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Management of Ocular Injuries and Emergencies.
  1. C J MAcEWEN

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    Management of Ocular Injuries and Emergencies. By Mathew W MacCumber. Pp 486. £43. Hagerstown, MD: Lippincott-Raven, 1997. ISBN 0-397-51496-4.

    This book aims to be a practical guide to the diagnosis and management of all ocular emergencies during the critical first 48 hour period. This is quite a tall order but it is achieved very satisfactorily.

    The book opens by identifying that true ocular emergencies requiring immediate attention are rare and that most emergencies give adequate time for evaluation and unhurried decision making which is a reassuring start especially for the novice or the non-ophthalmic accident and emergency trainee. Each condition is dealt with in a sensibly ordered fashion with a brief description of the problem then a step by step diagnostic and management plan.

    The order of the book is interesting in that it is anatomically ordered; injuries and non-traumatic emergencies are dealt with side by side. The chapter on corneoscleral lacerations and ruptures is next to infections of the conjunctiva and keratitis; and sudden non-traumatic visual loss follows traumatic maculopathy. This makes the continuum of orbital, anterior, and posterior segment trauma difficult to understand and therefore the assessment of the patient less clear. However, this does not seem to detract significantly from the text which comprehensively covers most areas with the emphasis on the practical side of diagnosis and treatment of ocular emergencies.

    There is a useful section on the preparation of antibiotics for ocular use (drops, subconjunctival, and intravitreal use), diagrams of suture placement, and step by step diagnostic and management guides. There is a short section on the management of paediatric ocular emergencies which may prove useful for those not dealing with children on a day to day basis.

    Details on imaging techniques are useful in identifying which method may be best, not only for the condition but also with regard to patient cooperation. Decisions on type of imaging in this country may be based on the availability of different techniques in some hospitals rather than on the optimum method. The section on epidemiology of ocular trauma is excellent providing a short overview of the current situation and for the medicolegally minded there is a comprehensive guide to various methods of evaluating visual disability.

    Overall, this book sets out what it plans to do and works well both as a text for general reading as well as a reference guide to those working in the front line of ophthalmology.

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