Essentials of Ophthalmology

The following sections are included:

• FOREWORD
• PREFACE
• ACKNOWLEDGEMENTS
• ABOUT THE EDITORS
• LIST OF CONTRIBUTORS
• CONTENTS

The following is the Learning Objectives:

• Basic Anatomy
  • Understand the basic anatomical structures of the globe.
• Cornea
  • Understand the components and functions of the different layers of the cornea.
• Anterior Chamber Angle
  • The components and position of each part of the anterior chamber angle from a gonioscopic view.
  • Understand the aqueous outflow dynamics and pathways.
• Vitreous
  • Understand the composition and function of the vitreous gel.
• Retina
  • Identify the different layers of the retina and their boundaries.
  • Understand the functions of the retina and how the different components contribute to vision.
• Eyelid
  • Understand the topographical and cross-sectional anatomy of the eyelid - blood and nerve supply.
  • Learn the function of the eyelid.
• Orbit
  • Understand the orbital wall boundaries and its bony parts.
  • Learn the relationship of the orbital walls with the blood and nerve supply that enters/exits the orbit.
• Lacrimal System
  • Understand the lacrimal drainage pathway of the eye.
• Visual Pathway
  • Learn the visual pathway from the optic nerve up to the visual cortex.
  • The relationship of the optic chiasm with the intracranial structures.
  • Familiarise with reflex pupillary pathways.
• Selected Cranial Nerves Related to Ophthalmology
  • Understand the pathway and function of the oculomotor, trochlear and abducen nerve.
  • Learn the components and their relationship within the cavernous sinus.

The following is the Learning Objectives:

• Basic Anterior Segment Examination
  • Recognising and understanding common corneal pathologies.
  • Recognising normal and pathological slit-lamp examination findings.
  • Ability to incorporate clinical findings with various common pathological cornea and external eye conditions.
• Subconjunctival Haemorrhage
  • Recognise the appearance of subconjunctival haemorrhage.
  • Management of subconjunctival haemorrhage.
• Corneal Infections
  • Recognise the signs and symptoms of infective keratitis.
  • Understanding the acute management of infective keratitits.
• Conjunctivitis
  • Recognising and understanding the various causes for conjunctivitis.
  • Management of the various causes of conjunctivitis.
• Corneal Transplant
  • Basic understanding of indications for a corneal transplant.
  • Recognising the presence of a corneal transplant graft.
• Pterygium
  • Recognising a pterygium and understanding the clinical consequences of the condition.
  • Understanding common differentials such as a pseudopterygium and a pinguecula (Fig. 2.13).
• Episcleritis and Scleritis
  • Recognising the difference between episcleritis and scleritis.
  • Understanding the necessary investigations and management in these cases.
• Anterior Segment Trauma
  • Recognising and understanding various types of anterior segment trauma.
  • Understanding the acute management of types of ocular trauma.

The following is the Learning Objectives:

• Recognising the different types of cataracts and the clinical implications.
• Understanding the indications and principles of management of cataract.

The following is the Learning Objectives:

• Primary Angle Closure Glaucoma
  • To be able to learn the characteristics of primary angle closure glaucoma and its clinical features.
  • To recognise acute angle closure and its immediate management.
• Primary Open Angle Glaucoma
  • Learn the definition of primary open angle glaucoma and the investigations required to make an accurate diagnosis.
  • Identify the characteristic visual field defects associated with glaucoma.
  • Definition of congenital glaucoma and its management principles.
• Secondary Glaucoma
  • Identify the different types and mechanisms of secondary glaucoma.
  • Outline the main principles of management specific to the aetiology of secondary glaucoma.
• Investigations related to Glaucoma
  • Familiarise with the common investigations performed for glaucoma patients.
  • Learn how to interpret static automated perimetry in a systematic approach.
• Management of Glaucoma and its Complications
  • Learn the principles and indications for medical, laser and surgical therapy for glaucoma.
  • Identify the potential side effects or complications associated with therapy.

The following is the Learning Objectives:

• Classification
  • Understanding the definition and classification of uveitis.
  • Understanding the descriptors and terminologies used in uveitis.
• Clinical Assessment and Investigations
  • Learning the approach to assessing a patient with uveitis.
  • Learning when to investigate a patient with uveitis.
  • Learning the roles of investigation in aiding management of a patient with uveitis.
• Toxoplasmosis
  • Understanding the clinical manifestation of congenital and acquired toxoplasmosis.
  • Understanding the management of ocular toxoplasmosis.
• Cytomegalovirus Retinitis
  • Understanding the clinical presentation of CMV retinitis.
  • Understanding the management of CMV retinitis.
• Endogenous Endophthalmitis
  • Understanding the clinical presentation of endophthalmitis.
  • Understanding the management of endophthalmitis.
• Systemic Diseases Associated Uveitis
  • Identify the systemic diseases associated with uveitis and its management.
• Scleritis and Episcleritis
  • Identify and differentiate scleritis from episcleritis.

The following is the Learning Objectives:

• Inherited Retinal Disorders
  • Introduction to retinitis pigmentosa.
  • Appreciate fundus changes in retinitis pigmentosa.
  • Understand syndromes associated with retinitis pigmentosa.
• Diabetic Retinopathy
  • Classification of diabetic retinopathy.
  • Understand mechanisms of vision loss due to diabetic retinopathy.
  • Principles of management of diabetic retinopathy.
• Retinal Vein Occlusions
  • Branch retinal vein occlusions (BRVO) vs Central retinal vein occlusions (CRVO).
  • Understand mechanisms of vision loss in retinal vein occlusions.
  • Role of systemic illness in retinal vein occlusions.
  • Principles of management of retinal vein occlusions.
• Retinal Artery Occlusions
  • Branch retinal artery occlusions vs Central retinal artery occlusions.
  • Understand mechanisms of vision loss in retinal artery occlusions.
  • Role of systemic illness in retinal artery occlusions.
  • Principles of management of retinal artery occlusions.
• Hypertensive Retinopathy
  • Classification of hypertensive retinopathy.
• Age-related Macular Degeneration
  • Difference between dry and wet age related macular degeneration (AMD).
  • Understand mechanisms of vision loss in AMD.
  • Role of smoking in AMD.
  • Principles of management of AMD.
• Retinal Tears/Retinal Detachments
  • Understanding symptoms of a retinal tear.
  • Development of a retinal detachment after a retinal tear.
  • Role of early detection and prophylactic treatment of retinal tears.

The following sections are included:

• Eyelid Disorders
  • Be aware of common causes of eyelid lumps and bumps and be alert to malignant lesions.
  • Know how to classify ptosis based on onset and cause and understand the mechanism of ptosis.
  • Be familiar with common eyelid malpositions including entropion and ectropion.
  • Know how to evaluate a patient with eyelid injury and be familiar with principles of management.
• Orbital Disorders
  • Know how to differentiate preseptal from orbital cellulitis and be familiar with their management.
  • Be familiar with the signs and symptoms of thyroid eye disease (TED) and various sight threatening complications.
  • Understand the management principles of TED.
  • Be aware of common orbital tumours and how they may present.
  • Know how to assess a patient with trauma and what to look out for in a patient with suspected orbital fractures.
• Lacrimal Disorders
  • Be aware of symptoms and signs of nasolacrimal duct obstruction in adults and children.

The following is the Learning Objectives:

• Assessment of Vision in Children
  • Understand visual milestones — from infancy to childhood.
  • How to assess vision in an infant or child.
  • How to recognize signs that may be a cause for concern.
• Amblyopia
  • Understand what is amblyopia.
  • Note the causes of amblyopia.
  • Understand the management of amblyopia.
• Strabismus
  • How to assess strabismus.
  • Causes and management of eso- and exo- deviations.
  • Principles of strabismus management.
• Leukocoria
  • Understand important causes of leukocoria.
  • Understand presentation and assessment of retinoblastoma.
  • Understand presentation and assessment of congenital cataracts.
• Tearing and Discharge in an Infant / Young Child
  • Understand the common and sight threatening causes of tearing in an infant or young child.
  • How to assess tearing in an infant or young child.
• Refractive Error
  • Understand how to prescribe refractive correction for children.
  • Know the definitions of emmetropia, ametropia, hyperopia, myopia and astigmatism.
  • Know how to read a refraction prescription.

The following is the Learning Objectives:

• Optic Neuropathy
  • To be able to recognise that optic neuropathy is a possible cause of visual loss.
  • To be able to clinically determine normal, swollen and pale optic discs(s), and to list differentials for each
• Visual Field Defects
  • To detect visual field defects on confrontational visual field.
  • To recognise patterns of monocular and binocular visual field defects and the site of the lesions causing these defects.
• Ocular Motility Disorders
  • Understand the innervation of the extraocular muscles and identify motility disorders (limitations).
  • Understand the use of cover test in the context of strabismus resulting from neuro-ophthalmic disease.
  • Recognize common patterns of ocular motility abnormalities.
• Pupillary Abnormalities
  • To be able to perform complete examination of the pupils.
  • To appreciate the various abnormalities in relation to afferent and efferent pathway disorders.

The following is the Learning Objectives:

• Understand the role of low vision care in ophthalmology.
• Identify patients with low vision.
• Understand the functional impact of low vision.
• Understand low vision evaluation and management.
• Refer patient for low vision rehabilitation services.

The following sections are included:

• Approach to Leukocoria
• Clinical Pathway for Chronic Visual Loss
• Clinical Pathway for Acute Visual Loss
• Diagnostic Flowchart in an Acute Red Eye
• Neuro-ophthalmology Approaches
• Pupil Examination

The following sections are included:

• Approaches to Visual Acuity
• Cover Test
• Normal Fundus Examination
• Visual Fields by Confrontation

The following sections are included:

• GLOSSARY
• INDEX