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Sclera

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141. CRACKCast E022 – Red and Painful Eye

Pressures OVER 30 mmhg need rapid treatment Slit lamp examination – explained A systematic, magnified view of the conjunctivae and anterior chamber Will not help you with something posterior to the lens Lids and lashes Blepharitis Hordeolum (lid abscess) Dacryocystitis Conjunctiva and sclera Punctures, lacerations, inflammatory patterns Cornea (with fluorescein) Abrasions, ulcers, foreign bodies Angled beam is needed to assess depth perception Edema (white haze / cloudiness) Anterior chamber Cells (RBCs

2017 CandiEM

143. CRACKCast E066 – Child Maltreatment

of it Look for blue sclerae Brownish teeth Deficiencies: Rickets of prematurity Scurvy Infections: Congenital syphilis / rubella Encephalitis / Meningitis / Post hypoxic edema 5) What cluster of injuries is seen in shaken baby syndrome? Head trauma Traumatic axonal injury → cerebral edema With retinal hemorrhages (85% of cases have this) “Due to vitreo-retinal traction due to centrifugal forces” Seen as dot, blot, shear and flame hemorrhages Skeletal injuries Abdominal injuries: *there may be no visible

2017 CandiEM

144. CRACKCast E071 – Ophthalmology Part A

: Artificial tears Cool compresses Topical ocular decongestants, antihistamines, topical NSAIDS 5) Define pterygium and pinguecula See YouTube video: Pterygium: Wedge shaped area of conjunctival fibrovascular tissue on the NASAL side of the sclera extending onto the cornea Risks Exposure to UV light (tropical areas) Surfer’s eye Symptoms: Eye irritation, visual changes Pinguecula: White/yellow flat/raised tissue next to the cornea Doesn’t extend into the cornea Treatment Protection from wind, sunlight

2017 CandiEM

145. Orbits, Vision and Visual Loss

patients for IOIS, IgG4-related orbital disease, or other inflammatory/granulomatous disease. Currently there is little evidence to support one modality’s superiority to others in evaluating this patient population [39-41]. A hallmark of IOIS in its chronic form is fibrosis, which results in decreased signal on T2-weighted MRI sequences [48]. A small subset of patients with isolated ocular manifestation of IOIS had posterior scleritis, with inflammatory enhancement of the sclera on postcontrast imaging

2017 American College of Radiology

147. Antibacterial-coated sutures versus non-antibacterial-coated sutures for the prevention of abdominal, superficial and deep, surgical site infection (SSI)

not been established [3]. Monocryl ® Plus Antibacterial Sutures are intended for use in general soft tissue approximation and/or ligation where an absorbable material is indicated [2]. PDS ® Plus Antibacterial sutures are intended for use in general soft tissue approximation, including use in paediatric cardiovascular tissue, and in ophthalmic surgery (other than contact with cornea and sclera). These sutures are particularly useful where the combination of an absorbable suture and extended wound

2017 EUnetHTA

148. Microinvasive subconjunctival insertion of a trans-scleral gelatin stent for primary open-angle glaucoma

at the same time as phacoemulsification and intraocular lens insertion for treating cataracts. 2.5 Under local or topical anaesthesia, a small incision is made in the cornea, and the anterior chamber is filled with viscoelastic. A preloaded implant injector is then advanced through the same corneal incision and directed towards the scleral spur. The injector needle is directed through the sclera to emerge under the conjunctiva, approximately 2 mm to 3 mm behind the limbus. The soft and permanent gelatin (...) stent is then injected, to traverse the anterior chamber, sclera and conjunctival space. After placement is checked (using a gonioscopy mirror) the viscoelastic is exchanged for a balanced salt solution and the injector is withdrawn. The corneal incision is usually self-sealing but is sometimes sutured. Subconjunctival injection of mitomycin-C may be done during the procedure. 3 3 Committee consider Committee considerations ations The e The evidence vidence 3.1 T o inform the committee, NICE did

2018 National Institute for Health and Clinical Excellence - Interventional Procedures

149. iStent trabecular micro-bypass stent (Glaukos Corp.) in combination with cataract surgery for treatment of open-angle glaucoma

micro-bypass stent include minimally invasive insertion, a clear corneal incision that spares the conjunctiva and sclera, and a low risk for hypotony. Patient Population: The iStent is indicated for use in conjunction with cataract surgery (often phacoemulsification) for the reduction of IOP in adult patients with mild to moderate open-angle glaucoma currently treated with ocular hypotensive medication. Final publication URL The report may be purchased from: Indexing Status Subject indexing assigned

2016 Health Technology Assessment (HTA) Database.

150. Argus II Retinal prosthesis

and transmitting coil and an electronic case fixed to the outside of the sclera (white of the eye), and an electrode array (60 electrodes) that is surgically attached to the surface of the retina. The electrode array is connected to the electronic case by a ribbon cable that passes through the sclera. 1 The camera housed within the glasses captures images that are sent to the video processing unit and converted to electronic signals. These signals are then sent to the transmitter coil on the glasses (...) Products, Inc. Implantation of the Argus II Retinal Prosthesis System can be performed by a single surgeon in a two-hour outpatient procedure under general anaesthesia. 3 Details regarding the surgery are as follows: ? At commencement of the implant procedure, antibiotics and steroids are administered by intravenous injection. ? In phakic eyes (eyes with a lens) the lens is removed. ? An incision is made into the conjunctiva surrounding the cornea, exposing the underlying sclera and extra-ocular

2016 COAG Health Council - Horizon Scanning Technology Briefs

151. Conjunctival pigmented lesions

is common in dark-skinned ethnicities. PAM typically affects older white-skinned patients (rarely in dark-skinned) Melanoma is more common with fair skin and blue eyes, extremely rare in dark-skinned races. Presentation peaks in mid-fifties Symptoms Asymptomatic except for cosmetic concern Signs Ethnic melanosis Bilateral, asymmetrical, flat, intra-epithelial (moves freely over sclera), patchy, brown pigmentation, most prominent in palpebral aperture especially at limbus or where anterior ciliary (...) arteries perforate the sclera, develops in early years (static by adulthood) C-MIN/PAM Unilateral, any part of conjunctiva (including tarsal or forniceal), flat, intraepithelial (moves freely over sclera), single or multiple, indistinct areas, light to dark brown, no cystic spaces, often extensive, can be stable or may change (enlarge, shrink, darken or lighten) Congenital Melanocytosis ocular Multifocal, slate-grey or blue grey, sub-epithelial (does not move freely over sclera) dermal Mottled, blue

2016 College of Optometrists

152. Microbial keratitis (Acanthamoeba sp.)

epithelial or subepithelial infiltrates pseudodendrites radial keratoneuritis (infiltrates along corneal nerves) recurrent breakdown of the corneal epithelium Later signs deep inflammation of the cornea consisting of a central or paracentral ring-shaped or disciform infiltrate or abscess stromal thinning extension of inflammation into sclera anterior chamber cells and flare hypopyon Differential diagnosis Signs may masquerade as herpes simplex with temporary improvement on anti-herpetic treatment

2016 College of Optometrists

153. Screening and Management of Lipids

is indicated only for those with abnormal baseline ALT, known liver disease, risk factors for liver disease, or in patients who are on other potentially hepatotoxic medications. Liver function tests (LFTs) should also be measured 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).For other patients with abnormal baseline LFTs, see Table 4 for monitoring based on level of abnormality

2016 University of Michigan Health System

154. Ab externo canaloplasty for primary open-angle glaucoma

, viscocanalostomy or laser trabeculoplasty may also be used. 3 3 The procedure The procedure 3.1 Ab externo canaloplasty is a surgical technique that aims to reduce intraocular pressure by improving drainage of aqueous fluid from the eye. It is done under local or general anaesthetic. A superficial hinged flap of sclera is made and a deeper flap excised, exposing the Schlemm's canal. An ultrasound imaging system is used to identify the canal and to visualise the surgical instruments when they are in the canal

2017 National Institute for Health and Clinical Excellence - Interventional Procedures

155. Sequential traumatic corneal open globe rupture in a patient with osteogenesis imperfecta type I (PubMed)

at school while wearing protective lenses. One year ago, he required surgical repair of a left open globe following blunt trauma during a middle school basketball game. His exam was significant for a full-thickness corneal laceration, necessitating open globe repair of his right eye, which was remarkably difficult given the poor tissue constitution of the cornea and sclera. He was referred to a genetics specialist, where he was found to have a pathogenic heterozygous splice site variant in the COL1A1

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2018 American journal of ophthalmology case reports

156. Conservative management of penetrating ocular trauma caused by a nail gun (PubMed)

Conservative management of penetrating ocular trauma caused by a nail gun To report the conservative management of a penetrating ocular trauma caused by a nail gun with a six-month follow up.A 21 year-old healthy female suffered an ocular penetrating trauma with a nail gun. She presented with a metallic foreign body that partially entered her left eye through the nasal sclera via pars plana, 3 mm posterior to the limbus, but did not reach the retina. Surgical removal of the foreign body

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2018 American journal of ophthalmology case reports

157. Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography. (PubMed)

according to the Ministry of Health and Welfare, Japan classification. A posterior displacement of the sclera and two OCT features indicating the staphyloma edges were used as markers of a staphyloma.Fifty-five eyes of 30 patients with the mean age of 12.3 years, and the mean axial length of 27.9 mm were studied. Seven of the 55 eyes (12.7%) had a posterior displacement of the sclera and were diagnosed as having a staphyloma. Among the two OCT features of the staphyloma edges, a gradual thinning (...) of the choroid toward the staphyloma edge and gradual re-thickening of choroid from the staphyloma edge toward the posterior pole were found in these 7 eyes. However, the other feature of an inward protrusion of the sclera at the staphyloma edge, was obvious in only 2 eyes. The subfoveal choroid and choroid nasal to the optic disc were significantly thinner in eyes with a staphyloma than those without it.The changes of the choroidal thickness toward the staphyloma edge with the posterior displacement

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2019 PLoS ONE

158. Lamina cribrosa and peripapillary sclera histomorphometry in normal and advanced glaucomatous Chinese eyes with various axial length. (PubMed)

Lamina cribrosa and peripapillary sclera histomorphometry in normal and advanced glaucomatous Chinese eyes with various axial length. To measure laminar and peripapillary scleral architecture in normal and glaucomatous Chinese eyes with normal and those with elongated axial length.The histomorphometric investigation included a normal group (nonaxially elongated eyes) of 40 human globes (40 patients; mean age, 41.3 +/- 13.4 years; range,15-68) enucleated because of malignant choroidal melanoma (...) significantly between the glaucomatous group and the normal group. The distance between the intraocular space and cerebrospinal fluid space was (P < 0.001) shorter in the two glaucomatous groups than in the normal group.Lamina cribrosa thickness and peripapillary sclera thickness decreased significantly with axial length, in addition to a glaucoma-related thinning of the lamina cribrosa. In non-axially elongated eyes, the peripapillary sclera thickness did not vary significantly between glaucomatous eyes

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2009 Investigative Ophthalmology & Visual Science

159. 5-Fluorouracil for glaucoma surgery. (PubMed)

5-Fluorouracil for glaucoma surgery. Trabeculectomy is performed as a treatment for many types of glaucoma in an attempt to lower the intraocular pressure. The surgery involves creating a channel through the sclera, through which intraocular fluid can leave the eye. If scar tissue blocks the exit of the surgically created channel, intraocular pressure rises and the operation fails. Antimetabolites such as 5-Fluorouracil (5-FU) are used to inhibit wound healing to prevent the conjunctiva (...) scarring down on to the sclera. This is an update of a Cochrane review first published in 2000, and previously updated in 2009.To assess the effects of both intraoperative application and postoperative injections of 5-FU in eyes of people undergoing surgery for glaucoma at one year.We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid

2014 Cochrane

160. Guidance for the reporting of ophthalmic pathology specimens

of the Joint Working Party of The Royal Colleges of Ophthalmologists and Pathologists and was ratified by both these Royal Colleges. Ophthalmic pathology encompasses specimens originating from the eyelid, conjunctiva, cornea, sclera, all intraocular sites, extraocular muscles, orbital tissues, optic nerve and sheath, optic chiasm, lacrimal gland and drainage apparatus and bony wall of orbit. Whilst some pathologists will regularly see the full range of ophthalmic pathology specimens, other pathologist

2015 Royal College of Pathologists

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