Common Eye Diseases and their Management

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1 Common Eye Diseases and their Management

2 N.R. Galloway, W.M.K. Amoaku, P.H. Galloway and A.C. Browning Common Eye Diseases and their Management Third Edition With 146 Figures

3 Nicholas R. Galloway, MBCHB, BA, FRCS, MD, FRCOphth Surgeon Emeritus Eye, Ear, Nose and Throat Centre University Hospital Queen s Medical Centre Nottingham, UK Winfried M.K. Amoaku, MBCHB, FRCS, FRCOphth, PhD Senior Lecturer and Honorary Consultant Ophthalmologist, University of Nottingham and University Hospital, Queen s Medical Centre, Nottingham, UK Peter H. Galloway, MBBS, FRCOphth Consultant Ophthalmologist, St James University Hospital, Leeds, UK Andrew C. Browning, BSc, FRCOphth Division of Ophthalmology and Visual Sciences, Eye, Ear, Nose and Throat Centre, University Hospital, Queen s Medical Centre, Nottingham, UK Artwork marked with symbol throughout the book is original to the 2nd edition (Galloway NR, Amoaku WMK. Common Eye Diseases and their Management, 2nd edition. Springer-Verlag London Ltd, 1999) and is being republished in this 3rd edition. A catalogue record for this book is available from the British Library Library of Congress Control Number: ISBN-10: rd edition e-isbn Printed on acid-free paper ISBN-13: ISBN ISBN nd edition st edition First published 1985 Second edition 1999 Third edition 2006 Springer-Verlag London Limited 2006 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Printed in Singapore (BS/KYO) Springer Science+Business Media springeronline.com

Amoaku, MBCHB, FRCS, FRCOphth, PhD Senior Lecturer and Honorary Consultant Ophthalmologist, University of Nottingham and University Hospital, Queen s Medical Centre, Nottingham, UK Peter H.

4 Preface to Third Edition It is a pleasure to welcome two new authors who have contributed to the third edition of Common Eye Diseases : Peter Galloway and Andrew Browning. Six years have passed since the last edition but even in this relatively short time there have been significant advances in the diagnosis and management of eye disease and an update has become necessary. Each author has taken a block of chapters for revision and, where needed, illustrations have been added or removed. Apart from the four main authors, I am indebted to Mr Roland Ling for his invaluable work on the chapter on the retina and once again to Professor Rubinstein for his help with the chapter on contact lenses. The original aims of the book have not been changed. It remains as a textbook for medical students and those starting a career in ophthalmology, but also for those in primary care who are likely to deal with eye problems, including nurses, optometrists and general practitioners. It has been the intention to keep explanations as simple and nontechnical as possible without losing scientific accuracy; more detailed accounts should be sought in the larger textbooks. An updated reference list for further reading is given at the end of the book. An internet version of this edition is being planned and, in order to keep down the retail price, some financial help is needed. For this we are grateful for the interest of Pfizer Ltd, whose policy of educational support has allowed this edition to go forward at its present low price. Acknowledgements Although it is now many years since the first edition appeared, I still owe a great debt to my former secretary, Mrs A. Padgett, for her original help in preparing the basis for these further editions. No amount of word processing can replace this painstaking work. In this new edition, I have kept Geoffrey Lyth s original cartoons, which will perhaps lighten the heaviness of the text for those with an artistic bent. The two new authors have revised a number of chapters and their fresh input to an ageing textbook has been essential and much appreciated. Finally, I would like to acknowledge the help and encouragement from Melissa Morton of Springer-Verlag, who has kept the ball bouncing back into my court with great efficiency and thereby played an important part in ensuring the birth of this new edition. v

necessary. Each author has taken a block of chapters for revision and, where needed, illustrations have been added or removed.

5 Preface to Second Edition Like the first edition, this textbook is intended primarily for medical students, but it is also aimed at all those involved in the primary care of eye disease, including general practitioners, nurses and optometrists. The need for the primary care practitioner to be well informed about common eye conditions is even more important today than when the first edition was produced. A recent survey from North London has shown that 30% of a sample of the population aged 65 and over are visually impaired in both eyes and a large proportion of those with treatable eye conditions were not in touch with eye services. It is clear that better strategies for managing problems of eyesight need to be set up. One obvious strategy is the improved education of those conducting primary care and it is hoped that this book will contribute to this. For this second edition, I am grateful for the help of my coauthor Winfried Amoaku, whose personal experience in teaching medical students here in Nottingham has been invaluable. His expertise in the management of macular disease, now a major cause of sensory deprivation in the elderly, is also evident in these chapters. The format of the book has not changed but some of the chapters have been expanded. For example, there is now a section dealing with the eye complications of acquired immune deficiency syndrome (AIDS). This problem barely existed at the time of the first edition. Cataract surgery has changed a great deal in this short time and is becoming one of the commonest major surgical procedures to be performed in a hospital. The management of glaucoma has also changed with the introduction of a range of new medications. Our aim has been to keep the original problem-oriented layout and to keep it as a book to read rather than a book to look at. There are a number of good atlases on eye disease and some of these are mentioned in the section at the end on further reading. Although the title of the book is Common Eye Diseases, some less common conditions are mentioned and it is hoped that the reader will gain some overall impression of the incidence of different eye diseases. vii

The need for the primary care practitioner to be well informed about common eye conditions is even more important today than when the first edition was produced.

6 Contents Preface to Third Edition Preface to Second Edition v vii Section I Introducing the Eye The Scope of Ophthalmology Basic Anatomy and Physiology of the Eye Examination of the Eye Section II Primary Eye Care Problems Long Sight, Short Sight Common Diseases of the Eyelids Common Diseases of the Conjunctiva and Cornea The Red Eye Failing Vision Headache Contact Lenses Section III Problems of the Eye Surgeon Cataract

......................... 27 4. Long Sight, Short Sight..................................... 29 5. Common Diseases of the Eyelids............................. 33 6.

7 x Contents 12. Glaucoma Retinal Detachment Squint Tumours of the Eye and Adnexae Ocular Trauma Section IV Problems of the Medical Ophthalmologist Testing Visual Acuity The Inflamed Eye The Ageing Eye The Child s Eye Systemic Disease and the Eye Neuro-ophthalmology Genetics and the Eye Drugs and the Eye Section V Visual Handicap Blindness Further Reading Index

Testing Visual Acuity...................................... 137 18. The Inflamed Eye......................................... 141 19. The Ageing Eye........................................... 149 20.

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