Ophthalmology Clerkship: A Guide for Senior Medical Students (Contemporary Surgical Clerkships)

This quick-reference guide is the first book written specifically for the many third- and fourth-year medical students rotating on the ophthalmology service. The book focuses on the diagnosis and management of the most common pathologic entities. Each chapter covers history, physical examination, imaging, and common diagnoses. For each diagnosis, the book sets out the typical presentation, options for non-operative and operative management, and expected outcomes. Chapters include key illustrations, quick-reference charts, tables, diagrams, and bulleted lists. Students can read the text from cover to cover to gain a general foundation of knowledge that can be built upon when they begin their rotation, then use specific chapters to review a sub-specialty before starting a new rotation or seeing a patient with a sub-specialty attending. Topics covered include glaucoma, cataracts, retinal tears, macular degeneration, ptosis, strabismus, thyroid eye disease, and much more. Practical and user-friendly, Ophthalmology Clerkship is the ideal, on-the-spot resource for medical students and practitioners seeking fast facts on diagnosis and management. Its bullet-pointed outline format makes it a perfect quick reference, and its content breadth covers the most commonly encountered problems in clinical practice. Preface 6 Contents 7 Abbreviations 8 Contributors 12 Chapter 1: Overview of Anatomy 14 Ocular Adnexa [1, 2] 14 Eyelid 14 Nasolacrimal System 16 Orbit [1, 2] 17 Bones 17 Extraocular Muscles 19 Globe [2] 20 Conjunctiva 21 Tenon’s Capsule 22 Sclera 22 Cornea 22 Anterior Chamber 23 Uvea 23 Lens 24 Vitreous 25 Retina 25 Introduction to Clinical Optics [3] 26 References 28 Chapter 2: Comprehensive Eye Exam 30 Ocular Vital Signs 30 Visual Acuity 30 Snellen Chart [1, 2] 30 Pupils 32 Pupillary Light Reflex [2] 32 Intraocular Pressure (IOP) 32 Goldmann Applanation Tonometer 34 Instructions [2] 34 Common Handheld Tonometers 35 Tono-Pen [2] 35 iCare Tonometer [2] 36 Perkins Tonometer 37 Noncontact Tonometer 37 Visual Field 37 Visual Field Testing 37 Confrontation Testing [1, 2] 37 Amsler Grid [1, 2] 37 Tangent Screen [1, 2] 38 Hemisphere Perimeters [1, 2] 38 Anterior Segment 40 Slit-Lamp Examination (SLE) Introduction 40 General Considerations 41 Positioning [3] 41 Eyelids and Conjunctiva [2, 3] 42 Cornea [1] 43 Fluorescein Examination for Corneal Epithelial Defects [1] 43 Tear Film Breakup Time (TBUT) [1] 43 Anterior Chamber [2, 3] 44 Iris [1, 3] 44 Lens [3] 44 Posterior Segment 45 Direct Ophthalmoscopy 45 Overview 45 Examination [1] 46 Indirect Ophthalmoscopy 46 Overview 46 Headset Adjustment 47 Lens Position and Examination [2] 47 Scleral Depression [1, 2] 47 References 48 Chapter 3: Oculoplastics and Periocular Oncology 49 Anatomy 49 Orbit Anatomy [1, 2] 49 Eyelid Anatomy [1, 2] 50 Lacrimal System Anatomy [3] 52 Ptosis [3] 54 Blepharoptosis 54 Ptosis Evaluation [3] 54 Ptosis Repair [3, 4] 56 Lower Eyelid Malposition [3] 56 Ectropion 56 Entropion 57 Eyelid Lesions [3, 5, 6] 58 Evaluation of Periocular Neoplasms 58 Benign Lesions of the Eyelid 59 Malignant Lesions of the Eyelid [3, 5, 6] 60 Epiphora [3] 61 Overview 61 Evaluation 61 Management 62 Trauma 63 Eyelid Lacerations 63 Orbital Fractures [7] 63 Thyroid Eye Disease [8–10] 64 Overview 64 Diagnosis 64 Management 65 Orbital Infections 66 Management 67 Eye Removal 67 References 68 Chapter 4: Anterior Segment: Cornea, Anterior Chamber, and Lens 69 Cornea [1–10] 69 Introduction 69 Anatomy 70 Epithelium 70 Bowman’s Layer 70 Stroma 70 Descemet’s Membrane 71 Endothelium 71 Physical Examination 72 Pathology 72 Corneal Foreign Body 72 Corneal Abrasion 73 Corneal Ulcers 74 Corneal Laceration 75 Herpes Simplex Virus Epithelial Keratitis 76 Chemical Injury 76 Dry Eye Syndrome [10] 77 Anterior Chamber [3–6] 78 Anatomy 78 Physical Examination 78 Pathology 80 Traumatic Iritis 80 Traumatic Hyphema 80 Hypopyon 81 Lens [3–6, 11] 81 Introduction 81 Anatomy 82 Capsule 82 Cortex 82 Nucleus 82 Physical Examination 82 Pathology 83 Cataract 83 References 84 Chapter 5: Glaucoma 85 Introduction 85 Anatomy and Pathophysiology 85 Aqueous Humor Production and Outflow 86 Optic Disc Anatomy 87 Intraocular Pressure 90 Classification 90 Open Angle Glaucoma 90 Closed Angle Glaucoma 90 Childhood Glaucoma 92 History and Physical 93 History 93 Physical Exam 93 Optic Nerve Evaluation 95 Imaging 95 Diagnosis 97 Primary Open Angle Glaucoma 97 Primary Angle Closure Glaucoma 98 Secondary Open/Angle Closure Glaucoma 98 Treatment 98 General Treatment Principles 98 Medical Treatment 99 Laser Treatment 100 Laser Trabeculoplasty 100 Laser Peripheral Iridotomy (LPI) 100 Laser Cyclophotocoagulation (CPC) 100 Surgical Treatments 101 Minimally Invasive Glaucoma Surgery 101 Tube Shunt Surgeries 101 Trabeculectomy 102 Lens Extraction 102 References 102 Chapter 6: Retina 105 Introduction 105 Anatomy/Structures of the Posterior Segment 105 The Layers of the Retina [6] 107 Exam Techniques 107 Retinal Imaging [7] 108 High Yield Pathology and Treatment 111 Age-Related Macular Degeneration (AMD) 114 Retina Procedures 115 Intravitreal Injection 115 Pars Plana Vitrectomy 116 References 116 Chapter 7: Uveitis 117 Anatomy 117 Epidemiology 118 History 118 Exam 119 Laboratory Evaluation 122 Treatment 123 Complications 123 References 124 Chapter 8: Pediatric Ophthalmology 125 Introduction 125 Amblyopia 125 Pathophysiology 125 Classification 126 Treatment 127 Strabismus 127 Esodeviations 128 Exodeviations 129 Vertical Deviations 130 Surgical Procedure for Strabismus 131 Types of Surgical Procedures 131 Weakening Procedures 131 Strengthening Procedures 132 Other Procedures 132 Examples 132 References 132 Chapter 9: Neuro-Ophthalmology 134 Visual Pathway 134 Retina 134 Optic Nerve 135 Optic Chiasm 135 Optic Tract 136 Optic Radiation 136 Visual Cortex 136 Afferent Pupillary Pathway 137 Efferent Pupillary Pathway 138 Parasympathetic Pathway 138 Sympathetic Pathway 138 Anisocoria 139 Motor Pathway 140 Cranial Nerve III (Oculomotor) 140 Cranial Nerve III Palsy 141 Cranial Nerve IV (Trochlear) 141 Cranial Nerve IV Palsy 142 Superior Oblique Myokymia 142 Cranial Nerve VI (Abducens) 143 Cranial Nerve VI Palsy 143 Internuclear Ophthalmoplegia 144 Cavernous Sinus Syndrome 144 Optic Disc Edema 145 References 147 Chapter 10: On Call Issues 148 Trauma 148 History Taking 148 Physical Exam 149 Ancillary Tests [2] 149 Selected Diagnoses [2–5] 149 Cellulitis [3] 152 Selected Diagnoses 153 High Eye Pressure [6] 154 Selected Diagnoses 154 Treatment 155 Prognosis 156 The Red Eye [7–9] 156 Anatomy of the Red Eye 156 History Taking 156 Physical Examination 157 Selected Diagnoses [7–9] 157 Flashes and Floaters [4, 5, 10] 159 Selected Diagnoses 159 References 161 Index 162