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121. Uveitis

corticosteroids are usually adequate for acute non-infectious anterior uveitis, but intermediate and posterior uveitis usually requires injected local corticosteroids or systemic steroids, or other immunosuppression. Definition Uveitis is an inflammation of one or all parts of the uvea, or the vascular area between the retina and sclera of the eye. The anterior uvea is composed of the iris and ciliary body; an irritation of this segment, or anterior uveitis, leads to acute painful symptoms and photophobia

2018 BMJ Best Practice

122. Cirrhosis

sclera) abdominal features (e.g., collateral circulation, hepatosplenomegaly, distension) altered mental status constitutional symptoms lower extremity swelling hepatic fetor muscle wasting peripheral oedema recurrent infections decreased libido chest wall features (e.g., gynaecomastia) dyspnoea chest pain syncope alcohol misuse intravenous drug use unprotected intercourse obesity blood transfusion tattooing Diagnostic investigations liver function tests gamma-glutamyl transferase (GGT) serum albumin

2018 BMJ Best Practice

123. Assessment of jaundice

Assessment of jaundice Assessment of jaundice - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of jaundice Last reviewed: February 2019 Last updated: June 2018 Summary Jaundice (icterus) is the result of accumulation of bilirubin in the bloodstream and subsequent deposition in the skin, sclera, and mucous membranes. The normal range for total bilirubin is 3.4 to 20 micromol/L (0.2-1.2 mg/dL). Jaundice may

2018 BMJ Best Practice

124. Neonatal jaundice

includes phototherapy and/or exchange transfusion. The major complication of unconjugated hyperbilirubinaemia is kernicterus. Definition Neonatal jaundice is the yellowing discoloration of the skin and sclera of a neonate, which is caused by increased levels of bilirubin in the blood. A neonate refers to an infant in the first 28 days of life. This topic focuses on recognising and managing early neonatal jaundice, which is most commonly caused by unconjugated hyperbilirubinaemia. While prolonged

2018 BMJ Best Practice

125. Kaiser Permanente National Cholesterol and Cardiovascular Risk Clinician Guide

the risk of myopathy. } During statin therapy, consider measuring CK in individuals with muscle symptoms, including pain, tenderness, stiffness, cramping, weakness, or generalized fatigue. Hepatic Function } Perform baseline measurement of ALT before initiating statin therapy. } During statin therapy, consider measuring hepatic function if symptoms suggesting hepatotoxicity arise (e.g., unusual fatigue or weakness, loss of appetite, abdominal pain, dark-colored urine or yellowing of the skin or sclera

2018 Kaiser Permanente National Guideline Program

126. Headache

. Characteristic findings of IIH on MRI include flattening of the posterior sclera, distension of perioptic subarachnoid space, enhancement and protrusion of the intraocular optic nerve, and an empty sella. If the neuroimaging study reveals no structural etiology for IIH, a lumbar puncture is performed. In addition to measuring the opening pressure, the CSF is analyzed for cell count and differential, glucose, protein, and sensitivity to microbial agents [106]. In individuals with contraindication to MRI (eg

2019 American College of Radiology

127. Trachoma

trichiasis (the contact of 1 or more lashes on any part of the globe) corneal opacification Herbert's pits (small pits around the margin of the cornea) asymptomatic ocular and nasal discharge red eye painful watery eye limbal (at the border of the cornea and sclera) follicles pannus (vessels growing over the clear cornea) children (active infection) poor facial hygiene female gender poverty poor community hygiene residence in or emigration from an endemic area Diagnostic investigations PCR (conjunctival

2017 BMJ Best Practice

128. Kaiser Permanente National Dyslipidemia Clinician Guide

fatigue. Hepatic Function ? Perform baseline measurement of ALT before initiating statin therapy. ? During statin therapy, consider measuring hepatic function if symptoms suggesting hepatotoxicity arise (e.g., unusual fatigue or weakness, loss of appetite, abdominal pain, dark-colored urine or yellowing of the skin or sclera). TABLE 2. STATIN THERAPY OPTIONS BY INTENSITY HIGH INTENSITY* Daily dose lowers LDL-C by approx. = 50% MODERATE INTENSITY Daily dose lowers LDL-C by approx. 30-50% LOW INTENSITY

2017 Kaiser Permanente National Guideline Program

129. Bruising

with gingival bleeding, prolonged bleeding after surgical procedures, and menorrhagia. Abnormalities in capillary structure and deficiencies of perivascular collagen cause vascular fragility, and blood vessels may rupture when subject to shearing forces. Has an estimated prevalence of 1 in 1000 people. Osteogenesis imperfecta This is characterised by blue sclerae, short stature, bone fragility, dentinogenesis imperfecta, and adult hearing loss. Easy bruising after minimal or no trauma is thought to occur

2017 Prodigy

130. Pigmented fundus lesions

. Ophthalmology. 2005;112(10):1784-9 Sumich P, Mitchell P, Wang JJ. Choroidal nevi in a white population: the Blue Mountains Eye Study. Arch Ophthalmol. 1998;116(5):645-50 Further information Lay summary A Choroidal Naevus (similar to a mole on the skin) occurs inside the eye in the choroid, which is the layer of nourishing and supportive tissue between the retina (the part of the eye that receives light and sends images to the brain) and the sclera (the ‘white’ of the eye). Choroidal naevus cannot be seen

2018 College of Optometrists

131. Uveitis (anterior, acute and recurrent)

-16 Lay Summary The uvea is the coloured part of the eye, lying beneath the white part of the eye (the sclera) and comprising the iris (which gives the eye its blue, brown or other colour), the ciliary body (which controls focussing and secretes the clear fluid that fills the front of the eye) and the choroid (which nourishes the outer layers of the retina). Inflammation of the uvea is called uveitis. When this inflammation affects the iris and the ciliary body only, it is known as anterior

2018 College of Optometrists

132. Scleritis

Scleritis Scleritis submit The College submit You're here: Scleritis Scleritis The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care. Share options Please login to view the images or . Aetiology Scleritis is a potentially severe inflammatory disease of the sclera which is bilateral in 50% of cases Predisposing factors Patients are usually in the middle age group (...) or severe pain (eye ‘ache’ may be referred to brow or jaw) which is exacerbated by eye movement May disturb sleep Gradual onset Tenderness of globe Photophobia Epiphora Visual loss Possible history of previous episodes Signs Scleritis may involve the anterior sclera, the posterior sclera, or both Anterior scleritis (90% of cases) (a) Non-necrotising (75% of cases) usually unilateral hyperaemia of superficial and deep episcleral vessels; does not blanch with vasoconstrictors (e.g. gutt. 2.5%) anterior

2018 College of Optometrists

133. Trauma penetrating

. 2004;27(2):206-10 Lecuona K. Assessing and managing eye injuries. Community Eye Health. 2005;18(55):101-4 Lay summary Full or partial penetration of the outer coat of the eye (the clear part, the cornea or the white part, the sclera) can result from industrial, work-related or DIY injuries, or from assaults with sharp objects. Such injuries occur three times as frequently in males as in females. Because they are so close to the eyeball, the eyelids may be injured also. The optometrist will check

2018 College of Optometrists

134. Pterygium

) Management category B2: alleviation/palliation; normally no referral B1: refer to ophthalmologist if pterygium: threatens visual axis induces irregular astigmatism is associated with chronic inflammation is cosmetically unacceptable Possible management by ophthalmologist Acute inflammation topical steroids non steroidal anti-inflammatory agents A variety of surgical techniques, including: surgical excision (bare sclera resection) surgical excision plus conjunctival closure, conjunctival flap closure (...) or conjunctival autografting; or amniotic membrane grafting adjunctive treatment sometimes given; includes: beta irradiation (post-op) topical thiotepa (post-op) mitomycin C (intra- or post-op) A recent systematic literature review concluded that bare sclera resection was associated with high rates of recurrence. By contrast, conjunctival or limbal autograft was associated with lower rates of recurrence Evidence base *GRADE: Grading of Recommendations Assessment, Development and Evaluation ( ) Sources

2018 College of Optometrists

135. Pinguecula

of the eye (the sclera) and the transparent window at the front of the eye (the cornea) meet. If the cornea is imagined as a clock face, a pinguecula will generally form at the three and nine o’clock positions. This condition becomes commoner as people age, so that by 70 years most people have them. Both eyes are usually affected. There is no effect on vision. This is a mild degenerative condition, due to long-term exposure to ultra-violet (UV) light, either occurring naturally in sunlight

2018 College of Optometrists

136. Spot the Diagnosis! The Case of the Dropsical Child

towards the woman’s hand in a possible gesture of being too weak to even support their own head. As a contrast to the pointed gazes of the man and the woman, the child’s gaze is unfixed and their affect completely flat. What signs does the child display that could point to a diagnosis? The child displays many signs pointing towards a pathology. Ashen blue / grey skin Grey / blue sclera and lips Significant swelling to the abdomen, face and eyes Unfixed gaze Flat affect Seemingly needing support from

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2018 CandiEM

138. Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery. (PubMed)

of attaching conjunctival autografts to the sclera are through suturing or fibrin glue. Each method presents its own advantages and disadvantages. Sutures require considerable skill from the surgeon and can be associated with a prolonged operation time, postoperative discomfort and suture-related complications, whereas fibrin glue may give a decreased operation time, improve postoperative comfort and avoid suture-related problems.To assess the effectiveness of fibrin glue compared to sutures

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2016 Cochrane

139. Conjunctival autograft for pterygium. (PubMed)

the visual axis.Surgery is the only effective treatment for pterygium, though recurrences are common. With simple excision techniques (that is, excising the pterygium and leaving bare sclera), the risk of recurrence has been reported to be upwards of 80%. Pterygium excision combined with a tissue graft has a lower risk of recurrence. In conjunctival autograft surgery, conjunctival tissue from another part of the person's eye along with limbal tissue is resected in one piece and used to cover the area (...) from which the pterygium was excised. Another type of tissue graft surgery for pterygium is amniotic membrane graft, whereby a piece of donor amniotic membrane is fixed to the remaining limbus and bare sclera area after the pterygium has been excised.The objective of this review was to assess the safety and effectiveness of conjunctival autograft (with or without adjunctive therapy) compared with amniotic membrane graft (with or without adjunctive therapy) for pterygium. We also planned

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2016 Cochrane

140. BSR guideline Management of Adults with Primary Sjögren's Syndrome

break-up time and Schirmer’s tests in patients with meibomian gland disease [ ]. Some patients with severe dry eye develop an associated blepharospasm. There are small case series describing a good response to botulinum toxin injections in these circumstances [ , ]. For severe dry eye bandage scleral contact lenses, designed to protect the surface and create an optimized environment for healing, may be indicated. These lenses vault over the corneal surface and rest on the sclera. They are rigid

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2017 British Society for Rheumatology

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