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

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1 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 The Eye Examination... 7 Objectives... 7 Relevance... 7 Basic Information... 8 The Patient s History... 8 Ocular Anatomy... 9 Anatomic Aging Changes... 9 Optics When to Examine...16 Additional Tests...16 How to Examine Visual Acuity Distance Visual Acuity Testing Near Visual Acuity Testing...20 Visual Acuity Estimation in an Uncooperative Patient Confrontation Visual Field Testing Amsler Grid Testing External Inspection Upper Eyelid Eversion Ocular Motility Testing Pupillary Reaction Testing Anterior Chamber Depth Assessment Intraocular Pressure Measurement Color Vision Testing Fluorescein Staining of Cornea Ophthalmoscopy...30 Summary of Steps in the Eye Examination Management or Referral BO10_Diana.indb 3

2 iv BASIC OPHTHALMOLOGY: ESSENTIALS FOR MEDICAL STUDENTS Reduced Visual Acuity Abnormal Fundus Appearance Shallow Anterior Chamber Depth/Elevated Intraocular Pressure Points to Remember Sample Problems Annotated Resources Acute Vision Loss Objectives...41 Relevance...41 Basic Information Narrowing the Diagnosis From the History How to Examine Visual Acuity Testing Confrontation Visual Field Testing Pupillary Reactions Red Reflex Evaluation and Ophthalmoscopy...44 Penlight Examination...44 Tonometry...44 How to Interpret the Findings...44 Acute Vision Loss Associated With Pain...44 Acute Vision Loss Without Pain Painless, Acute Vision Loss Without Clear Media Painless, Acute Vision Loss With Clear Media Functional Disorders Points to Remember Sample Problems Annotated Resources Chronic Vision Loss Objectives Relevance Basic Information Glaucoma Overview When to Examine How to Examine How to Interpret the Findings Management or Referral Cataract Overview When to Examine...72 How to Examine...73 How to Interpret the Findings...73 Management or Referral...74 Macular Degeneration...74 Overview...74 When to Examine How to Examine BO10_Diana.indb 4

3 Contents v How to Interpret the Findings Management or Referral The Visually Impaired Patient...80 Points to Remember...81 Sample Problems...81 Annotated Resources The Red Eye Objectives Relevance Basic Information History How to Examine Disorders Associated With a Red Eye...91 The Acute, Painful Red Eye...91 Acute, Nonpainful Red Eye Chronic, Irritated Red Eye Chronic Red Eye Without Irritation Adnexal Disease Further Interpretation of the Findings Symptoms of a Red Eye 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 Ocular and Orbital Injuries Objectives Relevance Basic Information Anatomy and Function When to Examine How to Examine History Visual Acuity Testing External Examination Pupillary Reactions Ocular Motility Testing Ophthalmoscopy Radiologic Studies Management or Referral True Emergency BO10_Diana.indb 5

4 vi BASIC OPHTHALMOLOGY: ESSENTIALS FOR MEDICAL STUDENTS Urgent Situations Treatment Skills Ocular Irrigation Foreign-Body Removal Prescribing Eye Medication Patching Points to Remember Sample Problems Annotated Resources Amblyopia and Strabismus 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 Neuro-Ophthalmology Objectives Relevance Basic Information How to Examine Visual Acuity Testing Visual Field Testing Color Perception and Saturation Pupillary Examination Ocular Motility Testing Ophthalmoscopy How to Interpret the Findings Pupillary Disorders Motility Disorders Optic Nerve Disease Optic Disc Elevation Visual Field Defects Visual Hallucinations Cognitive Vision Loss: The Visual Variant of Alzheimer s Disease Points to Remember BO10_Diana.indb 6

5 Contents vii Sample Problems Annotated Resources Eyelid, Lacrimal, and Orbital Disease Objectives Relevance Eyelid Disorders Eyelid Infections Eyelid Malpositions Eyelid Neoplasms Lacrimal Disease Orbital Disease How to Examine Orbital Neoplasms Inflammatory Processes of the Orbit Vascular Malformations Points to Remember Sample Problems Annotated Resources Ocular Manifestations of Systemic Disease Objectives Relevance Diabetes Mellitus Hypertension Arteriolar Sclerosis Elevated Blood Pressure Diagnostic Concerns Management Pregnancy Sickle Cell Anemia Thyroid Disease Sarcoidosis and Other Inflammatory and Autoimmune Conditions Dry Eye Syndrome Malignancy Acquired Immunodeficiency Syndrome Syphilis Other Systemic Infections Points to Remember Sample Problems Annotated Resources Drugs and the Eye Objectives Relevance Basic Information Topical Ocular Diagnostic Drugs BO10_Diana.indb 7

6 viii BASIC OPHTHALMOLOGY: ESSENTIALS FOR MEDICAL STUDENTS 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 β-adrenergic Antagonists Cholinergic-Stimulating Drugs α2-adrenoceptor Agonists Adrenergic-Stimulating Drugs Prostaglandin Analogues Carbonic Anhydrase Inhibitors Ocular Side Effects of Systemic Drugs Amiodarone Bisphosphonates Chloroquines Chlorpromazine Corticosteroids Digitalis Diphenylhydantoin Ethambutol HMG-COA Reductase Inhibitors (Statins) Rifabutin Sildenafil, Tadalafil, Vardenafil, and Avanafil Tamoxifen Tamsulosin Thioridazine Topiramate Points to Remember Sample Problems Annotated Resources Index BO10_Diana.indb :54:06 PM