Book Review

Diagnostic Problems in Clinical Ophthalmology

N Engl J Med 1994; 331:62July 7, 1994

Article

Diagnostic Problems in Clinical Ophthalmology
Edited by Curtis E. Margo, with Latif M. Hamed and Robert N. Mames. 932 pp., illustrated. Philadelphia, W.B. Saunders, 1994. $85. ISBN: 0-7216-3659-4

This comprehensive and encyclopedic textbook will guide the reader through the pitfalls in diagnosing clinical ophthalmologic disorders. Rather than merely list the differential diagnosis of a specific clinical finding, the authors describe in detail the nuances by which the reader can sort through various diseases that produce a specific ocular picture and arrive at the correct diagnosis. The editors have succeeded in maintaining a high level of quality in the writing throughout the book and have minimized overlap of material.

This book stands alone in its approach to the differential diagnosis of ocular problems, which is based on the history, symptoms, and findings of the clinical examination. The book is well organized: nine parts cover the major ophthalmologic subspecialties; those on the glaucomas, the uveal tract, and pediatric ophthalmology are representative. The major divisions are subdivided into chapters on 105 specific conditions; for example, the 11 chapters on the uveal tract cover conditions such as anterior uveitis in adults, atrophy of the iris, and uveitis after cataract surgery. All topics are commonly encountered problems, all are relevant to the practice of ophthalmology, and all present the latest information on the subject.

Each chapter begins with a brief paragraph on its contents; the body of each chapter is a complete, concise description of the differential diagnosis, focusing on ocular diseases with similar clinical manifestations. In chapter 2, for example, Lavallee-Grey, discussing inflammatory dermatosis of the eyelid, describes 11 conditions in some detail, and points out the salient features that distinguish atopic dermatitis from acne rosacea, seborrheic dermatitis, and 8 other inflammatory conditions of the lids. In this chapter, and liberally scattered throughout this fine book, are many clear, well-reproduced photographs that capture the skin lesions and complement the text nicely. The whole chapter on inflammatory dermatosis of the eyelid contains only nine jampacked pages and includes 34 references to direct the practitioner to more detailed descriptions of a specific condition.

I found the individual chapters very informative and of consistently high quality. Having completed my own residency 25 years ago and now serving as head of a residency training program in ophthalmology, I was pleasantly surprised by the relevance of this textbook to patients presented to me by the residents in clinic and in conferences. For example, it had long been my understanding that optic atrophy associated with the empty-sella syndrome was caused by the dragging of the optic chiasm into the empty sella. When I expounded on this theory at a recent conference on ophthalmic neuroradiology, our neuroradiologist pointed out that my explanation of the optic atrophy was not consistent with the results of computed tomography and magnetic resonance imaging and that the concurrent finding of optic atrophy must have some other, as yet unexplained, cause. It was refreshing to find our neuroradiology faculty supported by Purvin in her chapter on the chiasma syndrome. Another instance in which I found the book helpful concerned a patient with unilateral retinal arteriolar narrowing and cotton-wool spots in the fundus. I found the section by Brown on arterial occlusive disease and 57-5 on diseases associated with cotton-wool spots particularly helpful in the initial workup.

It was a pleasure for me to review this jewel of a textbook. I would urge its purchase by ophthalmology residents, faculty, and medical libraries and, most important, by ophthalmologists with a comprehensive practice.

This newly released textbook is likely to be a sleeper in the very competitive market of ophthalmological publications. For now, it is the sole work that focuses on the descriptive differential diagnosis of ocular conditions. If the editors continue to revise this book over the years, it should become a standard reference for years to come and eventually a collector's item.

James P. Ganley, M.D., Dr.P.H.
Louisiana State University Medical Center-Shreveport, Shreveport, LA 71130