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