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Corneal Reflex

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501. Aphakia Versus Pseudophakia in Children Under 2 Years Undergoing Bilateral Congenital Cataract Surgery

) assesed on slitlamp or under operating microscope in dilated pupil.VAO is defined as fibrous or proliferative cell growth leadind to a dull retinoscopic reflex. Glaucoma [ Time Frame: 4 years ] Intraocular pressure (IOP) measured with Perkins handheld applanation tonometer. Glaucoma defined as : IOP>21 mmHg >1 occasion with any of these 3 criteria Optic nerve cupping asymmetry >0.2 cd ratio asymmetry , CD ratio >0.4 Abnormal asymmetrical axial length elongation Corneal oedema or enlargement Central (...) Corneal Thickness [ Time Frame: 4 Years ] Corneal thickness assessed by ultrasonic pachymetry. An average of 3 values with an error less than 0.001 would be taken into account. Secondary Outcome Measures : Visual Acuity [ Time Frame: 4 years . ] An Objective visual assessment to be performed using Lea Grating Paddles(Grating Acuity Test developed by Lea Hyvarinen16), Cardiff Acuity Cards(Preferential Looking Test17), or ETDRS (Early Treatment of Diabetic Retinopathy Study) chart. Vision

2011 Clinical Trials

502. A case of inaccurate prognostication after the ARCTIC protocol. (PubMed)

of poor outcome included lack of one or more brainstem reflexes (pupillary or corneal reflex), absence of motor response at 72 hours, myoclonus, status epilepticus, electroencephalogram with generalized suppression, and absent bilateral cortical N20 response to somatosensory-evoked potentials. However, several studies have found these indicators to be unreliable after hypothermia. This may be the result of sedatives, which can affect physical examination and electroencephalogram results, and delayed (...) was defibrillated twice, with return of spontaneous circulation, and cooled to 33°C for 24 hours. Neurologic exam on Day 6 revealed limited brainstem reflexes, and the intensive care unit team discussed with the patient's family that his prognosis for neurologic recovery was poor. Palliative care was consulted to participate in a goals-of-care meeting. Just prior to the meeting on Day 7, the patient awoke. He fully recovered and walked out of the hospital on Day 18. Prior to induced hypothermia, indicators

2012 Journal of pain and symptom management

503. Measurement of angle kappa and centration in refractive surgery. (PubMed)

).Determination of the treatment center is very important in refractive surgery. Moving the ablation center from the center of the entrance pupil to points near visual axis, such as the corneal light reflex (line of sight) or corneal vertex normal, results in less induction of higher order aberrations (including coma aberration) and either the same or better visual outcomes both in hyperopic and myopic eyes when compared to laser ablation centered on the entrance pupil. Decentration of multifocal IOLs can

2012 Current Opinion in Ophthalmology

504. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines

- gencies (eg, intermittent volvulus, ovarian torsion), cardiac disease, corneal abrasion, bone fractures, hair tourniquet syndrome, tobacco smoke exposure, hunger, abuse, or neglect (438,439). Allergy to cow’s milk protein or other formula intolerance may cause infant irritability, distress, and vomiting indistinguishable from GER. In 1 controlled study, an empiric trial of formula made with partially hydrolyzed whey proteins, prebiotic oligosaccharides, and a high b-palmitic acid content significantly

2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

505. There may be no bigger mystery than chronic pain

an extremely weak gag reflex, and no corneal reflex. As a child, Miss C. bit off the tip of her tongue and sustained third-degree burns from her inability to sense pain. As an adult, she developed severe erosion and infection in her knees, hip and spine from failing to shift her weight or turn over in bed known as “Charcot joint.” It is also clear that pain perception can be “turned off” in some instances. In parts of India, in an ancient agricultural ritual that is still practiced, villagers hang from

2015 KevinMD blog

506. Simple method of determining the axial length of the eye. (PubMed)

Simple method of determining the axial length of the eye. By photographing the corneal reflex in two positions of gaze and measuring the radius of curvature of the cornea it is possible to calculate the radius of rotation of the eye. The measurements obtained in this way showed a high correlation with refraction in a series of 80 eyes. The axial length obtained by this method was about 3 mm greater than that obtained by ultrasonographic or x-ray methods, and the reasons for the discrepancy

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1976 The British journal of ophthalmology


CONGENITAL TRIGEMINAL ANAESTHESIA 14188342 1996 12 01 2018 12 01 0007-1161 47 1963 May The British journal of ophthalmology Br J Ophthalmol CONGENITAL TRIGEMINAL ANAESTHESIA. 308-11 HEWSON E G EG eng Journal Article England Br J Ophthalmol 0421041 0007-1161 OM Anesthesia Central Nervous System Diseases Corneal Opacity Humans Infant Keratitis Lacrimal Apparatus Reflex Reflex, Abnormal Trigeminal Nerve CENTRAL NERVOUS SYSTEM DISEASES CORNEAL OPACITY INFANT KERATITIS LACRIMAL APPARATUS REFLEX

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1963 The British journal of ophthalmology

508. Eye Signs of Neurological Disorders (PubMed)

Eye Signs of Neurological Disorders The author discusses common neurologic abnormalities as they involve the visual pathway and the ocular motor system. Mention is also made of the corneal reflex, eyelid closure and the pupillary response. Emphasis is placed on routine examination techniques that would assist the family physician in his office. The importance of early diagnosis is stressed and criteria for referral reviewed.

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1974 Canadian Family Physician

509. A BARBITURATE ANTIDOTE—Use of Methylethylglutarimide in Barbiturate Intoxication and in Terminating Barbiturate Anesthesia (PubMed)

of awakening as evidenced by the return of corneal and conjunctival reflexes, the opening of the eyes, and stirring or moving about. Many responded to questioning. Almost all showed evidence of greater responsiveness within five minutes. No untoward reactions were noted. No convulsions were produced. Five patients ranging in age from 24 to 70 years were treated for barbiturate poisoning with Mikedimide(R) given intravenously in doses varying from 550 mg. to 1950 mg. All recovered consciousness within 30

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1959 California Medicine

510. Ocular Emergencies

to the immediate environment preceding the injury. Small, sharp, high velocity objects, for example, resulting from hammering metal on metal, or through the use of a grinder, often lead to penetrating injuries. 1 An accident or fall may cause blunt trauma and present different issues. This knowledge is vital and will direct further testing. Observation of the patient can be performed with a bright light and pen torch. Particular care should be given to noticing the presence of foreign bodies, chemosis, corneal (...) haze and the presence of blood or pus in the anterior segment of the eye. 2 Fluorescein staining and examination under a blue light helps determine the extent of corneal injury. If full thickness corneal injury is present, aqueous humour may be seen to leak (Seidel test). This requires emergency referral. Pupil examination is a particularly useful objective assessment of the afferent and efferent visual pathways. 3 The presence of a pupillary defect is an important diagnostic sign. Pupil

2008 The Royal Australian College of General Practitioners

511. Rheumatoid Arthritis (RA)

your knowledge Sciatica Which of the following deficits is the most objective finding in sciatica? CNS Motor Reflex Sensory NEWS & VIDEOS FDA: Pulmonary Embolism Risk Up With Tofacitinib 10 mg for RA THURSDAY, Feb. 28, 2019 (HealthDay News) -- A safety clinical trial has revealed that tofacitinib (Xeljanz, Xeljanz XR) 10 mg twice daily is associated with an increased risk for pulmonary embolism... 3D Model The Foot Video How to Examine the Hand SOCIAL MEDIA Add to Any Platform Loading , MD (...) activity. Patients should be fully apprised of the risks of DMARDs and monitored closely for evidence of toxicity. Table Other Drugs Used to Treat Rheumatoid Arthritis Drug Dosage Adverse Effects Traditional disease-modifying antirheumatic drugs (DMARDs) Hydroxychloroquine 5 mg/kg po once/day (eg, with breakfast or dinner) or in 2 divided dosages (eg, 2.5 mg q 12 h) Usually mild dermatitis Myopathy Corneal opacity (generally reversible) Occasionally irreversible retinal degeneration Leflunomide 20 mg

2013 Merck Manual (19th Edition)

512. Specific Poisons

, confusion, delirium, loss of corneal reflex, respiratory failure, drowsiness, ataxia, coma Charcoal up to 24 h after ingestion, supportive care, forced alkaline diuresis for phenobarbital (to aid in elimination) For severe cases, hemodialysis Barium compounds (soluble) Barium acetate Barium carbonate Barium chloride Barium hydroxide Barium nitrate Barium sulfide Depilatories Explosives Fireworks Rat poisons Vomiting, abdominal pain, diarrhea, tremors, seizures, colic, hypertension, cardiac arrest (...) HgCl) See Mercury, compounds of — Ammonium carbonate ([NH 4 ] 2 CO 3 ) See — Ammonium fluoride (NH 4 F) See Fluorides — Amobarbital See Barbiturates — Amphetamines Amphetamine sulfate or phosphate Dextroamphetamine Methamphetamine Phenmetrazine Synthetic cathinones (bath salts) Increased activity, exhilaration, talkativeness, insomnia, irritability, exaggerated reflexes, anorexia, diaphoresis, tachyarrhythmia, anginal chest pain, psychotic-like states, inability to concentrate or sit still

2013 Merck Manual (19th Edition)

513. Chemical Warfare Agents

doses also causes abrupt loss of consciousness with convulsions. Direct damage to myocardium may be prominent. Continued exposure to initially sublethal concentrations may induce eye irritation with conjunctivitis and corneal abrasions and ulcerations (gas eye), irritation of nasal and pharyngeal mucous membranes, headache, weakness, ataxia, nausea, vomiting, chest tightness, and hyperventilation. Some of these manifestations appear to be a reaction to the offensive odor of the compound. A green (...) , and blister formation after a latent period. The latent period is inversely correlated with dose but is usually at least a few hours (and up to 36 h). Blisters caused by sulfur mustard sometimes resemble a string of pearls around a centrally unaffected area; blisters caused by nitrogen mustard are less likely to show this pattern. Blisters may become large and pendulous. Painful chemical conjunctivitis causing reflex lid closure occurs earlier than skin symptoms but still after a delay often of hours

2013 Merck Manual (19th Edition)

514. Eye Contusions and Lacerations

, the following are noted: How to do Lateral Canthotomy VIDEO Pupil shape and pupillary responses Extraocular movements Anterior chamber depth or hemorrhage Presence of red reflex Assessing Visual Acuity In descending order of acuity, vision is assessed as Reading a Snellen chart Counting fingers while noting distance (eg, counting fingers at 1') Detecting hand motion Perceiving light Lacking light perception An analgesic or, after obtaining any surgical consent, an anxiolytic may be given to facilitate (...) examination. Gentle and careful use of eyelid retractors or an eyelid speculum makes it possible to open the lids. If a commercial instrument is not available, the eyelids can be separated with makeshift retractors fashioned by opening a paperclip to an S shape, then bending the U-shaped ends to 180°. Globe laceration should be suspected with any of the following: A corneal or scleral laceration is visible. Aqueous humor is leaking (positive Seidel sign). The anterior chamber is very shallow (eg, making

2013 Merck Manual (19th Edition)

515. Ocular Burns

. Bend involved knee and loop towel or band around the ankle. 3. Gently pull towel or band to stretch muscle on front of thigh pulling ankle toward buttocks... SOCIAL MEDIA Add to Any Platform Loading , MD, MPH, Wills Eye Emergency Department, Wills Eye Hospital Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Thermal burns The blink reflex usually causes the eye to close in response to a thermal stimulus. Thus, thermal burns tend to affect (...) the everted eyelid and lifting it up until the fornix is visible). Mild chemical burns are generally treated with topical ocular antibiotics (eg, erythromycin ointment 0.5%) 4 times/day and cycloplegia if needed for comfort (eg, cyclopentolate ). Because topical corticosteroids can cause corneal perforation after chemical burns, they should be given only by an ophthalmologist. Topical anesthetics should be avoided after initial irrigation; significant pain may be treated with acetaminophen with or without

2013 Merck Manual (19th Edition)

516. Sjögren Syndrome (SS)

knowledge Sciatica Which of the following deficits is the most objective finding in sciatica? CNS Motor Reflex Sensory NEWS & VIDEOS Autoimmune Disorders May Up Risk for Carpal Tunnel Syndrome FRIDAY, March 1, 2019 (HealthDay News) -- Common autoimmune disorders are associated with an increased risk for carpal tunnel syndrome (CTS), according to a study presented at the annual meeting... 3D Model The Foot Video Standing Gastrocnemius Stretch 1. Stand facing or next to wall with hands on the wall (...) SS often affects the eyes or mouth initially and sometimes exclusively. Dry eyes can cause a sandy, gritty sensation. In advanced cases, the cornea is severely damaged, epithelial strands hang from the corneal surface (keratitis filiformis), and vision can be impaired. Diminished saliva ( ) results in difficulty chewing and swallowing, secondary Candida infection, tooth decay, and calculi in the salivary ducts. Taste and smell may be diminished. Dryness may also develop in the skin and in mucous

2013 Merck Manual (19th Edition)

517. Overview of Coma and Impaired Consciousness

by the tentorium to form Kernohan notch) Contralateral dilated pupil and oculomotor paresis Ipsilateral hemiparesis Compression of the ipsilateral cerebral peduncle Contralateral hemiparesis Eventually, compression of the upper brain stem and the area in and around the thalamus Impaired consciousness Abnormal breathing patterns Fixed, unequal pupils Further compromise of the brain stem Loss of oculocephalic reflex Loss of oculovestibular reflex Loss of corneal reflexes Decerebrate posturing Subfalcine (...) be dysconjugate or absent (oculomotor paresis) or involve unusual patterns (eg, ocular bobbing, ocular dipping, opsoclonus). Homonymous hemianopia may be present. Other abnormalities include absence of blinking in response to visual threat (almost touching the eye), as well as loss of the oculocephalic reflex (the eyes do not move in response to head rotation), the oculovestibular reflex (the eyes do not move in response to caloric stimulation), and corneal reflexes. Autonomic dysfunction: Patients may have

2013 Merck Manual (19th Edition)

518. Cataract

WESTERN OPHTHALMIC HOSPITAL/SCIENCE PHOTO LIBRARY Rarely, the cataract swells, pushing the iris over the trabecular drainage meshwork and causing its occlusion and thus secondary closed-angle glaucoma and pain. Diagnosis Ophthalmoscopy followed by slit-lamp examination Diagnosis is best made with the pupil dilated. Well-developed cataracts appear as gray, white, or yellow-brown opacities in the lens. Examination of the red reflex through the dilated pupil with the held about 30 cm away usually (...) discloses subtle opacities. Small cataracts stand out as dark defects in the red reflex. A large cataract may obliterate the red reflex. provides more details about the character, location, and extent of the opacity. Pearls & Pitfalls Examination of the red reflex through the dilated pupil with the ophthalmoscope held about 30 cm away can help identify early cataracts if a slit lamp is unavailable. Treatment Surgical removal of the cataract Placement of an intraocular lens Frequent refractions

2013 Merck Manual (19th Edition)

519. Tearing

: ). Obstruction of tear drainage can lead to stasis and infection. Recurrent infection of the lacrimal sac (dacryocystitis) can sometimes spread, potentially leading to . Anatomy of the lacrimal system. Etiology Overall, the most common causes of tearing are URI Allergic rhinitis Tearing can be caused by increased tear production or decreased nasolacrimal drainage. In many patients, the cause of tearing can be multifactorial. Increased tear production The most common causes are URI Dry eyes (reflex tearing (...) produced in response to dryness of the ocular surface) Any disorder causing conjunctival or corneal irritation can increase tear production (see ). However, most patients with corneal disorders that cause excess tearing (eg, corneal abrasion, corneal ulcer, corneal foreign body, keratitis) or with primary angle-closure glaucoma or anterior uveitis present with eye symptoms other than tearing (eg, eye pain, redness). Most people who have been crying do not present for evaluation of tearing. Decreased

2013 Merck Manual (19th Edition)

520. Diplopia

distorts light transmission through the eye to the retina. There may be > 2 images. One of the images is of normal quality (eg, brightness, contrast, clarity); the rest are of inferior quality. The most common causes of monocular diplopia are Corneal shape problems, such as keratoconus or surface irregularity Uncorrected , usually astigmatism Other causes include corneal scarring and dislocated lens. Complaints also may represent malingering. Binocular diplopia suggests disconjugate alignment (...) or MRI Tumors (near base of skull, in or near sinuses or orbit) Often pain (unrelated to eye motion), unilateral proptosis, sometimes other neurologic manifestations CT or MRI Neuromuscular transmission disorders (typically, pain is absent) Sometimes preceded by GI symptoms Descending weakness, other cranial nerve dysfunction, dilated pupils, normal sensation Serum and stool testing for toxin (Miller Fisher variant) Ataxia, decreased reflexes Lumbar puncture Intermittent, migratory neurologic

2013 Merck Manual (19th Edition)

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