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Corneal Reflex

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581. Cannabinoid antagonist AM 281 reduces mortality rate and neurologic dysfunction after cecal ligation and puncture in rats. (PubMed)

-iminoethyl)-lysine (4 mg/kg), was injected intraperitoneally immediately after CLP to produce the CLP + L-N6-(1-iminoethyl)-lysine group to exclude the influence of depressed hemodynamics on neurologic impairment.It was found that administration of AM 281 could prevent the hemodynamic changes induced by sepsis. Reflex responses, including the pinna, corneal, paw or tail flexion, and righting reflexes, and the escape response significantly decreased in the CLP and CLP + L-N6-(1-iminoethyl)-lysine groups (...) at 48 hrs after the surgery. In contrast, no changes in these reflex responses were found between the CLP + AM 281 and control and sham groups. In addition, no effects of the administration of AM 281 on neurologic function and mortality rate in the control group were found. Tissue caspase-3 levels were elevated at 48 hrs after CLP in the CLP alone group (means +/- sd: control, 3.9 +/- 0.4; sham, 4.2 +/- 0.4; CLP, 7.1 +/- 1.0 [p < .01]; CLP + AM 281, 4.0 +/- 0.5 densitometric units). In addition

2005 Critical Care Medicine

582. Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest. (PubMed)

after resuscitation from CA and treated with TIMH.None of six patients without pupillary reactivity, six without corneal reflexes on day 3, or eight with myoclonus status epilepticus recovered awareness. Two of 14 patients with motor responses no better than extension at day 3 recovered motor responses only after 6 days post-arrest (one at 5 and one at 6 days post-rewarming) and regained awareness.Loss of motor responses better than extension on day 3 was not prognostically reliable after (...) therapeutic induced mild hypothermia for comatose cardiac arrest survivors. None of the patients who lost pupillary or corneal reflexes on day 3 or developed myoclonus status epilepticus recovered awareness.

2008 Neurology

583. Intra-arterial Microplasmin Administration in Patients With Acute Intracranial Vertebrobasilar Artery Occlusion

of the onset of neurological symptoms Age 18-75 (inclusive). Exclusion Criteria: Patients with coma > 6 hrs duration and complete loss of brain stem reflexes (corneal reflex, gag reflex, VOR, pupil reflexes) as measured at the last assessment before sedation/intubation Rapidly improving neurologic signs at any time before initiation of study drug administration. Known contrast agent-sensitivity Uncontrolled hypertension defined as a systolic blood pressure > 180 mm Hg or a diastolic blood pressure > 100 mm

2005 Clinical Trials

584. Alternative Dosing and Regimen of Replagal to Treat Fabry Disease

and 1 month after the last infusion. Safety evaluations are done periodically and include vital sign measurements, physical examination, blood and urine tests, review of drug side effects, electrocardiogram (ECG), Holder monitor (2 hour ECG), and QSART (NIH only). The QSART (quantitative sudomotor axon reflex test) measures the amount of sweat in a particular area of skin, mostly the forearm. For this test, a cup partly filled with a liquid is strapped on the arm. A weak electric current is turned (...) in plasma or serum or less than 8% of average mean normal in leukocytes). Subject must have one or more clinical manifestations of Fabry disease including neuropathic pain, angiokeratoma, corneal verticillata, cardiomyopathy, hypo- or anhydrosis, abdominal pain and/or diarrhea, serum creatinine greater than 1.0 mg/dl or proteinuria greater than 300 mg/24 hours. Subject must have voluntarily signed an Institutional Review Board (IRB) approved informed consent form after all relevant aspects of the study

2004 Clinical Trials

585. Efficacy and Safety Study for Ecabet Ophthalmic Solution for Treating Dry Eye Syndrome

that could interfere with study Diagnosis of Sjogren's syndrome, lacrimal obstruction, reflex, lid-related or contact lens-related dry eye syndrome(DES); significant anterior blepharitis or meibomianitis Contraindications or hypersensitivity to use of study meds or components Wear contact lenses Secondary dry eye to surgery Eye surgery (including laser) within 6 months Use of systemic or topical ophthalmic meds within 14 days Punctal plugs in one or both eyes in place for <45 days Permanent occlusion (...) -CS01 First Posted: September 20, 2005 Last Update Posted: March 14, 2013 Last Verified: March 2013 Additional relevant MeSH terms: Layout table for MeSH terms Syndrome Keratoconjunctivitis Sicca Dry Eye Syndromes Disease Pathologic Processes Keratoconjunctivitis Conjunctivitis Conjunctival Diseases Eye Diseases Keratitis Corneal Diseases Lacrimal Apparatus Diseases Pharmaceutical Solutions Ophthalmic Solutions Ecabet Anti-Infective Agents Anti-Ulcer Agents Gastrointestinal Agents Protease

2005 Clinical Trials

586. Oriental oculopalpebral dimensions: Quantitative comparison between Orientals from Japan and Brazil (Full text)

palpebral surgery, and crossbreeding. Images were obtained with a digital camera, 30 cm from the frontal plane at pupil height, with the individual in a primary position and the eye trained on the camera lens. Images were transferred to computer and processed by the Scion Image program. Measurements were made of distance between medial canthi, distance between pupils (IPD), superior eyelid crease position, distance between the superior lid margin and corneal reflexes (MRD), horizontal width, height

2008 Clinical ophthalmology (Auckland, N.Z.)

587. Frontalis sling operation using silicone rod for the correction of ptosis in chronic progressive external ophthalmoplegia. (Full text)

retrospectively reviewed and the clinical characteristics and postoperative surgical results of these patients were analysed. This study was a retrospective, non-randomised, interventional case series and the main outcome measures were margin reflex distance, eyelid contour and corneal status.Seven patients were recruited (one male and six female). The mean age at the time of operation was 29.6 (range 15-62) years. Two patients had unilateral ptosis and five patients had bilateral ptosis. The mean follow-up (...) period was 22.7 (range 1-61) months. Satisfactory lid height was achieved in all patients. Although corneal erosions were detected in five patients 1 month after surgery, these findings eventually resolved in three patients 2 months later, after the use of artificial tear eyedrops and ointments.The frontalis sling operation using silicone rod can safely and effectively correct ptosis in chronic progressive external ophthalmoplegia patients without serious corneal complications.

2008 British Journal of Ophthalmology

588. Abnormal foveal avascular zone in nanophthalmos. (PubMed)

Abnormal foveal avascular zone in nanophthalmos. To evaluate the foveas of nanophthalmic patients.Retrospective observational case series.Four nanophthalmic patients examined between April 2005 and April 2006 were included. Visual acuity (VA), refractive correction, axial length, corneal diameter, presence or lack of foveal light reflex, as well as fluorescein angiograms (FAs), and optical coherence tomography (OCT) scans of the maculae were evaluated.None of the eight eyes had a foveal light (...) reflex, corresponding to lack of a normal foveal pit on OCT. Fluorescein angiography showed no normal foveal avascular zones; all were either completely absent or small and rudimentary.Nanophthalmic patients rarely have best-corrected visual acuity (BCVA) better than 20/40 at any point in their lives, even with an absence of known complications, such as uveal effusion or glaucoma. In many patients, this visual deficiency may correspond to an absent or rudimentary foveal avascular zone and lack

2007 American Journal of Ophthalmology

589. A useful augmented lateral tarsal strip tarsorrhaphy for paralytic ectropion. (PubMed)

to evaluate the technique.Prospective noncomparative surgical trial in which preoperative and postoperative symptoms, margin reflex distances, vertical palpebral aperture (PA), lagophthalmos, and corneal findings were recorded. The data were analyzed at 6 months after surgery using the Wilcoxon sign-rank test for nonparametric data.Fourteen consecutive adult patients (15 eyelids) with chronic lagophthalmos and paralytic ectropion.Patients underwent aug-LTS-T. This consisted of a long strip (10-15 mm (...) ) that is attached to the outer temporal orbital rim, at a point higher than a conventional LTS. It included removal of a small part of the upper eyelid anterior lamella laterally to pass the long strip up high enough.Improvement of symptoms, reduction of lower margin reflex distance, lagophthalmos, and improvement of corneal signs.Minimum follow-up was 6 months. There was a significant reduction in PA (P = 0.005) and lagophthalmos (P = 0.0002) with improvement of corneal signs (14 of 15 eyelids = 93%). Surgery

2006 Ophthalmology

590. Superior tarsectomy augments super-maximum levator resection in correction of severe blepharoptosis with poor levator function. (PubMed)

institution.Chart review of patients who underwent super maximum levator resection with or without superior tarsectomy. Data regarding eyelid position, surgical outcome, and postoperative complications were evaluated.Margin reflex distance-1 (distance [mm] between corneal light reflex and upper eyelid margin), bilateral eyelid symmetry, and postoperative complications.A statistically significant improvement in ptosis correction was demonstrated when integrating the superior tarsectomy with the super maximum (...) levator resection (P = 0.029). In addition, the superior tarsectomy significantly decreased the incidence of undercorrection (margin reflex distance-1 values less than 2.0 mm) compared with the super-maximum levator resection alone (12.5% vs. 70%; P = 0.023). Improved postoperative eyelid symmetry within 1.0 and 1.5 mm was demonstrated in cases treated by the superior tarsectomy. Postoperative complications were similar in both treatments.The super maximum levator resection combined with superior

2006 Ophthalmology

591. Positive angle kappa: a sign of albinism in patients with congenital nystagmus. (PubMed)

Positive angle kappa: a sign of albinism in patients with congenital nystagmus. To determine whether the association of positive angle kappa and congenital nystagmus is a distinguishing feature of albinism.Observational case series.Prospective examination of the location of the corneal light reflex in patients with albinism and idiopathic congenital nystagmus.A positive angle kappa in at least one eye was noted in 20/21 (95%) patients with albinism versus 4/12 (33%) patients with congenital

2004 American Journal of Ophthalmology

592. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. (Full text)

authors identified four class I studies, three class II studies, and five class III studies on clinical findings and circumstances. The indicators of poor outcome after CPR are absent pupillary light response or corneal reflexes, and extensor or no motor response to pain after 3 days of observation (level A), and myoclonus status epilepticus (level B). Prognosis cannot be based on circumstances of CPR (level B) or elevated body temperature (level C). The authors identified one class I, one class II (...) (level B). Ten class IV studies on brain monitoring and neuroimaging did not provide data to support or refute usefulness in prognostication (level U).Pupillary light response, corneal reflexes, motor responses to pain, myoclonus status epilepticus, serum neuron-specific enolase, and somatosensory evoked potential studies can reliably assist in accurately predicting poor outcome in comatose patients after cardiopulmonary resuscitation for cardiac arrest.

2006 Neurology

593. Macular Disorders

. Abnormalities of any of the answers suggest macular pathology. Patients can use the grid at home and test themselves (remind them to do one eye at a time) [ ] . Examination of the macula Ophthalmoscopy - the macula is visible as a dark circular patch between the vascular arches, the fovea being about 1 disc diameter lateral to the disc itself. The foveola is usually seen as a bright pinpoint yellow reflex at the centre of the macula. If you ask the patient to look directly at the light, the macula (...) . The optimal management for these conditions is discontinuation of the medication where possible and observation in the ophthalmology outpatient clinic. Many resolve in time. Chloroquine and hydroxychloroquine - these both have the potential for retinotoxicity and may also result in corneal deposits. The retinopathy is related to the total cumulative dose and is more marked with chloroquine. Patients present with decreased vision (which may be severe in end-stage chloroquine maculopathy - less than 6/60

2008 Mentor

594. Lowe's (Oculo-cerebro-renal) Syndrome

and because of the propensity to develop . Glaucoma develops in about half and is difficult to treat. Surgical implantation of artificial valves to control the release of intraocular fluid is often required. Corneal keloids may require surgical removal of the scar tissue, or radiation therapy. Corneal transplantation is difficult because of problems in administering the required intensive postoperative care. Sometimes surgical correction of is required. Other surgery Orchidopexy may be required. Medical (...) predisposes to dehydration and metabolic imbalance, which can be severe. They have a tendency to develop due to hypotonia and poor cough reflex. Other causes of death include infection and , and sudden unexplained death can occur. Death usually occurs in the second or third decade of life. Genetic counselling If the proband represents a new mutation, the risk to subsequent children is low. If the mother is a carrier, there is a 50% chance of any son being affected and any daughter being a carrier. Did you

2008 Mentor

595. Eye in Systemic Disease

deposits in the retinal vessels remain when blood pressure is reduced; however, retinopathy resolves when blood pressure is treated. Changes develop within 48 hours of blood pressure rising and resolve in 2-10 weeks of it being lowered. Complications of hypertensive retinopathy include optic neuropathy and central vein or artery occlusions. Hyperthyroidism may cause proptosis, which may be the first sign of the condition. This may be unilateral or bilateral. may include corneal ulceration and visual (...) loss. Hyperlipidaemia Corneal arcus may be present at birth, but usually appears in patients aged over 50; it results from cholesterol deposits and can be associated with Acromegaly Optic atrophy is common. There may be nystagmus. Cushing's syndrome Iatrogenic Cushing's syndrome may be associated with steroid-induced cataracts (this is not the case for Cushing's disease) and susceptible individuals may also develop glaucoma. Occasionally, a secreting pituitary tumour can cause bitemporal hemianopia

2008 Mentor

596. Eye Trauma

with 'panda eyes' from a base of skull fracture.) Conjunctiva : look for haemorrhage and lacerations (small lacerations can be subtle - they may show up on staining with fluorescein) - these can indicate an open globe injury. Cornea : lacerations may be small and missed: Perform a Seidel's test first (to assess for leakage from the cornea - see 'Techniques', below) and then assess for corneal abrasion with dilute fluorescein. Anterior chamber : look for hyphaema (the patient needs to be upright to see (...) level). Iris and pupils : check shape, size, reactive and equal. Pupil or iris damage is a serious sign. Fundus : loss of red reflex could be due to opacification from blood in the vitreous or a large retinal detachment. IOP : should also be assessed - if possible - unless you suspect an open globe injury. Perform a functional examination: Movement of the eyes (ask about diplopia before and during examination). Pupil reactions test visual fields . Test for relative afferent pupillary defect

2008 Mentor

597. Examination of the Cranial Nerves

. The pterygoids may jut the jaw forwards. Many neurologists omit the corneal reflex unless a sensory deficit is found, especially in the ophthalmic division, or if there is a lesion of another cranial nerve. Take a clean piece of cotton wool and ask the patient to look away from the side being tested. Gently touch the cornea with the cotton wool and the patient will blink. This requires the sensation of V but also the motor of VII. There may be a positive jaw jerk reflex in spasticity. This is difficult (...) pathway) and the oculomotor nerve (efferent pathway), as the response is dependent upon appreciation of light and the motor response of the muscles of the iris. There is also a consensual response in that the contralateral pupil will also respond but less markedly. Then use the ophthalmoscope to examine the eye. First hold it away from the patient and look through it at the eye. There should be an orange reflex from light reflected from the retina. This means that the lens is clear

2008 Mentor

598. Examination of the Eye

is held about an arm's length away from the patient. Look through the ophthalmoscope and turn the dial until you see the red reflex. This can be attenuated by any opacity between the cornea and the fundus: a corneal opacity is visible externally and a vitreous opacity may be mobile. The red reflex is part of the routine neonatal check. Use a direct ophthalmoscope in a dimly lit room and hold your ophthalmoscope about 2/3 of an arm's length away from the baby. If the baby is screwing their eyes shut (...) passing through the shaft of light) and for flare (slight cloudiness), suggestive of anterior . Pupils Look at their relative size - if you suspect anisocoria (different-sized pupils), stand back from the patient, darken the room and look through the ophthalmoscope. You can elicit the red reflex in both eyes and compare the size of these directly rather than shifting from one to the other close up. Look for change in shape (typically oval in acute angle-closure glaucoma, asymmetry in a penetrating

2008 Mentor

599. Epiphora (Watering Eyes)

- eg, . Tear film deficiency (inappropriate reflex reaction). . . Corneal disease. Inflammatory disease - eg, , . It may occasionally be a presentation in . Punctal malposition (lid laxity - eg, ectropion). Stenosis or obstruction at any point along the nasolacrimal duct: Congenital nasolacrimal duct obstruction - the most common cause of epiphora in childhood Lacrimal sac mass or mucocele Dacryocystitis Lacrimal pump failure - eg, . Nasal obstruction - eg, mass, inflammation or scarring. Previous (...) , or one of our other . In this article In This Article Epiphora In this article The tear film is a complex and important entity that provides corneal lubrication, nourishment and immunological protection among other functions. The air/tear interface is also the most important site of light ray refraction. Tears drain into the upper and lower puncta medially, into their respective canaliculi and then into the common canaliculus. From there, they enter the lacrimal sac (adjacent to the bridge

2008 Mentor

600. Foreign Body in the Eye

trauma from a scratch, grit or contact lens. Corneal abrasions may also arise if the eyelids do not close properly - eg, where there is neuropathy, proptosis, or ectropion or in unconscious patients. Superficial keratitis may occur in response to UV injury (photokeratitis), or to chemical injury (eg, from tear gas). Corneal FBs usually cause marked irritation, redness and watering, often with pain and a repeated blink reflex. Patients are usually very good at localising the FB [ ] . Some corneal FBs (...) and light perception (if the eye cannot be opened, check light perception through closed lids). Acuities of 6/6 do not necessarily exclude serious problems. Ask about diplopia; check visual fields. Check pupillary reflexes. Test for relative afferent pupillary defect if possible. General inspection Look for signs of infection - purulent discharge, an opaque base of a corneal surface defect, cells or pus in the anterior chamber. Intraocular pressure (IOP) should be assessed if possible, unless open globe

2008 Mentor

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