Preface 8.,..,,.,..,..,,.,. < >., Contact Lens Complications....,.. Nathan Efron.,.,. 2008 8 v
Preface 1999 2,.,..,,.. 11 (chapter) 150,...,. 9, 7..,,,,,,. xvii xxxix.,..,. 2 16. 29. 16, CD ROM. 30...,.. Nathan Efron vi
Acknowledgments,.,. Basch & Lomb, British Contact Lens Association, International Association of Contact Lens Educator, Cornea and Contact Lens Research Unit.. C. Brian Tompkins. Brian 39. A Terry Tarrant., CooperVision. Hydron UK( CooperVision) Joe Tanner 1990, CooperVison John Roger. Terry, Joe, John. Dr. Philip Morgan Gordon Addison. Gordon, Phil.. Dr. JP Guillon B, Kanski. Caroline Makepeace Elsevier, Kim Benson(development editor), John Ormiston(copy editor), Judith Campbell(designer). Suzanne,. Suzanne. listening board,.. Zoe Bruce..,.,. Nathan Efron vii
Foreword. Contanct Lens Complications,.... Elsevier. 21, 20.... 2008 8 Nathan Efron viii
Contents v vi vii viii PART I Eye Examination CHAPTER 1 Slit-lamp Biomicroscopy 2 5 9 10 PART II Eyelids CHAPTER 2 Blinking Abnormalities 14 16 17 21 22 ix
CHAPTER 3 Eyelid Ptosis 24 26 26 26 26 28 29 29 30 32 CHAPTER 4 Meibomian Gland Dysfunction 35 35 37 38 39 40 40 41 CHAPTER 5 Eyelash Disorders 43 44 45 50 PART III Tear Film CHAPTER 6 Dry Eye 54 56 63 63 66 68 69 CHAPTER 7 Mucin Ball 72 75 75 75 78 78 78 x
PART IV Conjunctiva CHAPTER 8 Conjunctival Staining 82 83 84 86 87 88 89 90 CHAPTER 9 Conjunctival Redness 92 93 93 94 95 97 97 99 99 CHAPTER 10 Papillary Conjunctivitis 102 103 103 105 106 109 109 112 112 PART V Limbus CHAPTER 11 Limbal Redness 119 120 122 123 123 124 xi
CHAPTER 12 Vascularized Limbal Keratitis 126 128 128 128 129 130 CHAPTER 13 Superior Limbic Keratoconjunctivits 133 134 135 137 139 140 141 PART VI Corneal Epithelium CHAPTER 14 Corneal Staining 144 145 149 150 152 152 153 153 CHAPTER 15 Epithelial Microcysts 156 156 159 160 160 161 162 CHAPTER 16 Epithelial Edema 164 166 166 167 167 168 xii
CHAPTER 17 Wrinkling 169 169 171 171 173 173 174 174 PART VII Corneal Stroma CHAPTER 18 Stromal Edema 178 178 179 180 181 182 183 184 186 186 CHAPTER 19 Stromal Thinning 189 191 191 194 195 195 196 197 CHAPTER 20 Deep Stromal Opacities 199 201 201 202 202 202 203 CHAPTER 21 Corneal Neovascularization 206 207 209 209 212 212 214 215 xiii
CHAPTER 22 Sterile Keratitis 218 218 222 223 224 225 228 230 232 CHAPTER 23 Microbial Keratitis 236 237 237 239 241 244 247 247 CHAPTER 24 Corneal Warpage 252 252 255 256 258 259 260 261 PART VIII Corneal Endothelium CHAPTER 25 Endothelial Bedewing 266 267 268 268 269 270 CHAPTER 26 Endothelial Blebs 272 272 273 274 275 276 276 277 xiv
CHAPTER 27 Endothelial Cell Loss 279 280 281 281 282 283 283 283 CHAPTER 28 Endothelial Polymegethism 285 286 287 289 290 290 291 291 PART XI Grading Systems CHAPTER 29 Grading Scales 296 297 Efron 299 300 306 CHAPTER 30 Grading Morphs Efron 308 Efron 310 312 315 321 327 333 xv
PARTI Eye Examination CHAPTER 1 Slit-lamp Biomicroscopy
CHAPTER 1 Slit-lamp Biomicroscopy ( 1.1)..,...,. [1].,..,.,.,.. 1 ( ) ( ), 2
3 ( 1.2)....,.,.,.,.. THE SLIT LAMP (slit of light). ( 1.3). ( 60 lux ).,., 45. (multi-position)....
4..... [2] ( : red-free) : (contrast).. (rose bengal). (ND ; Neutral Density) :. (polarizing) :. (diffusing) :,. (cobalt blue) : THE BIOMICROSCOPE ( 1.4). 3 3.5. 6 40.. 2..,.. 3. : 10 : 10 25 : 25 (sodium fluorescein). 460 490 nm 520 nm. (abraded area).. (corneal ectasia) (Fleischer s ring).,. (Kodak Wratten No. 12) : (barrier). [3].. (Lee filter No. 101).
5 6, 10, 16, 25 40.,... 40. (micronystagmoid) 40. ( ) 11 cm,. C A B D E 2.. 13,.,,. 1.5 (corneal neovascularization) 5. DIFFUSE ILLUMINATION (ground-glass filter).. (diffuser), 10 70, 45., ( 1.6).,,, (anterior segment)., a) b)
6,. (trichiasis).,. (ectropion) (blepharitis) (epiphora). FOCAL ILLUMINATION PARALLELEPIPED. (, ), 40 60.,. 0.1 0.5 mm,.. 0.5 mm (broad beam).,. Direct (direct parallelepiped focal illumination) ( 1.7)..,. Indirect (indirect parallelepiped focal illumination).... FOCAL ILLUMINATION OPTIC SECTION. 0.02 0.1 mm. 40 60.,.. Direct (direct optic section focal illumination) ( 1.8). ( 1.11 ). a) b)
7 a) b),,. ). (dystrophies). Indirect (indirect optic section focal illumination)..... RETROILLUMINATION,. ( ) ( Direct retro illumination ( 1.9)... Indirect retroillumination ( 1.10). (backscattered light). Marginal retroillumination, a) b)
8 a) b) ( 1.10).., (mucin ball), (epithelial microcyst), (vacuole) (bullae). SPECULAR REFLECTION ( 1.11). 40 50 ( 1.12 ).,..,.. ( ).,..,. 40 (guttae) (bleb) (bedewing) (endothelial rupture). (polymegethism)... [4] SCLEROTIC SCATTER (central corneal oedema). 45 60. a) b) i r i = r
9 a) b) ( 1.12)... TANGENTIAL OBLIQUE ILLUMINATION,. (parallepiped), 90. 90,.,. CONICAL BEAM. 1 2 mm, 1 2 mm.. 90, 90.. Static...... Oscillating... 3. ( ),.,... OVERALL VIEW., (eyebrow)
10. (lashes) (marginal blepharitis) (hordeolum),. (pinguecula),. (follicle).. CORNEA AND LIMBUS (coupling),., (2 mm ). ( ), ( ). (direct illumination) (indirect retroillumination)...,.. STAINING EXAMINATION. (Kodak Wratten No. 12)..,. (excitation),..,,. (devitalization) (necrosis). 8. LID EVERSION..........,....... 15. 4.
11.. 1 Goldberg JB (1970). Biomicroscopy for Contact Lens Practice: Clinical Procedures. (Chicago: Professional Press). 2 Jones LW and Jones DA (2001). Slit lamp biomicroscopy. In: The Cornea. Its Examination in Contact Lens Practice, p. 1 49. Ed. Efron N. (Oxford: Butterworth-Heinemann). 3 Courtney RC and Lee JM (1982). Predicting ocular intolerance of a contact lens solution by use of a filter system enhancing fluorescein staining detection. Int Contact Lens Clin. 9, 302 310. 4 Little SA and Bruce AS (1994). Postlens tear film morphology, lens movement and symptoms in hydrogel lens wearers. Ophthalmic Physiol Opt. 14, 65 69.