Ocular Therapeutics Handbook A Clinical Manual BRUCE E. ONOFREY, RPh, OD Director, Lovelace Montgomery Eye Clinic Lovelace Medical Center Albuquerque, New Mexico; Adjunct Assistant Professor of Clinical Optometry Pacific University and University of California Berkeley, California LEONID SKORIN, Jr, OD, DO Adjunct Assistant Professor of Ophthalmology Chicago College of Osteopathic Medicine, Midwestern University; Clinical Assistant Professor of Ophthalmology and Visual Sciences University of Illinois Eye and Ear Infirmary Chicago, Illinois Assistant Clinical Professor, Department of Osteopathic Medicine Division of Ophthalmology, Michigan State University, East Lansing, Michigan NICKY R. HOLDEMAN, OD, MD Associate Professor of Optometry University of Houston College of Optometry Houston, Texas Lippincott - Raven P U B [ i S H E R S Philadelphia Sew York
Contents t Quick Reference Section 1 OCULAR MICROBIOLOGY 1 Quick Reference Section 1 2 COMMON LABORATORY TESTS AND PROCEDURES 21 Common Laboratory Tests and Procedures 21 Laurance Freier and Abbreviations for Laboratory and Diagnostic Tests 58 Laurance Freier and 3 OPHTHALMOLOGIC LABORATORY AND DIAGNOSTIC TESTS 63 Selected Laboratory Tests in Ocular Disease 63 Laurance Freier 4 OCULAR SIDE EFFECTS OF SYSTEMIC MEDICATIONS 101 Ocular Side Effects of Systemic Medications 101 vii
viii Contents 5 PHARMACEUTICAL AGENTS 107 The Prescription/Patient Compliance 107 Ophthalmic Dyes 1 13 Anesthetic Agents 1 19 Dilating Agents and Procedures 1 19 Diagnostic Agents and Procedures for the Management of Accommodative Disorders 126 Ophthalmic Lubricants 133 Hyperosmotic Agents 140 Anti-Allergy Medications 141 Anti-Infective Agents 146 Management of Common Bacterial Eye Disorders: A Quick Reference 154 Glaucoma Agents 161, Ron Melton, and Randall K. Thomas Analgesic Agents 178 Nutritional Agents 180
Contents IX Ocular Therapeutics 6 BACTERIAL INFECTIOUS DISEASES 183 Bacterial Blepharitis 183 Bacterial Conjunctivitis 187 Bacterial Keratitis (Bacterial Infectious Corneal Infiltrates and Ulcers) 195 Adult Inclusion Conjunctivitis 201 Trachoma 204 7 VIRAL INFECTIOUS DISEASES 207 Adenovirus/Epidemic Keratoconjunctivitis (EKC) 207 Adenovirus/Pharyngeal Conjunctival Fever (PCF) 210 Herpes Simplex Virus 212 Varicella 220 Molluscum Contagiosum 224
X Contents 8 FUNGAL INFECTIOUS DISEASES 227 Fungal Keratitis 227 9 OTHER INFECTIOUS DISEASES 233 Acanthamoeba Keratitis 233 Demodicosis 236 Phthiriasis Palpebrarum 237 10 IMMUNE DISEASE 241 Anterior Uveitis 241 Ankylosing Spondylitis 243 Behcet's Syndrome 246 Atopic Disease 248 Juvenile Rheumatoid Arthritis 251 Pars Planitis 254 Reiter's Syndrome 257 Granulomatous Uveitis 260
Contents 11 LACRIMAL DISORDERS 267 Dacryoadenitis 267 Acute Infectious Dacryoadenitis 267 Chronic/Granulomatous Adenitis 269 Dacryocystitis 270 Epiphora 273 Lacrimal Tests and Procedures 284 Jones Test I and II 284 Dye Disappearance Test 285 Tear Break-Up Time (TBUT) 285 Schirmer Test I and Il/Basic Secretion Test 286 Rose Bengal Dye Test 287 Punctal Dilation 287 Lacrimal Irrigation 287 Lacrimal Probing 288 Dacryocystorhinostomy 289 Conjunctivodacryocystorhinostomy (Jones Tube Procedure) 289 xi
Xll Contents 12 4 OCULAR TRAUMA 291 Blunt Trauma 291 Corneal Abrasion 298 Recurrent Corneal Erosion 299 Superficial Ocular Foreign Body 301 Intraocular Foreign Body 303 Conjunctival/Corneal Lacerations 305 Ultraviolet-Induced Injury 307 Thermal Burns 308 13 OCULAR URGENCIES 311 Sudden Vision Loss 31 1 Anastas F. Pass Acute Angle Closure Glaucoma 317 Chemical Injuries 320 Anastas F. Pass Traumatic Hyphema 329 Anastas F. Pass
Contents 14 SYSTEMIC EMERGENCIES 335 Systemic Emergencies in an Office-Based Practice 335 Choking 337 Syncope (Fainting) 339 Anaphylaxis (Anaphylactic Shock) 343 Asthma 346 Chest Pain (Angina Pectoris and Acute Myocardial Infarction) 349 Hypoglycemia 353 15 4 SYSTEMIC DISEASE AND THE EYE 359 Diabetes Mellitus 359 Systemic Hypertension 364 Thyroid Ophthalmopathy 369 16 GLAUCOMA 375 Primary Open-Angle Glaucoma 375 Xlll
xiv Low/Normal-Tension Glaucoma 378 Steroid-Induced Glaucoma 381 Glaucoma Associated with Inflammation 383 Contents Glaucomatocyclitic Crisis (Posner-Schlossman Syndrome) 386 Neovascular Glaucoma 388 Pigmentary Glaucoma 391 Exfoliative Glaucoma 393 Congenital Glaucoma 395 Lens-Induced Secondary Open-Angle Glaucoma 397 Angle-Recession Glaucoma 400 Iridocorneal Endothelial Syndrome 402 Malignant Glaucoma (Ciliary Block Glaucoma, Aqueous Misdirection) 405 Plateau Iris 407
Contents XV 17 RETINA AND VITREAL DISEASE 41 1 Retinal Tears and Rhegmatogenous Detachment 411 W. Craig Lannin Degenerative Retinoschisis 420 W. Craig Lannin Posterior Vitreous Detachment 425 Idiopathic Epiretinal Membranes 428 Ocular Histoplasmosis Syndrome 431 Ocular Toxoplasmosis 434 Toxocariasis 438 Age-Related Macular Degeneration 440 Idiopathic Central Serous Chorioretinopathy (ICSC) 443 Angioid Streaks 448 Pathologic Myopia 450 Gyrate Atrophy 453 Choroideremia 455
xvi Arterial Occlusive Disease 456 Retinal Venous Occlusive Disease 460 Ocular Ischemic Syndrome 468 Diabetic Retinopathy 470 Hypertensive Retinopathy 480 Sickle Cell Hemoglobinopathies 484 Acute Retinal Necrosis 487 Retinopathy of Prematurity 489 W. Craig Lannin Contents 18 NEUROOPHTHALMIC DISEASE 495 Pupil Abnormalities 495 Adie's Tonic Pupil 499 Argyll Robertson Pupil 501 Homer's Syndrome 503 Oculomotor Nerve Palsy 506
Contents Trochlear Nerve Palsy 510 Abducens Nerve Palsy 512 Facial Nerve Palsy 515 Cavernous Sinus Syndrome 518 Tension-Type Headache 521 Migraine Headache 524 Cluster Headache 528 Nonprimary Headache 531 Myasthenia Gravis 536 Blepharospasm and Hemifacial Spasm 539 Traumatic Optic Neuropathy 542 Leber's Hereditary Optic Neuropathy 544 Optic Neuritis 546 Pseudotumor Cerebri 549 XVII
XviH Contents Temporal Arteritis 552 Nonarteritic Ischemic Optic Neuropathy 555 Appendices A OPHTHALMIC ABBREVIATIONS 559 B VERTEX CONVERSION CHART/DIOPTIC CONVERSION CHART 566 C EXTENDED RANGE KERATOMETRY CHART 572 D GRAND ROUNDS AND CASE REPORT SHEETS 574 E IMPORTANT PHONE NUMBERS 579 Index 58i