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
Behc¸et'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
