Ophthalmology Clerkship: A Guide for Senior Medical Students

Description:

This quick-reference guide is the first book written specifically for the many third- and fourth-year medical students rotating on the ophthalmology service. The book focuses on the diagnosis and management of the most common pathologic entities. Each chapter covers history, physical examination, imaging, and common diagnoses. For each diagnosis, the book sets out the typical presentation, options for non-operative and operative management, and expected outcomes. Chapters include key illustrations, quick-reference charts, tables, diagrams, and bulleted lists. Students can read the text from cover to cover to gain a general foundation of knowledge that can be built upon when they begin their rotation, then use specific chapters to review a sub-specialty before starting a new rotation or seeing a patient with a sub-specialty attending. Topics covered include glaucoma, cataracts, retinal tears, macular degeneration, ptosis, strabismus, thyroid eye disease, and much more.
Practical and user-friendly, Ophthalmology Clerkship is the ideal, on-the-spot resource for medical students and practitioners seeking fast facts on diagnosis and management. Its bullet-pointed outline format makes it a perfect quick reference, and its content breadth covers the most commonly encountered problems in clinical practice.

Preface

Ophthalmology, the study of disease and surgery of the eye and visual systems, is an intricate and rewarding field with direct impact on patients. Pathology of the eye and periorbita significantly impacts patients’ activities of daily living and quality of life and is associated with a variety of systemic conditions including infections, malignancies, and metabolic derangements. As a result, an understanding of the fundamentals of ophthalmic physiology and disease processes is beneficial to physician trainees of all persuasions.

The following compilation introduces and summarizes the ophthalmic anatomy, examination, and clinical evaluation. The material begins with an overview of ocular anatomy, which is closely entwined with visual function, and a brief discussion of optics. The remainder of the text is organized into traditional ophthalmic subspecialties, some of which may be defined anatomically (i.e., cornea and retina) while others focus on a specific pathophysiology (i.e., glaucoma or uveitis). Oculoplastics and neuro-ophthalmology encompass the study of the structures surrounding and supporting the eye itself. Overlap in content among these chapters reflects the interplay of ophthalmic anatomy and physiology among sub-specialties and highlights each discipline’s unique perspective and considerations.

Ophthalmologic annotation makes frequent use of esoteric jargon and abbreviations not commonly shared with other medical specialties. This unique terminology can be an obstacle to students first studying ophthalmology. The text discusses and defines specialty-specific terms as they become relevant so that students can develop a familiarity with the language commonly encountered on an ophthalmology rotation.

We hope that the following text serves as a practical companion to your ophthalmology clerkship and provides an immersive introduction that inspires further learning.

Table of contents :

Preface
Contents
Abbreviations
Contributors
Chapter 1: Overview of Anatomy
Ocular Adnexa [1, 2] Eyelid
Nasolacrimal System
Orbit [1, 2] Bones
Extraocular Muscles
Globe [2] Conjunctiva
Tenon’s Capsule
Sclera
Cornea
Anterior Chamber
Uvea
Lens
Vitreous
Retina
Introduction to Clinical Optics [3] References
Chapter 2: Comprehensive Eye Exam
Ocular Vital Signs
Visual Acuity
Snellen Chart [1, 2] Pupils
Pupillary Light Reflex [2] Intraocular Pressure (IOP)
Goldmann Applanation Tonometer
Instructions [2] Common Handheld Tonometers
Tono-Pen [2] iCare Tonometer [2] Perkins Tonometer
Noncontact Tonometer
Visual Field
Visual Field Testing
Confrontation Testing [1, 2] Amsler Grid [1, 2] Tangent Screen [1, 2] Hemisphere Perimeters [1, 2] Anterior Segment
Slit-Lamp Examination (SLE) Introduction
General Considerations
Positioning [3] Eyelids and Conjunctiva [2, 3] Cornea [1] Fluorescein Examination for Corneal Epithelial Defects [1] Tear Film Breakup Time (TBUT) [1] Anterior Chamber [2, 3] Iris [1, 3] Lens [3] Posterior Segment
Direct Ophthalmoscopy
Overview
Examination [1] Indirect Ophthalmoscopy
Overview
Headset Adjustment
Lens Position and Examination [2] Scleral Depression [1, 2] References
Chapter 3: Oculoplastics and Periocular Oncology
Anatomy
Orbit Anatomy [1, 2] Eyelid Anatomy [1, 2] Lacrimal System Anatomy [3] Ptosis [3] Blepharoptosis
Ptosis Evaluation [3] Ptosis Repair [3, 4] Lower Eyelid Malposition [3] Ectropion
Entropion
Eyelid Lesions [3, 5, 6] Evaluation of Periocular Neoplasms
Benign Lesions of the Eyelid
Malignant Lesions of the Eyelid [3, 5, 6] Epiphora [3] Overview
Evaluation
Management
Trauma
Eyelid Lacerations
Orbital Fractures [7] Thyroid Eye Disease [8–10] Overview
Diagnosis
Management
Orbital Infections
Management
Eye Removal
References
Chapter 4: Anterior Segment: Cornea, Anterior Chamber, and Lens
Cornea [1–10] Introduction
Anatomy
Epithelium
Bowman’s Layer
Stroma
Descemet’s Membrane
Endothelium
Physical Examination
Pathology
Corneal Foreign Body
Corneal Abrasion
Corneal Ulcers
Corneal Laceration
Herpes Simplex Virus Epithelial Keratitis
Chemical Injury
Dry Eye Syndrome [10] Anterior Chamber [3–6] Anatomy
Physical Examination
Pathology
Traumatic Iritis
Traumatic Hyphema
Hypopyon
Lens [3–6, 11] Introduction
Anatomy
Capsule
Cortex
Nucleus
Physical Examination
Pathology
Cataract
References
Chapter 5: Glaucoma
Introduction
Anatomy and Pathophysiology
Aqueous Humor Production and Outflow
Optic Disc Anatomy
Intraocular Pressure
Classification
Open Angle Glaucoma
Closed Angle Glaucoma
Childhood Glaucoma
History and Physical
History
Physical Exam
Optic Nerve Evaluation
Imaging
Diagnosis
Primary Open Angle Glaucoma
Primary Angle Closure Glaucoma
Secondary Open/Angle Closure Glaucoma
Treatment
General Treatment Principles
Medical Treatment
Laser Treatment
Laser Trabeculoplasty
Laser Peripheral Iridotomy (LPI)
Laser Cyclophotocoagulation (CPC)
Surgical Treatments
Minimally Invasive Glaucoma Surgery
Tube Shunt Surgeries
Trabeculectomy
Lens Extraction
References
Chapter 6: Retina
Introduction
Anatomy/Structures of the Posterior Segment
The Layers of the Retina [6] Exam Techniques
Retinal Imaging [7] High Yield Pathology and Treatment
Age-Related Macular Degeneration (AMD)
Retina Procedures
Intravitreal Injection
Pars Plana Vitrectomy
References
Chapter 7: Uveitis
Anatomy
Epidemiology
History
Exam
Laboratory Evaluation
Treatment
Complications
References
Chapter 8: Pediatric Ophthalmology
Introduction
Amblyopia
Pathophysiology
Classification
Treatment
Strabismus
Esodeviations
Exodeviations
Vertical Deviations
Surgical Procedure for Strabismus
Types of Surgical Procedures
Weakening Procedures
Strengthening Procedures
Other Procedures
Examples
References
Chapter 9: Neuro-Ophthalmology
Visual Pathway
Retina
Optic Nerve
Optic Chiasm
Optic Tract
Optic Radiation
Visual Cortex
Afferent Pupillary Pathway
Efferent Pupillary Pathway
Parasympathetic Pathway
Sympathetic Pathway
Anisocoria
Motor Pathway
Cranial Nerve III (Oculomotor)
Cranial Nerve III Palsy
Cranial Nerve IV (Trochlear)
Cranial Nerve IV Palsy
Superior Oblique Myokymia
Cranial Nerve VI (Abducens)
Cranial Nerve VI Palsy
Internuclear Ophthalmoplegia
Cavernous Sinus Syndrome
Optic Disc Edema
References
Chapter 10: On Call Issues
Trauma
History Taking
Physical Exam
Ancillary Tests [2] Selected Diagnoses [2–5] Cellulitis [3] Selected Diagnoses
High Eye Pressure [6] Selected Diagnoses
Treatment
Prognosis
The Red Eye [7–9] Anatomy of the Red Eye
History Taking
Physical Examination
Selected Diagnoses [7–9] Flashes and Floaters [4, 5, 10] Selected Diagnoses
References
Index