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61. Proceedings: Depletion of acetylcholine in the corneal epithelium. (PubMed)

Proceedings: Depletion of acetylcholine in the corneal epithelium. 4787540 1974 06 12 2018 11 13 0007-1188 49 1 1973 Sep British journal of pharmacology Br. J. Pharmacol. Proceedings: Depletion of acetylcholine in the corneal epithelium. 167P Stevenson R W RW Wilson W S WS eng Journal Article England Br J Pharmacol 7502536 0007-1188 0 Cholinesterase Inhibitors 0 Naphthalenes 0 Pyridines 0 Vinyl Compounds N9YNS0M02X Acetylcholine IM Acetylcholine analysis Animals Cholinesterase Inhibitors (...) pharmacology Cornea analysis physiology Depression, Chemical Epithelium analysis Naphthalenes pharmacology Pyridines pharmacology Rabbits Reflex drug effects Vinyl Compounds pharmacology 1973 9 1 1973 9 1 0 1 1973 9 1 0 0 ppublish 4787540 PMC1776399 Biochim Biophys Acta. 1970 May 13;206(2):242-51 5421956 Biochem Pharmacol. 1971 Oct;20(10):2741-8 5114509

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1973 British journal of pharmacology

62. A new mucolipidosis with psychomotor retardation, corneal clouding, and retinal degeneration. (PubMed)

A new mucolipidosis with psychomotor retardation, corneal clouding, and retinal degeneration. A man now 22 years of age had slow psychomotor development about 6 months after birth and developed intermittent corneal clouding at about 18 months. He developed truncal ataxia, hypotonia of the limbs combined with spasticity, and active deep reflexes. These have not progressed. His skeleton and facies are normal. Between his first and thriteenth year he developed sev ere optic atrophy, absence

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1975 Transactions of the American Ophthalmological Society

63. Interaction of corneal nociceptive stimulation and lacrimal secretion. (PubMed)

evoked measurable tear secretion, with central corneal mechanical stimulation evoking the strongest lacrimation reflex. Central mechanical corneal stimulation is the most effective stimulus-position pairing and appears to be the major sensory driving force for reflex tear secretion by the lacrimal functional unit. (...) Interaction of corneal nociceptive stimulation and lacrimal secretion. To investigate the interaction between corneal stimuli at different positions and tear secretion and to establish relationships between nociceptive stimuli detection thresholds and stimulated tearing.Using a computerized Belmonte-esthesiometer, mechanical and chemical stimuli, from 0% to 200% of the threshold in 50% steps, were delivered (in random order) to the central and peripheral (approximately 2-mm inside the limbus

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2010 Investigative Ophthalmology & Visual Science

64. Cold-Sensitive Corneal Afferents Respond to a Variety of Ocular Stimuli Central to Tear Production: Implications for Dry Eye Disease. (PubMed)

that innocuous "cold" cornea thermoreceptors are activated by drying of the ocular surface and hyperosmotic solutions, conditions that are consistent with a role in tear production. The authors hypothesize that the dysfunction of these corneal afferents and the lacrimation reflex pathway they activate lead to some forms of dry eye disease. (...) Cold-Sensitive Corneal Afferents Respond to a Variety of Ocular Stimuli Central to Tear Production: Implications for Dry Eye Disease. To investigate the response characteristics of the corneal afferents that detect ocular conditions critical to the activation of the "afferent limb" of the lacrimation reflex.In isoflurane-anesthetized male rats, trigeminal ganglia were explored extracellularly in vivo to identify the corneal neurons that can be activated by ocular stimuli important

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2010 Investigative Ophthalmology & Visual Science

65. Assessment of cranial nerve mononeuropathy

cortex. Efferent motor fibres originate in the motor nucleus of the trigeminal nerve in the mid-pons and travel with V3 through the foramen ovale to supply the muscles of mastication (masseter, temporalis, mylohyoid, medial and lateral pterygoid, and anterior belly of the digastric), as well as the tensor tympani and tensor veli palatini. The trigeminal nerve and its branches also mediate the afferent limbs of the corneal blink and lacrimal reflexes, and both afferent and efferent limbs of the jaw (...) . The strength of the pterygoid muscles may be tested by asking the patient to open the jaw against resistance. The corneal reflex can be tested with cotton wool (afferent-trigeminal, efferent-facial) and elicits an ipsilateral and contralateral blink response in normal individuals. Facial (VII) Anatomy The facial nerve is composed of both motor and sensory roots (nervus intermedius) and has a long intracranial course with 3 bends and multiple branches. The motor root has neuronal cell bodies in the facial

2018 BMJ Best Practice

66. Amblyopia

://www.ncbi.nlm.nih.gov/pubmed/5498493?tool=bestpractice.com History and exam presence of risk factors infant not tracking parent's face abnormal red reflex asymptomatic subnormal visual acuity for age in 1 or both eyes asymmetric corneal light reflex unequal behavioural response to alternate eye occlusion abnormal cover/uncover testing blurred vision eye strain congenital nystagmus abnormal pupil exam abnormal external eye exam age <9 years prematurity FHx of amblyopia or strabismus strabismus (misalignment (...) Amblyopia Amblyopia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Amblyopia Last reviewed: February 2019 Last updated: February 2018 Summary A visual impairment resulting from abnormal visual stimulation during early childhood, the prevalence of which ranges from 1% to 4%. Can result from strabismus, form deprivation (e.g., due to congenital cataracts or corneal opacities), and various types of refractive error

2018 BMJ Best Practice

67. Diabetic neuropathy

B12 electrolytes, urea, creatinine serum lipid profile LFTs FBC and erythrocyte sedimentation rate serum/urine immunoelectrophoresis corneal confocal microscopy oral glucose tolerance test nerve conduction studies (nerve conduction velocity, NCV) electromyography (EMG) quantitative sensory testing (QST) skin biopsy cardiovascular reflex testing heart rate variability (HRV) gastric emptying studies gastroduodenoscopy surface electrogastrography barium meal GI manometry hydrogen breath tests gastric (...) , people with DN are asymptomatic. History and exam presence of risk factors asymptomatic pain (peripheral) loss of sensation (peripheral) dysaesthesia (peripheral) reduced or absent ankle reflexes (peripheral) painless injuries (peripheral) resting tachycardia (autonomic) impaired heart rate variability (autonomic) urinary frequency, urgency, nocturia, incontinence, hesitancy, weak stream, or retention (autonomic) erectile dysfunction (autonomic) decreased sexual desire and increased pain during

2018 BMJ Best Practice

68. Tropical sprue

]. History and exam prolonged exposure to an endemic area constitutional symptoms diarrhoea bloating foul-smelling, greasy stools swollen/sore tongue and lips glossitis numbness of fingers and toes abdominal cramping fever leg swelling hair loss cheilitis/angular stomatitis pedal oedema hyperactive bowel sounds/borborygmi hyperpigmentation/eczematous rash pallor dry eyes corneal xerosis night blindness decreased deep tendon reflexes/decreased vibratory sensation prolonged exposure to an endemic area HLA

2018 BMJ Best Practice

69. Comparison of myopic LASIK centered on the coaxially sighted corneal light reflex or line of sight. (PubMed)

Comparison of myopic LASIK centered on the coaxially sighted corneal light reflex or line of sight. To compare refractive outcomes of myopic LASIK with centration on the coaxially sighted corneal light reflex (CSCLR) to centration on the center of the pupil (line of sight [LOS]).The NIDEK CXIII excimer laser was used to treat 268 eyes with centration on the CSCLR (CSCLR group) and 288 eyes with centration on the LOS (LOS group). For the CSCLR group, the laser ablation was delivered 80% closer

2009 Journal of Refractive Surgery

70. European Academy of Neurology guideline on trigeminal neuralgia

accuracy of trigeminal reflex testing and evoked potentials for distinguishing secondary TN from primary TN were sought. Also papers addressing the role of laboratory tests in detecting trigeminal afferent damage in other neuropathic facial pain conditions were sought. Eight studies reported the trigeminal reflex findings in patients with TN , - (Table ). The diagnostic accuracy of trigeminal reflexes for identifying secondary TN patients was relatively high with sensitivity 59%–100% and specificity 93 (...) %–100%; pooled sensitivity 94%; pooled specificity 88%. Six studies reported the evoked potential findings in patients with TN , , - (Table ). In contrast to the trigeminal reflexes, evoked potentials may be altered even in idiopathic or classical TN. A pooled sensitivity of 84% and a pooled specificity of 52% were found. Table 2. Diagnostic accuracy of trigeminal reflex testing for distinguishing secondary TN (STN) from primary TN (PTN) First author Year STN A/T PTN A/T P assoc Spe (CI) Sen (CI

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2019 European Academy of Neurology

71. Tests for detecting strabismus in children aged 1 to 6 years in the community. (PubMed)

Tests for detecting strabismus in children aged 1 to 6 years in the community. Strabismus (misalignment of the eyes) is a risk factor for impaired visual development both of visual acuity and of stereopsis. Detection of strabismus in the community by non-expert examiners may be performed using a number of different index tests that include direct measures of misalignment (corneal or fundus reflex tests), or indirect measures such as stereopsis and visual acuity. The reference test to detect

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2017 Cochrane

72. Cavernous sinus thrombosis

, ears, teeth, or mouth), affecting the cavernous sinus and its structures. Aseptic CST is usually a thrombotic process that is a result of trauma, iatrogenic injuries, or prothrombotic conditions. History and exam presence of risk factors rapid onset of signs and symptoms (acute septic CST) headache fever peri-orbital oedema chemosis and proptosis lateral gaze palsy ophthalmoplegia profound sepsis (acute septic CST) ptosis and mydriasis papilloedema and/or retinal-vein dilatation decreased corneal (...) reflex hypo- or hyper-aesthesia in the distribution of the ophthalmic and maxillary nerves mental state changes (e.g., confusion, drowsiness, coma) clinically detectable primary infection site meningismus (nuchal rigidity, photophobia, and headache) positive Kernig's or Brudzinski's signs seizures loss of visual acuity recent hx of acute sinusitis hx of facial infections hx of peri-orbital infection hx of otitis media, mastoiditis, or petrositis hx of dental or oral infection hx of sepsis

2017 BMJ Best Practice

73. Astigmatism

is incapable of generating a clear image. Benjamin WJ. Borish's clinical refraction, 1st ed. Philadelphia, PA: W.B. Saunders; 1998. History and exam presence of risk factors blurred vision asthenopia (eye strain) distorted retinal reflex Munson's sign positive family history presence of myopia East Asian, Hispanic, Native American, or indigenous Brazilian ethnicity eye trauma or surgery genetic syndromes eyelid pathology Diagnostic investigations retinoscopy keratometry corneal topography wavefront

2017 BMJ Best Practice

74. CRACKCast E165 – Sedative Hypnotics

with birth defects (category D). [4] What are the clinical symptoms of barbiturate overdose? Mild toxicity Drowsiness slurred speech Ataxia unsteady gait Nystagmus emotional lability impaired cognition Severe Toxicity CNS depression = stupor to deep coma and respiratory arrest Pupils are usually normal or small and reactive hypoxia can cause pupils to be fixed and dilated Corneal and gag reflexes may be diminished or absent muscle tone = flaccid DTRs = diminished or absent Flexor (decorticate

2018 CandiEM

76. DRY EYE (Tear deficiency (KCS)

Versus Host Disease (GVHD) Stevens-Johnson syndrome (SJS) cicatricial pemphigoid trachoma chemical injury hyposecretory states reflex afferent block topical anaesthesia trigeminal nerve injury refractive surgery neurotrophic keratitis secretomotor block parasympathetic damage pharmacological inhibition (wide range of systemic drugs, including antidepressants, anticholinergics, antipsychotics, antihistamines, chemotherapeutic agents, antihypertensives, anti-arrhythmics, antithyroid agents and opioid (...) grading systems are available (e.g.Oxford staining score) lid wiper epitheliopathy increased mucus strands and other tear film débris filaments (adherent comma-shaped mucus strands) mucus plaques Dellen thinning and (very rarely) perforation reduced corneal sensitivity Differential diagnosis Anterior blepharitis Allergic and infective conjunctivitis Eyelid abnormality or dysfunction leading to exposure (exposure keratopathy) Nocturnal lagophthalmos (failure to close eyes at night) Management

2018 College of Optometrists

77. Entropion

of the tarsal plate Predisposing factors Age-related degenerative changes in the lid Severe cicatrising disease affecting the tarsal conjunctiva Ocular irritation or previous surgery Symptoms Foreign body sensation, irritation Red, watery eye Blurring of vision Signs Corneal and/or conjunctival epithelial disturbance from abrasion by the lashes (wide range of severity) Localised conjunctival hyperaemia Lid laxity (involutional entropion) Conjunctival scarring (cicatricial entropion) Absence of lower lid (...) -term medication may develop sensitivity reactions which may be to active ingredients or to preservative systems (see Clinical Management Guideline on ). They should be switched to unpreserved preparations (GRADE*: Level of evidence=low, Strength of recommendation=strong) Management category B1: Initial management (including drugs) followed by routine referral Congenital entropion does not resolve spontaneously and the potential for severe corneal complications requires referral for prompt treatment

2018 College of Optometrists

78. Endophthalmitis (post operative)

, dressings, gloves (in corneal transplants) donor cornea Patient factors: diabetes, immunosuppression, HIV infection Symptoms Acute presentation: visual loss pain redness photophobia Chronic presentation: similar, usually milder, delayed Signs Acute presentation: lid oedema conjunctival chemosis and hyperaemia corneal haze cells and flare in AC; fibrinous exudate and/or hypopyon if severe pupil light reflex may be sluggish or absent IOP can be normal, low or raised vitritis (inflammation of the vitreous (...) is a rare but severe sight-threatening complication of ocular surgery e.g. cataract, corneal, glaucoma, retinal, and of intravitreal injections, e.g. anti-VEGF treatment Occurs most commonly as a complication of cataract surgery. Pooled estimates of incidence range from 1.09-2.65 per 1,000 cataract operations. A systematic review has demonstrated the value of intracameral cefuroxime with or without topical levofloxacin in reducing the incidence of post-operative endophthalmitis Bleb-associated

2018 College of Optometrists

79. CRACKCast E120 – Dermatologic presentations

or Stevens-Johnson syndrome. Plasmapheresis is considered in consultation with a specialist. [15] List 6 broad categorical causes of urticaria This is a review from Episode 119! Urticaria appears as papules or wheals that consist of central swelling with surrounding reflex erythema, and it is associated with itching or a burning type sensation → lasting less than 24 hours. This can occur in isolation (mast cell degranulation) or due to systemic disease (histamine, bradykinin, etc). Drug induced (often (...) , Hodgkin’s disease, lymphomas]. Complications include CNS involvement, abdominal organ involvement, ocular infection, and neuralgia. Meningoencephalitis, myelitis, and peripheral neuropathy have been reported. ” – Rosen’s 9 th edition Ophthalmicus Oticus Ocular complications occur in 20% to 70% of cases involving the ophthalmic division of the trigeminal nerve. The severity varies from mild conjunctivitis to panophthalmitis, which threatens the eye. Corneal dendritic lesions may be visible on fluorescein

2017 CandiEM

80. CRACKCast E022 – Red and Painful Eye

or WBCs) and flare (diffuse haziness) Hyphema or hypopion Foreign bodies Iris Red light reflex Tears in the iris – iridotomy Lens Position, Clarity Cataracts Artificial vs. native lens Fundoscopy – explained To help in you in cases of: Visual loss and/or vision changes Can find lens dislocation Non-dilated exam is commonly performed in the ED Because of the risk of causing AACG (acute angle closure glaucoma) Inability to obtain the red light reflex (pearl) Corneal opacification Hyphema or hypopion (...) Miotic pupil Lens cataracts Blood in the vitreous Retinal detachment Bedside testing: Fluorescein testing – uptake occurs only in damaged corneal tissue. Under slit-lamp Cobalt blue light: Have the patient blink, if there is uncertainty regarding the uptake of fluorescein on the cornea Local anesthetic testing: If the anesthetic abolishes the patient’s eye pain – the pain is of corneal origin If the pain is mildly relieved – probable conjunctival origin Seidel’s sign: Use with the suspicion of ocular

2017 CandiEM

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