Manual for Eye Examination and Diagnosis. Mark W. Leitman
followed by laser a...Fig 72 Phakic 6H2 anterior chamber intraocular lens to correct refractive er...Fig 73 Tomograms of corneal topography measure 25,000 points of elevation in...Fig 74 Limbal relaxing incision at 60° (the steepest meridian) super‐imposed...Fig 75 Manual limbal relaxing incision being created on the steepest axis at...Fig 76 Femtosecond laser as an alternative to manual relaxing incision using...Fig 77A SMILE refractive surgery: Femtosecond laser creates a lenticule, whi...Fig 77B Removal of stromal lenticle. Be sure all remnants are removed.
4 Chapter 3Fig 78 Lateral orbital view: adduction and abduction are around the superior...Fig 79 The eye rotates around three different axes coordinated by the action...Fig 80 Superior orbital view. Elevation and depression are on the horizontal...Fig 81 Blood is supplied to the brain by two vertebral arteries and two caro...Fig 82 Types of strabismus.Fig 83 Patching for amblyopia.Fig 84 Wirt stereopsis.Fig 85 Near point of convergence.Fig 86 Accommodative esotropia.Fig 87 Accommodative esotropia corrected with hyperopic lenses.Fig 88 Recession to weaken muscle.Fig 89 Resection to strengthen muscle.Fig 90 Strabismus surgery: after incising the conjunctiva (C), the medial re...Fig 91 Epicanthal folds causing a false impression of cross‐eye (pseudostrab...Fig 92 Right esotropia neutralized with prism (apex‐in).Fig 93 Prism cover test.Fig 94 Hirschberg: esotropia.Fig 95 Hirschberg: exotropia.Fig 96 Hirschberg: left hypotropia.Fig 97 The six cardinal fields of gaze.Fig 98 Right CN III paralysis. In straight gaze, eye turns down and out with...Fig 99 Inability of right eye to look to the left due to medial rectus paral...Fig 100 Inability of the right eye to look up to right due to superior rectu...Fig 101 Cerebral angiogram of right carotid artery showing a 3 mm × 4 mm pos...Fig 102 Stent‐assisted platinum coiling embolization of aneurysm. A small el...Fig 103 Left superior oblique paralysis. To avoid diplopia, head is tilted t...Fig 104 Paralytic left superior oblique with vertical diplopia in primary ga...Fig 105 Right lateral rectus paralysis causing an inability to abduct the ri...Fig 106 Right lateral rectus paralysis, straight gaze.Fig 107 Right lateral rectus paralysis left gaze.Fig 108 The three divisions of the trigeminal nerve, V1, V2, V3, and the ind...Fig 109 Herpes zoster dermatitis. Think of shingles when the blistering derm...Fig 110 Facial nerve to orbicularis oculi and oris muscles.Fig 111 Bell’s palsy due to right CN VII paralysis causes incomplete blink, ...Fig 112 In CN VII paralysis, the inability to close the eye may cause cornea...Fig 113 Botox is injected (X) into the orbicularis oculi muscle to treat ble...Fig 114 Optokinetic drum that causes optokinetic nystagmus when rotated. Hys...Fig 115 Schematic cross‐section of the retina. The ganglion cell fibers on t...Fig 116 Chalk white optic atrophy resulting from ischemia, transection, toxi...Fig 117 Optic atrophy with cupping due to glaucoma.Fig 118 Optic neuritis with papillitis.Fig 119 Swinging light test. (A) Both pupils constrict when light shines in ...Fig 120 Magnetic resonance imaging (MRI) of the brain. White areas of high i...Fig 121 Two of the clinical manifestations of cranial arteritis. (A) Photogr...Fig 122 Histopathologic examination of a temporal artery biopsy in a patient...Fig 123 Three examples of ischemic oral lesions caused by giant cell arterit...Fig 124 MRI of an optic nerve meningioma with secondary papilledema‐like opt...Fig 125 Cross‐section of anterior segment showing the iris‐corneal junction,...Fig 126 Sympathetic pathway.Fig 127 Right Horner’s syndrome. Associated neck pain on the same side is hi...Fig 128 Carotid artery dissection: magnetic resonance angiography (MRA) of r...Fig 129 Pupillary light reflex.Fig 130 Pupillary changesFig 131 Amsler grid. Distortion in wet macular degeneration.Fig 132 Tangent screen tests the central 60°. It is useful when automated pe...Fig 133 An automated hemisphere perimeter tests central and peripheral field...Fig 134 Normal blind spot.Fig 135 Central scotoma.Fig 136 Paracentral scotoma.Fig 137 Altitudinal scotoma.Fig 138 Visual field defects (scotomas) due to brain disease.Fig 139 Lesions of the visual pathway (inside back cover).Fig 140 MRI of pituitary adenoma pressing on the optic chiasm, which lies an...Fig 141 Light flashes called scintillating scotomas are common in migraine. ...Fig 142 CT scan of right occipital infarct.Fig 143 Arteriogram of internal carotid artery narrowing.Fig 144 Structures passing through the venous cavernous sinus are the intern...Fig 145 Carotid‐cavernous fistula, causing proptosis and dilated cork screw ...Fig 146 Carotid‐cavernous fistula causing bilateral CN VI palsies. Contrast ...Fig 147 Cerebral angiography through a femoral artery injection and passage ...
5 Chapter 4Fig 148 Lymph drainage.Fig 149 Lacrimal system.Fig 150 Patients administer one drop by holding the bottle like a pencil wit...Fig 151 After administering the drop, have the patient push on the upper and...Fig 152 Tear film.Fig 154 Meibomian glands in both the upper and lower lid that normally secre...Fig 153 There are 35 meibomian glands in the upper lid and 25 in the lower l...Fig 155 A white Bitot’s spot (↑) is due to conjunctival keratinization from ...Fig 156 Tear breakup time (TBUT). (A) Fluorescein placed on a normal cornea ...Fig 157 Schirmer test.Fig 158 Lissamine green stain of devitalized conjunctival epithelial cells. ...Fig 159 Punctal plug. Problems include 40% loss of plugs, 9% epiphora, and 1...Fig 160 Absorbable punctal plugs—no larger than a grain of rice—may be inser...Fig 161 (A) Fluorescein in both eyes. (B) Obstruction prevents exit of dye i...Fig 162 (A) Punctal probe. (B) Punctum dilator. (C) Pigtail probe.Fig 163 Bicanalicular stent for puncta stenosis or canalicular constriction....Fig 164 Repair of canalicular tear.Fig 165 Irrigation of NLD.Fig 166 Probing of NLD for congenital obstruction is successful 77% of the t...Fig 167 Balloon catheter dacryoplasty: inflate the balloon with sterile sali...Fig 168 Dacryocystitis.Fig 169 Shriveled skin following allergy.Fig 170 Dermatochalasis.Fig 171 Lid margin. The gray line delineates the mucocutaneous junction.Fig 172 Orbital fat herniated under conjunctiva.Fig 173 Prolapsed fat through septum is palpable beneath lower lid.Fig 174 Ectropion: Outturned lid.Fig 175 Entropion: Inturned lid causing trichiasis (rubbing of lashes).Fig 176 Full thickness laceration.Fig 177 Lid retraction in Grave’s disease causing the left eye to appear lar...Fig 178 The orbital septum, originating at the superior orbital rim, thicken...Fig 179 Ptosis due to partial disinsertion of the levator palpebral aponeuro...Fig 180 Repair of ptosis by surgically advancing the levator palpebrae apone...Fig 181 Disinserted levator aponeurosis in Fig. 179 sutured to inferior tars...Fig 182 Myasthenia gravis: no ptosis.Fig 183 Myasthenia gravis: ptosis after looking up for 5 minutes.Fig 184 Ingrown lash.Fig 185 Crab louse: also see Fig 209 which is an oft confused lash parasite....Fig 186 Madarosis or loss of lashes (↑).Fig 187 Verruca vulgaris (wart) with its typical cauliflower‐like appearance...Fig 188 Seborrheic keratosis.Fig 189 Molluscum contagiosum.Fig 190 Follicular conjunctivitis due to viral molluscum contagiosum.Fig 191 Epidermoid inclusion cyst.Fig 192 Nevus.Fig 193 Keratoacanthoma.Fig 194 Infantile hemangioma.Fig 195 Carcinoma of the lid is usually basal cell, but squamous cell looks ...Fig 196 Cutaneous horn.Fig 197 Ash‐leaf spots on the skin are multiple, depigmented macules with ir...Fig 198 Retinal astrocytoma in tuberous sclerosis. Areas of calcification gi...Fig 199 Sturge–Weber syndrome.Fig 200 Neurofibromatosis (von Recklinghausen disease) is characterized by n...Fig 201 Lisch nodules on the iris of a patient with neurofibromatosis.Fig 202 von‐Hipple‐Lindau syndrome: Hemangioblastoma of retina ↑ with dilate...Fig 203 Fluorescein angiogram of hemangioblastoma.Fig 204 A 22‐year‐old from Cape Verde Islands with lepromatous leprosy. Ther...Fig 205 Leprosy causing a solid nodule on the ocular surface together with g...Fig 206 Anterior blepharitis with crusting flakes on lashes.Fig 207 Anterior blepharitis with crusting and ulcerative lesions around las...Fig 208 Blepharoconjunctivitis in acne rosacea. This chronic condition is as...Fig 209 Demodex blepharitis is identified by a telltale cylindrical cuff aro...Fig 210 Toothpaste‐like meibum spontaneously exuding from glands make for an...Fig 211 Posterior blepharitis: dysfunctional meibomian glands may be diagnos...Fig 212 Posterior blepharitis with foamy residue overlying the meibomian gla...Fig 213 Anterior and posterior blepharitis often occur together.Fig 214 Chalazia point internally.Fig 215 A chalazion clamp is used to minimize bleeding during incision and c...Fig 216 Sties point externally.Fig 217 Preseptal cellulitis – i.e., in front of orbital septum (Fig. 218) –...
6 Chapter 5Fig 218 Side view of orbit; periosteum (periorbital) of the orbit (green), t...Fig 219 Yellow subconjunctival fat.Fig 220 Subcutaneous orbital fat often causes a desire for cosmetic excision...Fig 221 Front view shows the apex of the orbit. Note proximity to sinuses wi...Fig 222 CT scan of sphenoid sinusitis with air‐fluid level (↑).Fig 223 One piece of evidence for the diagnosis of sinusitis is to elicit te...Fig 224 CT showing three typical findings of ethmoiditis. A level flat surfa...Fig 225 CT scan showing preseptal lid swelling (↑) and periorbital celluliti...Fig 226 Orbital cellulitis with chemosis and ophthalmoplegia, causing inabil...Fig 227 CT scan of orbital cellulitis