Kanski Synopsis of Ophthalmology

6. Auflage 2014
ISBN: 978-1-4832-8124-7
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 250 Seiten

Synopsis of Ophthalmology, Sixth Edition provides information pertinent to the main aspects of ophthalmology. This book provides the correct diagnosis and treatment of many ocular disorders. Organized into 15 chapters, this edition begins with an overview of the various disorders of the eyelids, including cystic lesions, tumors, involution entropion, and neurogenic ptosis. This text then explains the cause of infiltrative ophthalmopathy, which is the increase in mucopolysaccharides in extraocular muscles leading to enlargement, fibrosis, and restrictive myopathy. Other chapters consider some of the more serious ophthalmological emergencies, including retinal vascular disorders, intraocular tumors, inflammatory glaucomas, retinal detachments, uveitis, conjunctivitis, corneal lesions, cataract, ectopia lentis, and acquired maculopathies. This book discusses as well the earliest clinical manifestations of age-related macular degeneration. The final chapter deals with the diagnosis, clinical features, signs and treatment of myopathies of extraocular muscles. This book is a valuable resource for ophthalmologists, clinicians, and postgraduate students.

Honorary Consultant Ophthalmic Surgeon, Prince Charles Eye Unit, King Edward VII Hospital, Windsor, Royaume-Uni

Autoren/Hrsg.

Kanski, Jack J.

Leseproben

Chapter 1

The eyelids

Publisher Summary

This chapter discusses cystic lesions. The cause of external hordeolum (stye) is an acute staphylococcal infection of a lash follicle and its associated gland of Zeis or Moll. This very common lesion presents at any age with an acute onset of a tender swelling, which erupts through the skin. The treatment includes removal of the associated eyelash and application of an antibiotic ointment to the lid margin to prevent spread of the infection; incision of a large abscess may be required. Meibomian gland dysfunction is characterized by the following symptoms: (1) duct obstruction and retention of sebum and (2) secondary chronic lipogranulomatous inflammation. Meibomian cyst (chalazion)—a very common lesion—presents at any age with a gradual onset of a painless swelling in the tarsal plate. Incision through the conjunctiva is the treatment of choice, and injection of triamcinolone into the cyst may also be effective.

CYSTIC LESIONS

External hordeolum (stye)

Cause

An acute staphylococcal infection of a lash follicle and its associated gland of Zeis or Moll.

Clinical features

This very common lesion presents at any age with an acute onset of a tender swelling which points through the skin.

Treatment

• Removal of the associated eyelash and application of an antibiotic ointment to the lid margin to prevent spread of the infection.

•Incision of a large abscess may be required.

Meibomian cyst (chalazion)

Cause

Meibomian gland dysfunction is characterized by:

•Duct obstruction and retention of sebum.

•Secondary chronic lipogranulomatous inflammation.

Clinical features

This very common lesion presents at any age with a gradual onset of a painless swelling in the tarsal plate.

Treatment

•Incision through the conjunctiva is the treatment of choice.

•Injection of triamcinolone into the cyst may also be effective.

Internal hordeolum

Cause

An acute staphylococcal infection of a meibomian gland.

Clinical features

This very common lesion presents in a similar manner to a stye but it is more painful and it may discharge anteriorly or posteriorly.

Treatment

This is similar to a stye but incision may be necessary if a hard nodule remains.

Miscellaneous

Cyst of Moll is a tiny translucent retention cyst of a modified sweat gland which contains clear fluid.

Cyst of Zeis is a retention cyst of a modified sebaceous gland which is less translucent than a cyst of Moll.

Sebaceous cyst is a cyst of an ordinary sebaceous gland which contains cheesy secretions.

BENIGN TUMOURS

Molluscum contagiosum

Cause

Virus infection.

Clinical features

Signs – presents usually in children with small pale umbilicated lid nodules.

Complications – ipsilateral chronic follicular conjunctivitis and epithelial keratitis.

Treatment

Expression or cauterization of the nodule.

Miscellaneous

Squamous papilloma may be sessile or pedunculated.

Verruca vulgaris characterized by filiform warts which may grow in crops.

Seborrhoeic keratosis which is greasy brown and friable.

Senile keratosis characterized by multiple, flat and scaly lesions which may occasionally undergo malignant change.

Xanthelasma are flat, yellow plaques.

Keratoacanthoma which starts as a red papule, then turns into a nodule with a crater and regresses within weeks. It may mimic a squamous cell carcinoma.

MALIGNANT TUMOURS

Basal cell carcinoma

Clinical features

This is the most common malignant eyelid tumour. It is locally invasive but does not metastasize. The tumour typically presents in old age in one of the following two ways.

Noduloulcerative (rodent ulcer) is the most common type. It consists of a well-defined nodule with telangiectatic blood vessels, central ulceration and a ‘pearly’ appearance due to associated hyperkeratosis.

Sclerosing (morphea type) is less common. The tumour may be multifocal and because it grows radially it has a flat, ill-defined, scar-like appearance.

Treatment

• is the treatment of choice.

• for tumours unsuitable for exision but it should be avoided for the medial canthus because deep infiltration is common.

• for small superficial tumours.

• for diffusely growing tumours in which the lesion is excised in layers and examined by frozen section.

• in the rare event of orbital invasion.

Squamous cell carcinoma

Clinical features

This very rare tumour presents in late adult life as an ulcer (most common), a nodule, a ‘papilloma’ or a cutaneous horn. The tumour grows faster than a rodent ulcer and it may metastasize.

Treatment

Wide excision.

Sebaceous gland carcinoma

Clinical features

This very rare tumour may be multifocal and it may mimic ‘recurrent chalazion’ or ‘severe chronic blepharitis’, hence the frequent delay in diagnosis and poor prognosis.

Treatment

Wide excision.

DISORDERS OF EYELASHES

Trichiasis

Definition

An inward misdirection of normal eyelashes.

Causes

•Primary (rare).

•Secondary to entropion (common).

Treatment

• is easy but recurrence occurs within 4–6 weeks.

• is tedious and recurrences are common.

• is effective but it may cause skin depigmentation in Black patients.

• is effective but may need to be repeated.

• as a temporary measure.

Distichiasis

Definition

An extra row of lashes arising from meibomian gland orifices.

Causes

•Congenital and familial (very rare).

•Secondary to cicatrizing conjunctivitis (see Chapter 4).

Treatment

•Cryotherapy for the lower eyelid.

•Lid splitting and cryotherapy for the upper lid.

ENTROPION

Classification

•Involutional

•Cicatricial

•Congenital

•Acute spastic

Involutional entropion

Cause

A combination of the following age-related changes:

•Preseptal orbicularis overrides pretarsal orbicularis (factor a).

•Horizontal lid laxity (factor b).

•Weakness of lower lid retractors (factor c).

Treatment

• through the skin – corrects factor a.

• corrects factor a.

• (horizontal lid splitting and marginal rotation) –corrects factors a and...