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Corneal Reflex

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521. 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

522. 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

523. Miosis

exposed eye associated parasympathetic fibers signal opposite iris to constrict Accommodation Visual focusing Near Reaction (e.g. Reading) Also results in eye convergence (under control as well) Pathway Ciliary body smooth muscle contracts Lens changes shape (more convex) constricts during accommodation to aid focusing Both ciliary body contraction and Pupil Constriction are mediated by related parasympathetic fibers Visual cortex controls accommodation as part of a reflex loop based on signals III (...) užívají léky, které ji vyvolávají – miotika. Opak mydriáza. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) Definition (MSH) Pupillary constriction. This may result from congenital absence of the dilatator pupillary muscle, defective sympathetic innervation, or irritation of the CONJUNCTIVA or CORNEA. Concepts Finding ( T033 ) MSH ICD9 379.42 SnomedCT 194166000 , 61514009 , 63251006 English Mioses , Miosis , MIOSIS , PUPILS CONSTRICTED , Small pupil , Miosis disorder

2015 FP Notebook

524. 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

525. 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

526. 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

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

. The disease passes through two phases: active and inactive. The active phase lasts between 18 and 24 months. During this phase, TED signs and symptoms generally worsen and then often improve. The inactive phase follows, during which the signs and symptoms of TED cease to improve and usually stabilize. Lid retraction is a cardinal sign of TED. In addition to potentially causing cornea damage due to improper lid closure, lid retraction is also very troublesome for patients due to its cosmetic appearance (...) . 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

2012 Clinical Trials

528. Brow ptosis: are we measuring the right thing? The impact of surgery and the correlation of objective and subjective measures with postoperative improvement in quality-of-life Full Text available with Trip Pro

eyelid position (ie, distance mm from corneal reflex to upper skin fold (FRD1), lowest brow hair to lower limbus (LLB), centre of lower lid to upper lid skin fold (LLF)) and number of points missing in 'superior' and 'superior plus elsewhere' Humphrey 120-point visual field, as well as a Quality-of-life and Visual Function questionnaire before and after brow lift surgery.The strongest correlation between pre-op functional index score and any pre-op objective measure was visual fields (r=-0.46, P

2012 Eye

529. Measurement of angle kappa and centration in refractive surgery. (Abstract)

).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

530. A case of inaccurate prognostication after the ARCTIC protocol. Full Text available with Trip Pro

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

531. Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis. Full Text available with Trip Pro

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

2012 Journal of Neurosurgery

532. Brain death--think twice before labeling a patient. (Abstract)

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

533. Occult Intraocular Trauma: Evaluation of the Eye in an Austere Environment. (Abstract)

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

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

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

535. Prognosis of coma after therapeutic hypothermia: A prospective cohort study. Full Text available with Trip Pro

with hypothermia (32-34°C). False-positive rates (FPRs 1 - specificity) with their 95% confidence intervals (CIs) were calculated for pupillary light responses, corneal reflexes, and motor scores 72 hours after CPR; NSE levels at admission, 12 hours after reaching target temperature, and 36 hours and 48 hours after collapse; and SEPs during hypothermia and after rewarming. The primary outcome was poor outcome, defined as death, vegetative state, or severe disability (Glasgow Outcome Scale 1-3) after 6 (...) months.Of 391 patients included, 53% had a poor outcome. Absent pupillary light responses (FPR 1; 95% CI, 0-7) or absent corneal reflexes (FPR 4; 95% CI, 1-13) 72 hours after CPR, and absent SEPs during hypothermia (FPR 3; 95% CI, 1-7) and after rewarming (FPR 0; 95% CI, 0-18) were reliable predictors. Motor scores 72 hours after CPR (FPR 10; 95% CI, 6-16) and NSE levels were not.In patients with persisting coma after CPR and therapeutic hypothermia, use of motor score or NSE, as recommended in current

2012 Annals of Neurology

536. 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

537. A BARBITURATE ANTIDOTE—Use of Methylethylglutarimide in Barbiturate Intoxication and in Terminating Barbiturate Anesthesia Full Text available with Trip Pro

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

1959 California Medicine

538. 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

539. Eye Signs of Neurological Disorders Full Text available with Trip Pro

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.

1974 Canadian Family Physician

540. Simple method of determining the axial length of the eye. Full Text available with Trip Pro

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

1976 The British journal of ophthalmology

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