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to convergence ratio [CA/C]). Small imprecisions in this system can be compensated for by a cortical process called sensory fusion. [ ] However, when convergence responses to near are sufficiently reduced, convergence insufficiency results. Next: Pathophysiology Convergence insufficiency is a supranuclear disorder of ocular motility. In the cerebral cortex, the primary and secondary visual cortices respond to binocular disparity and depth. The secondary visual cortex can generate reflexive vergence eye (...) Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute J James Rowsey, MD is a member of the following medical societies: , , , , , , , Disclosure: Nothing to disclose. Chief Editor Hampton Roy, Sr, MD Associate Clinical Professor
. Trigeminoparasympathetic activation during CPH attacks has been suggested; increases in the vasoactive intestinal peptide (ie, parasympathetic peptide) level have been reported. levels of calcitonin gene-related peptide also are reported to be high during CPH attacks. Pain and pressure threshold, nociceptive flexion reflex, and blink and cornealreflexes have been studied in patients with CPH. The cornealreflex thresholds have been found to be decreased bilaterally during CPH attacks. Increases in corneal temperature
, consistent outlines for taking histories and doing physical examinations. Scientific methods were applied to pathology and clinical medicine because of discoveries in physics and chemistry (both organic and inorganic). The discoveries led to knowledge of the organic chemistry of dyes, tissue staining, and improved microscopy. [ , ] The blood pressure apparatus, thermometer, stethoscope, tuning fork, and later, the reflex hammer were added to the clinician's armamentarium. [ ] With these tools, physicians (...) substances in various tissues and organs. Manifestations generally include neurologic impairment, skeletal deformities, intellectual and cardiac abnormalities, and gastrointestinal problems. Ocular complications often cause severe reduction in visual acuity and can affect any part of the eye including cataract, vitreous degeneration, retinopathy, optic nerve swelling and atrophy, ocular hypertension, and glaucoma. Corneal opacification of varying severity is frequently seen. Most of these patients have
above the nerve. To accomplish this, the patient must be looking in primary gaze, and the probe should be centered on the corneal vertex. Because the probe is being placed on the cornea rather than the conjunctiva, additional gel-type solution should be used for cushioning to protect the corneal surface. Because the optic nerve inserts into the globe just nasal to the macula, the probe should be tilted to aim the sound beam slightly nasally to image the nerve in the right center of the echogram (...) , severe edema, partial or total tarsorrhaphy), keratoprosthesis, corneal opacities (eg, scars, severe edema), hyphema, hypopyon, miosis, pupillary membranes, dense , or vitreous opacities (eg, hemorrhage, inflammatory debris). [ ] In such cases, diagnostic B-scan ultrasound can accurately image intraocular structures and give valuable information on the status of the lens, vitreous, retina, choroid, and sclera. However, in many instances, ultrasound is used for diagnostic purposes even though
on the cornea is acceptably small. It cannot be used for successful photography of a single eye because its proximity to the eye creates a very large reflection on the corneal surface that may obscure detail. If only one camera setup is to be used for all external ocular photographic assignments, then one with a point source type of electronic flash is more universally applicable. The electronic flash is attached to the front of the macro lens by means of a special rotating flash bracket. One of the most (...) be predicted easily; when the patient assumes primary gaze, the reflection always is located between the corneal apex and the limbus in the same quadrant as the flash position relative to the lens. Thus, if the flash is set directly above the lens, then the reflection appears in the superior cornea. Preset the lens magnification to its 1:1 setting, and set the aperture to the predetermined setting. Instruct the patient to look in the direction that presents the proper aspect of the eye to be photographed
respirations (apnea) No oculovestibular reflexes No oculocephalic reflexes No corneal and pupillary reflexes No cough and gag reflexes Identifiable cause for the coma Irreversibility over a 12- to 24-hour observation period Cause of death In patients who become cardiac donors in urban United States, the usual mechanism of brain death is penetrating or blunt head trauma. Most deaths in these patients are secondary to motor vehicle collisions, gunshot wounds to the head, or . Intracranial bleeding, drug
muscle rigidity with intermittent reflex spasms in response to stimuli (eg, noise, touch). Tonic contractions cause opisthotonos (ie, flexion and adduction of the arms, clenching of the fists, and extension of the lower extremities). During these episodes, patients have an intact sensorium and feel severe pain. The spasms can cause fractures, tendon ruptures, and acute respiratory failure. Patients with localized tetanus present with persistent rigidity in the muscle group close to the injury site (...) . Tetanus can also develop as a complication of chronic conditions such as abscesses and gangrene. It may infect tissue damaged by burns, frostbite, middle ear infections, dental or surgical procedures, abortion, childbirth, and intravenous (IV) or subcutaneous drug use. In addition, possible sources not usually associated with tetanus include intranasal and other foreign bodies and corneal abrasions. Underimmunization is an important cause of tetanus. Tetanus affects nonimmunized persons, partially
size. [ ] Smoke inhalation may produce injury through several mechanisms. Heated air from a fire can cause significant thermal injury to the upper airway. Particulate matter produced during combustion (soot) can mechanically obstruct and irritate the airways, causing reflex bronchoconstriction. Noxious gases released from burning materials include carbon monoxide (CO) and hydrogen cyanide (CN). Smoke may also contain aldehydes from combustion of furniture and cotton, and a variety of chemicals (...) reflexes help protect the lower lung areas from direct thermal injury. Animal experiments have shown that 142°C inhaled air cools to 38°C by the time it reaches the carina. Steam, volatile gases, explosive gases, and the aspiration of hot liquids provide some exceptions, as moist air has a much greater heat-carrying capacity than dry air. Asphyxiation Tissue hypoxia can occur via several mechanisms. Combustion in a closed space can consume significant amounts of oxygen, decreasing the ambient
daily (QD) or twice daily (BID) administration of RVL-1201 and the safety profile following 14 days of treatment in 72 subjects (24 per arm) with acquired blepharoptosis. Efficacy will be assessed at each treatment visit by the Humphrey Visual Field 36-point ptosis protocol test, photographic measurement of marginal reflex distance, palpebral fissure distance and contrast sensitivity in the study eye only and Visual Acuity assessment in both eyes. Safety assessments will include slit lamp (...) examination/corneal fluorescein staining, pupil size measurement, ophthalmoscopy/ fundus examination, tonometry, visual acuity; urine pregnancy test (for women of childbearing potential only), vital signs (Heart Rate/Blood Pressure); and collection of adverse events. Subject rating of study medication comfort and assessment of ongoing tolerability will also be obtained. Primary efficacy endpoint is the mean increase from baseline in points seen on the HVF 36-point ptosis protocol test at various
to 2 Years (Child) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Patients younger than 2 years of age Unilateral or bilateral congenital cataracts compromising the red reflex Exclusion Criteria: Corneal opacity Glaucoma Aniridia Subluxated cataract Traumatic cataract Complex microphthalmia Persistant hyperplastic primary vitreous Retinal detachment Patients with intraoperative complications, such as IOL implanted in the sulcus Contacts and Locations Go (...) acetonide Other Name: Triancinolona Ophthalmos Active Comparator: Prednisolone syrup The control group will receive prednisolone syrup postoperatively Drug: Prednisolone syrup Outcome Measures Go to Primary Outcome Measures : Visual axis obscuration [ Time Frame: 1 year after surgery ] Visual axis obscuration will be evaluated under sedation, with a dilated pupil. All patients will be classified by the principal investigator as having or not a significant visual axis obscuration, based on the red reflex
for recent articles on the assessment of prognosis in persons who are comatose after CPR and therapeutic hypothermia.On the basis of 21 clinical trials, 4 of which yielded level I evidence, 9 level II evidence, and 8 level III evidence, the following were identified as reliable indicators of a poor prognosis: generalized myoclonus, bilateral absence of the pupillary light response or of the cornealreflex, bilateral absence of the cortical components of median nerve somatosensory evoked potentials
) motor response was assessed in 811 patients from nine studies. A GCS motor score of 1-2 at 72 h had a high FPR of 0.21 (CI 0.08-0.43). Cornealreflex and pupillary reactivity at 72 h after the arrest were available in 429 and 566 patients, respectively. Bilaterally absent cornealreflexes had an FPR of 0.02 (CI 0.002-0.13). Bilaterally absent pupillary reflexes had an FPR of 0.004 (CI 0.001-0.03).At 72 h after the arrest the motor response to painful stimuli and the cornealreflexes
mg/kg b.w. midazoram (Mid.), and 5.0 mg/kg b.w. butorphanol (But.) produced an anesthetic duration of around 40 min in outbred ICR mice. However, the anesthetic effect of the mixture for inbred mice strains remains unknown. Therefore, we examined anesthetic effects of the mixture of Med., Mid., and But. in the BALB/c and C57BL/6J strains. After intraperitoneal injection into mice, right front paw, left hind paw, and tail pinch reflexes as well as corneal and righting reflexes were observed. Every (...) 5 min, we scored each reflex category as 0 for reaction or 1 for no reaction. As long as the total score was at least 4 out of 5, we considered the mixture as putting a mouse in a surgical anesthetic state. The mixture produced an anesthetic duration of more than 45 min in both strains of mice. These results indicate that the mixture of Med., Mid., and But. can be a useful and effective anesthesia for the BALB/c and C57BL/6J strains of inbred mice as well as outbred ICR mice.
at a distance of 50 cm). 2. Changes in the illumination system: minimizing the narrowed angle between illumination and observation axis by holding a "recentration" prism of 14 dpt horizontally in front of the slit light. This procedure creates equally sufficient illumination of the patient's face and central cornealreflexes. 3. Recording clinical findings with a digital recorder. This enables us to identify binocular eye positions, which sometimes last only part of a second, eg, in latent or intermittent (...) strabism. 4. Visualizing clinical findings by using Microsoft PowerPoint® to build up 9-gaze composites or adjust cornealreflexes on subsequent foils. Changes in binocular eye positions (eg, after surgery, but also during diagnostic covering) can be made visible by flickering between the foils to compare.
Cluster Headache After Cataract Surgery. Symptomatic cluster-like headache has been described with some ophthalmological disorders such as glaucoma, orbital myositis, posterior scleritis, enucleation, herpes zoster ophthalmicus, and cataract surgery.We report a new case of a 79-year-old nonsmoker woman who developed cluster-like symptoms 2 days after a cataract surgery and review the 2 previously reported cases.The surgical technique of cataract removal involves corneal incision, which can (...) trigger the trigeminal-autonomic reflex, a pathophysiological mechanism potentially implicated in idiopathic cluster headache. Differential diagnosis in these cases includes surgical and anesthetic complications.
osmolarity, tear instability (tear break-up time [TBUT]), tear reflex (Schirmer's I test), and central corneal sensitivity with the Cochet-Bonnet esthesiometer (Luneau, France) were measured in the HK and control groups.Tear osmolarity, TBUT, Schirmer's I, and central corneal sensitivity were compared between the affected and unaffected eyes of the HK and control groups.Tear osmolarity and tear secretion reflex were similar between the affected and unaffected eyes of the HK group. Corneal sensitivity (...) and TBUT were statistically lower in the affected eyes compared with the unaffected eyes in the HK group (P = 0.001 and P<0.001, respectively). The central corneal sensitivity of unaffected eyes in the HK group was not significantly different from that in the control group (P>0.05). The tear stability and tear secretion reflex were decreased and tear osmolarity was increased in the unaffected eyes of the HK group compared with the control group (P<0.05, all cases). The difference between unaffected
membrane bioengineered eyelid spacer grafts from 2008 through 2011. Outcome measures included lower eyelid height (measured from the corneal light reflex to the lower eyelid margin, or marginal reflex distance-2 [MRD2]), reduction of lagophthalmos, cosmetic appearance, complications, and need for further surgery. Presurgery and postreconstruction photographs were reviewed for functional and cosmetic outcome.A total of 32 Graves patients and 37 eyelids underwent lower eyelid retraction surgery using (...) decellularized porcine-derived membrane. There were 10 male and 22 female patients with mean age of 41.8 ± 8.6 years. Mean improvement in MRD2 was 1.4 ± 0.4 mm. Mean reduction of lagophthalmos was 1.3 ± 0.4 mm. There are statistically significant differences between preoperative and postoperative MRD2 and lagophthalmos (paired t test, both P < .0001). No evidence of infection and corneal erosion was noted and none of the patients needed further surgeries. Prolonged lower lid swelling and slight puffy
microscope and wide-angle digital retinal image acquisition system. The retinal fundus examination utilised the RetCam wide-field digital imaging system (Clarity Medical Systems, Pleasanton, California, USA). The external eye, pupillary light reflex, red reflex, opacity of refractive media, anterior chamber and posterior segments were also examined.A total of 3573 healthy full-term newborns were enrolled and examined in the programme. There was detection of 871 abnormal cases (24.4%). The majority (...) of abnormal exams were 769 (21.52%) retinal haemorrhages. Of these, there were 215 cases of significant retinal haemorrhage, possible sight threatening or amblyogenic, representing 6.02% of the total. In addition, 67 cases (1.88%) involved macular haemorrhage. The other 107 cases (2.99%) with abnormal ocular findings included subconjunctival haemorrhage, congenital microphthalmos, congenital corneal leukoma, posterior synechia, persistent pupillary membrane, congenital cataract, enlarged C/D ratio