Manual for Eye Examination and Diagnosis

Now in its tenth edition, Manual for Eye Examination and Diagnosis is the leading introductory clinical textbook in the field, providing concise and practical coverage of anatomy, instrumentation, differential diagnosis and treatment of ophthalmic diseases and disorders. This accessible resource offers clear explanations of current diagnostic techniques, equipment and best practice; hundreds of full-color clinical photographs and diagrams; and step-by-step guidance on a range of key procedures. Author Mark Leitman, a practicing Ophthalmology specialist with nearly five decades’ experience, provides the foundational knowledge required to excel on an ophthalmology rotation. This is a must-have companion for medical students and junior doctors, trainee ophthalmologists and optometrists, optometry nurses, and ophthalmic technicians.

ABOUT THE AUTHOR

MARK W. LEITMAN is Clinical Assistant Professor, Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine.

TABLE OF CONTENTS

Preface v

Introduction to the eye team and their instruments vi

1 Medical history 1

Table 1 – Common chief complaints 1

Medical illness 3

Medications (ocular side effects) 4

Family history of eye disease 7

2 Measurement of vision and refraction 9

Visual acuity 9

Optics 10

Refraction 14

Contact lenses 18

Common problems 21

Refractive surgery 21

3 Neuro-ophthalmology 28

Eye movements 28

Table 2 – Extraocular muscles 30

Table 3 – Nerves to ocular structures 30

Strabismus 31

Table 4 – Types of eye-turn 32

Table 5 – Comparison of paralytic and nonparalytic strabismus 36

Cranial nerves III–VIII 37

Nystagmus 41

Common brain tumors 47

The pupil 49

Adie’s pupil (tonic pupil) 51

Visual field testing 52

Table 6 – Causes of small (miotic) and large (mydriatic) pupil (Fig. 125) 53

Color vision 56

Circulatory disturbances affecting vision 56

Table 7 – Visual disturbances due to compromised blood flow (Fig. 81) 58

4 External structures 61

Lymph nodes 61

Lacrimal system 61

Failure of the tear to reach the puncta 68

Obstruction at the puncta or canaliculus 68

Tearing due to NLD obstructions 69

Table 8 – Common topical anti-infectives 70

Lids 71

Lashes 74

Phakomatoses 77

Anterior and posterior blepharitis 78

5 The orbit 83

Imaging 83

Sinusitis 84

Exophthalmos 87

Enophthalmos 88

6 Slit lamp examination 91

Cornea 91

Corneal epithelial disease 93

Table 9 – Superficial punctate keratitis (commonly causes photophobia) 94

Table 10 – Conjunctivitis – redness more pronounced in peripheral conjunctiva (see Figs 305 and 395) 96

Corneal endothelial disease 100

Corneal transplantation (keratoplasty) 102

Conjunctiva 108

Sclera 114

7 Glaucoma 117

Glaucoma vs. glaucoma suspect 118

The iridocorneal angle 119

The optic disk (optic papilla) 120

Signs of nerve fiber damage 122

Medical treatment (Table 11) 125

Table 11 – Common glaucoma medications and side effects 126

Table 12 – Common types of glaucoma 134

8 Uvea 137

Malignant uveal tumors 139

Inflammation of the uvea (uveitis) 142

Table 13 – Common causes of an injected conjunctiva (Fig. 395) 144

Anti-inflammatories 144

Table 14 – Ocular Anti-inflammatories (see Fig. 367) 145

Table 15 – Topical Anticholinergics 147

Table 16 – Causes of Uveitis 148

9 Cataracts 158

Laser-assisted cataract surgery 163

Some complications of cataract

surgery 165

10 The retina and vitreous 168

Retinal anatomy 168

Fundus examination 171

Table 17 Scheie classification of hypertensive retinopathy (see Fig. 486) 179

Table 18 – Blood sugar levels in diabetes 186

Age-related macular degeneration 188

Central serous chorioretinopathy 192

Pseudoxanthoma elasticum 193

Albinism 195

Retinitis pigmentosa 196

Retinoblastoma 198

Retinopathy of prematurity 198

Vitreous 199

Retinal holes 204

Retinal detachment 206

Appendix 1: Hyperlipidemia 209

Appendix 2: Amsler grid 211

Index 212