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Corneal Reflex

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681. 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

682. Endophthalmitis

, particularly in contact lens wear (high-risk factors include extended wear and poor hygiene), where there is pre-existing corneal disease and, occasionally, in other conditions (eg, chronic blepharoconjunctivitis or dacrocystitis, tear film deficiency or topical steroid therapy). If this is severe, there may be progressive ulceration of the cornea which can lead to a bacterial endophthalmitis. Such patients are usually already under the care of an ophthalmic team. Differential diagnosis There are a number (...) Guidelines. You may find one of our more useful. In this article In This Article Endophthalmitis In this article Description Endophthalmitis is severe inflammation of the anterior and/or posterior chambers of the eye. Whilst it may be sterile, usually it is bacterial or fungal, with infection involving the vitreous and/or aqueous humours. Most cases are exogenous and occur after eye surgery (including cataract surgery) or penetrating ocular trauma, or as an extension of corneal infection. An increasing

2008 Mentor

683. Floaters Flashes and Halos

. - complex visual hallucinations brought about by bilateral, severe visual loss. Pseudo flashes Although not strictly speaking flashes, the following may be described as such by the patient: Photophobia - usually associated with anterior segment inflammation or retinal hypersensitivity. Glare - a dazzle usually associated with media opacities. Haloes - the ring effect associated with media clouding (eg, the corneal oedema of acute ) and occasionally, media opacities. Floaters Floaters are opacities (...) . Oedema of the corneal epithelium from any cause (eg, overwear). Corneal dystrophies in their later stages. Chronic . Early (glare of headlights making night-time driving impossible). Pigment dispersion syndrome. Vitreous opacities. Drugs (eg, digitalis and chloroquine). When to suspect a retinal detachment [ ] New onset of floaters (mobile dots, lines, or haze). New PINK floater (being almost always associated with a retinal tear and small bleed). New onset of flashes (light often seen as recurrent

2008 Mentor

684. Facial Nerve Palsy (Including Bell's Palsy)

from corneal exposure. This may be successfully achieved by using lubricating drops hourly and eye ointment at night ± an eye patch. Botulinum toxin or surgery (upper lid weighting or tarsorrhaphy) may also be required temporarily. [ ] After the cornea has been protected but recovery is thought to be unlikely, longer-term management of eyelid and facial re-animation may be arranged. Bell's palsy management Steroids : Steroids are effective in the treatment of facial nerve palsy. [ ] Of the 29 (...) (taste and salivation) on the medial side of the middle ear, whence it turns sharply (and the chorda tympani leaves), to emerge through the stylomastoid foramen to supply all the muscles of facial expression, including the platysma. Presentation Weakness of the muscles of facial expression and eye closure. The face sags and is drawn across to the opposite side on smiling. Voluntary eye closure may not be possible and can produce damage to the conjunctiva and cornea. In partial paralysis, the lower

2008 Mentor

685. Eye and Optic Nerve Tumours

layer and inner layers of the eye. The middle layer consists of the uveal tract: iris, ciliary body and choroid; the inner layer of the retina and optic nerve. The outer layer (cornea and sclera) is more prone to infections and degenerative disorders than to tumour - see separate article. Tumours of the uveal tract Melanoma Uveal melanomas have an incidence of 6 per million per year. Most are choroidal, with the remainder arising from the iris and ciliary body. The melanoma arises in the pigmented (...) . ; Optic nerve glioma and optic neuritis mimicking one another: case report. Neurosurgery. 2005 Jul57(1):E190 ; Long-term results of Gamma Knife surgery for optic nerve sheath meningioma. J Neurosurg. 2010 Dec113 Suppl:28-33. ; Total blindness from presumed optic nerve melanocytoma. Am J Ophthalmol. 2005 Jun139(6):1113-4. ; Malignant Transformation of Optic Nerve Melanocytoma into Melanoma Associated with Ocular Ischemic Syndrome and Oculocardiac Reflex: Case Report and Review of the Literature. Semin

2008 Mentor

686. 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

687. 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 (...) , treat as for corneal abrasion. Pepper spray has the potential to cause severe and permanent damage to the corneo-conjunctival tissue. It is not clear whether the damage results from the irritative and lipophilic properties of the benzyl alcohol mixture or the pyrotechnical additives nitrocellulose and sinoxide. Mustard gas exposure [ , ] Mustard gas causes chronic and delayed destructive lesions in the ocular surface and cornea, leading to progressive visual deterioration and ocular irritation

2008 Mentor

688. Glaucoma and Ocular Hypertension

between the cornea and the iris to assess whether the glaucoma is open-angle or closed-angle. A mirror is placed on the surface of the numbed eye to allow the operator to measure the angle directly. Corneal thickness - this influences the IOP reading. If it is thicker than usual, it will take greater force to indent the cornea and an erroneously high reading will be obtained. (The opposite is true for a thin cornea.) Corneal thickness is measured by pachymetry. Tonometry - this is the objective (...) , the pupillary reflex is lost and the eye has a stony appearance. The condition is very painful and is treated by destructive processes. Pathophysiology of glaucoma [ , ] The primary problem in glaucoma is disease of the optic nerve. The pathophysiology is not fully understood, but there is a progressive loss of retinal ganglion cells and their axons. In its early stages it affects peripheral visual field only but as it advances it affects central vision and results in loss of visual acuity, which can lead

2008 Mentor

689. Foreign Body in the Eye

in an upright patient). Look for signs of injury beyond the cornea. Iris and pupils Check the shape and size and whether reactive and equal. Any pupil or iris damage is a serious sign. Fundus Loss of red reflex could be due to blood in the vitreous or a large retinal detachment. If possible, examine with a slit lamp for corneal oedema, epithelial disruption, or anterior chamber penetration. Seidel's test [ ] This should be performed if penetrating injury is a possibility. Apply 10% fluorescein (this is dark (...) on research evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Corneal Foreign Bodies, Injuries and Abrasions In this article This article covers superficial injuries to the cornea: corneal foreign body (FB), arc eye (welder's eye) and corneal abrasion. For other eye injuries, see separate article. Note that immediate action is required for acid or alkali injury (chemical burn) - start copious irrigation immediately

2008 Mentor

690. Nystagmus

a small fixation target, observe the nystagmus in all positions of gaze. Ask the patient to comment on visual symptoms as the eyes move (eg, blurring, double vision). Enquire about the 'null' point: this is an angle which some patients find minimises their visual impairment - it often results in abnormal head positioning. Check oculocephalic reflex (doll's head phenomenon): This reflex is produced by moving the patient's head left to right or up and down. When the reflex is present, the eyes remain (...) stationary while the head is moved, moving in relation to the head. An alert patient normally does not have the doll's-eye reflex because it is suppressed. Inability to suppress the oculocephalic reflex suggests vestibular imbalance. The test may be performed by having the patient extend the arm out in front of the body and fixate on the outstretched thumb: Patients should be instructed to rotate their torso such that the thumb remains in front of the body at all times. Patients with the ability

2008 Mentor

691. Non-diabetic Retinal Vascular Disease

layer, outer plexiform layer, outer nuclear layer, external limiting membrane, rod and cone inner and outer segments and a single layer of cells called the retinal pigment epithelium (RPE). The only cells which are sensitive to light are the photoreceptor cells, comprising the rods and cones (for vision) and the photosensitive ganglion cells for entrainment and reflex responses to light. Neural signals from the rods and cones are processed by other nerve cells in the retina. The macula has a high (...) include a red eye, corneal oedema, a mid-dilated poorly reacting pupil and there may be rubeosis iridis. Fundoscopy shows venous dilatation, micro-aneurysms, neovascularisation and disc oedema. Management Urgent referral to ophthalmology : management involves a multidisciplinary team, including the cardiologist, neurologist and vascular and neurological surgeons. Patients will be treated with topical steroids and long-acting cycloplegic agents, with laser treatment to any new vessel growth. Any

2008 Mentor

692. Organ Donation

. You may find one of our more useful. In this article In This Article Organ Donation In this article The first human transplant was a cornea harvested from a cadaver in 1905. Blood transfusion became established in 1918 and the first successful human kidney transplant was in 1954. The first heart transplant took place in 1967. There are three different ways of donating an organ: Deceased organ donation can include kidneys, heart, liver, lungs, pancreas, small bowel, corneas and other tissues (eg (...) in favour of consent for organ donation unless a person has registered an objection in advance. The UK has had an opt-in organ donation system where a person has to register their consent to donate their organs in the event of their death. However, Wales changed to an opt-out system in December 2015. [ ] What can be donated? Kidneys, heart, liver, lungs, pancreas, small bowel, corneas, heart valves and bone can all be transplanted. Skin can be used to treat patients with severe burns. National Institute

2008 Mentor

693. Ocular Local Anaesthetics

: they are toxic to the corneal epithelium. They also abolish the corneal reflex so increasing the risk of corneal damage. Topical non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac eye drops, may have some role in pain management but their efficiency is uncertain and they should not be used as a substitute for oral analgesia (paracetamol, oral NSAIDs) [ ] . LAs work by blocking initiation and propagation of neuronal action potentials. Small-diameter, myelinated nerves are most susceptible (...) [ ] . Examples - lidocaine hydrochloride, oxybuprocaine hydrochloride, proxymetacaine hydrochloride, tetracaine hydrochloride (amethocaine hydrochloride) [ ] . Use - largely for initial assessment of minor trauma and for removal of conjunctival and corneal foreign bodies. There is some debate about their use in surgery, particularly cataract surgery, where some authors claim equal or better analgesia to injected LA [ ] . However, in the UK, injected LA is very much the norm for ocular surgery in the absence

2008 Mentor

694. Idiopathic and symptomatic trigeminal pain. Full Text available with Trip Pro

Idiopathic and symptomatic trigeminal pain. The trigeminal reflexes (corneal reflex, blink reflex, masseter inhibitory periods, jaw-jerk) and far field scalp potentials (nerve, root, brainstem, subcortical) evoked by percutaneous infraorbital stimulation were recorded in 30 patients with "idiopathic" trigeminal neuralgia (ITN) and 20 with "symptomatic" trigeminal pain (STP): seven postherpetic neuralgia, five multiple sclerosis, four tumour, two vascular malformation, one Tolosa-Hunt syndrome (...) , and one traumatic fracture. All the patients with STP and two of those with ITN had trigeminal reflex abnormalities; 80% of patients with STP and 30% of those with ITN had evoked potential abnormalities. The results indicate that 1) trigeminal reflexes and evoked potentials are both useful in the examination of patients with trigeminal pain, and in cases secondary to specific pathologies provide 100% sensitivity; 2) in "symptomatic" and "idiopathic" paroxysmal pain the primary lesion affects

1990 Journal of neurology, neurosurgery, and psychiatry

695. Circadian rhythms in the body temperatures of intensive care patients with brain lesions. Full Text available with Trip Pro

Circadian rhythms in the body temperatures of intensive care patients with brain lesions. The body core temperatures of 31 patients suffering from severe cerebral lesions were measured. Evidence for the existence or nonexistence of circadian rhythms in these patients was found to be associated with diagnosis (acute versus chronic lesions), with the level of consciousness, and with neurological findings (such as best motor response and pupillary reaction), but not with heart rate, corneal reflex

1990 Journal of neurology, neurosurgery, and psychiatry

696. The orbicularis oculi response after hemispheral damage. Full Text available with Trip Pro

The orbicularis oculi response after hemispheral damage. The corneal and blink reflexes were evaluated in 20 normal subjects and in 30 patients with motor deficits secondary to unilateral hemispheral lesions of vascular origin. In the normal population there were no differences between subjects below and subjects above 50 years of age. In the patients the reflex evoked by electrical stimulation of the cornea of the clinically affected side was depressed in 24 out of 30 cases. The depression (...) . The changes of the corneal reflex and of the R2 component of blink reflex were similar, but the blink reflex had a greater safety factor. The patients with an abnormal corneal reflex had more extensive damage than had the patients with normal corneal response, as shown by computer tomography, but the site of the lesion was comparable in the two groups. Conduction through the brain stem circuits mediating the orbicularis oculi response is normally under pyramidal facilitatory influences while facial

1983 Journal of neurology, neurosurgery, and psychiatry

697. Seizures triggered by blinking in a non-photosensitive epileptic. Full Text available with Trip Pro

Seizures triggered by blinking in a non-photosensitive epileptic. An epileptic girl with Lennox-Gastaut syndrome had seizures triggered specifically by blinking, but not by other eye movements or by photic stimulation. Electrographic and clinical seizures were most reliably precipitated by repetitive blinking produced voluntarily on command, by reflex blinking on corneal stimulation, or by psychogenic triggers of blinking such as social stress or cognitive effort.

1986 Journal of neurology, neurosurgery, and psychiatry

698. Potentiation of barbiturate-induced alterations in presynaptic noradrenergic function in rat frontal cortex by imidazol(in)e α2-adrenoceptor agonists Full Text available with Trip Pro

with a return of the corneal blink reflex. 4. Basal NA levels in conscious animals were not affected by an intravenous infusion of equally radioactive solutions of either imidazoline (clonidine) or imidazole (mivazerol) alpha2-adrenoceptor agonists. The dose rate employed for each compound was 2 microg kg(-1) h(-1) over 2 h. 5. The co-administration of intravenous clonidine or mivazerol, each at 2 microg kg(-1) h(-1) for 2 h, with sodium pentobarbitone (85 mg kg(-1), i.p.), produced a marked and prolonged

1998 British journal of pharmacology

699. In vivo pharmacology of BIIR 561 CL, a novel combined antagonist of AMPA receptors and voltage-dependent Na+ channels Full Text available with Trip Pro

. Dimethyl-[2-[2-(3-phenyl-[1,2,4]oxadiazol-5-yl)-phenoxyl]-ethyl]-amine hydrochloride (BIIR 561 CL) combines both, AMPA receptor - and Na(+) channel blocking properties in one molecule. Here, BIIR 561 CL was investigated in vivo. BIIR 561 CL protected mice against AMPA-induced toxicity with an ED(50) value of 4.5 mg kg(-1) following subcutaneous (s.c.) administration. A 0.1% solution of BIIR 561 CL provided local anaesthesia in the corneal reflex test in rabbits. In mice, the compound prevented tonic

2001 British journal of pharmacology

700. Anesthésie du lapin de Nouvelle-Zélande utilisant les combinaisons tilétamine-zolazépam et kétamine-midazolam avec ou sans xylazine. Full Text available with Trip Pro

Anesthésie du lapin de Nouvelle-Zélande utilisant les combinaisons tilétamine-zolazépam et kétamine-midazolam avec ou sans xylazine. In this study, anesthesia levels obtained with tiletamine-zolazepam (TZ) and ketamine-midazolam (KM) with or without xylazine (X) were compared in rabbits. Reflexes (corneal, palpebral and withdrawal), blood parameters (PaO2, PaCO2, pH and ions HCO3-), cardiovascular function (heart rate and mean arterial blood pressure) and body temperature were evaluated (...) before and after the injections of the anesthetic combination in the same rabbits (n = 10). With KM and TZ, no suppression of reflexes occurred. The body temperature and pH decreased and HCO3- increased similarly to KMX et TZX. Some physiological and blood parameters were less (PAM, PaCO2) and not (PaO2) affected comparatively to KMX et TZX. These protocols were of short duration of action and did not offer any anesthesia or analgesia. Therefore, their utilization should be restricted to short

2001 The Canadian Veterinary Journal

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