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Corneal Reflex

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541. 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

542. 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

543. 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

544. 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

545. Screening of pre-school children for ocular anomalies. I. Screening methods and their practicability at different ages. Full Text available with Trip Pro

Screening of pre-school children for ocular anomalies. I. Screening methods and their practicability at different ages. 5557522 1971 09 14 2018 11 13 0007-1161 55 7 1971 Jul The British journal of ophthalmology Br J Ophthalmol Screening of pre-school children for ocular anomalies. I. Screening methods and their practicability at different ages. 462-6 Oliver M M Nawratzki I I eng Journal Article England Br J Ophthalmol 0421041 0007-1161 IM Age Factors Child Child Behavior Child, Preschool Cornea (...) Humans Infant Mass Screening Reflex Social Class Vision Disorders epidemiology Vision Tests Visual Acuity 1971 7 1 1971 7 1 0 1 1971 7 1 0 0 ppublish 5557522 PMC1208419 JAMA. 1968 May 27;204(9):767-70 5694573 Ophthalmologica. 1968;155(3):234-44 5652197 Br Med J. 1960 Aug 6;2(5196):453-6 14445872

1971 The British journal of ophthalmology

546. CONGENITAL TRIGEMINAL ANAESTHESIA Full Text available with Trip Pro

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

1963 The British journal of ophthalmology

547. Hydroxychloroquine and ocular toxicity recommendations on screening

of hydroxychloroquine and chloroquine include disturbances in hepatic and renal function. Ocular side effects include retinal toxicity (which can lead to permanent visual impairment) and deposition of the drug in the cornea. The mechanism of retinal toxicity is not well understood, though it appears that the earliest changes occur in the cytoplasm of ganglion cells and photoreceptors with later involvement of the retinal pigment epithelium 2 , where it binds to melanin. Hydroxychloroquine has been used since (...) physician and the ophthalmologist. The Royal College of Ophthalmologists - Hydroxychloroquine and Ocular Toxicity Recommendations on Screening – October 2009 Page 3 of 9 Clinical features of ocular complications Quinolones can precipitate in the corneal epithelium in a diffuse punctate or whorl-like pattern which can sometimes result in visual haloes. This is much less common with hydroxychloroquine than with chloroquine 4,8 . The effect is reversible on stopping the drug. The earliest sign of retinal

2009 British Association of Dermatologists

549. 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

550. 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

551. Overview of Lysosomal Storage Disorders

disease Treatment: Supportive care Sialolipidosis (phospholipidosis; mucolipidosis IV, Berman disease; 252650) MCOLN1 (19p13.3-p13.2)* Onset: 1st yr Urine metabolites: No mucopolysaccharides Clinical features: Severe (Berman disease) and mild forms Developmental delay, corneal opacities, visual deficiency, strabismus, hypotonia, increased deep tendon reflexes; no radiographic skeletal abnormality, macrocephaly, or organomegaly Treatment: Supportive care Mannosidosis Onset: In type I, 3–12 mo In type (...) , corneal crystals and erosion, rickets, hepatosplenomegaly, pancreatic insufficiency, renal calculi, renal failure, renal Fanconi syndrome, decreased sweating, myopathy, dysphagia, cerebral atrophy, normal intelligence but neurologic deterioration in long-term survivors Cystine accumulation throughout reticuloendothelial system, WBC, and cornea Treatment: Replacement therapy for Fanconi syndrome, renal transplant for failure, cysteamine orally or as eyedrops, growth hormone Late-onset juvenile form

2013 Merck Manual (19th Edition)

552. Cataract

) Within the first week: (infection within the eye—very rare and could result in irreversible blindness) and glaucoma Within the first month: Cystoid macular edema Months later: (ie, swelling of the cornea due to damage to the corneal pump cells during cataract surgery), , and posterior capsular opacification (common but treatable with laser) After surgery, vision returns to 20/40 (6/12) or better in 95% of eyes if there are no preexisting disorders such as , , , and . If an intraocular lens (...) 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

2013 Merck Manual (19th Edition)

553. 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)

554. Floaters

affect entire visual field Loss of red reflex Indirect ophthalmoscopy by an ophthalmologist after pupillary dilation Vitreous inflammation (eg, cytomegalovirus, Toxoplasma , or fungal chorioretinitis) Pain Loss of visual acuity Loss of vision affecting the entire visual field Retinal lesions (sometimes cotton-like) that do not conform to an arterial or a venous territory Risk factors (eg, AIDS) Decreased red reflex May be bilateral Evaluation and testing as directed by an ophthalmologist, based (...) . The eyes are inspected for redness. Visual fields are assessed in all patients. However, recognition of visual field defects by bedside examination is very insensitive, so inability to show such a defect is not evidence that the patient has full visual fields. Extraocular movements and pupillary light responses are assessed. If patients have a red eye or eye pain, the corneas are examined under magnification after fluorescein staining, and slit-lamp examination is done if possible. Ocular pressure

2013 Merck Manual (19th Edition)

555. 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)

556. Blurred Vision

by a small retinal detachment) may describe their symptoms as blurring. Podcast Etiology The most common causes of blurred vision (see ) include (the most common cause overall) Blurred vision has 4 general mechanisms: Opacification of normally transparent ocular structures (cornea, lens, vitreous) through which light rays must pass to reach the retina Disorders affecting the retina Disorders affecting the optic nerve or its connections Refractive errors Table Some Causes of Blurred Vision Cause (...) 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

2013 Merck Manual (19th Edition)

557. 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 (...) their symptoms as blurred vision. Podcast Pathophysiology Acute loss of vision has 3 general causes: Opacification of normally transparent structures through which light rays pass to reach the retina (eg, cornea, vitreous) Retinal abnormalities Abnormalities affecting the optic nerve or visual pathways Etiology The most common causes of acute loss of vision are Vascular occlusions of the retina ( , ) Ischemic optic neuropathy (often in patients with ) Vitreous hemorrhage (caused by or trauma) Trauma

2013 Merck Manual (19th Edition)

558. 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 (...) the thickness of the light reflex Silver wiring, a sign of hypertension in which thin, fibrotic arteriolar walls decrease the thickness of the light reflex Loss of venous pulsations, a sign of increased intracranial pressure in patients known to have had pulsations Slit-lamp examination A slit lamp focuses the height and width of a beam of light for a precise stereoscopic view of the eyelids, conjunctiva, cornea, anterior chamber, iris, lens, and anterior vitreous. With a handheld condensing lens, it can

2013 Merck Manual (19th Edition)

559. 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)

560. 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)

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