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Corneal Reflex

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561. Strabismus

in Philadelphia. The university... 3D Model Cystic Fibrosis: Defective Chloride Transport Video How to do Neonatal Resuscitation SOCIAL MEDIA Add to Any Platform Loading Topic Resources Strabismus is misalignment of the eyes, which causes deviation from the parallelism of normal gaze. Diagnosis is clinical, including observation of the corneal light reflex and use of a cover test. Treatment may include correction of visual impairment with patching and corrective lenses, alignment by corrective lenses (...) difficulty in fusing images from misaligned eyes and to reduce diplopia. Some children with tropias have normal and equal visual acuity; however, amblyopia frequently develops with tropias and is due to cortical suppression of the image in the deviating eye to avoid confusion and diplopia. Diagnosis Physical and neurologic examinations at well-child checkups Tests (eg, corneal light reflex, alternate cover, cover-uncover) Prisms Strabismus can be detected during well-child checkups through the history

2013 Merck Manual (19th Edition)

562. Crying

, blood in the canal or behind the tympanic membrane) or infection (eg, red, bulging tympanic membrane). The corneas are stained with fluorescein and examined with a blue light to rule out corneal abrasion, and the fundi are examined with an ophthalmoscope for signs of hemorrhage. (If retinal hemorrhages are suspected, examination by an ophthalmologist is advised.) The oropharynx is examined for signs of thrush or oral abrasions. The skull is gently palpated for signs of fracture. Red flags (...) , or decreased breath sounds on auscultation Chest x-ray (UTI) Fever Possible vomiting Urinalysis and culture Trauma Corneal abrasion Crying with no other symptoms Fluorescein test Fracture ( ) Area of swelling and/or ecchymoses Favoring of a limb Skeletal survey x-rays to check for current and old fractures Hair tourniquet Swollen tip of a toe, finger, or penis with hair wrapped around the appendage proximal to the swelling Clinical evaluation Head trauma with intracranial bleeding Inconsolable, high

2013 Merck Manual (19th Edition)

563. 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)

564. 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)

565. General Principles of Poisoning

or respiratory arrest. Eye contact with toxins (solid, liquid, or vapor) may damage the cornea, sclera, and lens, causing eye pain, redness, and loss of vision. Some substances (eg, cocaine, phencyclidine, amphetamine ) can cause severe agitation, which can result in hyperthermia, acidosis, and rhabdomyolysis. Diagnosis Consideration of poisoning in patients with altered consciousness or unexplained symptoms History from all available sources Selective, directed testing The first step of diagnosis (...) except the mildest and most routine. Initial stabilization Maintain airway, breathing, and circulation IV naloxone IV dextrose and thiamine IV fluids, sometimes vasopressors Airway, breathing, and circulation must be maintained in patients suspected of a systemic poisoning. Patients without a pulse or BP require emergency . If patients have apnea or compromised airways (eg, foreign material in the oropharynx, decreased gag reflex), an endotracheal tube should be inserted (see ). If patients have

2013 Merck Manual (19th Edition)

566. 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 eyelid rather than the conjunctiva or cornea. Eyelid burns should be cleansed thoroughly with sterile isotonic saline solution followed by application of an ophthalmic antimicrobial ointment (eg, bacitracin bid). Most thermal burns affecting the conjunctiva or cornea are mild and heal without significant sequellae. They are treated with oral analgesics ( acetaminophen with or without oxycodone ), cycloplegic mydriatics (eg, homatropine 5% qid), and topical ophthalmic antibiotics (eg, bacitracin

2013 Merck Manual (19th Edition)

567. Overview of Eye Trauma

, and tendons), and/or bones of the orbit. (See also .) General evaluation should include the following: Tests of visual acuity Range of extraocular motion Visual fields to confrontation Pupillary appearance and responses Location and depth of lid and conjunctival lacerations and of foreign bodies Depth of anterior chamber Presence of anterior chamber or vitreous hemorrhage, cataract, or red reflex Retinal examination Intraocular pressure determination Detailed examination of the sclera, anterior segment (...) (cornea, anterior chamber, ciliary body, iris), lens, and anterior vitreous is best done with a slit lamp. Although direct ophthalmoscopy can be used to examine the lens and posterior structures of the eye, indirect ophthalmoscopy, usually done by an ophthalmologist, provides a more detailed and binocular view of these structures. Indications for indirect ophthalmoscopy include clinical suspicion of vitreous abnormalities (eg, hemorrhage, foreign body) and retinal abnormalities; clinical suspicion may

2013 Merck Manual (19th Edition)

568. Eye Contusions and Lacerations

the cornea appear to have folds) or very deep (due to rupture posterior to the lens). The pupil is irregular. The red reflex is absent. If globe laceration is suspected, measures that can be taken before an ophthalmologist is available consist of and combating possible infection with systemic antimicrobials as for . Topical antibiotics are avoided. Vomiting, which can increase intraocular pressure (IOP) and contribute to extravasation of ocular contents, is suppressed using antiemetics as needed. Because (...) , 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

2013 Merck Manual (19th Edition)

569. 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

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

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

571. Predictors of poor neurologic outcome in patients after cardiac arrest treated with hypothermia: A retrospective study. (Abstract)

cardiac arrest treated with hypothermia. All data were collected from medical charts and laboratory files and analyzed from the day of admission to the intensive care unit until day 7, discharge from the intensive care unit or death using the Utstein definitions for the registration of the data.We analyzed the data of 103 patients. The combination of an M1 or M2 on the Glasgow Coma Scale or absent pupillary reactions or absent corneal reflexes on day 3 was present in 80.6% of patients (...) with an unfavourable and 11.1% of patients with a favourable outcome. The combination of M1 or M2 and absent pupillary reactions to light and absent corneal reflexes on day 3 was present in 14.9% of patients with an unfavourable and none of the patients with a favourable outcome. None of the patients with a favourable outcome had a bilaterally absent somatosensory evoked potential of the median nerve. The value of electroencephalogram patterns in predicting outcome was low, except for reactivity to noxious

2011 Resuscitation

572. Propofol and Etomidate Depress Cortical, Thalamic, and Reticular Formation Neurons During Anesthetic-Induced Unconsciousness. (Abstract)

an anesthetic effect; peak power occurred at 12 to 13 Hz during propofol infusion. There were 2 major peaks during etomidate anesthesia: one at 12 to 14 Hz and another at 7 to 8 Hz. The cats were heavily sedated, with depressed corneal and whisker reflexes; withdrawal to noxious stimulation remained intact.These data show that neurons in the cortex, thalamus, and reticular formation are similarly depressed by propofol and etomidate. Although anesthetic depression of neuronal activity likely contributes

2011 Anesthesia and Analgesia

573. Reversible brain death after cardiopulmonary arrest and induced hypothermia. (Abstract)

protection. After rewarming to 36.5°C, neurologic examination showed no eye opening or response to pain, spontaneous myoclonic movements, sluggishly reactive pupils, absent corneal reflexes, and intact gag and spontaneous respirations. Over 24 hrs, remaining cranial nerve function was lost. The neurologic examination was consistent with brain death. Apnea test and repeat clinical examination after a duration of 6 hrs confirmed brain death. Death was pronounced and the family consented to organ donation (...) . Twenty-four hrs after brain death pronouncement, on arrival to the operating room for organ procurement, the patient was found to have regained corneal reflexes, cough reflex, and spontaneous respirations. The care team faced the challenge of offering an adequate explanation to the patient's family and other healthcare professionals involved.Induced hypothermia and brain death determination.This represents the first published report in an adult patient of reversal of a diagnosis of brain death made

2011 Critical Care Medicine

574. Difficulties with the neurological assessment of humans following a chimpanzee attack. Full Text available with Trip Pro

, soft-tissue, and eye injuries, and scalp degloving. An emergency tracheotomy was performed at the scene, with an unclear duration of hypoxia. The patient was unresponsive without spontaneous movements, papillary or corneal reflexes, cough, or gag. Attempts to lighten sedation were not tolerated. Brain CTs were normal. Intracranial pressure monitoring was deemed infeasible. Brain MR imaging suggested diffuse axonal injury consistent with severe shaking trauma. Diffusion tensor imaging indicated

2011 Journal of Neurosurgery

575. Use of Lipid Emulsion or Nanoemulsion of Propofol on Children Undergoing Ambulatory Invasive Procedures.

will be administered by 1mL per 5 seconds, adjustment dose can be given. Drug: propofol 3 - 4 mg/kg IV, adjustment dose if necessary Active Comparator: propofol lipid emulsion 3-4 mg/kg will be administered by 1 ml per 5 seconds. Drug: propofol 3 - 4 mg/kg IV, adjustment dose if necessary Outcome Measures Go to Primary Outcome Measures : Classification of the sedation level [ Time Frame: time 0 ] Instantly after the loss of consciousness (loss of corneal-palpebral reflex) will be measured the sedation using (...) the Ramsay Modified Scale. Secondary Outcome Measures : Time of latency [ Time Frame: 3-10 seconds ] Time between the injection and loss of the corneal-palpebral reflex Pain at injection [ Time Frame: 3 - 10 seconds: during the injection ] The pain will be measured by CHEOPS Scale which evaluates the behavior of the child against pain. Physician satisfaction [ Time Frame: 12 hours: end of procedure ] The satisfaction of the medical specialist will be assessed through a questionnaire that assesses

2011 Clinical Trials

576. DASH After TBI Study: Decreasing Adrenergic or Sympathetic Hyperactivity After Traumatic Brain Injury

Criteria: Pre-existing heart disease (i.e. coronary heart disease) Pre-existing cardiac dysrhythmia Allergy to study drugs Penetrating brain injury Pre-existing brain dysfunction (i.e. prior severe TBI, debilitating stroke) Impending brain herniation (i.e. loss of bilateral corneal reflexes) Craniectomy or craniotomy Spinal cord injury Myocardial injury Severe liver disease Current use of beta-blockers and/or alpha-2-agonist Withdrawal of care expected in 24 hours Prisoners Pregnant women Unable

2011 Clinical Trials

577. Light-Induced Trigeminal Sensitization Without Central Visual Pathways - Another Mechanism for Photophobia. Full Text available with Trip Pro

Light-Induced Trigeminal Sensitization Without Central Visual Pathways - Another Mechanism for Photophobia. The authors investigated whether trigeminal sensitization occurs in response to bright light with the retina disconnected from the rest of the central nervous system by optic nerve section.In urethane-anesthetized rats, trigeminal reflex blinks were evoked with air puff stimuli directed at the cornea in darkness and at three different light intensities. After normative data were collected (...) , the optic nerve was lesioned and the rats were retested. In an alert rat, reflex blinks were evoked by stimulation of the supraorbital branch of the trigeminal nerve in the dark and in the light.A 9.1 × 10(3) μW/cm(2) and a 15.1 × 10(3) μW/cm(2) light significantly enhanced the magnitude of reflex blinks relative to blinks evoked by the same trigeminal stimulus when the rats were in the dark. In addition, rats exhibited a significant increase in spontaneous blinking in the light relative to the blink

2011 Investigative Ophthalmology & Visual Science

578. Optic nerve

information is relayed to the visual cortex, while other axons terminate in the and are involved in reflexive eye movements. Other axons terminate in the and are involved in regulating the sleep-wake cycle. Its diameter increases from about 1.6 mm within the eye to 3.5 mm in the orbit to 4.5 mm within the cranial space. The optic nerve component lengths are 1 mm in the globe, 24 mm in the orbit, 9 mm in the optic canal, and 16 mm in the cranial space before joining the optic chiasm. There, partial (...) from the contralateral inferior visual field terminate more superiorly, to the [ ] . Function [ ] The optic nerve transmits all visual information including brightness perception, color perception and contrast (visual acuity). It also conducts the visual impulses that are responsible for two important neurological reflexes: the and the . The light reflex refers to the constriction of both pupils that occurs when light is shone into either eye; the accommodation reflex refers to the swelling

2012 Wikipedia

579. Graves' ophthalmopathy Full Text available with Trip Pro

/100,000 in women, 3/100,000 in men. About 3–5% have severe disease with intense pain, and sight-threatening corneal ulceration or compression of the optic nerve. Cigarette smoking, which is associated with many autoimmune diseases, raises the incidence 7.7-fold. Mild disease will often resolve and merely requires measures to reduce discomfort and dryness, such as artificial tears and if possible. Severe cases are a medical emergency, and are treated with (steroids), and sometimes . Many anti (...) , the cornea is more prone to dryness and may present with , and . The patients also have a dysfunction of the lacrimal gland with a decrease of the quantity and composition of tears produced. with these pathologies include irritation, grittiness, , tearing, and blurred vision. Pain is not typical, but patients often complain of pressure in the orbit. Periorbital swelling due to inflammation can also be observed. Eye signs in TED Sign Description Named for Abadie's sign Elevator muscle of upper eyelid

2012 Wikipedia

580. General anaesthesia Full Text available with Trip Pro

, also known as surgical anaesthesia , the skeletal muscles relax, vomiting stops, respiratory depression occurs, and eye movements slow and then stop. The patient is unconscious and ready for surgery. This stage is divided into four planes: The eyes roll, then become fixed; Corneal and laryngeal reflexes are lost; The pupils dilate and light reflex is lost; Intercostal paralysis and shallow abdominal respiration occur. Stage 4 Stage 4, also known as overdose , occurs when too much anaesthetic (...) % of patients. In addition, tear production and tear-film stability are reduced, resulting in corneal epithelial drying and reduced protection. The protection afforded by (in which the eyeball turns upward during sleep, protecting the cornea) is also lost. Careful management is required to reduce the likelihood of . Neuromuscular blockade [ ] prepared with medications that are expected to be used during an operation under general anaesthesia maintained by gas: - , a hypnotic - , in case

2012 Wikipedia

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