Eye Diseases - Ophthalmology: lecture notes

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This edition first published 2017 2017 by Bruce James, Anthony Bron and Manoj V Parulekar

Previous editions 1960, 1965, 1968, 1971, 1974, 1980, 1986, 1997, 2003, 2007, 2011

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Library of Congress Cataloging-in-Publication Data

Names: James, Bruce, 1957- author. | Bron, Anthony J., author. | Parulekar, Manoj V., author.

Title: Lecture notes. Ophthalmology / Bruce James, Anthony Bron, Manoj V. Parulekar.

Other titles: Ophthalmology

Description: 12th edition. | Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons, Inc., 2017. | Includes bibliographical references and index.

Identifiers: LCCN 2016026509 (print) | LCCN 2016027367 (ebook) | ISBN 9781119095903 (pbk.) | ISBN 9781119095927 (pdf) | ISBN 9781119095941 (epub)

Subjects: | MESH: Eye Diseases | Handbooks | Problems and Exercises

Classification: LCC RE50 (print) | LCC RE50 (ebook) | NLM WW 39 | DDC 617.7dc23

LC record available at https://lccn.loc.gov/2016026509

A catalogue record for this book is available from the British Library.

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Welcome to the twelfth edition of Ophthalmology Lecture Notes! As in the past, our aim has been to make the diagnosis and management of eye disease a palatable process and once again we stress the value of a good history and careful clinical examination of the eye.

The eye is remarkably accessible. Optical and digital techniques continue to develop giving increasingly detailed access to the structures of the eye at cellular level. Specular microscopy can image the corneal endothelial cells which regulate corneal hydration and transparency; optical coherence tomography allows the layers of the retina to be dissected and recently allows the retinal vasculature to be imaged without the need for injection of fluorescein. Confocal microscopy provides a three-dimensional view of the optic nerve head. The shape of the cornea can be plotted digitally and, outside the globe, orbital structures and the visual pathway can be viewed by neuroimaging.

Therapeutically, lasers are used to relieve acute, angle closure glaucoma, to lower ocular pressure in chronic glaucoma, to open up an opaque lens capsule following cataract surgery and to seal retinal holes. They have an established role in reshaping the cornea to treat refractive errors of the eye and their role is now extending to use in cataract surgery itself. Sight-threatening diabetic retinopathy can be treated effectively by retinal photocoagulation, to remove the angiogenic stimulus to vasoproliferation. More recently, it has become possible to inhibit new vessel formation in diabetic retinopathy, macular degeneration and other retinal vascular disorders by intravitreal injections of antiangiogenic drugs. Roles for these drugs in treating oedema of the retina, see for example in diabetes, are also becoming established.

These techniques are matched by technological innovations in microsurgery, responsible for dramatic advances in cataract and vitreoretinal surgery. Optical function in cataract surgery is restored by insertion of a lens which unfolds within the eye. These are becoming increasingly complex allowing for the treatment of astigmatism and restoring near and distance vision in some patients without the need for glasses. Vitreoretinal surgery employs inert gases and silicone oil to flatten the detached retina and endoscopic probes which allow manipulations in the vitreous space and the dissection of microscopic membranes from the retinal surface. Glaucoma surgery is developing tiny drainage implants to reduce intraocular pressure.

Despite these advances, most ophthalmic diagnoses can still be made from a good history and clinical examination of the eye. This book aims to teach skills which will be useful to anyone engaged in medical practice. Many systemic disorders have ocular features which are critical in diagnosis. This book covers the ophthalmic features of systemic hypertension, diabetes, sarcoidosis, endocarditis, demyelinating disease and space-occupying lesions of the brain. It also explains how to recognize iritis, distinguish various forms of retinopathy and understand the difference between papilloedema and papillitis.