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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. Clinical results after spherotoric intraocular lens implantation using the bag-in-the-lens technique. (PubMed)

pupillary entrance using Purkinje reflexes of the surgical microscope light.The study enrolled 52 eyes of 35 patients (23 women) with corneal astigmatism ranging from 0.90 to 6.19 diopters (D). The toric power was between 1.00 D and 8.00 D. One-third of eyes had an additional ocular comorbidity (including amblyopia) that could influence the clinical outcomes; 5.2% had an irregular astigmatism up to 15 degrees. Twelve eyes had high myopia (axial length [AL] >26 mm) and 5 eyes, high hyperopia (AL <21 mm (...) Clinical results after spherotoric intraocular lens implantation using the bag-in-the-lens technique. To evaluate the clinical results after implantation of a spherotoric intraocular lens (IOL) using the bag-in-the-lens (BIL) technique.Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium.Evidence-based manuscript.Consecutive eyes with cataract and corneal astigmatism had implantation of a spherotoric BIL intraocular lens (IOL). The IOL was centered based on the patient's

2011 Journal of cataract and refractive surgery

504. 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

505. 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

506. CONGENITAL TRIGEMINAL ANAESTHESIA (PubMed)

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

507. 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

508. 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)

509. Brain Death

been done, brain death can be confirmed. Some states advise clinicians to do two separate examinations separated by at least 48 h in children; this approach is not consistently recommended or required for adult patients (see Table: ). Examination includes Assessment of pupil reactivity Assessment of oculovestibular, oculocephalic, and corneal reflexes Apnea testing Sometimes EEG or tests of brain perfusion are used to confirm absence of brain activity or brain blood flow and thus provide additional (...) ( 35 ° C), and hypotension (MAP 55 mm Hg) have been excluded. No neuromuscular blockers contribute to the neurologic findings. 3. Any observed movements can be attributed entirely to spinal cord function. 4. The cough reflex, pharyngeal reflexes, or both are tested and shown to be absent. 5. Corneal and pupillary light responses are absent. 6. Oculocephalic reflex testing that observes fixed eye movement with rotation of the head and caloric vestibulo-ocular reflexes that show no caloric response

2013 Merck Manual (19th Edition)

510. 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)

511. 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)

512. 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)

513. Blurred Vision

Suggestive Findings Diagnostic Approach Opacification of eye structures Gradual onset, often risk factors (eg, aging, corticosteroid use), loss of contrast, glare Lens opacification on ophthalmoscopy or slit-lamp examination Clinical evaluation Corneal opacification (eg, posttraumatic or postinfectious scarring) Corneal abnormalities on slit-lamp examination Clinical evaluation Disorders affecting the retina Gradual onset, central vision affected (central scotoma) without loss of peripheral vision (...) reflex decreased more than consensual (afferent pupillary defect), sometimes loss of optic disk margins and/or globe tenderness Often MRI to rule out multiple sclerosis Disorders affecting focus Visual acuity varying with distance from objects, acuity corrected with refraction Clinical refraction by an optometrist or ophthalmologist Certain disorders can have more than one mechanism. For example, refraction can be impaired by early cataracts or the reversible lens swelling caused by poorly controlled

2013 Merck Manual (19th Edition)

514. Evaluation of the Ophthalmologic Patient

conjunctivae and the fornices can be inspected for foreign bodies, signs of inflammation (eg, follicular hypertrophy, exudate, hyperemia, edema), or other abnormalities. Corneal examination Indistinct or blurred edges of the corneal light reflex (reflection of light from the cornea when illuminated) suggest the corneal surface is not intact or is roughened, as occurs with a corneal abrasion or keratitis. Fluorescein staining reveals abrasions and ulcers. Before staining, a drop of topical anesthetic (eg (...) , and then the eye is examined under magnification and cobalt blue illumination. Areas where corneal or conjunctival epithelium is absent (abraded or ulcerated) fluoresce green. Pupil examination The size and shape of the pupils are noted, and pupillary reaction to light is tested in each eye, one at a time, while the patient looks in the distance. Then the swinging flashlight test is done with a penlight to compare direct and consensual pupillary response. There are 3 steps: One pupil is maximally constricted

2013 Merck Manual (19th Edition)

515. 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)

516. 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)

517. Acute Vision Loss

to be the presence of optokinetic nystagmus). Red flags Acute loss of vision is itself a red flag; most causes are serious. Interpretation of findings Diagnosis of acute vision loss can be begun systematically. Specific patterns of help suggest a cause. Other clinical findings also help suggest a : Difficulty seeing the red reflex during ophthalmoscopy suggests opacification of transparent structures (eg, caused by corneal ulcer, vitreous hemorrhage, or severe endophthalmitis). Retinal abnormalities (...) to ) ESR, C-reactive protein (CRP), platelet count Temporal artery biopsy Functional loss of vision (uncommon) Normal pupillary light reflexes, positive optokinetic nystagmus, no objective abnormalities on eye examination Often inability to write name or bring outstretched hands together Sometimes indifferent affect despite severity of claimed loss of vision Clinical evaluation If diagnosis is in doubt, ophthalmologic evaluation and visual evoked responses Macular hemorrhage due to neovascularization

2013 Merck Manual (19th Edition)

518. 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)

519. 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)

520. 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)

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