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Corneal Reflex

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81. 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 (...) in the dioptric power of the eye from one meridian to another. Instead of having a spherical cross-section, the cornea and/or lens is cylindrical, with different focal power depending on the plane in which the light travels (the meridian). The meridians that have the greatest and the least dioptric power are known as the principal meridians. Astigmatism is termed regular when the principal meridians are at 90° to each other; otherwise, it is termed irregular. When astigmatism is present, the optical system

2017 BMJ Best Practice

82. 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

84. Cenegermin (Oxervate) - neurotrophic keratitis

that occurs as a result of partial or total impairment of trigeminal innervation, leading to a reduction (hypoesthesia) in or loss (anaesthesia) of corneal sensation (Bonini et al., 2003; Sacchetti et al, 2014; Semeraro et al, 2014). Impairment of corneal trigeminal innervation causes a reduction in the lacrimation reflex, as well as morphological and metabolic corneal epithelial disturbances, with subsequent development of recurrent or persistent epithelial defects. 2.1.2. Epidemiology As the underlying (...) % relative standard deviation SAP Statistical Analysis Plan SC subcutaneous SD Standard Deviation SDS-PAGE Sodium dodecyl sulfate polyacrylamide gel electrophoresis SE-HPLC Size exclusion HPLC Ser Serine SH-SY5Y Human neuroblastoma cell line SIRC Statens Seruminstitut Rabbit Cornea SLPM Standard litre per minute S/N ratio Signal to noise ratio ssDNA single stranded DNA SOC System Organ Class TAMC Total aerobic microbial count TF-1 Human bone marrow erythroblast suspension cell line TFA Trifluoracetic

2017 European Medicines Agency - EPARs

85. 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

86. Voretigene Neparvovec for Biallelic RPE65-Mediated Retinal Disease: Effectiveness and Value

to investigational agent) MLMT Multi-Luminance Mobility Testing OCT Optical Coherence Tomography PDUFA Prescription Drug User Fee Act PLR Pupillary Light Reflex PP Per Protocol RP Retinitis Pigmentosa RPE Retinal Pigment Epithelium SAE Serious Adverse Event SECORD Severe Early Childhood Onset Retinal Dystrophy TEAE Treatment Emergent Adverse Event VA Visual Acuity VF Visual Field VN Voretigene Neparvovec vg Vector Genomes, units in VN product ©Institute for Clinical and Economic Review, 2018 Page ES1 Evidence (...) , fluorescein angiography, optical coherence tomography, indocyanine green angiography, laser photocoagulation, intravitreal drug injections, photodynamic therapy VA 0 to 10dB): 8(80) Visual acuity No change: 8(80) Improved: 1(10) Worsened: 1(10) Mobility-at lower light levels No change: 2(20) 1 level: 1(10) 2 levels: 3(30) 3 levels: 3(30) 5 levels: 1 (10) No AEs related to AAV vector Dellen formation (uneven surface of cornea) - 3 patients Cataracts – 2 pts SAEs: Post-op bacterial endophthalmitis

2018 California Technology Assessment Forum

88. Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. (Abstract)

/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent (...) to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving

2020 JAMA

89. TearLab osmolarity system for diagnosing dry eye disease

, whereas grade 4 refers to severe and constant DED with potentially disabling symptoms. Severe symptoms can impair vision, limiting vision-related daily activities such as reading and driving. The complications of DED include conjunctivitis, keratitis (infection of the cornea) and corneal scarring. The condition is estimated to affect 15–33% of people aged over 65 years, and is about 50% more common in women than men (NICE clinical knowledge summary on dry eye syndrome; Lemp et al. 2012). DED is also (...) mucin layer (Bron et al. 2004). The tear film is essential for maintaining the transparency and health of the cornea and conjunctiva, providing a smooth, moist surface for light to pass through. It also supplies nutrients and flushes away waste products, protects against shear forces produced by blinking and eye movements, and helps to protect the eye against environmental challenges. Dry eye disease (DED; also known as dry eye syndrome or keratoconjunctivitis sicca) was described in the Report

2015 National Institute for Health and Clinical Excellence - Advice

90. Vision in Children Ages 6 Months to 5 Years: Screening

, strabismus, or refractive errors include family history in a first-degree relative, prematurity, low birth weight, maternal substance abuse, maternal smoking during pregnancy, and low levels of parental education. Screening Tests Various screening tests are used in primary care to identify vision abnormalities in children, including: the red reflex test, the cover-uncover test, the corneal light reflex test, visual acuity tests (such as Snellen, Lea Symbols, and HOTV charts), autorefractors (...) opacity), and the corneal light reflex test (for strabismus). , Instrument-based vision screening (ie, with autorefractors and photoscreeners) may be used in very young children, including infants. Autorefractors are computerized instruments that detect refractive errors; photoscreeners detect amblyopia risk factors (ocular alignment and media opacity) and refractive errors. , Vision screening in children older than 3 years may include the red reflex test, the cover-uncover test (for strabismus

2017 U.S. Preventive Services Task Force

93. CRACKCast E071 – Ophthalmology Part B

for perforation Grinding, drilling, saws, hammering –> consider CT orbits Treatment full eye exam Topical anesthetic Remove: Irrigation, moistened cotton tip applicator 18 ga BLUNT needle Rust ring: Needs 24 hrs to prime and move to the surface of the cornea Referral Deeply embedded, in the visual axis Conjunctival Foreign Body Same approach as corneal but less risk of affecting vision Use topical phenylephrine to help reduce the bleeding on removal Subconjunctival Hemorrhage Common occurrence with valsalva (...) with hemostat Incise the lateral canthus Pull lower lid down and localize the inferior canthal tendon – then cut it with iris scissors Reassess, and repeat for the superior canthal tendon if needed Table copied from: See: And For videos explaining it! 10) List 3 complications of ocular trauma Post-traumatic corneal ulcers: Can develop post-trauma due to bacterial or fungal infection Signs: white/gray cornea Hypopyon Treatment: Ophtho referral Cycloplegic Topical antibiotics Endophthalmitis Infection

2017 CandiEM

94. CRACKCast E071 – Ophthalmology Part A

need topical anesthetics Irrigate until pH is NORMAL Remove particulate matter from the fornices After irrigation Cycloplegic 5% erythromycin ointment QID Pain management Check IOP Severity of injury judged by corneal cloudiness Long term: scarring, symblepharon, glaucoma, cataracts Irritants, solvents, detergent, super glue, mace exposures are treated just like chemical burns Superglue: only need referral if eyelids are inverted and lashes scratching the eyeball 2) What is the treatment of UV (...) SYSTEMIC extension of the infections require IV abx 4) Describe typical features of conjunctivitis and management options Conjunctivitis #1 cause of a red eye Symptoms: Redness, FB sensation, lid swelling, eye crusting, drainage NO photophobia, NO visual loss Caseus: Viral, bacterial, mechanical, allergic, toxic Called KERATOconjunctivitis when the cornea is involved as well Most commonly viral Bacterial causes: Pneumoniae, H. influenzae, Staph, Moraxella, Neisseria gonorrhoeae, Klebsiella, Pseudomonas

2017 CandiEM

95. 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

96. CRACKCast E120 – Dermatologic presentations

feature of non–staphylococcal-induced toxic epidermal necrolysis, or Lyell’s disease, is the separation of large sheets of epidermis from underlying dermis. The cornea may become involved and can lead to permanent blindness. Risk factors for poor prognosis include age older than 40 years old, underlying malignancy, heart rate more than 120, initial per- centage of epidermal detachment more than 10%, BUN level more than 10 mmol/L, serum glucose level more than 14 mmol/L (or 252 mg/dL), and bicarbonate (...) 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

2017 CandiEM

97. Final recommendation statement: vision in children ages 6 months to 5 years: screening.

in primary care settings. Visual acuity tests screen for visual deficits associated with amblyopia and refractive error. Ocular alignment tests screen for strabismus. Steroacuity tests assess depth perception. For children younger than 3 years, screening may include the fixation and follow test (for visual acuity), the red reflex test (for media opacity), and the corneal light reflex test (for strabismus). Instrument-based vision screening (i.e., with autorefractors and photoscreeners) may be used (...) in very young children, including infants. Autorefractors are computerized instruments that detect refractive errors; photoscreeners detect amblyopia risk factors (ocular alignment and media opacity) and refractive errors. Vision screening in children older than 3 years may include the red reflex test, the cover-uncover test (for strabismus), the corneal light reflex test, visual acuity tests (e.g., Snellen, Lea Symbols [Lea-Test], and HOTV [Precision Vision] charts), autorefractors and photoscreeners

2017 National Guideline Clearinghouse (partial archive)

98. Point-of-care devices for detecting diabetic polyneuropathy

in Greece. In this study the Neuropad was compared to the neuropathic disability score, which comprises of history and examination of multiple modalities including ankle reflexes, sensation, pin-prick and temperature. The prevalence of DPN in this study population would be significantly greater than in the general population seen in primary care. However given that this device would likely only be used in patients diagnosed with diabetes in primary care, then the prevalence may be more similar (...) motor nerve action potential, PMNCV – peroneal motor nerve conduction velocity, IENFD – intraepidermal nerve fibre density, CNFD – corneal nerve fibre density, CNBD – corneal nerve branch density, CNFL – corneal nerve fibre length, DB-HRV – deep breathing heart rate variability, WPT – warm perception thresholds NC – Stat DPN Check In a study of 72 consecutive patients with diabetes from a diabetes and neuropathy outpatient clinic, patients were evaluated concurrently with conventional nerve

2016 Publication 4878904

99. Hepatitis C Screening

be screened for the hepatitis C virus. Table 1. Screening for hepatitis C virus Consider providing a patient information handout on HCV screening, which is also available as the SmartPhrase .AVSHEPCSCREENING. Eligible population Test 1,2 Frequency All adults born during 1945–1965 Hep C screening test with reflex to Hep C RNA quantitative test One time Adults and adolescents of any age with risk factors: • Current and past injection drug use. This includes patients who injected only once or many years ago (...) • Receipt of clotting-factor concentrates before 1987 • Receipt of blood transfusion or solid organ transplant before July 1992 • Receipt of long-term hemodialysis treatment • Known exposure to HCV (e.g., by accidental needle stick). See Infection Control accidental exposure policy on the staff intranet • HIV infection • Being born to an HCV antibody–positive mother Hep C screening test with reflex to Hep C RNA quantitative test One time or, if patient has ongoing risks for HCV exposure, screening

2016 Kaiser Permanente Clinical Guidelines

100. Briviact - brivaracetam

discussion 2.1. Introduction Problem statement Epilepsy is a disorder of the brain characterized by the recurrence of spontaneous, unprovoked seizures, i.e. seizures not provoked by transient systemic, metabolic or toxic disorders. In 2014, the International League Against Epilepsy (ILAE) furthermore proposed to define epilepsy by any of the following conditions: (i) At least two unprovoked (or reflex) seizures occurring >24 h apart, (ii) one unprovoked (or reflex) seizure and a probability of further

2016 European Medicines Agency - EPARs

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