LUN I tntzi CHAPTER 1:THE EYE WMINATION ix ... FIGURES... PREFACE... WHO'S WHO IN EYE CARE... xv TEST YOUR KNOWLEDGE...

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1 LUN I tntzi FIGURES ix PREFACE XIII WHO'S WHO IN EYE CARE... xv TEST YOUR KNOWLEDGE... xvii CHAPTER 1:THE EYE WMINATION.-. 1 OBJECTIVES... 1 RELEVANCE... 1 BASIC INFORMATION The Patient's History Anatomy... 3 Anatomic Aging Changes... 3 Optics... 8 Visual Acuity... 8 WHEN TO EXAMINE... 8 Additional Tests... 9 HOW TO EXAMINE... 9 Distance Visual Acuity Testing... 9 Near Visual Acuity Testing Visual Acuity Estimation in an Uncooperative Patient Confrontation Visual Field Testing Amsler Grid Testing External Inspection Upper Lid Eversion Ocular Motility Testing Pupillary Reaction Testing Anterior Chamber Depth Assessment Intraocular Pressure Measurement Color Vision Testing Fluoresce~n Staln~ng of Cornea Ophthalmos~op~ SUMMARY OF STEPS IN EYE EXAMINATION MANAGEMENT OR REFERRAL Reduced Visual Acuity Abnormal Fundus Appearance Shallow Anterlor Chamber DepthIElevated Intraocular Pressure POINTS TO REMEMBER SAMPLE PROBLEMS ANNOTATED RESOURCES... 28

2 iv BASIC OPHTHALMOLOGY CHAPTER 2: ACUTE VISUAL LOSS. 31 OBJECTIVES RELEVANCE BASIC INFORMATION HOW TO EXAMINE Visual Acuity Testing Confrontation Visual Field Testing Pupillary Reactions Ophthalmoscopy Penlight Examination Tonometry HOW TO INTERPRET THE FINDINGS Media Opacities Corneal Edema Hyphema Cataract V~treous Hemorrhage Retinal D~sease Optic Nerve Disease Visual Pathway Disorders Functional Disorders Acute Discovery of Chronic Visual Loss POINTS TO REMEMBER SAMPLE PROBLEMS ANNOTATED RESOURCES CHAPTER 3: CHRONIC VISUAL LOSS.,~.~ OBJ ECTXVES CHRONIC VISUAL LOSS IN THE GERIATRIC POPULATION GLAUCOMA Basic Information When to Examine How to Exam~ne How to Interpret the Findings Management or Referral CATARACT Baslc Information When to Examine How to Examlne How to Interpret the Findings Management or Referral MACULAR DEGENERATION Basic Information When to Exam~ne How to Examine How to Interpret the Findings Management or Referral The Visually Impa~red Patient... 67

3 POINTS TO REMEMBER SAMPLE PROBLEMS ANNOTATED RESOURCES CkWTER4:THE RED - - EYE- 7 3 OBJECTIVES RELEVANCE BASIC INFORMATION /I Disorders Associated With a Red Eye History HOW TO EXAMINE I HOW TO INTERPRET THE FINDINGS Symptoms of a Red Eye I Signs of a Red Eye Associated Systemic Problems Laboratory Diagnosis MANAGEMENT OR REFERRAL Blepharitis Stye and Chalazion Subconjunctival Hemorrhage Conjunctivitis Therapeutic Warnings POINTS TO REMEMBER SAMPLE PROBLEMS ANNOTATED RESOURCES CHAPTER 5: OCULAR AND. ORBITAL. INJURIES.. 97 OBJECTIVES RELEVANCE BASIC INFORMATION Anatomy and Function WHEN TO EXAMINE HOW TO EXAMINE History Visual Acu~ty Testing External Examination Pupillary Reactions Ocular Motility Testing Ophthalmoscopy Radiologic Studies MANAGEMENT OR REFERRAL True Emergency Urgent Situation Semiurgent Condition TREATMENT SKILLS Ocular Irrigation Foreign-Body Removal CONTENTS v

4 vi BASIC OPHTHALMOLOGY Prescribing Eye Medication Patching Suturing POINTS TO REMEMBER SAMPLE PROBLEMS ANNOTATED RESOURCES CHAPTER 6: AMBLYOPIA AND STRABISMUS..-,. 117 OBJECTIVES RELEVANCE BASIC INFORMATION Amblyopia Strabismus HOW TO EXAMINE AND INTERPRET THE FINDINGS Amblyopia Testing Strabismus Testing Other Tests MANAGEMENT OR REFERRAL Amblyopia Strabismus Serious Intraocular Lesions POINTS TO REMEMBER SAMPLE PROBLEMS ANNOTATED RESOURCES CHAPTER 7: NEURO.OPHTHALMOL0GY OBJECTIVES RELEVANCE HOW TO EXAMINE Visual Acuity Testing Visual Field Testing Color Perception and Saturation Pupillary Exammation Ocular Motility Testing Ophthalmvscopy HOW TO INTERPRET THE FINDINGS Pupillary Disorders Motility Disorders Optic Nerve Disease Optic DISC Elevation Visual Field Defects Visual Hallucinations Cognitive Visual Loss: The Visual Varlant of Alzheimer's Disease POINTS TO REMEMBER SAMPLE PROBLEMS ANNOTATED RESOURCES

5 CHAPTER 8: OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE.,...,.,.....,.., QBJECTIW RELEVANCE DIABETES MEUITUS HYPERTENSION keriolar Sclerosis Elevated Blood Pwsure..., Ditggiostic Concerns Management PREGNANCY SICKLE CELL ANEMIA THYXQID DISEASE SARCOIM5SIS AND OTHER INFLAMMATORY AND AUTOIMMLJNE CONDITIONS Dq Eye Synhrne MMi~NANCY ACQUIRED lmmunodeficiency SYNDROME SYPHILIS M'HER SYSTEMIC INFECTIONS..., ) POINTS TO REMEUBER SAMPLE JPROBLEMS ANNOTATED RESOmCES CHAPTER 9: DRUGS AND THE EYE. -a n.-.n..nn m e n 183 OBJECTIVES RELEVANCE BASIC INFORMATION TOPICAL OCULAR DIAGNOSTIC DRUGS Fluorescein Dye Anesthetics Mydriatics TOPICAL OCULAR THERAPEUTIC DRUGS Decongestants Agents for Relief of Allergic Conjunctivitis Anti-Inflammatory Agents Agents for the Relief of Dry Eye Symptoms Antibiotics Antiviral Agents SYSTEMIC SIDE EFFECTS OF GLAUCOMA MEDICATIONS Beta-Adrenergic Blockers Cholinergic-Stimulating Drugs Alpha-2 Adrenoreceptor Agonists Adrenergic-Stimulating Drugs Prostaglandin Analogues Carbonic Anhydrase Inhibitors CONTENTS vii

6 viii BASIC OPHTHALMOLOGY OCULAR SIDE EFFECTS OF SYSTEMIC DRUGS Amiodarone... I93 Bisphosphonates Chloroquines Chlorpromazine Corticosteroids Digitalis Diphenylhydantoin Ethambutol HMG-COA Reductase Inhib~tors (Statins) RiFabutin (Mycobutin) Sildenafil (Viagra), Tadalifil (Cialis), and Vardenafil (Levitra) Tamoxifen Tamsulosin (Flomax) Thioridazine Topiramate (Topamax) POINTS TO REMEMBER SAMPLE PROBLEMS ANNOTATED RESOURCES INDEX

Resources from the American Academy of Ophthalmology...1 Meet the Eye Care Team...1 Eye Myths... 3

CONTENTS Preface...ix Acknowledgments... x About the Executive Editors... x Introduction to Ophthalmology... 1 Resources from the American Academy of Ophthalmology...1 Meet the Eye Care Team...1 Eye Myths...