Читать книгу Manual for Eye Examination and Diagnosis - Mark W. Leitman - Страница 4

1 IntroductionFig 1 A seed introduced into the eye of an 8‐year‐old boy through a penetrat...

2 Chapter 1Fig 1 Thyroid exophthalmos with exposed sclera at superior limbus, due to bu...Fig 2 CT scan of thyroid orbitopathy showing fluid infiltration of the media...Fig 3 Orbital CT scan of Graves’ orbitopathy before surgical decompression (...Fig 4 Bull’s eye maculopathy due to hydroxychloroquine in a patient with sys...Fig 5 Phenothiazine maculopathy with pigment mottling of the macula.Fig 6 Tamoxifen maculopathy with crystalline deposits (A); and (B) OCT showi...Fig 7 Tamoxifen causes cataracts.Fig 8 Besides causing maculopathy and cataracts, tamoxifen also causes cryst...Fig 9 Iris retractors are one method used to open poorly dilated pupils duri...Fig 10 Stevens–Johnson syndrome with inflammation and adhesions of lid and b...Fig 11 Irreversible darkening of a blue iris after 3 months of latanoprost (...Fig 12 (A) Prostaglandin‐analogue induced fat atrophy of the left orbit with...Fig 13 After long‐term use of prostaglandin analogue in the left eye, the pa...Fig 14 Epithelial deposits radiating from a central point in the inferior co...Fig 15 Neomycin allergy occurs in 5–10% of the population.

3 Chapter 2Fig 16 Snellen chart measures the central eight degrees of vision.Fig 17 Emmetropic eye.Fig 18 A hyperopic eye often has a shorter than normal axial length creating...Fig 19 Hyperopic eye corrected with convex lens.Fig 20 Parallel rays focused by 1 D lens.Fig 21 Myopic eye.Fig 22 OCT of pathologic myopia showing: A—degeneration of macula; and B—inc...Fig 23 Myopic eye corrected by concave lens.Fig 24 Myopic astigmatism. For explanation, see text.Fig 25 Myopic astigmatism corrected with a myopic cylinder, axis 90°.Fig 26 Tomographic image of corneal astigmatism with the steepest power +47....Fig 27 Full reading glass blurs distance vision.Fig 28 Half glasses.Fig 29 Bifocals.Fig 30 Lens case with red concave and black convex lenses.Fig 31 Trial frame.Fig 32 Phoropter dials in lenses instead of manual placement in trial frame....Fig 33 Streak retinoscope.Fig 34 Retinoscopic determination of the axis of astigmatism.Fig 35 Pupillary reflex with motion and against motion.Fig 36 Computerized autorefractor may replace retinoscopy.Fig 37 Bifocal prescription for farsighted presbyopic patient with astigmati...Fig 38 Measurement of interpupillary distance.Fig 39 Determination of bifocal segment height.Fig 40 Plastic contact lens.Fig 41 Contacts are beneficial for every sport.Fig 42 Manual keratometer.Fig 43 Manual keratometer showing circular images projected on a damaged cor...Fig 44 (A) 13.5 mm diameter. (B) 14.5 mm diameter.Fig 45 Contact lens properly overlapping limbus.Fig 46 (A) Steep base curve, 8.2 mm. (B) Flat base curve, 9.1 mm.Fig 47 Mucus deposits on contact lenses.Fig 48 Lens properly aligned on eye with center marking at 180°.Fig 49 A spectacle correction for the above eye needed an axis of 180 degree...Fig 50 Bifocal contact lens with concentric zones of alternating near and fa...Fig 51 Colored contact lenses.Fig 52 Place contact lens directly on the cornea using the tip of the index ...Fig 53 Remove lens by sliding it off cornea onto sclera and then gently pinc...Fig 54 Contact lens solutions.Fig 55 Fluorescein staining of the cornea.Fig 56 Papillary conjunctivitis with characteristic redness and small, whiti...Fig 57 Limbal injection from a tightfitting lens.Fig 58 Normal cornea. The average central thickness is 545 μm, about half th...Fig 59 Rare instance of traumatic rupture of radial keratotomy wound.Fig 60 Excimer laser used to remove a layer of central corneal stroma.Fig 61 LASIK performed with topical anesthetic.Fig 62 LASIK: a 110 μm flap of epithelium, Bowman’s membrane, and stroma is ...Fig 63 Sculpted cornea after LASIK with remaining Bowman’s membrane.Fig 64 Superficial corneal flap created with a microkeratome. Laser creation...Fig 65 LASIK surgery showing flap being lifted with spatula and laser beam o...Fig 66 Late dislocation of a LASIK flap by self‐inflicted injury.Fig 67 (A) Gray area (arrows) where epithelial cells grew under the flap. (B...Fig 68 Removal of corneal epithelium precedes excimer laser thinning of corn...Fig 69 PRK laser ablation of Bowman’s membrane and stroma after mechanical d...Fig 70 Sculpted cornea after PRK or epi‐LASIK.Fig 71 Epi‐LASIK: creation of epithelial flap with blade followed by laser a...Fig 72 Phakic 6H2 anterior chamber intraocular lens to correct refractive er...Fig 73 Tomograms of corneal topography measure 25,000 points of elevation in...Fig 74 Limbal relaxing incision at 60° (the steepest meridian) super‐imposed...Fig 75 Manual limbal relaxing incision being created on the steepest axis at...Fig 76 Femtosecond laser as an alternative to manual relaxing incision using...Fig 77A SMILE refractive surgery: Femtosecond laser creates a lenticule, whi...Fig 77B Removal of stromal lenticle. Be sure all remnants are removed.

4 Chapter 3Fig 78 Lateral orbital view: adduction and abduction are around the superior...Fig 79 The eye rotates around three different axes coordinated by the action...Fig 80 Superior orbital view. Elevation and depression are on the horizontal...Fig 81 Blood is supplied to the brain by two vertebral arteries and two caro...Fig 82 Types of strabismus.Fig 83 Patching for amblyopia.Fig 84 Wirt stereopsis.Fig 85 Near point of convergence.Fig 86 Accommodative esotropia.Fig 87 Accommodative esotropia corrected with hyperopic lenses.Fig 88 Recession to weaken muscle.Fig 89 Resection to strengthen muscle.Fig 90 Strabismus surgery: after incising the conjunctiva (C), the medial re...Fig 91 Epicanthal folds causing a false impression of cross‐eye (pseudostrab...Fig 92 Right esotropia neutralized with prism (apex‐in).Fig 93 Prism cover test.Fig 94 Hirschberg: esotropia.Fig 95 Hirschberg: exotropia.Fig 96 Hirschberg: left hypotropia.Fig 97 The six cardinal fields of gaze.Fig 98 Right CN III paralysis. In straight gaze, eye turns down and out with...Fig 99 Inability of right eye to look to the left due to medial rectus paral...Fig 100 Inability of the right eye to look up to right due to superior rectu...Fig 101 Cerebral angiogram of right carotid artery showing a 3 mm × 4 mm pos...Fig 102 Stent‐assisted platinum coiling embolization of aneurysm. A small el...Fig 103 Left superior oblique paralysis. To avoid diplopia, head is tilted t...Fig 104 Paralytic left superior oblique with vertical diplopia in primary ga...Fig 105 Right lateral rectus paralysis causing an inability to abduct the ri...Fig 106 Right lateral rectus paralysis, straight gaze.Fig 107 Right lateral rectus paralysis left gaze.Fig 108 The three divisions of the trigeminal nerve, V1, V2, V3, and the ind...Fig 109 Herpes zoster dermatitis. Think of shingles when the blistering derm...Fig 110 Facial nerve to orbicularis oculi and oris muscles.Fig 111 Bell’s palsy due to right CN VII paralysis causes incomplete blink, ...Fig 112 In CN VII paralysis, the inability to close the eye may cause cornea...Fig 113 Botox is injected (X) into the orbicularis oculi muscle to treat ble...Fig 114 Optokinetic drum that causes optokinetic nystagmus when rotated. Hys...Fig 115 Schematic cross‐section of the retina. The ganglion cell fibers on t...Fig 116 Chalk white optic atrophy resulting from ischemia, transection, toxi...Fig 117 Optic atrophy with cupping due to glaucoma.Fig 118 Optic neuritis with papillitis.Fig 119 Swinging light test. (A) Both pupils constrict when light shines in ...Fig 120 Magnetic resonance imaging (MRI) of the brain. White areas of high i...Fig 121 Two of the clinical manifestations of cranial arteritis. (A) Photogr...Fig 122 Histopathologic examination of a temporal artery biopsy in a patient...Fig 123 Three examples of ischemic oral lesions caused by giant cell arterit...Fig 124 MRI of an optic nerve meningioma with secondary papilledema‐like opt...Fig 125 Cross‐section of anterior segment showing the iris‐corneal junction,...Fig 126 Sympathetic pathway.Fig 127 Right Horner’s syndrome. Associated neck pain on the same side is hi...Fig 128 Carotid artery dissection: magnetic resonance angiography (MRA) of r...Fig 129 Pupillary light reflex.Fig 130 Pupillary changesFig 131 Amsler grid. Distortion in wet macular degeneration.Fig 132 Tangent screen tests the central 60°. It is useful when automated pe...Fig 133 An automated hemisphere perimeter tests central and peripheral field...Fig 134 Normal blind spot.Fig 135 Central scotoma.Fig 136 Paracentral scotoma.Fig 137 Altitudinal scotoma.Fig 138 Visual field defects (scotomas) due to brain disease.Fig 139 Lesions of the visual pathway (inside back cover).Fig 140 MRI of pituitary adenoma pressing on the optic chiasm, which lies an...Fig 141 Light flashes called scintillating scotomas are common in migraine. ...Fig 142 CT scan of right occipital infarct.Fig 143 Arteriogram of internal carotid artery narrowing.Fig 144 Structures passing through the venous cavernous sinus are the intern...Fig 145 Carotid‐cavernous fistula, causing proptosis and dilated cork screw ...Fig 146 Carotid‐cavernous fistula causing bilateral CN VI palsies. Contrast ...Fig 147 Cerebral angiography through a femoral artery injection and passage ...

5 Chapter 4Fig 148 Lymph drainage.Fig 149 Lacrimal system.Fig 150 Patients administer one drop by holding the bottle like a pencil wit...Fig 151 After administering the drop, have the patient push on the upper and...Fig 152 Tear film.Fig 154 Meibomian glands in both the upper and lower lid that normally secre...Fig 153 There are 35 meibomian glands in the upper lid and 25 in the lower l...Fig 155 A white Bitot’s spot (↑) is due to conjunctival keratinization from ...Fig 156 Tear breakup time (TBUT). (A) Fluorescein placed on a normal cornea ...Fig 157 Schirmer test.Fig 158 Lissamine green stain of devitalized conjunctival epithelial cells. ...Fig 159 Punctal plug. Problems include 40% loss of plugs, 9% epiphora, and 1...Fig 160 Absorbable punctal plugs—no larger than a grain of rice—may be inser...Fig 161 (A) Fluorescein in both eyes. (B) Obstruction prevents exit of dye i...Fig 162 (A) Punctal probe. (B) Punctum dilator. (C) Pigtail probe.Fig 163 Bicanalicular stent for puncta stenosis or canalicular constriction....Fig 164 Repair of canalicular tear.Fig 165 Irrigation of NLD.Fig 166 Probing of NLD for congenital obstruction is successful 77% of the t...Fig 167 Balloon catheter dacryoplasty: inflate the balloon with sterile sali...Fig 168 Dacryocystitis.Fig 169 Shriveled skin following allergy.Fig 170 Dermatochalasis.Fig 171 Lid margin. The gray line delineates the mucocutaneous junction.Fig 172 Orbital fat herniated under conjunctiva.Fig 173 Prolapsed fat through septum is palpable beneath lower lid.Fig 174 Ectropion: Outturned lid.Fig 175 Entropion: Inturned lid causing trichiasis (rubbing of lashes).Fig 176 Full thickness laceration.Fig 177 Lid retraction in Grave’s disease causing the left eye to appear lar...Fig 178 The orbital septum, originating at the superior orbital rim, thicken...Fig 179 Ptosis due to partial disinsertion of the levator palpebral aponeuro...Fig 180 Repair of ptosis by surgically advancing the levator palpebrae apone...Fig 181 Disinserted levator aponeurosis in Fig. 179 sutured to inferior tars...Fig 182 Myasthenia gravis: no ptosis.Fig 183 Myasthenia gravis: ptosis after looking up for 5 minutes.Fig 184 Ingrown lash.Fig 185 Crab louse: also see Fig 209 which is an oft confused lash parasite....Fig 186 Madarosis or loss of lashes (↑).Fig 187 Verruca vulgaris (wart) with its typical cauliflower‐like appearance...Fig 188 Seborrheic keratosis.Fig 189 Molluscum contagiosum.Fig 190 Follicular conjunctivitis due to viral molluscum contagiosum.Fig 191 Epidermoid inclusion cyst.Fig 192 Nevus.Fig 193 Keratoacanthoma.Fig 194 Infantile hemangioma.Fig 195 Carcinoma of the lid is usually basal cell, but squamous cell looks ...Fig 196 Cutaneous horn.Fig 197 Ash‐leaf spots on the skin are multiple, depigmented macules with ir...Fig 198 Retinal astrocytoma in tuberous sclerosis. Areas of calcification gi...Fig 199 Sturge–Weber syndrome.Fig 200 Neurofibromatosis (von Recklinghausen disease) is characterized by n...Fig 201 Lisch nodules on the iris of a patient with neurofibromatosis.Fig 202 von‐Hipple‐Lindau syndrome: Hemangioblastoma of retina ↑ with dilate...Fig 203 Fluorescein angiogram of hemangioblastoma.Fig 204 A 22‐year‐old from Cape Verde Islands with lepromatous leprosy. Ther...Fig 205 Leprosy causing a solid nodule on the ocular surface together with g...Fig 206 Anterior blepharitis with crusting flakes on lashes.Fig 207 Anterior blepharitis with crusting and ulcerative lesions around las...Fig 208 Blepharoconjunctivitis in acne rosacea. This chronic condition is as...Fig 209 Demodex blepharitis is identified by a telltale cylindrical cuff aro...Fig 210 Toothpaste‐like meibum spontaneously exuding from glands make for an...Fig 211 Posterior blepharitis: dysfunctional meibomian glands may be diagnos...Fig 212 Posterior blepharitis with foamy residue overlying the meibomian gla...Fig 213 Anterior and posterior blepharitis often occur together.Fig 214 Chalazia point internally.Fig 215 A chalazion clamp is used to minimize bleeding during incision and c...Fig 216 Sties point externally.Fig 217 Preseptal cellulitis – i.e., in front of orbital septum (Fig. 218) –...

6 Chapter 5Fig 218 Side view of orbit; periosteum (periorbital) of the orbit (green), t...Fig 219 Yellow subconjunctival fat.Fig 220 Subcutaneous orbital fat often causes a desire for cosmetic excision...Fig 221 Front view shows the apex of the orbit. Note proximity to sinuses wi...Fig 222 CT scan of sphenoid sinusitis with air‐fluid level (↑).Fig 223 One piece of evidence for the diagnosis of sinusitis is to elicit te...Fig 224 CT showing three typical findings of ethmoiditis. A level flat surfa...Fig 225 CT scan showing preseptal lid swelling (↑) and periorbital celluliti...Fig 226 Orbital cellulitis with chemosis and ophthalmoplegia, causing inabil...Fig 227 CT scan of orbital cellulitis (↑) caused by ethmoid sinusitis (↑↑). ...Fig 228 CT scan of left orbital pseudotumor, which is non‐infectious inflamm...Fig 229A Exophthalmometer.Fig 229B CT scan of orbital lymphoma, exhibiting proptosis.Fig 230 Phthisis bulbi: a shrunken globe.Fig 231 CT scan of an orbital blow‐out fracture (↓).Fig 232 A blow‐out fracture may cause entrapment of the inferior rectus musc...Fig 233 Test for hypesthesia using two paper clips to compare the sensitivit...Fig 234 CT scan of traumatic orbital fracture showing lens dislocation.Fig 235 Orbital hemorrhage with overlay of lateral canthal ligament and its ...Fig 236 Retrobulbar injections of anesthesia are used for most ocular surger...

7 Chapter 6Fig 237 Slit lamp microscope.Fig 238 Slit lamp beam.Fig 239 Slit lamp view of anterior segment. C, cornea; A, anterior chamber; ...Fig 240 Cross‐section of cornea.Fig 241 (A) Slit beam cross‐section of a cornea. A, epithelium; B, stroma; C...Fig 242 Corneal abrasion stained with fluorescein.Fig 243 Linear abrasions from trichiasis or particle under lid.Fig 244 A 360° limbal stem cell allograft: sutured or glued to sclera (↑)....Fig 245 Corneal foreign body.Fig 246 Axenfeld loop.Fig 247 Recurrent corneal erosion with localized epithelial edema.Fig 248 Superficial punctate keratitis (SPK) see Table 9, p. 94.Fig 249 SPK stained with fluorescein.Fig 250 Filamentary keratitis presents with strings of epithelium and is oft...Fig 251 Lagophthalmos is a condition in which the lids don’t close completel...Fig 252 SPK from trichiasis.Fig 253 Superficial vascularization, often due to poorly fitting contact len...Fig 254 Sodium hydroxide injury minutes after the event.Fig 255 Sodium hydroxide injury months after the event.Fig 256 Epidemic keratoconjunctivitis with characteristic white, punctate su...Fig 257 Herpes simplex keratitis with tree‐like branching lesions.Fig 258 Herpes simplex with large fluorescein‐stained dendrites. Lesions may...Fig 259 Herpetic inflammation of the stroma could cause permanent scarring w...Fig 260 Herpes dermatitis with multiple small blisters.Fig 261 Marginal corneal ulcer.Fig 262 Central corneal ulcer with secondary hypopyon.Fig 263 Perforated corneal ulcer.Fig 264 Severe corneal edema with epithelial cysts is referred to as bullous...Fig 265 At birth, the normal endothelial cell count is 5,000 cells/mm. It st...Fig 266 Specular microscopy after cataract surgery that damaged the endothel...Fig 267 Edematous folds in the cornea – called stria – usually result from l...Fig 268 Fuchs’ dystrophy with central corneal thickening and haze due to ede...Fig 269 Endothelial cell changes in aging with guttata due to Fuch’s dystrop...Fig 270 Diagram outlining full‐thickness corneal transplant (penetrating ker...Fig 271 Full‐thickness corneal transplant (penetrating keratoplasty).Fig 272 Descemet‐stripping endothelial keratoplasty (DSEK): After removing d...Fig 273 Replacement of endothelium and Descemet’s membrane. (A) Stripping of...Fig 274 OCT showing detached endothelial graft.Fig 275 DSEK graft separation (↑) 3 days after transplant. It was reattached...Fig 276 Successful DSEK surgery with 8.0 mm implant in place (↑).Fig 277 DALK removes most of the stroma up to Descemet’s membrane. A common ...Fig 278 DALK: step 1 is to inject air into the corneal stroma to begin separ...Fig 279 DALK: step 2 is to complete stromal dissection with crescent blade....Fig 280 DALK: step 3 is to remove Descemet’s membrane from donor cornea (↑)....Fig 281 DALK: step 4 is to suture donor graft to recipient bed.Fig 282 The Boston Keratoprosthesis: collar‐button device made of PMMA plast...Fig 283 Eye of a 23‐year‐old patient with congenital endothelial dystrophy. ...Fig 284 Keratoconus with scarring at apex of cone.Fig 285 Munson’s sign: conical cornea indents lid when looking down.Fig 286 Intracorneal ring strengthens and flattens the cornea in keratoconus...Fig 287 Corneal tomography of keratoconus showing thin, steep, eccentrically...Fig 288 Down’s syndrome patient with keratoconus. Corneal edema (hydrops) is...Fig 289 Argyrosis: deposition of silver in conjunctiva, cornea, and lid. Sil...Fig 290 Copper deposited in Descemet’s membrane causing an orange ring at th...Fig 291 Corneal dermoid.Fig 292 Bulbar palpebral and forniceal conjunctiva.Fig 293 Chemosis refers to conjunctival edema.Fig 294 Pterygium.Fig 295 Excision of conjunctival autograft which is usually harvested from t...Fig 296 Autograft is usually sutured (rarely glued) to nasal bulbar conjunct...Fig 297 A pinguecula is a very common benign yellow elevation of the conjunc...Fig 298 Pingueculitis.Fig 299 Subconjunctival hemorrhage.Fig 300 Lymphangiectasia.Fig 301 Conjunctival concretions.Fig 302 Conjunctival verruca (wart) with typical cauliflower appearance.Fig 303 Pemphigoid causes itchy, red blisters on the skin and conjunctivaFig 304 Symblepharon: adhesions of bulbar to palpebral conjunctiva should be...Fig 305 Conjunctivitis is usually due to a bacterial or viral infection. All...Fig 306 Papillae of the palpebral conjunctiva.Fig 307 Follicles of the palpebral conjunctiva.Fig 308 Corneal inflammation from trachoma.Fig 309 Infectious conjunctivitis: Assume conjunctivitis – “pink eye” – of a...Fig 310 Bacterial blepharoconjunctivitis.Fig 311 Conjunctival nevus.Fig 312 Conjunctival melanoma.Fig 313 Melanosis oculi with cutaneous involvement (lower right) has a 4× in...Fig 314 Episcleritis has a 60% occurrence rate.Fig 315 Scleritis.Fig 316 Rheumatoid arthritis causing thin sclera with visible underlying cho...Fig 317 Staphyloma is a weakening of the sclera causing a bulging of the wal...Fig 318 Jaundice (icterus): yellow skin and sclera due to elevated bilirubin...

8 Chapter 7Fig 319 Aqueous flow from ciliary body to Schlemm’s canal.Fig 320 Histology showing Schlemm’s canal (arrows), trabecular meshwork (arr...Fig 321 Uveoscleral outflow of aqueous produced by ciliary processes exits t...Fig 322 Microscopic view of trabecular meshwork that overlies Schlemm’s cana...Fig 323 Goldmann tonometer: The gold standard for measuring eye pressure.Fig 324 Portable tonometers: (A) Schiötz tonometer. (B) Tono‐Pen applanation...Fig 325 Measurement of corneal thickness with ultrasonic pachymeter.Fig 326 Normal trabecular meshwork: grade 4 angle as seen in a goniolens.Fig 327 Peripheral anterior synechiae ↑ are adhesions between the iris and c...Fig 328 The anterior chamber is the space between the iris and cornea. It is...Fig 329 Deep anterior chamber with wide open angle in long myopic eye.Fig 330 Trabecular meshwork seen with a goniolens at the slit lamp (see Fig....Fig 331 (A) Goldmann and (B) Zeiss gonioscope lenses used to examine the ang...Fig 332 Examination of angle with Goldmann lens at slit lamp.Fig 333 Grading angle by progressive widening from 0 to 4.Fig 334 Schematic cross‐section of retina.Fig 335 Lamina cribrosa forms the floor of optic disk. Note perforations for...Fig 336 Drawing of retinal nerve fiber layer with 1.2 million ganglion cell ...Fig 337 “Red‐free” photograph of glaucomatous cupping and loss of retinal ne...Fig 338 Optical coherent tomography (OCT) performed in office showing normal...Fig 339 OCT of glaucoma left eye showing ganglion cell axon layer (nerve fib...Fig 340 Optic cup/disk ratio (A) C/D = 0.25; (B) C/D = 0.40; (C) C/D = 0.70 ...Fig 341 Scanning laser optic disk tomography (OCT) with red color indicating...Fig 342 Three‐dimensional OCT using high‐speed ultra‐high resolution to crea...Fig 343 Color‐coded GDx scanning laser polarimetry showing loss of thicker (...Fig 344 Visual field defects in glaucoma.Fig 345 SLT trabeculoplasty requires a reflecting mirror on the eye to visua...Fig 346 Drawing of SLT trabeculoplasty. Up to 100 shots (causing bubble form...Fig 347 Surgical trabeculectomy showing aqueous flow from ciliary body throu...Fig 348 Dissection of sclera towards the limbus. A window of the sclera is t...Fig 349 A trabeculectomy is a surgically created fistula from anterior chamb...Fig 350 Fundus photo with OCT scan of hypotony maculopathy showing wrinkled ...Fig 351 Very low pressure (hypotony) or posterior scleritis can cause a chor...Fig 352 The rate of trabeculectomy bleb‐related infection is about 1.5% afte...Fig 353 Ahmed glaucoma valve. Tube in anterior chamber drains aqueous to sub...Fig 354 The titanium iStent Trabecular Micro‐Bypass Stent (Glaukos) drains a...Fig 355 Trabectome unroofing Schlemm’s canal.Fig 356 Trabectome removal of trabecular meshwork (↑↑) to expose Schlemm’s c...Fig 357 Photo of trabectome.Fig 358 Kahook Dual Blade enters cornea avoiding conjunctiva.Fig 359 Kahook Dual Blade used to remove 3–4 hours of trabecular meshwork—al...Fig 360 Transscleral cryotherapy is applied for less than 20 seconds to 180°...Fig 361 Endoscopic cyclophotocoagulation for partial destruction of aqueous‐...Fig 362 OCT of closed angle after pupil dilation (see Table 6, p. 53). v...Fig 363 Acute angle‐closure glaucoma with dilated pupil.Fig 364 Angle closure glaucoma: As the eye pressure steadily rises above 35 ...Fig 365 Nd: YAG laser peripheral iridotomy at 2 o’clock.Fig 366 Pigment of dispersion syndrome causing secondary glaucoma.Fig 367 There are a number of types of steroids. Corticosteroids are one typ...Fig 368 Pseudoexfoliation is identified by white flakes on the anterior lens...Fig 369 Hyphema with large iris disinsertion (dialysis) from its root causin...Fig 370 Angle recessed posteriorly following traumatic hyphema. The recessed...Fig 371 Very high pressure, often over 35 mmHg damage the pumping action of ...Fig 372 Congenital glaucoma in an 8‐month‐old, with squinting, an enlarged g...

9 Chapter 8Fig 373 Uvea.Fig 374 The uvea is made up of the iris, ciliary body, and choroid.Fig 375 Brushfield spots are lightly colored spots on the iris common to Dow...Fig 376 Ciliary body.Fig 377 Ciliary muscle contraction lessens tension on zonules causing the le...Fig 378 Tigroid fundus with clearly visible, lightly pigmented choroidal vas...Fig 379 A flat benign choroidal nevus is present in 8% of Americans. Maligna...Fig 380 Elevated malignant choroidal melanoma. Note change in direction as a...Fig 381 Ruthenium radioactive plaque sewn or glued to the episclera of the e...Fig 382 Gross section of malignant ↑ melanoma treated with removal of the ey...Fig 383 B‐scan ultrasound of a malignant choroidal melanoma showing typical ...Fig 384 Exenteration of the orbit for malignant melanoma extending beyond th...Fig 385 Benign iris freckle.Fig 386 Malignant iris melanoma with elevated lesions and distorted pupil.Fig 387 Gonioscopic view of elevated iris melanoma.Fig 388 Rubeosis iridis with neovascularization.Fig 389 Rubeosis iridis. These abnormal iris blood vessels scar the angle of...Fig 390 Iris coloboma.Fig 391 Iritis.Fig 392 Slit‐beam view of flare and cells in anterior chamber.Fig 393 Keratic precipitates (Fig. 395) and posterior synechiae.Fig 394 Larger greasy yellowish keratic precipitates called mutton‐fat occur...Fig 395 Sites of conjunctival injection and pupil size in three cases of an ...Fig 396 Patient with Behcet’s disease with ulcers and fissures on her tongue...Fig 397 Band keratopathy with calcium deposits in Bauman’s membrane in centr...Fig 398 Hilar adenopathy is the number one sign of sarcoidosis occurring in ...Fig 399 Iritis occurs in 25% of patients with sarcoidosis and is the number ...Fig 400 Sarcoidosis with intermediate uveitis and “snowballs” of inflammator...Fig 401 Intermediate uveitis (pars planitis) with snowballing of inflammator...Fig 402 CT scan of sarcoidosis with bilaterally enlarged lacrimal glands (↑)...Fig 403 Sarcoidosis with visibly enlarged right lacrimal gland (↑). Notice e...Fig 404 A lacrimal gland biopsy often helps confirm the diagnosis of sarcoid...Fig 405 Light photomicrograph of lacrimal gland infiltrated with non‐caseati...Fig 406 Tender erythematous subcutaneous sarcoid nodule.Fig 407 Sarcoidosis with vasculitis causing “candle‐wax” drippings on vessel...Fig 408 (A) Toxoplasma gondii is an intracellular parasite. It is the most c...Fig 409 Histoplasmosis with multiple punched out chorioretinitic lesions cal...Fig 410 Unknown southeastern US subretinal nematode (↑) causing neuroretinit...Fig 411 Syphilitic, yellow, flat chorioretinal lesions.Fig 412 Maculopapular syphilitic eruption involving palms.Fig 413 Maculopapular syphilitic eruption involving soles.Fig 414 Syphilitic zones of alopecia prompted patient to wear a wig.Fig 415 Syphilitic painless mucous membrane ulcers occurred at the corners o...Fig 416 Kaposi’s sarcoma of skin in AIDS due to the opportunistic infection ...Fig 417 Kaposi’s sarcoma of conjunctiva.Fig 418 AIDS retinopathy with cotton‐wool spots and intraretinal hemorrhages...Fig 419 Cytomegalovirus (CMV) is the most frequent opportunistic infection i...Fig 420 Fishhook in eye.Fig 421 Open‐globe injury through corneoscleral wall with prolapse of iris a...Fig 422 Penetrating injury through iris and lens capsule causing a cataract ...Fig 423 Enucleation: the eye is removed by first exposing and then severing ...Fig 424 Silicone orbital implant with scleral prosthesis.Fig 425 Porous hydroxyapatite implant allows ingrowth of blood vessels to pr...Fig 426 Enucleated socket with scleral prosthesis.

10 Chapter 9Fig 427 Slit lamp view of lens: A, cornea; B, anterior capsule; C, nucleus; ...Fig 428 Anterior cortical spokes.Fig 429 Posterior subcapsular cataract.Fig 430 Congenital (zonular) cataract surrounded by clear cortex.Fig 431 Brunescent (brown) cataract.Fig 432 Mature lens dislocated into the anterior chamber, obscuring pupil an...Fig 433 Superiorly dislocated lens.Fig 434 A three‐plane corneal incision for entering the eye during cataract ...Fig 435 Iris prolapse into gaping wound causing superiorly peaked pupil.Fig 436 Laser or manual continuous tear capsulotomy (capsulorrhexis). Trypan...Fig 437 Anterior capsulotomy needle. Punctures of the anterior capsule could...Fig 438 Removal of nucleus by phacoemulsification.Fig 439 Manual phacofragmentation of nucleus after dislocation into anterior...Fig 440 After cracking the hard nucleus, it is removed in two pieces with to...Fig 441 Removal of hard nucleus in one piece.Fig 442 After removing the hard nucleus by any technique, the surrounding co...Fig 443 Insertion of rigid lens through a 6‐mm incision.Fig 444 Foldable implant inserted through a 3.2‐mm incision is overwhelmingl...Fig 445 Posterior chamber lens behind iris and in the capsular bag is first ...Fig 446 An anterior chamber lens is sometimes used when the posterior capsul...Fig 447 Femtosecond laser‐assisted grid fragmentation allows surgeons to sof...Fig 448 ReSTOR multifocal intraocular lens with 12 concentric steps of focus...Fig 449 Crystalens utilizes the natural action of the ciliary muscle during ...Fig 450 AcrySof IQ Toric intraocular lens. A marker is first used to mark th...Fig 451 Secondary cataract occurs in 12% of eyes at 1 year and 28% at 5 year...Fig 452 Office‐based YAG laser capsulotomy for secondary cataract of posteri...Fig 453 Dislocated intraocular lens due to weakened zonules.Fig 454 Lens implant (↑ lens haptic) and capsular bag dislocated into the vi...Fig 455 Dislocated posterior chamber lens with haptics sutured to iris. Sutu...Fig 456 Endophthalmitis with hypopyon following cataract surgery.Fig 457 Severe endophthalmitis with visibly dislocated lens implant in anter...

11 Chapter 10Fig 458 Posterior retinal landmarks.Fig 459 Posterior retina.Fig 460 Cross‐section of peripheral retina.Fig 461 Peripheral retina.Fig 462 Schematic cross‐section of retina. The choroidal blood nourishes the...Fig 463 OCT of normal macula with central foveal pit. Note choroidal‐scleral...Fig 464 OCT ‐ Plaquenil toxicity causing disruption of outer retina includin...Fig 465 Normal color OCTA of perifoveal retina. Superficial retinal vessels ...Fig 466 Direct ophthalmoscope.Fig 467 Indirect ophthalmoscope.Fig 468 Three‐mirror contact lens.Fig 469 Three mirror contact lens allows detailed three‐dimensional visualiz...Fig 470 Normal fluorescein angiogram. Retinal vessels terminate at the perif...Fig 471 Normal tigroid (tessellated) fundus with pigment around disk and dee...Fig 472A Normal myopic conus (crescent) at disk margin.Fig 472B Pathologic myopic happens most often in eyes with more than 10 D of...Fig 473 Disk drusen are not related to retinal drusen that occurs in macular...Fig 474 Myelination of the optic nerve. The white myelin sheath covering the...Fig 475 OCT image of papilledema showing elevated disk margin and hyporeflec...Fig 476 Papilledema with elevated disk, engorged veins, and flame‐shaped hem...Fig 477A Fluorescein angiogram of papilledema reveals leakage in and around ...Fig 477B An enlarged blind spot can be plotted most accurately on a tangent ...Fig 478 Papilledema with macular star (↑) due to extension of disk edema.Fig 479 B‐Scan ultrasound showing hyperreflective calcification from buried ...Fig 480 CT scan performed during workup of what was thought to be papilledem...Fig 481 Fluorescein angiogram of vasculitis causing loss of the blood‐retina...Fig 482 Sickle cell retinopathy with vascular inflammation (↑), pale areas o...Fig 483 Sickle cell retinopathy with compensatory neovascularization at edge...Fig 484 Fluorescein angiogram showing leakage from abnormal new vessels.Fig 485 Retinal detachment.Fig 486 Stage III hypertensive retinopathy with cotton‐wool spots, flame‐sha...Fig 487 Drawing of branch retinal vein occlusion with flame hemorrhage and a...Fig 488A Arteriosclerosis with partial vein occlusion causing an engorged ve...Fig 488B OCT‐A of partial vein occlusion with dilated tortuous veins and cap...Fig 489 Central retinal vein occlusion 3 months after occurrence. Compensato...Fig 490 Colored OCT of macular edema after retinal vein occlusion causing th...Fig 491 OCT A of branch retinal vein occlusion with tortuous and engorged ca...Fig 492 Intravitreal steroidal implants last longer than injection and is co...Fig 493 OCT of resolved macular edema from retinal vein occlusion after intr...Fig 494 Retinal artery occlusion with a cholesterol Hollenhorst plaque on th...Fig 495 Branch retinal artery occlusion with embolus (↑) and sludging of blo...Fig 496 Late‐stage retinal artery occlusion with pale disc due to optic atro...Fig 497 OCT of central retinal artery occlusion with inner retinal layer thi...Fig 498 Stage 1: background retinopathy with microaneurysms, exudates, and d...Fig 499 Leakage of fluorescein from microaneurysms. Normal retinal vessels d...Fig 500 OCT of diffuse diabetic macular edema with hyporeflective (black) re...Fig 501 6 Stage 1: retinopathy with cotton‐wool spots, microaneurysms, and d...Fig 502 Fluorescein angiogram showing neovascularization (↓) adjacent to dar...Fig 503 Stage 2: Proliferative retinopathy with preretinal neovascularizatio...Fig 504 Stage 2: Bleeding into the vitreous may cause fibrous proliferation....Fig 505 Normal black and white OCTA. Note ring of interconnected capillaries...Fig 506 Black and white OCTA of diabetic retinopathy showing microaneurysms ...Fig 507 Normal black and white (OCT‐A) of perifoveal retina. Normal black an...Fig 508 Diabetic retinopathy imaged with color OCTA showing microaneurysms a...Fig 509 Pre‐retinal hemorrhages lie between the retina internal limiting mem...Fig 510 This central retinal vein occlusion shows superficial flame‐shaped h...Fig 511 Cross‐section of the retina.Fig 512 Intraretinal hemorrhages in partial central retinal vein occlusion....Fig 513 Wet macular degeneration with subretinal hemorrhages that are grayis...Fig 514 Schematic of normal retina showing retinal pigment epithelium sittin...Fig 515 Dry AMD, with thinning of retina, thickening of Bruch’s membrane (dr...Fig 516 Dry AMD with pigment mottling, drusen, and loss of the foveal reflex...Fig 517 OCT of dry AMD with large drusen ↑.Fig 518 Geographic atrophy is the more advanced form of dry AMD resulting in...Fig 519 Neovascular (nAMD) is also called the wet type. Abnormal choroidal v...Fig 520 Hemorrhagic stage of wet AMD may be associated with severe vision lo...Fig 521 Fluorescein angiogram of subretinal neovascular membrane.Fig 522 OCT of wet AMD with increased retinal thickening due to edema (appea...Fig 523 OCT of wet AMD with cystoid macular edema. This loculated type of ed...Fig 524 AMD imaged with OCTA showing choroidal neovascularization on left an...Fig 525 Late‐stage wet AMD with disciform scar following hemorrhage.Fig 526 Pars plana injection of an anti‐VEGF to treat wet AMD. Calipers meas...Fig 527 Intravitreal injections are becoming the most common intraocular oph...Fig 528 White‐centered pre‐retinal hemorrhages called Roth spots may occur i...Fig 529 Central serous chorioretinopathy.Fig 530 Fluorescein leakage through the RPE in central serous chorioretinopa...Fig 531 Central serous chorioretinopathy.Fig 532 OCT of central serous chorioretinopathy showing subretinal fluid det...Fig 533 Cotton‐wool spots in AIDS. Arteriolar closure causes infarctions of ...Fig 534 White, inflammatory cells in cytomegalovirus retinitis.Fig 535 Schematic cross‐section of retina.Fig 536 Exudate in background diabetic retinopathy. Leaking fluid from vesse...Fig 537 Drusen, together with pigment mottling and decreased vision is often...Fig 538 Pseudoxanthoma elasticum: Angloid streaks are breaks in Bruch’s memb...Fig 539 Do not confuse pseudoxanthoma elasticum and Ehlers–Danlos (ED) syndr...Fig 540 Albinotic fundus.Fig 541 Transilluminated iris in albinism.Fig 542 Albinotic hair and skin.Fig 543 Retinitis pigmentosa with boney pigmented spicules.Fig 544 Retinitis pigmentosa with macular cyst clearly visible on OCT.Fig 545 Constricted visual field in late‐stage retinitis pigmentosa. Dark sq...Fig 546 A microchip in the subretinal space (note black pigment clumping typ...Fig 547 Retinoblastoma.Fig 548 Leukocoria (white pupil) due to retinoblastoma.Fig 549 Stage 3 retinopathy of prematurity (ROP). Note line of demarcation w...Fig 550 Regression of abnormal vessels and hemorrhages after treating ischem...Fig 551 Late stage retinopathy of prematurity with disk and retinal vessels ...Fig 552 Posterior vitreous detachment. The posterior surface of the vitreous...Fig 553 Pars plana vitrectomy—The vitrector cuts out at a rate of 15,000/min...Fig 554 Pars plana vitrectomy showing sites for illumination, irrigation, an...Fig 555 Pars plana vitrectomy.Fig 556 Vitreous opacity.Fig 557 Vitreolysis of vitreous opacity with laser breaking it up into small...Fig 558 Slit lamp view of asteroid hyalosis with lens seen on left and vitre...Fig 559 Hazy view of toxoplasmosis choroiditis due to white cells in the vit...Fig 560 Vitreous hemorrhage or inflammatory cells could hinder one from gett...Fig 561 Blunt trauma, causing pre‐, intra‐, and subretinal hemorrhages is re...Fig 562 Vitreomacular tractionFig 563 OCT of epiretinal membrane appearing as a thickened white line on su...Fig 564 Macular pucker with visible traction lines It occurs in 6% of the po...Fig 565 A blade or forceps is used to create an initial flap in the internal...Fig 566 A circular tear then peels off the opacified epithelial membrane wit...Fig 567 Photograph of peeling epiretinal membrane.Fig 568 OCT scan of full‐thickness macular hole with no detachment caused by...Fig 569 OCT scan of macular hole resolution after vitrectomy with injection ...Fig 570 OCT showing vitreomacular traction (↑) with pigment epithelial detac...Fig 571 Diabetic retinopathy with exudates and macular hole (↑).Fig 572 OCT of partial‐thickness macular hole, called a lamellar hole. Also,...Fig 573 Retinal hole with detachment of sensory retina from pigment epitheli...Fig 574 Lattice degeneration, with a small, round hole with fluid entering t...Fig 575 Retinal detachment caused by a large tear and hole in area of lattic...Fig 576 Pneumatic retinopathy is performed in office. After laser photocoagu...Fig 577 Bubble tamponading retinal hole after laser treatment creates barrie...Fig 578 Retinal detachment with a large hole referred to as horseshoe tear. ...Fig 579 Retinal detachment due to contraction of vitreous membranes treated ...Fig 580 Scleral buckling repair of retinal detachment.Fig 581 Repair of retinal detachment with silicone buckle.

12 Appendix 1Fig 582 Branch retinal artery embolus (↑) from carotid artery and resulting ...Fig 583 In diabetes, hard exudates are caused by lipoproteins leaking from r...Fig 584 Carotid endarterectomy showing temporary shunt (↑) to bypass surgica...Fig 585 Thrombectomy using spatula and forceps (see Fig. 135).Fig 586 Plaque removed from carotid artery.Fig 587 Xanthelasma are irregular yellowish plaque on the medial side of the...Fig 588 Creamy, white retinal blood vessels indicating lipemia retinalis whi...Fig 589 Corneal arcus is a narrow, white band of lipid infiltration separate...

13 Appendix 2Fig 590 Amsler grid.