The Eye in Clinical Practice (eBook)

Peggy Frith (Autor)

eBook Download: PDF

2008 | 2. Auflage
John Wiley & Sons (Verlag)
978-0-470-75987-5 (ISBN)

Infos

The new edition of this highly successful book provides a concise and practical guide to eye disease for the non-specialist, avoiding jargon and giving clear guidance on the practical management of common eye complaints.

Containing fully updated chapters, it provides the GP and optometrist with everything they need to know to enable them to deal with eye problems in primary care. The early sections describe the scope and limitations of eye care in general practice, including training, equipment and tests for ophthalmic disorders. The bulk of the text is confined to common symptoms of eye disease with particular emphasis on differential diagnosis. Later chapters describe systemic disorders with eye problems, eye trauma, surgery of the eye and the screening of asymptomatic patients. Appendices cover a formulary of ophthalmic practice, a list of suppliers, patient information, and a glossary of terms.

A conversational style is used and patients' frequently asked questions are included. Advice is given on the use of basic equipment, on when to treat simple problems, and when to refer more complex ones. This book is well illustrated with full color photographs.

Peggy Frith is the author of The Eye in Clinical Practice, 2nd Edition, published by Wiley.

Inhalt

The Eye in Clinical Practice 4
Contents 7
Preface 11
1 Introduction 13
Primary eye care in general practice 13
Secondary care by other eye professionals 14
Referral letter and GOS 2 form 15
Training 15
Basic equipment 15
Some old wives’ tales in ophthalmology 15
2 A practical approach to the eye andvisual problems 18
Equipment 18
Magnifying aids 18
Slit-lamp examination 18
Abnormal eye appearance 18
Anaesthetic drops to examine a painful eye 19
Fluorescein staining the cornea 20
Upper eyelid eversion 21
The red painful eye 21
Schirmer testing for dryness 23
Cover test for the squinting eye 23
Problems with seeing clearly 23
Testing visual acuity 23
Poor focusing and the pin hole test 25
Opacities in the eye media 25
Testing central vision 26
The fovea (sometimes referred to as the macula) 26
Ophthalmoscopy 27
Drops to dilate the pupil 27
The ophthalmoscope 27
Neurological problems 30
Testingvisual fields 30
Input pupillary imbalance 31
Summary 32
Short guide to urgency of referral 32
3 Disturbance of vision 34
Blurring of vision 34
Opacities within the eye 34
Focusing problems 34
Macular problems 35
Other causes 35
Difficulty in reading 35
Focusing difficulty 35
Other disorders of the lens 36
Problems with the retina 36
Problems with the brain 36
Problems with learning to read 36
Sudden loss of vision 37
Symptoms that may help define the cause 37
Examination in sudden visual loss 37
Retinal vein occlusion 38
Retinal artery occlusion 39
Giant cell (temporal or cranial) arteritis 41
Optic neuritis 43
Retinal detachment 44
Acute glaucoma 45
Vitreous haemorrhage 47
Transient loss of vision 47
Floaters 48
Vitreous shrinkage 49
Vitreous haemorrhage 49
Uveitis 50
Flashing lights 50
Pulling on the retina 50
Migraine 50
Double vision 51
Pattern of doubleness 51
Associated symptoms 52
Monocular diplopia 53
Squint without diplopia 53
Sensation of visual movement 53
Haloes 54
Glare 55
Distortion 55
Central serous retinopathy 56
Age-related macular disease 57
Other causes of distortion 57
Night blindness 57
Disturbance of colour vision 58
Bogus visual symptoms 58
4 Pain and discomfort 61
Pain with an eye cause 61
Foreign body sensation with pain 61
Recurrent corneal erosion 62
Arc eye (welder’s keratitis) 62
Pain without an eye cause 63
Cranial (temporal) arteritis 64
Sinusitis 64
Migraine 64
Trigeminal neuralgia 65
Atypical facial pain 65
Herpes zoster ophthalmicus 65
Intracranial aneurysm 65
Depression 65
Discomfort of the eyes 66
Dry eyes 66
Blepharitis 66
Other lid and lash problems 66
Photophobia 66
Watering 67
Itching 68
5 Abnormal eye appearances 69
The red eye 69
Relevant features in the history 69
Accompanying symptoms (and their likelyrelevance) 69
Examination 69
Conjunctivitis 72
Episcleritis 84
Scleritis 84
Corneal inflammation and ulceration 85
Iritis 91
Acute glaucoma 93
Miscellaneous causes of red eyes 95
Blepharitis 96
Associated features and complications 96
The sticky eye 100
Abnormal corneal appearances 100
Arcus 100
Pterygium 101
Band keratopathy and other corneal deposits 102
Scarring 102
Corneal ulcers 102
Iritis 103
Hyphaema 103
Corneal oedema 103
Corneal dystrophy 104
Lumps around the eye 104
Benign lid lumps 104
Malignant lid tumours 106
Lacrimal gland and sac tumours 107
Swelling around the eye 108
Acute swelling around the eye 108
Chronic swelling around the eye 111
Proptosis 112
Abnormal eyelid position 113
Ptosis 113
Retraction 114
Nystagmus 115
Abnormalities of the pupil 116
Equal pupils with an unequal response to light 116
The large pupil 116
The small pupil 117
The white pupil 117
Squint 118
Abnormal retinal appearances 118
Retinal haemorrhages 118
Pale lesions 119
Pigmented areas 122
6 Problems with focus, spectacles and contact lenses 123
Error of refraction and its measurement 123
Refraction 123
Accommodation, 123
Dioptres 123
Types of focusing problem 123
Presbyopia, or getting older 123
Myopia, or short-sightedness 125
Hypermetropia, or long-sightedness 125
Astigmatism 125
The pin hole occluder 125
Prisms 126
Testing for errors of refraction 126
How to assess spectacle lenses 126
Professionals qualified in eye care 126
Optometrist 126
Dispensing optician 127
Ophthalmic medical practitioner 127
Spectacles 127
Types of spectacle 129
The spectacle frames 130
Intolerance of spectacles 130
Contact lenses 130
Extended wear contact lenses 131
Disposable contact lenses 131
Supervision 132
Lens stuckin the eye 132
Overwear symptoms 132
Criteria for the provision of contact lenses on the NHS, 132
Surgery for errors of refraction 132
7 Five common eye disorders 133
Cataract 133
Glaucoma 134
Treatment of chronic glaucoma 134
Surgery in glaucoma 137
Prognosis 137
Age-related macular degeneration 137
Squint 138
Diabetic eye disease 139
Change in focus 139
Retinopathy 139
Cataract 144
Glaucoma 144
Neurological disorders 144
8 The eye in systemic disorders 145
Thyroid eye disease 145
Ophthalmic problems in neurological disorders 145
Multiple sclerosis 145
Stroke 146
Intracranial tumours 146
Benign intracranial hypertension 147
Facial palsy 148
Eye problems in joint disorders 148
Rheumatoid arthritis 148
Ankylosing spondylitis 149
Reiter’s syndrome 149
Sarcoidosis 149
Sjogren’s syndrome (sicca syndrome) 149
Juvenile arthritis 149
Eye problems in skin disorders 150
Allergic reactions 150
Seborrhoeic eczema 150
Rosacea 150
Psoriasis 150
Blistering disorders 151
Alopecia 151
Infections of the skin involving the eyes 151
Inherited disorders of the skin with eye features 152
Skin and eye in systemic disorders 152
Ocular side-effects of skin therapies 152
Eye problems in sexually transmitted disorders 153
Ophthalmic problems in vascular disorders 153
Hypertension 153
Diabetes 154
Hyperlipidaemia 155
Haematological disorders 155
Vasculitis 156
Ischaemic optic nerve disease 156
Retinal vascular occlusions 156
9 Screening asymptomatic patients 157
Diabetic eye screening 157
Why screen? 157
How to screen 157
Ophthalmoscopic findings 159
A practical screening programme 163
Other factors in diabetic eye care 164
Glaucoma screening 164
What is glaucoma? 164
Screening 165
Screening programmes 166
Screening children 167
Why screen? 167
When to screen? 167
How to screen 167
Sharing with other professionals 170
Why bother to screen all children? 171
Screening for genetic abnormalities 171
Screening for drug toxicity 172
Corticosteroids 172
Antimalarials 172
Ethambutol 172
Other drugs 173
10 Trauma 174
Importance of the clinical history 174
Risk of foreign body within the eye 174
Risk of significant blunt trauma 174
Risk of penetrating eye injury 174
Risk of chemical injury 174
Warning signs in eye trauma 176
Foreign body sensation 176
Black eye 176
Hyphaema 176
Dilated pupil 176
Subconjunctival haemorrhage 177
Crackling of the skin 177
Vitreous haemorrhage 177
Retina1 oedema 177
Double vision 178
Is the eyeball intact? 178
Lid lacerations 179
Loss of vision-summarizing the causes 179
Management plan for the injured eye 179
Subtarsal foreign body 179
Lost contact lens 179
Corneal abrasion 179
Corneal foreign body 180
Black eyes and other blunt injuries 180
Double vision 180
Internal blood 181
The damaged eye that appears to be perforated 181
Chemical injuries 182
Superglue 182
11 Eye surgery 183
Cataract surgery 183
Day-case cataract surgery 183
Local anaesthesia for cataract surgery 183
The operation 184
Postoperative care 184
Complications 186
Glaucoma surgery 187
Chronic ’simple’ glaucoma 187
Acute (angle closure) glaucoma 187
Retinal detachment surgery 188
Timing of surgery 188
The operation 188
Postoperative care 190
Complications 190
Squint surgery 191
The operation 192
Corneal graft surgery 192
Corneal refractive procedures 194
Removal of an eye (enucleation) 194
Postoperative eye drops 195
Minor surgery around the eyes 196
Ingrowing eyelashes (trichiasis) 196
Syringeing the tear ducts 196
Removal of a meibomian cyst (chalazion) 198
Retropunctal cauterization 198
‘Three snip’ operation 200
Tarsorrhaphy 201
Entropion 202
Ectropion 202
Conjunctival cysts 202
Pterygium 202
12 Management of visual handicap 203
Loss of central vision 203
Loss of visual field alone 203
Loss of both acuity and field 204
Other visual handicaps 204
Colour vision defects 204
Night blindness 204
Loss of vision in one eye 204
Low vision aids 204
Registration as blind or partially sighted 205
Requirements for blind registration 206
Requirements for partially sighted registration 206
Benefits and concessions for registered blind and partially sighted people 206
Voluntary help 206
Visual handicap in children 207
Requirements for driving 207
Ordinary driving licences 207
Professional and vocational driving licences 208
Occupational requirements 208
Appendix 1: Formulary for eye care ingeneral practice 209
Formulations and application 209
Patient information leaflets 209
Drops 209
Ointments 209
Lotions 211
Other formulations 211
Medication in contact lens wearers 211
Preservatives and minims 212
Side-effects 212
Allergic reactions to eye medication 212
Systemic effects of absorbed eye medication 212
Anti-infective preparations 212
Topical antibiotics 212
Systemic antibiotics 213
Tetanus vaccination 213
Antiviral agents 213
Anti-inflammatory preparations 213
Corticosteroids 213
Non-steroidal anti-inflammatory preparations 214
Anti-allergic preparations 214
Antihistamines 214
Sodium cromoglycate 214
Medications for the dry eye 215
Hypromellose 215
Polyvinyl alcohol 215
Acetylcysteine 215
Simple eye ointment 215
Drugs acting on the pupil 215
Tropicamide 1% 215
Cyclopentolate 1% 215
Atropine 1% 215
Phenylephrine 10% 215
Pilocarpine 215
Diagnostic agents 215
Fluorescein 215
Topical anaesthetics 215
Drugs to control intraocular pressure 216
Appendix 2: List of suppliers and charities 217
Appendix 3: Patient information sheet:applying a pad 218
Appendix 4: Patient information sheet :blepharitis 219
Glossary of terms used in ophthalmology 220
Index. 223

Rezensionen

"...easily readable and an excellent introduction to clinical
practice" -British Journal of Optometry

"I would recommend it highly" -British Journal of General
Practice

"This text is a winner..." -American Journal of
Ophthalmology

Produkt-Details

• Erscheint lt. Verlag: 15.4.2008
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Augenheilkunde
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• Schlagworte: AIM • Allgemeinpraxis, hausärztliche Praxis • Allgemeinpraxis, hausärztliche Praxis • Book • Care • Chapters • clear • Common • complaints • concise • Diagnosis • disorders • Edition • everything • General • General Practice/Family Practice • Giving • Guide • highly • Jargon • Limitations • Medical Science • Medizin • New • Ophthalmic • Ophthalmologie • Ophthalmology • Optometrist • Practical • Practice • Problems • sections • Successful
• ISBN-10: 0-470-75987-9 / 0470759879
• ISBN-13: 978-0-470-75987-5 / 9780470759875