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Decision Making in OPHTHALMOLOGY
THIRD EDITION
Decision Making in OPHTHALMOLOGY
An Algorithmic Approach
Editor
Johan Zwaan MD PhDProfessor of Ophthalmology, Pediatrics, and Structural and Cellular Biology (Retired)
The University of Texas Health Science Center San Antonio, Texas, USA
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Decision Making in Ophthalmology: An Algorithmic Approach
Third Edition: 2014ISBN: 978-93-5152-091-7Printed at:
Dedicated toThree men have had a significant influence on my career in ophthalmology, as mentors and friends, and I wish to dedicate this book to three of them.
Dr Richard M Robb, then Chief of Pediatric Ophthalmology, Children’s Hospital of Boston, MA, USA, exposed me to clinical ophthalmology and awakened my interest in the discipline. When I asked him for advice about a career in ophthalmology, he enthusiastically encouraged me to pursue it.
I knew Dr Robert D Reinecke, then Chair of the Department of Ophthalmology, Albany Medical Center, Albany, NY, USA, from my days as a member of one of the NIH Visual Sciences Study Sections. Hearing about my plans for an ophthalmology residency, he immediately invited me to join his department, eased my entry in many ways, and provided a great training program. I admired him particularly for his all-out support of the residents, his high ethical standards, and his terrific organizational talents.
At the end of my residency, Dr Claes H Dohlman, then Chief of the Department of Ophthalmology, Harvard Medical School, Boston, MA, USA, asked me to return to Boston, MA, USA, to the Massachusetts Eye and Ear Infirmary and later made me the Head of Pediatric Ophthalmology at the hospital. He obviously had more confidence in my capacities than I had myself, and I hope that I did not disappoint him.
All the three men have given me an example of what a dedicated ophthalmologist should be like.
Contributors
Gelareh Abedi MD Assistant Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Ron A Adelman MD MPH MBA Professor and Director of Retina Center Department of Ophthalmology and Visual Science Yale University School of Medicine New Haven, Connecticut, USA
Negin Agange MD Resident, PGY-3 Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Kent L Anderson MD PhD Associate Professor, Clinical Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
John Awad Medical Student The University of Texas Health Science Center Houston, Texas, USA
James E Bell MD Resident Department of Ophthalmology Moran Eye Center University of Utah Salt Lake City, Utah, USA
Susan M Berry MD Pediatric Ophthalmology Alamo City Eye Physicians San Antonio, Texas, USA
John W Boyle IV MD Gulf South Eye Associates Metairie, Louisiana, USA
John E Carter MD Professor Departments of Neurology and Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Timothy P Cleland MD MSE Adjunct Associate Professor Department of Ophthalmology The University of Texas Health Science Center Retina Associates of South Texas, PA San Antonio, Texas, USA
Steven R Cohen MD Resident Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Armand Daccache MD Assistant Clinical Professor Yale Eye Center Danbury, Connecticut, USA
Lindsay T Davis MD Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Christopher M DeBacker MD FACS Assistant Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Manishi A Desai MD Assistant Professor Department of Ophthalmology Boston University Boston, Massachusetts, USA
Sonya Dhar MD Adjunct Assistant Professor Department of Ophthalmology and Visual Science John A Moran Eye Center University of Utah Salt Lake City, Utah Clinical Instructor Department of Ophthalmology New York University New York, New York, USA
Clinton Duncan MD Resident Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Ambar Faridi MD Resident Department of Ophthalmology Oregon Health and Science University Portland, Oregon, USA
Sandra M Fox OD Assistant Professor, Clinical Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Constance L Fry MD Associate Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Decision Making in Ophthalmologyviii
Kevin Gamett MD Department of Ophthalmology University of Virginia School of Medicine Charlottesville, Virginia, USA
Mitchell J Goff MD Rocky Mountain Retina Consultants Salt Lake City, Utah, USA
Melanie P Gonzalez OD FAAO Assistant Professor, Clinical Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Mary Kelly Green MD Adjunct Assistant Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Ankur Gupta Medical Student University of Virginia School of Medicine Charlottesville, Virginia, USA
Barrett G Haik MD FACS Hamilton Professor Department of Ophthalmology The University of Tennessee Health Science Center Memphis, Tennessee, USA
Joseph M Harrison PhD Associate Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Angela M Herro MD Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Eric Hink MD Assistant Professor Department of Ophthalmology University of Colorado Aurora, Colorado, USA
David EE Holck MD FACS Adjunct Associate Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Deeba Husain MD Associate Professor Department of Ophthalmology Harvard Medical School Boston, Massachusetts, USA
Maria Q Husain MD Resident Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Maria Stephanie R Jardeleza MD Assistant Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Daniel A Johnson MD Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Ekta Kakkar BS BA Medical Student Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Marilyn C Kincaid MD Clinical Professor Department of Ophthalmology and Pathology Saint Louis University School of Medicine St Louis, Missouri, USA
Nitya Kumar Medical Student Department of Ophthalmology The University of Texas Health Science Center Houston, Texas, USA
Lorena Larez MD Ophthalmologist Wilmer Eye Institute Johns Hopkins School of Medicine Baltimore, Maryland, USA
Bailey L Lee MD Houston Eye Associates Houston, Texas, USA
Irene M Lee MD Clinical Instructor Department of Surgery Division of Ophthalmology The Warren Alpert Medical School of Brown University Providence, Rhode Island, USA
Gary L Legault MD Cornea Fellow Department of Ophthalmology Duke University Durham, North Carolina, USA
Alvaro PC Lupinacci MD PhD Private Practice Vinhedo, São Paulo, Brazil
Farhan F Malik MD Department of Ophthalmology Boston University School of Medicine Boston, Massachusetts, USA
Lina Marouf MD Adjunct Professor Department of Ophthalmology The University of Texas Health Science Center at San Antonio Retina Associates of South Texas, PA San Antonio, Texas, USA
Mark L McDermott MD MBA CPE Professor Department of Ophthalmology Wayne State University School of Medicine Detroit, Michigan, USA
J Kevin McKinney MD, MPH Glaucoma Specialist Eye Health Northwest Portland, Oregon, USA
John Ryan McManus MD Instructor Department of Ophthalmology University of Virginia Charlottesville, Virginia, USA
James L Mims III MD Clinical Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Amir Mohsenin MD PhD Resident Department of Ophthalmology and Visual Science Yale University School of Medicine New Haven, Connecticut, USA
Contributors ix
Reid A Mollman BS Medical Student University of Colorado School of Medicine Aurora, Colorado, USA
Jorge A Montes MD Assistant Professor Clinical Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Kundandeep S Nagi MD Assistant Professor Clinical Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Patricia C Nelson MD Resident PGY-4 Department of Ophthalmology San Antonio Military Medical Center San Antonio, Texas, USA
Steven Ness MD Assistant Professor Department of Ophthalmology Boston University School of Medicine Boston, Massachusetts, USA
Peter A Netland MD PhD Vernah Scott Moyston Professor and Chair Department of Ophthalmology University of Virginia School of Medicine Charlottesville, Virginia, USA
Anhtuan H Nguyen BS Medical Student Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Lilian Nguyen BA Medical Student Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Joshua Nunn Medical Student University of Virginia School of Medicine Charlottesville, Virginia, USA
Lanny S Odin MD Clinical Assistant Professor Prairie Eye Center Southern Illinois University School of Medicine Springfield, Illinois, USA
Mary A O’Hara MD Professor Departments of Ophthalmology and Pediatrics University of California, Davis Sacramento, California, USA
Abbie S Ornelas BS Medical Student Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Sotiria Palioura MD PhD Resident Department of Ophthalmology Massachusetts Eye and Ear Infirmary Harvard Medical School Boston, Massachusetts, USA
Thanos D Papakostas MD Resident Department of Ophthalmology Massachusetts Eye and Ear Infirmary Harvard Medical School Boston, Massachusetts, USA
John M Parkinson MD Private Practice Durango, Colorado, USA
Aaron J Parnes MD Eyecare Medical Group Portland, Maine, USA
Mark Pennesi MD PhD Assistant Professor Department of Ophthalmology Oregon Health and Science University Portland, Oregon, USA
*Kenneth L Piest MD
Vasiliki Poulaki MD PhD Associate Professor Department of Ophthalmology Boston University School of Medicine Boston, Massachusetts, USA
Omar S Punjabi MD Retina Staff Physician Department of Ophthalmology Charlotte Eye Ear Nose and Throat Associates Charlotte, North Carolina, USA
Ashvini K Reddy MD Assistant Professor Department of Ophthalmology University of Virginia School of Medicine Charlottesville, Virginia, USA
Juan E Rubio Jr MD Retina Associates of South Texas, PA San Antonio, Texas, USA
David K Scales MD Clinical Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Brian P Schallenberg Medical Student School of Medicine The University of Texas Health Science Center San Antonio, Texas, USA
Martha P Schatz MD Assistant Professor Clinical Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Frank W Scribbick MD Professor, Clinical Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Elizabeth Shane BS Medical Student The University of Texas Health Science Center Houston, Texas, USA
Olga A Shif MD Resident Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
*Deceased
Decision Making in Ophthalmologyx
Dimitrios Sismanis MD Fellow, Oculoplastics San Antonio, Texas, USA
Scott D Smith MD MPH Chairman, Eye Institute Cleveland Clinic, Abu Dhabi United Arab Emirates
Tomy Starck MD Private Practice Houston, Texas, USA
Kristin Story Held MD Clinical Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Manju Subramanian MD Associate Professor Department of Ophthalmology Boston University School of Medicine Boston, Massachusetts, USA
WAJ van Heuven MD Professor and Herbert F Mueller Chair of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Lisa Vogel Medical Student School of Medicine The University of Texas Health Science Center San Antonio, Texas, USA
Martha A Walton MD Clinical Associate Professor Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Nisha Warrier MD MPH Chief Resident Department of Ophthalmology Boston University Medical Center Boston, Massachusetts, USA
Roy Whitaker Jr MD President Eye Consultants of Greensboro, PA Greensboro, North Carolina, USA
Ronald E Wise MD Assistant Professor Department of Ophthalmology University of Colorado Denver, Colorado, USA
John P Wooten BS
Medical Student Department of Ophthalmology The University of Texas Health Science Center San Antonio, Texas, USA
Elizabeth Yang MD Resident Department of Ophthalmology Yale-New Haven Hospital New Haven, Connecticut, USA
Richard W Yee MD Private Practice Houston, Texas, USA
Johan Zwaan MD PhD Professor of Ophthalmology, Pediatrics, and Structural and Cellular Biology (Retired) The University of Texas Health Science Center San Antonio, Texas, USA
Preface
Physicians approaching a patient or a clinical problem come to the right diagnosis or the most appropriate treatment by a process of selection and elimination of choices. Some of this takes place subliminally and the more experience the practitioner has, the quicker and more automatically the process becomes.
This is a book of algorithms or ‘decision trees’ which make the process of decision-making visible. Not everyone follows the same pathways of thinking, and you may find chapters in the book where you would have made different choices, but in most cases, you hopefully would have finished at the same end point(s).
To emphasize the central position of the ‘decision trees’ in the chapters, I have moved them to the front of the chapters, with the text amplifying points of the tree (marked by capital letters referring to paragraphs of the text) to follow.
Other changes from previous editions include the use of tables and graphs and inclusion of color illustrations. The ‘trees’ have partially been color-coded: surgical treatments are shown in red, pharmaceutical ones in green, and other treatments in blue.
In each chapter, the text is not meant to provide a complete review of a topic and the references mostly refer to the text in general, not to a specific paragraph. This is also true for the figures.
Within the framework of the book, the authors had a great deal of freedom in composing their chapters. For those readers who used the previous editions, you will notice that some chapters have stayed virtually the same, while others have been (almost) completely rewritten. All chapters have been reviewed.
I hope that this edition will be found equally useful to practitioners of eyecare at any level as the previous editions were.
Johan Zwaan
Acknowledgments
A book of this nature requires the cooperation of many different authors. I am grateful to all the contributors to the book, but some stand out, going well beyond the call of duty.
First, I wish to thank Dr WAJ van Heuven, retired Chair of the Department of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, USA. He was the one who started the Decision Making in Ophthalmology book (the first and second editions). I was quite honored, when he asked me to be a co-editor. He was very gracious in allowing me to start work on a third edition.
Dr Gelareh Abedi did not only contribute several chapters, but did so very fast. She was also very helpful in recommending other potential authors.
Dr Lina Marouf recruited several other authors, in addition to submitting her own chapters.
Dr Daniel A Johnson, Chair of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, USA, wrote several chapters and got his entire department to collaborate.
The staff of the Philadelphia office, USA, of Jaypee Brothers Medical Publishers (P) Ltd., bent over backwards to make the production of this manuscript pleasant, professional, and fast.
Contents
SECTION 1 General Ophthalmology
1. Visual Loss 2WAJ van Heuven
2. Transient Visual Loss 6 John E Carter, Susan M Berry, Martha P Schatz
3. Distorted Vision 8WAJ van Heuven
4. Poor Color Vision 12 Joseph M Harrison
5. Poor Night Vision 16Joseph M Harrison
6. Isolated Diplopia 20Susan M Berry, John E Carter, Martha P Schatz
7. Photophobia 24Johan Zwaan
8. Flashes and Floaters 26WAJ van Heuven
9. Acquired Increasing Myopia 30Johan Zwaan
10. Acquired Hyperopia 34Johan Zwaan
11. Low Vision 36Sandra M Fox, Melanie P Gonzalez
12. Headache 42Johan Zwaan
13. Eye Pain 46Tomy Starck, Lorena Larez
14. Red Eye 50Tomy Starck, Lorena Larez
15. Itchy Eye 54Kristin Story Held
16. Dry Eye 58Kristin Story Held
17. Epiphora 62Kenneth L Piest (Deceased), Martha A Walton
18. Blepharitis 64Kristin Story Held
19. Nonpigmented Lesion of the Eyelid 68Reid A Mollman, Eric Hink
20. Pigmented Lesion of the Eyelid 72Marilyn C Kincaid, Frank W Scribbick
21. Lesion of the Conjunctiva 74Marilyn C Kincaid, Frank W Scribbick
22. Acute Conjunctivitis 78Kristin Story Held, Ronald E Wise
23. Chronic Conjunctivitis 82Kristin Story Held
24. Subconjunctival Hemorrhage 86Patricia C Nelson
25. Pigment Alterations of the Iris 90Maria Q Husain
26. Increased Transillumination of the Iris 94Johan Zwaan
27. Tumor of the Iris 98Negin Agange, Johan Zwaan
28. Hyphema 100John P Wooten, Kent L Anderson
29. Hypopyon 104Lilian Nguyen, Kent L Anderson
30. Microphthalmos 108 Johan Zwaan
31. Macrophthalmos 112Johan Zwaan
32. Painful Orbital Swelling 116Constance L Fry
33. Orbital Compartment Syndrome 122Constance L Fry, Barrett G Haik
34. Eye Trauma 126Johan Zwaan
35. Intraocular Calcium Density 130Marilyn C Kincaid, Frank W Scribbick
Decision Making in Ophthalmologyxvi
SECTION 2 Oculoplastics
36. Eyelid Swelling 134David EE Holck, Dimitrios Sismanis
37. Retraction of the Upper Eyelid 138Christopher M DeBacker, David EE Holck
38. Drooping of Upper Eyelid (Blepharoptosis) 140Constance L Fry, Mary Kelly Green, Kenneth L Piest (Deceased)
39. Acquired Ectropion 144Christopher M DeBacker, David EE Holck
40. Acquired Entropion 148Christopher M DeBacker, David EE Holck
41. Upper Eyelid Reconstruction 152David EE Holck, Dimitrios Sismanis
42. Lower Eyelid Reconstruction 154Christopher M DeBacker, David EE Holck
43. Blepharospasm 158Christopher M DeBacker, David EE Holck
44. Orbital Floor Fracture (Blowout Fracture) 162David EE Holck, Dimitrios Sismanis
45. Enophthalmos 166David EE Holck, Dimitrios Sismanis
46. Exophthalmos 168Christopher M DeBacker, David EE Holck
47. Symblepharon 172Dimitrios Sismanis, David EE Holck
SECTION 3 Pediatric Ophthalmology and Strabismus
48. Treatment of Amblyopia Secondary to a Refractive Error 176James L Mims Ill
49. The Diagnosis of Strabismus 180Johan Zwaan
50. Infantile Esotropia 184James L Mims Ill
51. Overaction of the Inferior Oblique Muscles and Dissociated Vertical Deviation 186James L Mims Ill
52. Recurrent Esotropia After Bimedial Recession for Infantile Esotropia 188James L Mims III
53. Surgical Treatment of Consecutive Exotropia 190James L Mims Ill
54. Intermittent Exotropia 192James L Mims Ill
55. Acquired Esotropia of Childhood 194James L Mims Ill
56. Diagnosis of Head Tilts and Face Turns in Children 196James L Mims Ill
57. Diagnosis of Cyclovertical Muscle Palsies 198James L Mims Ill
58. Choice of Surgery for Unilateral Superior Oblique Palsy 200James L Mims Ill
59. Choice of Surgery for Duane Retraction Syndrome 202James L Mims Ill
60. Choice of Surgery for Limited Supraduction in a Child 206James L Mims Ill
61. Choice of Surgery for Sixth Cranial Nerve Palsy 208James L Mims Ill
62. Choice of Surgery for A- and V-Pattern Strabismus 212James L Mims Ill
63. Surgical Treatment of Nystagmus with Constant Face Turn, Head Tilt, or Chin Depression 214James L Mims Ill
64. Developmental Glaucoma 218Ankur Gupta, Johan Zwaan, Peter A Netland
65. Conjunctivitis of the Newborn (Ophthalmia Neonatorum) 222Johan Zwaan
66. Does This Baby See? 226Johan Zwaan
Contents xvii
67. Leukocoria 230Johan Zwaan
68. Cloudy Cornea in a Neonate 234Johan Zwaan
69. Cataract in a Child: Diagnosis 240Johan Zwaan
70. Cataract in a Child: Treatment 244Mary A O’Hara, Johan Zwaan
71. Retinoblastoma 248Timothy P Cleland, Johan Zwaan, Lina Marouf
72. Uncorrectable Poor Vision in a Child 252Johan Zwaan
73. Nasolacrimal Duct Obstruction in Children 256Johan Zwaan
SECTION 4 Corneal Disorders
74. Punctate Corneal Staining 260Lisa Vogel, Daniel A Johnson
75. Corneal Dendritic Lesions 264Brian P Schallenberg, Daniel A Johnson
76. Marginal Corneal Ulcer 268Anhtuan H Nguyen, Kent L Anderson
77. Central Corneal Ulcers 272Ekta Kakkar, Kent L Anderson
78. Corneal Endothelial Dystrophies 276Lindsay T Davis
79. Corneal Edema 280John Awad, Richard W Yee
80. Interstitial Keratitis 284Elizabeth Shane, Richard W Yee
81. Corneal Neovascularization 288Clinton Duncan, Daniel A Johnson
82. Band Keratopathy 292Abbie S Ornelas, Kent L Anderson
83. Corneal Pigmentation 296Mark L McDermott, Nitya Kumar, Richard W Yee
84. Corneal Crystals 302Mark L McDermott, Lindsay T Davis
85. Corneal Epithelial Dystrophy 306Maria Q Husain, Richard W Yee
86. Corneal Stromal Dystrophy 310Maria Q Husain, Richard W Yee
87. Corneal Hypesthesia 314Gary L Legault, Mark L McDermott
SECTION 5 Glaucoma and Intraocular Pressure Problems
88. Diagnosis of Glaucoma 318Scott D Smith
89. Elevated Intraocular Pressure 320Scott D Smith
90. Anatomically Narrow Angles 324John M Parkinson, J Kevin McKinney, Manishi A Desai
91. Acutely Elevated Intraocular Pressure 328Scott D Smith, John M Parkinson
92. Primary Open-Angle Glaucoma 332Scott D Smith, Roy Whitaker Jr
93. Low-Tension (Normal-Tension) Glaucoma 334Alvaro PC Lupinacci, Peter A Netland
94. Neovascularization of the Iris 338Roy Whitaker Jr, Scott D Smith, Manishi A Desai
95. Enlarged Episcleral Veins 342Joshua Nunn, John Ryan McManus, J Kevin McKinney, Peter A Netland
96. Surgical Treatment of Medically Uncontrolled Primary Open-Angle Glaucoma 346Scott D Smith, John M Parkinson
97. Shallow Anterior Chamber After Glaucoma Surgery 350J Kevin McKinney, Roy Whitaker Jr, Kundandeep S Nagi
98. High Intraocular Pressure After Glaucoma Filtration Surgery 354John M Parkinson, J Kevin McKinney, Kundandeep S Nagi
99. The Glaucoma Patient with Cataract 358John W Boyle IV, Peter A Netland
100. Ocular Hypotony 362John Ryan McManus, J Kevin McKinney, Peter A Netland
101. Medical Therapy of Glaucoma 364Kevin Gamett, Johan Zwaan, Peter A Netland
Decision Making in Ophthalmologyxviii
101A. Uveitis-Associated Glaucoma 368John Ryan McManus, Ashvini K Reddy, Peter A Netland
SECTION 6 Lens Disorders
102. Opacities on the Lens Surface 372Johan Zwaan
103. Subluxated and Dislocated Lenses 376Johan Zwaan
104. Pain After Cataract Surgery 380Kristin Story Held, Irene M Lee
105. Poor Vision After Cataract Surgery 386Sonya Dhar
106. Shallow Anterior Chamber After Cataract Surgery 390Sonya Dhar
107. Diplopia After Cataract Surgery 394Johan Zwaan
SECTION 7 Retinal and Vitreous Disorders
108. Retinal Imaging (Imaging in Ophthalmology) 398Gelareh Abedi
109. Macular Bull’s Eye 400Gelareh Abedi, Joseph M Harrison
110. Macular Star 404Gelareh Abedi
111. Macular Cherry-Red Spot 406Armand Daccache, Amir Mohsenin, Elizabeth Yang
112. Crystals in the Fundus 408Gelareh Abedi
113. Retained Lens Fragments 410Lina Marouf, Gelareh Abedi, Timothy P Cleland
114. Subretinal Neovascular Membranes 412Juan E Rubio Jr, Lina Marouf, Bailey L Lee
115. Juxtapapillary Lesion 418Ron A Adelman, Aaron J Parnes
116. Choroidal Folds 422Farhan F Malik, Deeba Husain
117. White Spots in the Fundus 426Manju Subramanian
118. Hard Exudates in the Fundus 430Nisha Warrier, Steven Ness
119. Black Spots in the Fundus 434Vasiliki Poulaki, Sotiria Palioura
120. Intraocular Hemorrhages 438Negin Agange, Gelareh Abedi
121. Cotton-Wool Spots in the Fundus 444Gelareh Abedi
122. Retinal Vascular Anomalies 448Ambar Faridi, Mark Pennesi
123. Sheathing of Retinal Vessels 454Lina Marouf, Lanny S Odin, Juan E Rubio Jr, Timothy P Cleland
124. Retinal Arterial Occlusive Disease 458Timothy P Cleland, Lina Marouf
125. Retinal Vein Occlusion 462Omar S Punjabi, Lina Marouf
126. Retinal Elevation 466Steven Ness
127. Malignant Melanoma of the Choroid 470Thanos D Papakostas, Vasiliki Poulaki
128. Vitreous Opacities 474Lina Marouf, Lanny S Odin, Bailey L Lee
129. Retinal Holes and Tears 480Maria Stephanie R Jardeleza, WAJ van Heuven
130. Retinal Detachment 484Mitchell J Goff, James E Bell
131. Diabetic Retinopathy 490Maria Stephanie R Jardeleza, WAJ van Heuven
132. Retinal Drug Toxicity 494Bailey L Lee
SECTION 8 Uveitis
133. External Ocular Inflammation 498Olga A Shif, Daniel A Johnson
134. Anterior Uveitis 502Daniel A Johnson
135. Intermediate Uveitis 506Daniel A Johnson
136. Retinitis 508Daniel A Johnson
137. Choroiditis 510Daniel A Johnson
Contents xix
138. Panuveitis 512Daniel A Johnson
139. Local Ocular Therapy 514Steven R Cohen, Daniel A Johnson
140. Systemic Therapy 518Steven R Cohen, Daniel A Johnson
SECTION 9 Neuro-Ophthalmic Disorders
141. The Abnormal Pupil 524Angela M Herro, Martha P Schatz, John E Carter
142. Nystagmus 528Jorge A Montes, Martha P Schatz, John E Carter, Susan M Berry
143. Swollen Disc 530Martha P Schatz, Angela M Herro
144. Optic Neuropathy 532John E Carter, Susan M Berry, Martha P Schatz, David K Scales
145. Loss of Visual Field 536Angela M Herro, Johan Zwaan
Index 541