Contents
1 Eyelids ……………………………………………………………… 1
Introduction ……………………………………………………………. 2
Non-neoplastic lesions …………………………………………….. 3
Benign epidermal tumours ……………………………………….. 7
Benign pigmented lesions ………………………………………… 9
Benign adnexal tumours …………………………………………. 10
Miscellaneous benign tumours ………………………………… 12
Malignant tumours …………………………………………………. 13
Disorders of the eyelashes ………………………………………. 25
Allergic disorders …………………………………………………… 30
Bacterial infections ………………………………………………… 31
Viral infections ………………………………………………………. 32
Blepharitis ……………………………………………………………. 34
Ptosis ………………………………………………………………….. 38
Ectropion ……………………………………………………………… 45
Entropion ……………………………………………………………… 50
Miscellaneous acquired disorders …………………………….. 51
Cosmetic eyelid and periocular surgery……………………… 56
Congenital malformations ……………………………………….. 57
2 Lacrimal drainage system …………………….. 63
Introduction ………………………………………………………….. 64
Acquired obstruction………………………………………………. 69
Congenital obstruction ……………………………………………. 72
Chronic canaliculitis……………………………………………….. 73
Dacryocystitis ……………………………………………………….. 73
3 Orbit ………………………………………………………………. 77
Introduction ………………………………………………………….. 78
Thyroid eye disease ……………………………………………….. 82
Infections ……………………………………………………………… 87
Non-infective inflammatory disease ………………………….. 89
Non-neoplastic vascular abnormalities ……………………… 92
Cystic lesions………………………………………………………… 95
Vascular tumours …………………………………………………… 98
Lacrimal gland tumours ………………………………………… 103
Neural tumours ……………………………………………………. 106
Lymphoma ………………………………………………………….. 109
Rhabdomyosarcoma …………………………………………….. 109
Metastatic tumours ………………………………………………. 110
The anophthalmic socket ………………………………………. 113
Craniosynostoses …………………………………………………. 117
4 Dry eye ………………………………………………………. 119
Introduction ………………………………………………………… 120
Sjögren syndrome ………………………………………………… 121
Clinical features …………………………………………………… 122
Investigation ……………………………………………………….. 124
Treatment ……………………………………………………………. 127
5 Conjunctiva ………………………………………………. 131
Introduction ………………………………………………………… 132
Bacterial conjunctivitis ………………………………………….. 135
Viral conjunctivitis ………………………………………………… 141
Allergic conjunctivitis ……………………………………………. 144
Conjunctivitis in blistering mucocutaneous disease …… 152
Miscellaneous conjunctivitides ……………………………….. 158
Degenerations……………………………………………………… 162
Subconjunctival haemorrhage ………………………………… 166
6 Cornea ……………………………………………………….. 167
Introduction ………………………………………………………… 168
Bacterial keratitis …………………………………………………. 175
Fungal keratitis ……………………………………………………. 180
Herpes simplex keratitis ………………………………………… 183
Herpes zoster ophthalmicus …………………………………… 189
Interstitial keratitis ……………………………………………….. 194
Protozoan keratitis ……………………………………………….. 197
Helminthic keratitis ………………………………………………. 199
Bacterial hypersensitivity-mediated
corneal disease………………………………………………… 199
Rosacea …………………………………………………………….. 201
Peripheral corneal ulceration/thinning …………………….. 202
Neurotrophic keratopathy ………………………………………. 206
Exposure keratopathy ……………………………………………. 207
Miscellaneous keratopathies ………………………………….. 209
Corneal ectasias ………………………………………………….. 213
Corneal dystrophies ……………………………………………… 216
Corneal degenerations ………………………………………….. 225
Metabolic keratopathies ……………………………………….. 230
Contact lenses …………………………………………………….. 232
Congenital anomalies of the cornea and globe ………… 233
7 Corneal and refractive surgery ………… 239
Keratoplasty ……………………………………………………….. 240
Keratoprostheses …………………………………………………. 245
Refractive procedures …………………………………………… 246
8 Episclera and sclera …………………………….. 253
Anatomy …………………………………………………………….. 254
Episcleritis ………………………………………………………….. 254
Immune-mediated scleritis ……………………………………. 255
Infectious scleritis ………………………………………………… 262
Scleral discoloration …………………………………………….. 262
Blue sclera …………………………………………………………. 262
Miscellaneous conditions………………………………………. 264
9 Lens …………………………………………………………….. 269
Acquired cataract ………………………………………………… 270
Management of age-related cataract ………………………. 273
Congenital cataract ………………………………………………. 297
Ectopia lentis ………………………………………………………. 300
Abnormalities of lens shape ………………………………….. 303
10 Glaucoma ………………………………………………….. 305
Introduction ………………………………………………………… 306
Tonometry …………………………………………………………… 307
Gonioscopy …………………………………………………………. 309
Evaluation of the optic nerve head …………………………. 316
Imaging in glaucoma ……………………………………………. 320
Perimetry ……………………………………………………………. 323
Medical treatment of glaucoma ……………………………… 330
Laser treatment of glaucoma …………………………………. 334
Trabeculectomy ……………………………………………………. 338
Non-penetrating glaucoma surgery …………………………. 345
Drainage shunts ………………………………………………….. 346
Ocular hypertension ……………………………………………… 348
Primary open-angle glaucoma ……………………………….. 349
Normal-tension glaucoma ……………………………………… 358
Primary angle-closure glaucoma …………………………….. 360
Classification of secondary glaucoma ……………………… 366
Pseudoexfoliation ………………………………………………… 366
Pigment dispersion ………………………………………………. 368
Neovascular glaucoma ………………………………………….. 371
Inflammatory glaucoma ………………………………………… 374
Lens-related glaucoma …………………………………………. 377
Traumatic glaucoma ……………………………………………… 379
Iridocorneal endothelial syndrome ………………………….. 381
Glaucoma associated with intraocular tumours ………… 383
Glaucoma secondary to epithelial ingrowth ……………… 384
Iridoschisis …………………………………………………………. 384
Primary congenital glaucoma …………………………………. 384
Iridocorneal dysgenesis ………………………………………… 388
Glaucoma in phacomatoses ………………………………….. 394
11 Uveitis ………………………………………………………… 395
Classification ………………………………………………………. 396
Anterior uveitis …………………………………………………….. 396
Uveitis in spondyloarthropathies …………………………….. 404
Fuchs uveitis syndrome ………………………………………… 407
Uveitis in juvenile idiopathic arthritis ………………………. 408
Uveitis in bowel disease ……………………………………….. 411
Uveitis in renal disease ………………………………………… 412
Intermediate uveitis ……………………………………………… 412
Vogt–Koyanagi–Harada (VKH) syndrome …………………… 415
Sympathetic ophthalmitis ……………………………………… 416
Lens-induced uveitis …………………………………………….. 419
Sarcoidosis …………………………………………………………. 420
Behçet disease ……………………………………………………. 424
Parasitic uveitis ……………………………………………………. 426
Viral uveitis …………………………………………………………. 437
Fungal uveitis ……………………………………………………… 444
Bacterial uveitis …………………………………………………… 448
Miscellaneous idiopathic chorioretinopathies ……………. 455
12 Ocular tumours ……………………………………….. 467
Benign epibulbar tumours …………………………………….. 468
Malignant and premalignant epibulbar tumours ……….. 473
Iris tumours ………………………………………………………… 477
Iris cysts …………………………………………………………….. 480
Ciliary body tumours …………………………………………….. 483
Tumours of the choroid …………………………………………. 484
Neural retinal tumours ………………………………………….. 497
Retinal vascular tumours ………………………………………. 506
Primary intraocular lymphoma ……………………………….. 512
Tumours of the retinal pigment epithelium ……………….. 514
Paraneoplastic syndromes …………………………………….. 517
13 Retinal vascular disease …………………….. 519
Retinal circulation ………………………………………………… 520
Diabetic retinopathy ……………………………………………… 520
Non-diabetic retinopathy ………………………………………. 538
Retinal venous occlusive disease ……………………………. 538
Retinal arterial occlusive disease ……………………………. 549
Ocular ischaemic syndrome …………………………………… 556
Hypertensive eye disease ………………………………………. 557
Sickle cell retinopathy…………………………………………… 559
Thalassaemia retinopathy ……………………………………… 561
Retinopathy of prematurity …………………………………….. 561
Retinal artery macroaneurysm ……………………………….. 565
Primary retinal telangiectasia…………………………………. 569
Eales disease ……………………………………………………… 569
Radiation retinopathy ……………………………………………. 572
Purtscher retinopathy ……………………………………………. 572
Valsalva retinopathy ……………………………………………… 572
Lipaemia retinalis ………………………………………………… 574
Retinopathy in blood disorders ………………………………. 574
14 Acquired macular disorders ………………. 579
Introduction ………………………………………………………… 580
Clinical evaluation of macular disease …………………….. 581
Investigation of macular disease …………………………….. 586
Age-related macular degeneration ………………………….. 598
Retinal angiomatous proliferation …………………………… 616
Polypoidal choroidal vasculopathy ………………………….. 617
Peripheral exudative haemorrhagic
chorioretinopathy ……………………………………………… 618
Idiopathic choroidal neovascularization ……………………. 618
Vitreomacular interface disorders……………………………. 618
Central serous chorioretinopathy …………………………….. 624
Idiopathic macular telangiectasia …………………………… 627
Cystoid macular oedema ………………………………………. 630
Microcystic macular oedema …………………………………. 630
Degenerative myopia ……………………………………………. 631
Angioid streaks ……………………………………………………. 635
Choroidal folds ……………………………………………………. 635
Hypotony maculopathy………………………………………….. 637
Solar retinopathy …………………………………………………. 638
Focal choroidal excavation …………………………………….. 638
15 Hereditary fundus dystrophies ………….. 641
Introduction ………………………………………………………… 642
Investigation ……………………………………………………….. 642
Generalized photoreceptor dystrophies ……………………. 646
Macular dystrophies …………………………………………….. 660
Generalized choroidal dystrophies ………………………….. 667
Hereditary vitreoretinopathies ………………………………… 669
Albinism …………………………………………………………….. 678
Cherry-red spot at the macula ……………………………….. 680
16 Retinal detachment ………………………………. 681
Introduction ………………………………………………………… 682
Peripheral lesions predisposing to retinal
detachment ……………………………………………………… 688
Posterior vitreous detachment………………………………… 694
Retinal breaks …………………………………………………….. 698
Rhegmatogenous retinal detachment ………………………. 701
Tractional retinal detachment …………………………………. 711
Exudative retinal detachment …………………………………. 712
Pars plana vitrectomy …………………………………………… 713
17 Vitreous opacities …………………………………. 721
Introduction ………………………………………………………… 722
Muscae volitantes ………………………………………………… 722
Vitreous haemorrhage …………………………………………… 722
Asteroid hyalosis ………………………………………………….. 722
Synchysis scintillans …………………………………………….. 722
Amyloidosis ………………………………………………………… 722
Vitreous cyst ……………………………………………………….. 726
Persistent fetal vasculature ……………………………………. 726
18 Strabismus ……………………………………………….. 727
Introduction ………………………………………………………… 728
Amblyopia ………………………………………………………….. 737
Clinical evaluation ……………………………………………….. 738
Pseudostrabismus ……………………………………………….. 755
Heterophoria ……………………………………………………….. 756
Vergence abnormalities …………………………………………. 756
Esotropia ……………………………………………………………. 757
Exotropia ……………………………………………………………. 762
Congenital cranial dysinnervation disorders ……………… 764
Monocular elevation deficiency ………………………………. 766
Brown syndrome ………………………………………………….. 766
Alphabet patterns ………………………………………………… 767
Surgery ………………………………………………………………. 769
Botulinum toxin chemodenervation …………………………. 771
19 Neuro-ophthalmology ……………………………. 773
Neuroimaging ……………………………………………………… 774
Optic nerve …………………………………………………………. 779
Pupils ………………………………………………………………… 806
Chiasm ………………………………………………………………. 812
Retrochiasmal pathways ……………………………………….. 819
Ocular motor nerves …………………………………………….. 821
Supranuclear disorders of ocular motility …………………. 830
Nystagmus ………………………………………………………….. 832
Ocular myopathies ……………………………………………….. 838
Miller Fisher syndrome………………………………………….. 842
Neurofibromatosis ……………………………………………….. 842
Migraine …………………………………………………………….. 846
Neuralgias ………………………………………………………….. 847
Facial spasm ………………………………………………………. 848
20 Ocular side effects of systemic
medication………………………………………………… 851
Cornea……………………………………………………………….. 852
Ciliary effusion …………………………………………………….. 853
Lens ………………………………………………………………….. 853
Uveitis ……………………………………………………………….. 854
Retina ………………………………………………………………… 854
Optic nerve …………………………………………………………. 859
21 Trauma ……………………………………………………….. 861
Eyelid trauma ……………………………………………………… 862
Orbital trauma …………………………………………………….. 864
Trauma to the globe …………………………………………….. 867
Chemical Injuries …………………………………………………. 881
Index …………………………………………………………………. 887
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