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Corneal Reflex

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481. Primary bilateral silicone frontalis suspension for good levator function ptosis in oculopharyngeal muscular dystrophy. (PubMed)

performed by a single individual. The following data were collected: age; gender; pre-operative margin reflex distance (MRD), palpebral fissure height (PF), and LF; post-operative MRD, PF and lagophthalmos; follow-up; and complications.Mean age at surgery was 61.5 ± 5.8 years. Pre-operative measurements for MRD, PF and LF were -0.05 ± 0.82 mm (OD), -0.13 ± 0.91 mm (OS); 5.2 ± 1.2 mm (OD), 5.2 ± 1.3 mm (OS); 11.6 ± 1.3 mm (OD), and 11.7 ± 1.3 mm (OS), respectively. Post-operative measurements for MRD (...) and PF were 2.23 ± 0.97 mm (OD), 2.10 ± 1.09 mm (OS), 7.9 ± 1.4 mm (OD), and 7.7 ± 1.6 mm (OS), respectively (all p < 0.0001). The mean follow-up period was 22.8 ± 22.4 months. There was no sling (infection or extrusion) or ophthalmic (significant corneal compromise) complication after the surgery. Six patients (19%) underwent early (within 3 months) tightening of their slings for under correction. Three patients (10%) underwent late (> 39 months) tightening of their frontalis slings for recurrent

2012 British Journal of Ophthalmology

482. Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis. (PubMed)

group (all due to sensory loss and paresthesia) and 66.7% in the PRGR group (mostly hypalgesia, with 2 patients having corneal reflex loss and 1 patient suffering from meningitis).Both GKS and PRGR are satisfactory strategies for treating MS-related TN. Gamma Knife surgery has a lower rate of sensory and overall morbidity than PRGR, but requires a delay before pain relief occurs. The authors propose that patients with extreme pain in need of fast relief should undergo PRGR. For other patients, both

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2012 Journal of Neurosurgery

483. Occult Intraocular Trauma: Evaluation of the Eye in an Austere Environment. (PubMed)

in an austere or hostile environment.A 25-year-old male U.S. Marine was fired upon at a Mexican Army checkpoint where he sustained glass shrapnel injuries, the most serious being to his right eye. He was taken from a detention facility to a Mexican hospital, where he was evaluated and given the diagnosis of corneal laceration. Twelve hours later, a U.S. Navy physician arrived to evaluate the patient; he was allowed limited access to the patient. His ophthalmologic examination revealed a closed corneal (...) laceration on the right eye, worse than 20/800 vision, absent red reflex, and obscured funduscopic examination. These findings made it impossible to rule out globe penetration. The patient was released 48 h later to a U.S. Naval Hospital, where intraocular foreign bodies were confirmed by imaging and he was taken to emergency surgery.This case illustrates that even under austere conditions, a focused history and evaluation can reveal the likelihood of occult intraocular foreign body, thereby triaging

2012 Journal of Emergency Medicine

484. A Study of 2-Iminobiotin in Neonates With Perinatal Asphyxia

concentration). t1/2 (terminal elimination half-life) CL (clearance) V (volume of distribution) Neurological status as assessed by full neurological examination [ Time Frame: at discharge from level III NICU on the average this will 7-14 days after birth. ] Full neurological examination includes: Prechtl state, Higher cortical functions, Pupillary reflexes right,Pupillary reflexes left, corneal reflex right, corneal reflex left, optokinetic reflexes, nystagmus, facial symmetry, tone, spontaneous movements (...) right, spontaneous movements left, tendon reflexes, ankle clonus right, ankle clonus left, sucking reflex, grasp reflex right, grasp reflex left, moro reflex right, moro reflex left, glabella reflex, snout reflex, palmomental reflex right, palmomental reflex left. Outcomes will be compared between arms aEEG. Time to normal aEEG [ Time Frame: Up to 72 hours after start treatment ] The time to normal aEEG will be determined for each subject. aEEG. Seizures (clinical and sub-clinical) [ Time Frame: 48

2012 Clinical Trials

485. Hyaluronic Acid Gels for Upper Lid Retraction in Active Stage Thyroid Eye Disease

. The precise pathophysiology of lid retraction is poorly understood, but a leading hypothesis is that it occurs due to scarring and fibrosis in the muscles that lift the eyelid. Currently, the definitive treatment for lid retraction is surgery, which can be used to lengthen the lid itself or remove inflamed tissue from behind the eye, thus causing the eye to bulge less. In cases when patients first present to their physician with corneal ulceration or compression of the optic nerve, surgery may (...) and lower eyelid retraction in TED. Hence, HAG may be for patients with active stage TED. It is also thought that if employed early in active phase disease, HAG may also help to decrease the severity of associated symptoms and reduce the need for surgery. The purpose of the current investigation is to define the clinical utility of HAG correction of upper eyelid in active TED in terms of anatomic (lid position), quantitative (corneal dry eye signs) and qualitative effects (symptom severity and thyroid

2012 Clinical Trials

486. The Role of Xerostomia in Burning Mouth Syndrome: Case

; thermal detection thresholds for cold and warm sensations; mechanical detection thresholds for touch, vibration and electrical perception; mechanical pain sensitivity including superficial and deep pain thresholds; electric pain threshold at the teeth. corneal reflex. Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 38 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double (Participant

2012 Clinical Trials

487. Identification and Validation of Functional Biomarkers for Keratoconus

signs like retinoscopy scissors reflex, Munson sign, stromal thinning, Vogt's striae, and Fleischer's ring, but corneal topography is the most useful method in the diagnosis of keratoconus, especially in the absence of clinical signs. Several devices are currently available for detecting early keratoconus by measuring anterior and posterior corneal topography and elevation(Mihaltz et al. 2009; Ishii et al. 2012). Corneal topographic and tomographic techniques which generate color-coded maps (...) . 2002). These indices have been shown to identify keratoconus with a high degree of sensitivity and specificity. The Orbscan II is a three-dimensional slit-scan topography system for analysis of the corneal surfaces and anterior chamber and has been used on all patients in the study. It uses calibrated video and a scanning slit beam to measure x, y, and z locations of several thousand points. These points are used to construct topographic maps(Rao et al. 2002). The Pentacam (Oculus Inc) is a corneal

2012 Clinical Trials

488. Brain death--think twice before labeling a patient. (PubMed)

Brain death--think twice before labeling a patient. Brain death is defined as the cessation of cerebral and brainstem function. A 12-year-old boy presented with alleged history of snake bite. He was brain dead with Glasgow Coma Score of 3 and absent corneal reflexes. However, it was only neuroparalytic effect of the venom, which improved in due course of time with antivenoms. This case highlights the occurrence of both internal and external ophthalmoplegia, which would mimic brain death in many

2012 American Journal of Emergency Medicine

489. Angle Kappa and its importance in refractive surgery (PubMed)

over the corneal light reflex is safe, efficacious, and recommended. Centering in-between the corneal reflex and the entrance pupil is also safe and efficacious. The literature regarding PRK in patients with an angle kappa is sparse but centering on the corneal reflex is assumed to be similar to centering LASIK on the corneal reflex. Thus, centration of MFIOLs, LASIK, and PRK should be focused on the corneal reflex for patients with a large angle kappa. More research is needed to guide surgeons

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2013 Oman journal of ophthalmology

490. Orbital apex tumour caused by chronic lymphocytic leukaemia: an unlikely suspect (PubMed)

Orbital apex tumour caused by chronic lymphocytic leukaemia: an unlikely suspect An 88-year-old woman with a background of chronic lymphocytic leukaemia (CLL) and presented with unilateral ptosis and dull facial pains for 1 month. Examination revealed a complete right-sided ptosis and pupillary dilation. Vision in her right eye was limited to light perception. She had total external ophthalmoplegia. Her corneal reflex was not present in her right eye and she had lost sensation on the right side

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2013 BMJ case reports

491. The emergency medicine approach to an unconscious patient

and herniation My first priority is getting the glucose checked, primarily so it does not get overlooked. Next, I ask my nurses to start working on vascular access while I perform a rapid, focused primary survey: Neuro: Pupils, eye movements, corneal reflex, moving all 4 extremities, reflexes, muscle tone, any asymmetry? Signs of impending herniation: Hypertension, bradycardia, and irregular respirations (Cushing’s triad); posturing; unilateral blown pupil? Breathing pattern: Regular, Cheyne-Stokes (...) the rapid assessment and management of immediate life threats, the next step is to ensure the patient is adequately resuscitated before the inevitable trip to the CT scanner. A definitive airway should be in place before traveling to radiology. Any signs of shock are addressed with fluids, blood, and/or vasopressors. Blood work, probably already drawn reflexively by the nurses, should be sent off. Unless there is a clear alternative diagnosis, I start empiric antibiotics on everyone. (Acyclovir can also

2016 First10EM

492. MKSAP: 53-year-old man with right-sided facial weakness

right side of the tongue. Facial sensation and the muscles of mastication are intact. The corneal reflex is present bilaterally, and the jaw reflex is normal. Hearing is intact bilaterally, as are extraocular reflexes, motor and sensory function, and deep tendon reflexes. Which of the following is the most appropriate next step in management? A: Acyclovir B: Clinical observation C: MRI of the brain D: Physical therapy MKSAP Answer and Critique The correct answer is C: MRI of the brain. An MRI

2016 KevinMD blog

493. Eye Examination Signs of Chemical Dependency

: Abnormal Extraocular Movements Fails to hold gaze (PCP) - may occur Abnormal Convergence (unable to hold crossed eyes) s V. Exam: Abnormal Corneal Reflex (Decreased rate of blinking) (PCP) VI. Exam: Abnormal Retinal Exam Talc retinopathy (talc used to cut IV drugs) Peri- r vessels show white retractile spots VII. Exam: Corneal defects Keratopathy or s Associated with crack smoking VIII. Contributors Paul Rock, OD at Outer Banks Eye Care IX. Reference Images: Related links to external sites (from Bing

2015 FP Notebook

494. Bell's Palsy

MRI Identifies central causes (Schwannoma, , meningioma and ) MRI offers prognostic information based on nerve contrast enhancement Indications Suspected central cause (see Red Flags above) Persistent or progressive peripheral Facial Nerve Palsy lasting >2 months Facial twitching or spasm XV. Management: Loss of Blink Reflex Rewetting the eye Frequent use of preservative-free artificial tears (every 15 to 30 minutes) Refresh PM ointment six times daily Protective glasses with side pieces Use (...) ://lekarske.slovniky.cz/ ) Definition (MSH) A syndrome characterized by the acute onset of unilateral FACIAL PARALYSIS which progresses over a 2-5 day period. Weakness of the orbicularis oculi muscle and resulting incomplete eye closure may be associated with corneal injury. Pain behind the ear often precedes the onset of paralysis. This condition may be associated with HERPESVIRUS 1, HUMAN infection of the facial nerve. (Adams et al., Principles of Neurology, 6th ed, p1376) Concepts Disease or Syndrome ( T047 ) MSH

2015 FP Notebook

495. Reversible brain death after cardiopulmonary arrest and induced hypothermia. (PubMed)

protection. After rewarming to 36.5°C, neurologic examination showed no eye opening or response to pain, spontaneous myoclonic movements, sluggishly reactive pupils, absent corneal reflexes, and intact gag and spontaneous respirations. Over 24 hrs, remaining cranial nerve function was lost. The neurologic examination was consistent with brain death. Apnea test and repeat clinical examination after a duration of 6 hrs confirmed brain death. Death was pronounced and the family consented to organ donation (...) . Twenty-four hrs after brain death pronouncement, on arrival to the operating room for organ procurement, the patient was found to have regained corneal reflexes, cough reflex, and spontaneous respirations. The care team faced the challenge of offering an adequate explanation to the patient's family and other healthcare professionals involved.Induced hypothermia and brain death determination.This represents the first published report in an adult patient of reversal of a diagnosis of brain death made

2011 Critical Care Medicine

496. Propofol and Etomidate Depress Cortical, Thalamic, and Reticular Formation Neurons During Anesthetic-Induced Unconsciousness. (PubMed)

an anesthetic effect; peak power occurred at 12 to 13 Hz during propofol infusion. There were 2 major peaks during etomidate anesthesia: one at 12 to 14 Hz and another at 7 to 8 Hz. The cats were heavily sedated, with depressed corneal and whisker reflexes; withdrawal to noxious stimulation remained intact.These data show that neurons in the cortex, thalamus, and reticular formation are similarly depressed by propofol and etomidate. Although anesthetic depression of neuronal activity likely contributes

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2011 Anesthesia and Analgesia

497. Predictors of poor neurologic outcome in patients after cardiac arrest treated with hypothermia: A retrospective study. (PubMed)

cardiac arrest treated with hypothermia. All data were collected from medical charts and laboratory files and analyzed from the day of admission to the intensive care unit until day 7, discharge from the intensive care unit or death using the Utstein definitions for the registration of the data.We analyzed the data of 103 patients. The combination of an M1 or M2 on the Glasgow Coma Scale or absent pupillary reactions or absent corneal reflexes on day 3 was present in 80.6% of patients (...) with an unfavourable and 11.1% of patients with a favourable outcome. The combination of M1 or M2 and absent pupillary reactions to light and absent corneal reflexes on day 3 was present in 14.9% of patients with an unfavourable and none of the patients with a favourable outcome. None of the patients with a favourable outcome had a bilaterally absent somatosensory evoked potential of the median nerve. The value of electroencephalogram patterns in predicting outcome was low, except for reactivity to noxious

2011 Resuscitation

498. Difficulties with the neurological assessment of humans following a chimpanzee attack. (PubMed)

, soft-tissue, and eye injuries, and scalp degloving. An emergency tracheotomy was performed at the scene, with an unclear duration of hypoxia. The patient was unresponsive without spontaneous movements, papillary or corneal reflexes, cough, or gag. Attempts to lighten sedation were not tolerated. Brain CTs were normal. Intracranial pressure monitoring was deemed infeasible. Brain MR imaging suggested diffuse axonal injury consistent with severe shaking trauma. Diffusion tensor imaging indicated

2011 Journal of Neurosurgery

499. Use of Lipid Emulsion or Nanoemulsion of Propofol on Children Undergoing Ambulatory Invasive Procedures.

will be administered by 1mL per 5 seconds, adjustment dose can be given. Drug: propofol 3 - 4 mg/kg IV, adjustment dose if necessary Active Comparator: propofol lipid emulsion 3-4 mg/kg will be administered by 1 ml per 5 seconds. Drug: propofol 3 - 4 mg/kg IV, adjustment dose if necessary Outcome Measures Go to Primary Outcome Measures : Classification of the sedation level [ Time Frame: time 0 ] Instantly after the loss of consciousness (loss of corneal-palpebral reflex) will be measured the sedation using (...) the Ramsay Modified Scale. Secondary Outcome Measures : Time of latency [ Time Frame: 3-10 seconds ] Time between the injection and loss of the corneal-palpebral reflex Pain at injection [ Time Frame: 3 - 10 seconds: during the injection ] The pain will be measured by CHEOPS Scale which evaluates the behavior of the child against pain. Physician satisfaction [ Time Frame: 12 hours: end of procedure ] The satisfaction of the medical specialist will be assessed through a questionnaire that assesses

2011 Clinical Trials

500. DASH After TBI Study: Decreasing Adrenergic or Sympathetic Hyperactivity After Traumatic Brain Injury

Criteria: Pre-existing heart disease (i.e. coronary heart disease) Pre-existing cardiac dysrhythmia Allergy to study drugs Penetrating brain injury Pre-existing brain dysfunction (i.e. prior severe TBI, debilitating stroke) Impending brain herniation (i.e. loss of bilateral corneal reflexes) Craniectomy or craniotomy Spinal cord injury Myocardial injury Severe liver disease Current use of beta-blockers and/or alpha-2-agonist Withdrawal of care expected in 24 hours Prisoners Pregnant women Unable

2011 Clinical Trials

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