OPHTALMOLOGY Manual of Ocular Diagnosis and Therapy by Deborah Pavan-Langston

By Deborah Pavan-Langston

Thoroughly up-to-date for its 6th version, this guide is a hugely functional consultant to the analysis and administration of eye problems and accidents. specialists from Harvard scientific college and the Massachusetts Eye and Ear Infirmary current authoritative, state of the art ideas in a rapid-access define layout. Appendices contain updated ophthalmic drug and systemic antimicrobial formularies with dosages.

All chapters were up to date to incorporate the newest details on new sickness entities, diagnostic recommendations, medicines, and coverings, together with LASIK and LASEK surgical procedure, cataract extractions, intraocular lenses, use of botulinum for blepharospasm, and clinical therapy of glaucoma. Thirty new full-color photos were added.

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The cornea, lens, uvea, retina, and optic nerve may suffer from injury, but also may be protected from it by use of lead screens and leaded glass to absorb x, gamma, and neutron radiation. 1. Signs and symptoms are conjunctival hyperemia, circumcorneal injection, and watery or mucopurulent discharge. The earliest sign of corneal damage is hypesthesia. Radiation keratitis ranges from a punctate epithelial staining to sloughing of large areas of epithelium, and stromal edema with interstitial keratitis and aseptic corneal necrosis.

The younger the lens, the greater the vulnerability to x-ray. A latency period of 6 months to 12 years exists, depending on dosage, but independent of whether gamma rays or neutrons were the source of injury. The uveal tract may undergo vascular dilation with subsequent boggy edema. Intraretinal hemorrhages, papilledema, and central retinal vein thrombosis may rarely be seen after radiation injury. 2. Therapy of radiation injury is symptomatic. 1% bid, and topical antibiotic ointments or drops, such as ciprofloxacin, ofloxacin, or gentamicin qid, should be used to reduce the pain of ciliary spasm, to prevent synechia formation, and to protect against infection.

Differential diagnosis. Viral keratitis, particularly that resulting from either herpes simplex or herpes zoster, may produce a foreign body sensation associated with lacrimation and blepharospasm. Fluorescein staining of the corneal ulcer, however, will usually reveal a diagnostic branching dendritic ulcer, although a nondescript ovoid or map-shaped ulcer similar to that seen after traumatic abrasion may also be secondary to herpetic infection. 3. Treatment involves the instillation of antibiotic ointment such as polymyxin–bacitracin or gentamicin and a short-acting cycloplegic such as cyclopentolate 1% bid.

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