AMERICAN JOURNAL OF OPHTHALMOLOGY
mucous thread in the inferior conjunctival fornix. M O G E N S S. N O R N ,
REFERENCES 1. Norn, M. S.: External Eye. Methods of Exami nation. Copenhagen, Scriptor, 1974, p. 200. 2. : Lissamine green. Vital staining of cor nea and conjunctiva. Acta Ophthalmol. 51:483, 1973. 3. Sauter, J.: Xerophthalmia and Measles in Kenya. Denderen, Groningen, B.V., 1976, p. 235. 4. Kusin, J. A., Parlindungan-Sinaga, H. S. R., and Marpaung, A. M.: Xerophthalmia in North Su matra. Trop. Geogr. Med. 29:41, 1977.
Reply Editor: The purpose of our communication was to report corneal epithelial involvement early in the course of clinical xeroph thalmia. Slit-lamp examination of the fluorescein-stained cornea allowed for positive, reproducible diagnosis and pho tographic documentation in cases in which this was not apparent on routine examination. Neither Kusin 1 nor Sauter 2 claim handlight examination of the rose bengal or lissamine green stained cornea is useful for detecting preclinical corneal disease. We suggested that these corneal abnor malities might arise directly from the affect of vitamin A deficiency on cor neal epithelial metabolism, or indirectly through its affect on tear film stability with local drying. We do not doubt tear film break-up time and mucus production are abnormal in xerophthalmia, or that they improve with vitamin A therapy. The reappearance of mucus-producing goblet cells lags sufficiently behind resolution of the corneal epithelial changes, however, to suggest that their loss was not respon sible for those changes. 3 ' 4 Dr. Norn draws our attention to another
aspect entirely: the use of lissamine green staining as a practical method for the early detection of xerophthalmia. These suggestions are based on its propensity for staining the conjunctiva, not the cor nea, in early disease. 1,2 ' 5 Follow-up stud ies by Dr. Kusin on her original popula tion (personal communication) and the data of Vijayaraghavan and co-workers 5 indicate that many cases without active vitamin A deficiency will stain with rose bengal and lissamine green. More alarm ing is that one fourth of the corneas in children with vitamin A-responsive Bitot's spots or active corneal disease in our own series failed to stain. 6 A L F R E D SOMMER
REFERENCES 1. Sauter, J.: Xerophthalmia and Measles in Kenya. Denderen, B. V. Groningen, 1976, pp. 137, 187. 2. Kusin, J. A., Parlindungan-Sinaga, H. S. R., and Marpaung, A. M.: Xerophthalmia in North Su matra. Trop. Geogr. Med. 29:41, 1977. 3. Sommer, A., Sugana, T., Edi, D., and Green, W. R.: Vitamin A responsive panocular xerophthal mia in a healthy adult. Arch. Ophthalmol. 96:1630, 1978. 4. Sullivan, W. R., McCulley, J. P., and Dohlman, C. H.: Return of goblet cells after vitamin A therapy in xerosis of the conjunctiva. Am. J. Ophthalmol. 75:720, 1973. 5. Vijayaraghavan, K., Rameshwar Sarma, K. V., Reddy V., and Bhaskaram, P.: Rose bengal staining for detection of conjunctival xerosis in nutrition surveys. Am. J. Clin. Nutr. 31:829, 1978. 6. Emran, N., and Sommer, A.: Lissamine green staining in the clinical diagnosis of xerophthalmia. Arch. Ophthalmol. In press.
BOOK REVIEWS Synopsis of Ophthalmology, 5th ed. By William H. Havener. St. Louis, C. V. Mosby Company, 1979. Clothbound, 675 pages, index, glossary, 336 black and white figures, 28 color figures. $24.95
VOL. 88, NO. 5
The fifth edition of Havener's "Synop sis of Ophthalmology" is a lucid summary of ophthalmic knowledge. The text is primarily written for medical students and house officers. As such it provides more than adequate coverage of the tech niques of ocular examination, medical ophthalmology, neuro-ophthalmology, ex ternal disease, uveitis, glaucoma, stra bismus, refraction, and the basics of ocu lar surgery. Although much of the text has not been changed since the fourth edition, the au thor has added many color plates of com mon posterior pole lesions and improved many of the photographs. Additional im provements in this edition include a new chapter on ocular anatomy and physiolo gy, and an improved chapter dealing with the essentials of taking an ophthalmic history. The highlights of the book continue to be the detailed illustration of the tech niques of ophthalmoscopic examination, and the excellent glossary and subject index. This is a useful manual for medical students and house officers, which will provide them with a good primary refer ence for ophthalmic problems. D A V I D J. S C H A N Z L I N
Birth Defects Compendium, 2nd ed. Ed ited by Daniel Bergsma. New York, Alan R. Liss, Inc., for the National Foundation-March of Dimes, 1979. Hardcover, 1,222 pages, preface, table of contents, author index, 108 color figures, 284 black and white figures. $50 This impressive volume brings together 425 authors from 24 countries, aided by 21 assistant and 24 associate editors. The volume leads off with an atlas (mainly of the ocular fundus and external eye with
some illustrations less than optimum), followed by a compendium of 1,004 ana tomic or functional variants from the normal range in humans, which are inher ited by an mendelian mode of transmis sion, or caused by a fresh mutation, any chromosomal abnormality, or any infec tious, chemical or physical insult to the embryo or fetus before birth. Each syndrome is described in the same manner: its common name and phenotypically similar conditions; then the conditions excluded, followed by the minimal diagnostic criteria: clinical findings, complications, etiology, and pathogenesis. Then related factors (sex ra tio, risk of occurrence for patients' sibling and patients' child, the age of detectability, and the prevalence.) Treatment is discussed under the headings of primary and secondary prevention and other ther apy. This is followed by prognosis, detec tion of carrier, special considerations, and references. The references are often to other than original sources and curiously, in this rapidly changing field, most are more than ten years old. The final section of 36 tables synopsizes order of transmission and major organs involved in various disorders. There are an additional seven diagrams. Most conditions are described on a sin gle page and many are illustrated. The syndromes dealing with ocular involve ment are well done. Bernard Becker is the sole associate editor identified with oph thalmology. The chief editor states in the preface that certain birth defects or syndrome types, according to present knowledge, are so phenotypically similar that they are presented as single entities. This causes confusion in many syndromes with both systemic and ocular manifestations. The Stilling-Tiirk-Duane syndrome is de scribed under sixth nerve paralysis; the