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Corneal Reflex

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501. Tetanus (Overview)

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

2014 eMedicine Emergency Medicine

502. Smoke Inhalation (Overview)

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

2014 eMedicine Emergency Medicine

503. Stroke, Ischemic (Follow-up)

is not recommended for patients older than 60 years Clinical evidence of deterioration in swollen supratentorial hemispheric ischemic stroke includes new or further impairment of consciousness, cerebral ptosis, and changes in pupillary size In patients with swollen cerebellar infarction, level of consciousness decreases because of brainstem compression; this decrease may include early loss of corneal reflexes and the development of miosis Standardized definitions are needed to facilitate studies of incidence

2014 eMedicine Emergency Medicine

504. Snake Envenomation, Cobra (Follow-up)

of the proper antivenom to be administered. If the patient is bitten by a wild snake, identification may be equally problematic and important, particularly if there is more than one antivenom option for the region. Attempts to capture or kill the snake could result in additional bites or delay in transporting the victim to medical care. If possible, a digital photo of the snake may be a better choice. If the snake is killed, it must be handled with care as it may have a prolonged bite reflex after death (...) ophthalmic anesthetic agent may reduce pain and aid in irrigation. The topical use of 1:1000 epinephrine solution is reported to relieve pain promptly. A fluorescein-aided slit lamp examination helps to find evidence of corneal damage. A brief course of topical ophthalmic antibiotics and preservative-free lubricating drops may be prescribed. Previous Next: Inpatient Care Admit all cobra snakebite patients to closely monitored settings, whether or not antivenom is given. Observe asymptomatic patients

2014 eMedicine Emergency Medicine

505. Evaluation of Objective Perimetry Using Chromatic Multifocal Pupillometer

Sampling Method: Non-Probability Sample Study Population Two Groups: 1. Control, 2. Patients - Glaucoma patients with early damage (nasal step) of Humphrey visual field (HVF), Glaucoma patients with advanced damage of HVF (arcuate , tubular vision) and retinal dystrophy patientsl Criteria Inclusion Criteria: Age 18-80 years old. Signing informed consent. Pupillary reflex to light. Exclusion Criteria: Cloudy corneas. Surgical intraocular ophthalmic procedure within the past 30 days. No reactive pupils (...) Sponsor: Sheba Medical Center Information provided by (Responsible Party): Dr. Ygal Rotenstreich, Sheba Medical Center Study Details Study Description Go to Brief Summary: Objective perimetry can better monitor visual field defects in retinal dystrophy and Glaucoma patients than conventional subjective perimetry. The PLR ( Pupil Light Reflex to short and long wavelength stimuli should be significantly lower compared to healthy participants in areas of visual field defects in retinal dystrophy

2013 Clinical Trials

506. Effect of Contact Lens With Alginic Acid in Dry Eye Patients

segment assessment with a slit lamp microscope will be carried out to evaluate corneal health and clinical signs. Assessment of positive fluorescein staining on cornea and conjunctiva will be assessed. A scoring system will be applied as adapted by Bron A, Evans VE, Smith JA. (2003).The grading scheme depends on the intensity and the area of the staining for each panel with scale from 0 to 5. Briefly, there will be corneal zone and exposed interpalpebral conjunctival regions as shown in Figure 2 (...) temporal half of the lower lid margin in both eyes at the same time. The study participant will be asked to close their eyes during the test. Any excessive irritation signs or reflex tearing will be noted. The extent of the wetting in each strip will be recorded after 5 minutes of testing. The strip will be collected and stored in 1.5ml eppendorf tubes at -80˚C until further tear lipid and protein analysis. Tear break up time (TBUT) [ Time Frame: 7 days ] Keratograph 5M will be used to perform the non

2013 Clinical Trials

507. Rare Disease Patient Registry: Coordination of Rare Diseases at Sanford

Epilepsy and/or Ataxia With Myoclonus as a Major Feature Spectrin-associated Autosomal Recessive Cerebellar Ataxia Spasticity-ataxia-gait Anomalies Syndrome Spastic Ataxia With Congenital Miosis Spastic Ataxia - Corneal Dystrophy Spastic Ataxia Rare Hereditary Ataxia Rare Ataxia Recessive Mitochondrial Ataxia Syndrome Progressive Epilepsy and/or Ataxia With Myoclonus as a Major Feature Posterior Column Ataxia - Retinitis Pigmentosa Post-Stroke Ataxia Post-Head Injury Ataxia Post Vaccination Ataxia (...) Episodic Ataxia Type 3 Episodic Ataxia Type 1 Epilepsy and/or Ataxia With Myoclonus as Major Feature Early-onset Spastic Ataxia-neuropathy Syndrome Early-onset Progressive Neurodegeneration - Blindness - Ataxia - Spasticity Early-onset Cerebellar Ataxia With Retained Tendon Reflexes Early-onset Ataxia With Dementia Childhood-onset Autosomal Recessive Slowly Progressive Spinocerebellar Ataxia Dilated Cardiomyopathy With Ataxia Cataract - Ataxia - Deafness Cerebellar Ataxia, Cayman Type Cerebellar Ataxia

2013 Clinical Trials

508. Cataract Surgery With Intracameral Triamcinolone in Infants

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

2013 Clinical Trials

509. Safety and Efficacy Study of RVL-1201 in Acquired Blepharoptosis

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

2013 Clinical Trials

510. Anesthetic Effects of a Mixture of Medetomidine, Midazolam and Butorphanol in Two Strains of Mice Full Text available with Trip Pro

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.

2013 Experimental Animals

511. Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature. (Abstract)

) 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). Corneal reflex and pupillary reactivity at 72 h after the arrest were available in 429 and 566 patients, respectively. Bilaterally absent corneal reflexes 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 corneal reflexes

2013 Intensive Care Medicine

512. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: Patients treated with therapeutic hypothermia. (Abstract)

and corneal reflexes plus a motor response no better than extension (M≤2) (1 study; QOE: Very low) after rewarming predicted CPC 3-5 with 0% FPR and narrow (<10%) 95% confidence intervals. No consistent threshold for 0% FPR could be identified for blood levels of biomarkers. In 6/8 studies on SSEP, in 1/3 studies on EEG reactivity and in the single study on clinical examination the investigated predictor was used for decisions to withdraw treatment, causing the risk of a self-fulfilling (...) the first 7 days after CA, a bilaterally absent N20 SSEP wave anytime, a nonreactive EEG after rewarming or a combination of absent ocular reflexes and M≤2 after rewarming predicted CPC 3-5 with 0% FPR and narrow 95% CIs, but with a high risk of bias.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

2013 Resuscitation

513. Assessing prognosis following cardiopulmonary resuscitation and therapeutic hypothermia-a critical discussion of recent studies. Full Text available with Trip Pro

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 corneal reflex, bilateral absence of the cortical components of median nerve somatosensory evoked potentials

2013 Deutsches Ärzteblatt international

514. Clinical examination for prognostication in comatose cardiac arrest patients. Full Text available with Trip Pro

indicating good outcome. The clinical examination was performed on days 0, 1, 3 and 7 post-arrest, and clinical variables analyzed for importance in prognostication of outcome. A classification and regression tree analysis (CART) was used to develop a predictive algorithm.Good outcome was achieved in 9.9% of patients. In CART analysis, motor response was often chosen as a root node, and spontaneous eye movements, pupillary reflexes, eye opening and corneal reflexes were often chosen as splitting nodes (...) . Over 8% of patients with absent or extensor motor response on day 3 achieved a good outcome, as did 2 patients with myoclonic status epilepticus. The odds of achieving a good outcome were lower in patients who suffered asystole (OR 0.187, 95% CI: 0.039-0.875, p=0.033) compared with ventricular fibrillation or non-perfusing ventricular tachycardia, but some still achieved good outcome. The absence of pupillary and corneal reflexes on day 3 remained highly reliable for predicting poor outcome

2013 Resuscitation

515. Assessment of the effects of intramuscular administration of alfaxalone with and without medetomidine in Horsfield's tortoises (Agrionemys horsfieldii). (Abstract)

of four different protocols: 1) 10 mg kg(-1) alfaxalone; 2) 10 mg kg(-1) alfaxalone + 0.10 mg kg(-1) medetomidine; 3) 20 mg kg(-1) alfaxalone; and 4) 20 mg kg(-1) alfaxalone + 0.05 mg kg(-1) medetomidine. During the experiment, the following variables were recorded: heart rate; respiratory rate; peripheral nociceptive responses; muscle strength; ability to intubate; palpebral, corneal and tap reflexes; and cloacal temperature.Protocols 1 and 2 resulted in moderate sedation with no analgesia

2013 Veterinary anaesthesia and analgesia

516. Intramuscular administration of alfaxalone in red-eared sliders (Trachemys scripta elegans)--effects of dose and body temperature. (Abstract)

minutes. Endotracheal intubation was successful in 80%, 100%, 0% and 30% of turtles, respectively. At 35°C, all animals retained nociceptive sensation in the front limbs, hind limbs and vent, whereas at 20°C a few turtles lost peripheral nociceptive sensation. Corneal and tap reflexes were retained in all trials. Mean heart rates were 30±2 and 66±4 beats minute(-1) at 20 and 35°C, respectively.Alfaxalone administered i.m. in red-eared sliders provided smooth, rapid induction and uneventful recovery (...) respectively. Time to maximal effect and plateau and recovery periods were recorded. Skeletal muscle tone, presence of various reflexes, response to noxious stimuli, and heart rate were assessed.Results are given for protocols 10 mg kg(-1) 20°C; 20 mg kg(-1) 20°C; 10 mg kg(-1) 35°C and 20 mg kg(-1) 35°C, respectively: mean time (±SD) to maximal effect was 16±8, 19±6, 5±2 and 7±5 minutes; duration of the plateau phase was 13±12, 28±13, 8±5 and 8±5 minutes and recovery time was 76±20, 126±17, 28±9 and 41±20

2013 Veterinary anaesthesia and analgesia Controlled trial quality: uncertain

517. Findings of perinatal ocular examination performed on 3573, healthy full-term newborns. Full Text available with Trip Pro

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

2013 British Journal of Ophthalmology

518. The Orthoptic Slit Lamp. (Abstract)

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 corneal reflexes. 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 corneal reflexes 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.

2013 Strabismus

519. Cluster Headache After Cataract Surgery. (Abstract)

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.

2013 Clinical Journal of Pain

520. Impairment of Lacrimal Secretion in the Unaffected Fellow Eye of Patients with Recurrent Unilateral Herpetic Keratitis. (Abstract)

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

2013 Ophthalmology

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