Rapid Ophthalmology

Zahir Mirza is a Specialist Registrar in Surrey, UK.

Preface x

Acknowledgements xi

Abbreviations xii

About the companion website xiv

Basic anatomy and physiology

Osteology of the orbit 3

Orbital fissures 3

Superior orbital fissure 3

Inferior orbital fissure 3

Optic canal 3

The globe 3

Cornea 3

Anatomical terms 5

Retinal overview 6

Layers of the retina 6

Blood supply to the eye 7

Ciliary body and lens 7

Trabecular meshwork 7

Aqueous humour flow 7

Tears 8

Vitreous humour 8

Ocular muscles (origin / insertion / primary actions) 8

Superior rectus (SR) 8

Inferior rectus (IR) 8

Medial rectus (MR) 8

Lateral rectus (LR) 8

Superior oblique (SO) 9

Inferior oblique (IO) 9

The visual pathway 9

Pupillary reflexes 11

Direct and consensual light reflex 11

Accommodation 11

Pupil defects 12

Holmes-Adie pupil 12

Essential anisocoria 12

Argyll Robertson pupils 12

Horner’s syndrome 12

Cranial nerve III palsy (complete) 12

Relative afferent pupillary defect (RAPD) or Marcus Gunn pupil 12

Myopia hypermetropia and astigmatism 14

Ophthalmological assessment

History taking 17

Examination 17

Examination techniques 18

Colour vision 18

Pupil reflexes 18

Visual fields by confrontation 18

Eye movements 19

Objective structured clinical examination (OSCE) section 20

Visual acuity 20

Ophthalmoscopy 21

Differentials

Watery eye 25

Proptosis 25

Optic disc atrophy 25

Toxic optic neuropathy 25

Swollen optic discs 26

Ptosis 26

The red eye 26

Classic presentations of a red eye and associated conditions 26

Differentials – classified anatomically (from anterior to posterior) 27

Differential flow charts 27

Diseases

Age-related macular degeneration (AMD) dry 37

Age related macular degeneration wet 39

Amaurosis fugax 41

Amblyopia 43

Blepharitis 44

Cataract age-related 46

Cataract congenital 48

Cavernous sinus syndrome 49

Cellulitis orbital 51

Cellulitis preseptal 52

Chemical injury to the eye 53

Conjunctivitis bacterial and chlamydial 55

Conjunctivitis other (including ophthalmia neonatorum) 57

Allergic conjunctivitis 57

Ophthalmia neonatorum 57

Conjunctivitis viral 58

Cranial nerve III (CNIII) palsy 60

Cranial nerve IV (CNIV) palsy 62

Cranial nerve VI (CNVI) palsy 63

Cytomegalovirus (CMV) retinitis 65

Dacrocystitis 66

Diabetic retinopathy 67

Ectropion 69

Endophthalmitis 70

Entropion 71

Episcleritis 72

Exposure keratopathy 73

Eye trauma 74

Eyelid lacerations/cuts 74

Corneal foreign bodies 74

Corneal abrasion 74

Hyphaema 74

Iris mydriasis 74

Lens subluxation/dislocation 74

Vitreous haemorrhage 75

Retinal detachment 75

Traumatic optic neuropathy 75

Globe rupture/penetrating eye injury 75

Orbital fractures 75

Retrobulbar haemorrhage 75

Eye tumours 76

Primary choroidal melanoma 76

Secondary (metastatic) choroidal 76

Retinal haemangioma 76

Ocular non-Hodgkin lymphoma 76

Giant cell arteritis (GCA) 77

Wegener’s granulomatosis 78

Behçet’s disease 78

Glaucoma acute primary angle-closure 79

Glaucoma chronic open angle 81

Herpes zoster ophthalmicus (HZO) 83

Horner’s syndrome 85

Hypertensive retinopathy 87

Keratitis bacterial 89

Keratitis herpetic 91

Keratoconjunctivitis sicca 93

Keratoconus 95

Lid lumps basal cell carcinoma 97

Lid lumps chalazion 99

Lid lumps other (benign) 100

Cyst of Zeiss 100

Cyst of Moll 100

Molluscum contagiosum 100

Stye (external hordeolum) 100

Squamous cell papilloma 100

Xanthelasma 100

Lid lumps other (malignant) 101

Squamous cell carcinoma (SCC) 101

Melanoma 101

Merkel cell carcinoma 101

Keratocanthoma 101

Migraine 102

Multiple sclerosis (MS) 104

Pinguecula 106

Posterior vitreous detachment (PVD) 107

Pterygium 108

Retinal artery occlusion 109

Retinal detachment 110

Retinal vein occulsion 112

Retinitis pigmentosa and other inherited retinal dystrophies 114

Retinitis pigmentosa 114

Albinism 114

Leber congenital amaurosis 114

Stargardt’s disease 114

Retinoblastoma 115

Retinopathy of prematurity (ROP) 117

Sarcoidosis (and Tuberculosis) 119

Note on tuberculosis (TB) 121

Scleritis 122

Squint (strabismus) childhood 124

Thyroid eye disease 126

Uveitis anterior 128

Uveitis intermediate 129

Uveitis posterior 130

Glossary 131

Index 133