inflammation 38 Ocular fundus: macular disease I 58 Neonatal conjunctivitis 80
Cornea: dystrophies and Ocular fundus: macular disease II 60 Episcleritis and scleritis 81
degenerations 40 Ocular fundus: hereditary disease 62
Glaucoma: primary open angle 42 Ocular fundus: retinal detachment 64
Glaucoma: angle closure and other
types 44
SPECIAL TOPICS IN OPHTHALMOLOGY 83
Correcting refractive errors 84 Epidemiology and the functional Lasers in ophthalmology 94
HIV and the eye 86 implications of visual impairment 90 Ocular genetics 96
Tropical ophthalmology 88 Ophthalmic surgery 92
CLINICAL DECISION-MAKING 99
Gradual visual loss 100 Trauma 106 Irritable eyes 112
Sudden visual loss 102 The squinting child 108 Double vision 114
The acute red eye 104 ‘Spots before the eyes’ 110 Eye database (UK perspective) 116
Index 121
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Basic Principles
