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    An Outline of Ophthalmology
    An Outline of Ophthalmology
    An Outline of Ophthalmology
    Ebook466 pages2 hours

    An Outline of Ophthalmology

    By Roger L. Coakes and Patrick J. Holmes Sellors

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    About this ebook

    An Outline of Ophthalmology focuses on the anatomy, diseases, and diagnosis of the impairments of the eyes. The book first offers information on the assessment of vision and visual symptoms and the sudden, gradual, and transient loss of vision. Discussions focus on refractive errors, occlusion of the central retinal artery, retinal detachment, choroiditis, cataract, chronic glaucoma, retinitis pigmentosa, and retinal emboli and temporary vascular occlusion. The manuscript also examines blindness, ocular pain and discomfort, and irritable eye. The text ponders on the dry and watering eye, headache and facial pain, and the eyelids. The publication also takes a look at proptosis, conjunctiva, sclera, and cornea, pupil and iris, and abnormal eye movements, double vision, and squint. Topics include pseudoproptosis, tumor of the orbit, orbital hematoma, abnormal iris, nystagmus, and conjugate gaze. The manuscript is a valuable source of information for medical students and professionals and readers interested in the diseases of the eyes.
    LanguageEnglish
    PublisherElsevier Science
    Release dateOct 22, 2013
    ISBN9781483280981
    An Outline of Ophthalmology

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      Book preview

      An Outline of Ophthalmology - Roger L. Coakes

      text.

      Outline anatomy of the eye

      The palpebral aperture.

      The upper eyelid.

      The eye from above.

      The drainage angle.

      The ocular fundus.

      The retina.

      Part 1

      Diseases of the eye

      Section 1

      Loss of vision

      1

      Assessment of vision and visual symptoms

      One of the commonest presenting features in ophthalmology is loss of vision. This may be sudden, gradual or transient and involve either a decline in visual acuity, loss of peripheral field or both. In order to determine the cause it is necessary, in addition to taking a careful history, to be able to assess visual function, interpret visual symptoms and examine the eye with the aid of an ophthalmoscope.

      Assessment of visual function

      Visual acuity

      Visual acuity is a measure of the ability of the eye to discriminate between two points. It is the central vision required for seeing details at all distances.

      It is a function of the macular area of the retina, and in particular the central fovea, and is mediated by the retinal cones and their central connections.

      Distance vision

      The most familiar test of visual acuity is the Snellen chart. This has a series of letters of graduated size, each subtending an angle of 5 minutes of arc at a specific distance. The top letter on the chart subtends this angle at 60 metres while the smallest letters subtend the angle at 5 metres.

      The test is conducted at a distance of 6 metres (20 feet) which is optically equivalent to infinity. A patient who can only see the top letter has a visual acuity of 6/60, while a patient who can read down to those letters subtending an angle of 5 minutes of arc at 12 metres has a visual acuity of 6/12. Visual acuity of 6/6 is the accepted normal (in America, expressed as 20/20).

      Snellen chart.

      When the visual acuity is less than 6/60 the distance between the observer and the chart can be reduced (for example 2/60 means that the top letter can only be seen at a distance of 2 metres). Vision below 1/60 can be recorded as the ability to count fingers (CF), to see hand movements (HM) or perceive light (PL). A totally blind eye is unable to perceive light (NPL).

      Near vision

      Visual acuity at reading distance is measured with varying sizes of printed text. Special books printed in ‘Times Roman’ type are used. The smallest print is 4.5 or 5.0 point and the largest 48 point. The acuity is prefixed by the letter N (near). N8 is the size of the average newspaper column but normal near vision is N5 or better. N5 is approximately equivalent to 6/12 on the Snellen chart. Books using Jaeger’s types are still used. The smallest print, J1, is nearly equivalent to N5.

      The measurement of near vision is important as reading is a part of everyday life but it should be used in addition to the Snellen chart and not as an alternative. It is difficult to standardize the test as the text can be held at varying distances from the eyes and the result will also be affected by the degree of illumination.

      Near test type.

      The Sheridan–Gardiner test

      This simple test is designed to measure visual acuity in children below reading age. The child holds a card with seven letters. From a distance of 6 metres the examiner shows the child a single letter (corresponding in size to the Snellen letters) and the child points to the matching letter on his chart. Children as young as two and a half years may be able to manage this test. It is also useful for illiterate patients and for those who do not know Roman letters.

      Sheridan–Gardiner test.

      Peripheral vision

      The field of vision is that portion of space which can be seen by the eye. It is bounded medially by the nose, superiorly by the upper lid or brow and below by the cheek. An area of absent or depressed vision within this field is known as a scotoma. The optic nerve head (optic disc) has no visual receptors and thus results in an absolute scotoma temporal to fixation—the blind spot.

      The visual field.

      The visual field and defects within it can be measured by plotting the light threshold of different areas of the retina with static lights of varying intensity (static perimetry) or by moving targets of known size and luminance across the field (kinetic perimetry). Accurate charting of the visual fields requires instruments of varying complexity but simple diagnostic assessment is possible with confrontation methods.

      A In each quadrant of the field of vision the patient is asked to state whether one or two fingers are being held up by the examiner.

      B One eye is covered and the patient fixates the examiner’s opposite eye. A target, e.g. a neurological pin, is brought in from the periphery and the extent of the patient’s visual field, and defects within it, are assessed using the examiner’s field as a control.

      Both of these methods will quickly identify gross field loss such as a homonymous or bitemporal hemianopia. With practise small central and paracentral field defects can be detected by method B.

      Colour vision

      Normal colour vision is required for certain occupations, for example certain branches of the armed forces and electrical engineering. About 7% of men and 0.5% of women are congenitally colour blind. The defect is usually in red/green differentiation and is hereditary, transmitted as a sex-linked abnormality.

      Colour vision is most easily tested with pseudoisochromatic colour plates such as those of Ishihara and Hardy, Rand & Rittler. Acquired colour defects may be found in macular and optic nerve disease.

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