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This document discusses the classification and evaluation of ptosis (drooping of the upper eyelid). Ptosis can be neurogenic, myogenic, aponeurotic, mechanical or pseudoptosis. Common causes include third nerve palsy, Horner syndrome, myasthenia gravis, and congenital conditions. Evaluation involves measuring the marginal reflex distance, levator function, and upper lid excursion. Treatment depends on the type and severity of ptosis, and may include procedures like levator resection or frontalis brow suspension.
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Last edited: Feb 202
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Last edited: Feb 202
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This document discusses sources and management of postoperative astigmatism after cataract surgery. It notes that the main sources of astigmatism are preexisting astigmatism, incision characteristics like length and location, and suture characteristics like type, tension, and placement. Larger or superior incisions, and sutures that degrade quickly or are placed unevenly, tend to cause more astigmatism. Managing factors like smaller incisions, frown-shape cuts, posterior placement, uniform tension, and non-degrading suture material can help minimize postoperative astigmatism. Precise suture removal timing and selective cutting can further refine astigmatism outcomes after surgery.
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Air pump
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ptosis
This document discusses examination of ptosis, or drooping of the upper eyelid. Examination includes evaluating the degree of ptosis, measuring the margin reflex distance, and assessing levator function. Ptosis is graded as mild, moderate, or severe depending on the amount the eyelid covers the cornea. Levator function is measured using Burke's method and graded as normal, good, fair, or poor based on eyelid excursion. Special tests like Tensilon or Phenylephrine may be used and photographic records should be taken.
ptosis ppt
1) Ptosis is an abnormally low position of the upper eyelid that can be congenital or acquired. Congenital ptosis is usually bilateral and hereditary, caused by defective development of the levator palpebrae superioris muscle. Acquired ptosis has several causes including neurogenic (e.g. third nerve palsy), myogenic (e.g. myasthenia gravis), aponeurotic, or mechanical factors like tumors.
2) Myasthenia gravis is tested for using edrophonium, which temporarily improves ptosis and diplopia. Marcus Gunn jaw-winking syndrome is a rare form of congenital ptosis where the eyel
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This document provides information on angle-closure glaucoma, including its classification, terminology, risk factors, pathogenesis, and clinical presentation. It discusses the three main mechanisms of angle closure - pupillary block, phacomorphic, and plateau iris. Primary angle closure glaucoma progresses from primary angle closure suspects with a narrow angle, to primary angle closure with elevated pressure or synechiae, and eventually to chronic primary angle closure glaucoma if untreated, resulting in optic nerve damage and visual field loss. The clinical presentations include latent, subacute, acute, and chronic forms depending on symptoms.
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This document provides information on rhegmatogenous retinal detachment including:
- The pathogenesis which involves vitreoretinal traction from liquefaction of the vitreous gel creating a hole that allows fluid into the subretinal space.
- Symptoms include photopsia, floaters, and visual field defects.
- Signs include Marcus Gunn pupil, low intraocular pressure, retinal breaks, and mild iritis.
- Treatment options depend on factors like location and size of retinal break, state of vitreous gel, and include laser photocoagulation, cryotherapy, scleral buckling, pneumatic retinopexy, and drainage of subretinal fluid in
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This document discusses different types of noninfectious keratitis, including recurrent erosion syndrome, filamentary keratitis, Thygeson's superficial punctate keratitis, and neurotrophic keratitis. Recurrent erosion syndrome involves repeated breakdown of the corneal epithelium and is associated with trauma, corneal dystrophy, or abnormal attachment complexes. Filamentary keratitis features filaments of degenerated epithelial cells firmly attached to the cornea. Thygeson's keratitis presents as chronic, bilateral punctate epithelial keratitis of unknown cause. Neurotrophic keratitis results from impaired corneal healing due to denervation and involves decreased tearing and blinking. Treatment focuses on managing underlying causes and symptoms for each condition.
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This document discusses the anatomy, structure, glands, blood supply, nerve supply, anomalies, diseases, and clinical features of the eyelid. It focuses on congenital and acquired ptosis, including the causes, clinical features, investigations, and treatment options. Specific conditions covered include congenital ptosis, neurogenic ptosis, myogenic ptosis, aponeurotic ptosis, mechanical ptosis, entropion, and ectropion. Surgical correction techniques are described for various types of ptosis and eyelid positioning anomalies.
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Surgeon:
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- Inserts infusion cannula
- Inserts vitrectomy probe
- Removes blood clots
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ptosis
This document discusses examination of ptosis, or drooping of the upper eyelid. Examination includes evaluating the degree of ptosis, measuring the margin reflex distance, and assessing levator function. Ptosis is graded as mild, moderate, or severe depending on the amount the eyelid covers the cornea. Levator function is measured using Burke's method and graded as normal, good, fair, or poor based on eyelid excursion. Special tests like Tensilon or Phenylephrine may be used and photographic records should be taken.
ptosis ppt
1) Ptosis is an abnormally low position of the upper eyelid that can be congenital or acquired. Congenital ptosis is usually bilateral and hereditary, caused by defective development of the levator palpebrae superioris muscle. Acquired ptosis has several causes including neurogenic (e.g. third nerve palsy), myogenic (e.g. myasthenia gravis), aponeurotic, or mechanical factors like tumors.
2) Myasthenia gravis is tested for using edrophonium, which temporarily improves ptosis and diplopia. Marcus Gunn jaw-winking syndrome is a rare form of congenital ptosis where the eyel
Ptosis surgery
This document discusses various surgical techniques for treating ptosis including modified Fasanella-Servat procedure, levator resection, and tarsofrontalis sling. It provides details on patient evaluation, surgical steps, guidelines for amount of levator resection, and potential complications. The modified Fasanella-Servat procedure involves tarso-conjunctival mullerectomy and is best for mild congenital ptosis. Levator resection is performed through skin or transcutaneous approaches. A tarsofrontalis sling uses silicone or fascia and is ideal for bilateral or severe ptosis. Potential complications include under or overcorrection, contour abnormalities, crease issues, and conjunctival prolapse.
Congenital ptosis
This document discusses congenital ptosis, including its types, causes, signs, and treatments. There are several types of congenital ptosis, including simple congenital ptosis which is not associated with other anomalies, ptosis associated with weakness of the superior rectus muscle, and blepharophimosis syndrome where ptosis occurs with additional facial features. Congenital ptosis is caused by underdevelopment of the levator palpebrae superioris muscle. Treatment depends on the severity of ptosis and amount of levator function, and may include conjunctiva-Müller resection for mild ptosis, levator resection for moderate ptosis with sufficient levator function, or brow suspension for severe ptosis with poor
Ptosis
This document discusses ptosis, or drooping of the upper eyelid. It defines ptosis as the upper eyelid covering more than 2mm of the cornea. The document describes the different types of ptosis, including congenital, acquired, neurogenic, myogenic, aponeurotic, and mechanical. It also covers examinations for ptosis including measurements of marginal reflex distance, vertical fissure height, upper lid crease, and pretarsal show. The document discusses treatments for ptosis such as the Fasanella-Servat procedure, levator resection, and frontalis brow suspension.
Ptosis
This document discusses ptosis, or drooping of the upper eyelid. It defines ptosis as the upper eyelid covering more than 2mm of the cornea. There are two main types - congenital and acquired. Congenital ptosis can be further divided into simple congenital ptosis, Blepharophimosis syndrome, and Marcus Gunn jaw winking ptosis. Acquired ptosis has causes such as neurogenic (Horner's syndrome, third nerve palsy), myogenic (ocular myasthenia), aponeurotic, or mechanical. Examination of ptosis evaluates the degree using measurements like marginal reflex distance and levator function. Treatment depends on the type and severity of
Ptosis
This document discusses different types of ptosis (drooping of the upper eyelid), including neurogenic, myogenic, aponeurotic, mechanical, congenital, traumatic, and involutional ptosis. It describes how to clinically evaluate ptosis by taking a patient history and performing measurements of the eyelid. Specific types of ptosis like Marcus Gunn Jaw-Winking Syndrome and simple congenital ptosis are explained. Surgical treatment options are provided depending on the type and severity of ptosis.
Ptosis
This document discusses ptosis, or drooping of the eyelid. It begins by describing the functional anatomy of the levator palpebrae superioris muscle and other muscles involved in eyelid elevation. It then defines ptosis and classifies it as congenital or acquired, with the acquired category further divided into neurogenic, myogenic, aponeurotic, mechanical, and neurotoxic causes. Several types of congenital ptosis are described in detail, including blepharophimosis syndrome and Marcus Gunn jaw-winking syndrome. Evaluation of ptosis involves assessing history, appearance of eyelids at rest, levator function testing, and identifying associated signs. Investigations may include imaging or blood tests depending on
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This document discusses ptosis, or low-lying eyelids, including its definition, types, examination, and treatment. There are two main types of ptosis: congenital and acquired. Congenital ptosis can be simple or associated with other conditions. Acquired ptosis has neurological, muscular, aponeurotic, or mechanical causes. A full examination involves measuring lid position, levator function, ocular motility, and associated signs. Treatment options include observation, glasses, or surgical procedures like mullar resection, levator resection/advancement, or brow suspension depending on the type and severity of ptosis. Careful examination and documentation is important for successful ptosis management.
ptosis.pptx
Ptosis, or drooping of the upper eyelid, can be congenital or acquired. It is caused by weakness or damage of the levator palpebrae superioris muscle or aponeurosis. Clinical evaluation involves measuring eyelid position and function of the levator muscle. Ptosis is classified based on severity and etiology. Surgical treatment options aim to strengthen the eyelid lift through techniques like levator resection or frontalis sling suspension. Proper diagnosis and management require a thorough history and examination.
Eye pain for neurologist
Dr. Vaishal Shah provides an overview of eye pain for neurologists. The trigeminal system supplies sensation to the eye and is involved in many causes of eye pain. Common ophthalmological causes of painful red eye include conjunctivitis, while neurological causes can include optic neuritis. Evaluation of painful white eye involves considering ophthalmological issues like glaucoma, uveitis, or scleritis, as well as neurological conditions such as optic neuritis. Eye pain with ophthalmoplegia may indicate orbital cellulitis, thyroid eye disease, giant cell arteritis, or structural lesions. Primary headache syndromes like cluster headache or trigeminal neuralgia can also cause eye pain and
Neurocutaneous syndromes.pptx
This document discusses neurocutaneous syndromes, which are disorders characterized by abnormalities of both the skin and central nervous system. It provides details on several specific syndromes - neurofibromatosis types 1 and 2, tuberous sclerosis complex, and Sturge-Weber syndrome. For each, it describes genetic causes, diagnostic criteria and features, management approaches, and importance of long-term follow up. Neurofibromatosis type 1 is the most common and involves tumors arising from nerves, while type 2 features bilateral acoustic neuromas. Tuberous sclerosis is characterized by benign tumors in multiple organs and a triad of symptoms. Sturge-Weber syndrome involves a facial birthmark, eye and brain abnormalities,
Neurocutaneous syndromes
Neurocutaneous syndromes involve abnormalities of both the skin and central nervous system. This document summarizes several key neurocutaneous syndromes including tuberous sclerosis complex, neurofibromatosis type 1, and Sturge-Weber syndrome. Tuberous sclerosis complex is characterized by benign tumors in multiple organ systems and features such as facial angiofibromas and hypomelanotic macules. Neurofibromatosis type 1 causes cafe-au-lait spots and benign nerve tumors known as neurofibromas. Sturge-Weber syndrome is associated with a port-wine stain of the face and leptomeningeal angiomas of the brain.
Thyroid eye disease presentation
This document discusses Thyroid Eye Disease (TED), a common orbital disorder associated with thyroid dysfunction. It covers the epidemiology, pathology, clinical features, evaluation, and management of TED. Some key points:
- TED is an autoimmune condition causing inflammation and swelling of extraocular muscles and orbital tissues. It is seen in Graves' disease and Hashimoto's thyroiditis.
- Symptoms include eye irritation, bulging eyes (proptosis), and impaired eye movement. Signs include eyelid retraction, proptosis, and restrictive extraocular muscle involvement.
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Clival Pathology.ppt
1) The document discusses various pathologies that can affect the clivus region, including congenital malformations, acquired conditions, and primary and secondary neoplasms.
2) Examples of discussed pathologies include proatlas segmentation failure, neuroenteric cysts, basilar invagination, fibrous dysplasia, chordoma, plasmacytoma, and meningioma.
3) The pathologies are described in terms of their etiology, clinical presentation, diagnostic evaluation, and treatment options.
NEUROCUTANEOUS SYNDROME
This document discusses several neurocutaneous syndromes including their definitions, genetics, classifications, and key details. It provides in-depth information on Neurofibromatosis types 1 and 2, Tuberous Sclerosis, Sturge-Weber Syndrome, and Von Hippel-Lindau disease. For each condition, it outlines diagnostic criteria, clinical manifestations, management approaches, and important follow-up considerations.
Neurocutaneous syndrome
This document discusses several neurocutaneous syndromes including their definitions, genetics, classifications, and key details. It provides in-depth information on Neurofibromatosis types 1 and 2, Tuberous Sclerosis, Sturge-Weber Syndrome, and Von Hippel-Lindau disease. For each condition, it outlines diagnostic criteria, clinical manifestations, management approaches, and important follow-up considerations.
Phakomatoses
This document discusses various phakomatoses, which are defined as neurocutaneous syndromes with autosomal dominant inheritance and multi-organ hamartomas or tumors. It describes several specific phakomatoses including neurofibromatosis types 1 and 2, tuberous sclerosis, Sturge-Weber syndrome, Von Hippel-Lindau disease, and Wyburn-Mason syndrome. For each, it covers epidemiology, pathogenesis, characteristic ocular and systemic findings, diagnostic criteria, investigations, and treatment.
Neurocutaneous
This document provides an overview of several neurocutaneous syndromes:
- Neurofibromatosis causes tumors on nerves and affects 1 in 3,000 people. Common features include café-au-lait spots and tumors called neurofibromas.
- Tuberous sclerosis causes non-cancerous tumors in many organs and affects 1 in 6,000 people. Common signs include ash-leaf shaped skin lesions and seizures.
- Sturge-Weber syndrome is characterized by a birthmark on the face and abnormalities of blood vessels in the brain. It causes seizures and developmental delays.
Congenital glaucoma part2; developmental glaucoma
developmental glaucoma/ juvenile onset glaucoma: axenfield rieger anomaly, peter's anomaly , aniridia, associated with other syndromes and chromosomal anomalies, mucopolysacharidosis , stickler syndrome etc..
MICROCEPHALY jo.pptx
This document defines microcephaly and discusses its classification, etiology, pathogenesis, and diagnosis. Microcephaly is defined as an occipitofrontal circumference more than 3 standard deviations below the mean for age and gender. It can be classified as congenital or postnatal, genetic or environmental, symmetric or asymmetric, and isolated or syndromic. Causes include genetic conditions like primary microcephaly and chromosomal abnormalities, as well as congenital infections, metabolic disorders, and environmental factors. Neuroimaging can aid diagnosis by identifying brain abnormalities and calcifications.
Neurocutaneous syndromes
Neurocutaneous syndromes involve abnormalities of both the skin and central nervous system that are mostly inherited. Some key neurocutaneous syndromes discussed in the document include neurofibromatosis, tuberous sclerosis, Sturge Weber syndrome, incontinentia pigmenti, ataxia telangiectasia, linear nevus syndrome, hypomelanosis of Ito, and Von Hippel Lindau syndrome. They arise due to defects in ectodermal differentiation and have varied clinical manifestations affecting the skin, brain, eyes, and other organ systems. Treatment depends on the specific syndrome but may include seizure management, tumor treatment, and genetic counseling.
DISEASES OF THE LIDS---pptx
The major diseases of the lids and adnexa are covered in these PPTs along with the important benign and malignant tumors of the eye lids.
Approach for ptosis
1. Ptosis, or drooping of the upper eyelid, can be congenital or acquired through various mechanisms including myogenic, neurogenic, mechanical, or aponeurotic causes.
2. Clinical evaluation of ptosis involves measuring the margin-reflex distance, palpebral fissure height, and levator function to determine severity.
3. Simple congenital ptosis is usually treated through levator resection surgery during preschool years to prevent amblyopia, while Marcus Gunn jaw-winking syndrome may require levator disinsertion and brow suspension surgery.
Neurocutaneous syndromes final powepoint
neurocutaneous syndromes are vital part of cns disorders which are extensively studied
Pituitary adenoma
Pituitary adenomas are tumors that arise from the pituitary gland. They are the most common cause of optic chiasm compression. Pituitary adenomas are classified based on their size, hormonal activity, and staining pattern. Symptoms vary depending on the type of adenoma but can include headaches, vision problems, and hormonal imbalances. Investigations include blood tests and MRI to determine tumor size and effects. Treatment options are surgery to remove the tumor, medication to suppress hormone secretion, and radiation therapy.
Neurologic Causes Of Stransimus
Neurological causes of strabismus can include cranial nerve palsies, neurological diseases like myasthenia gravis and mitochondrial disorders, posterior fossa tumors/malformations, and increased intracranial pressure. The neurological examination and history regarding acute onset, head trauma, and other neurological signs can help identify neurological causes of strabismus, which sometimes require further testing like MRI to identify underlying conditions like tumors or hydrocephalus.
blepharoptosis
slide presentation about ptosis in ophthalmology department
including mechanical,myogenic,aponeurotic,traumatic,neurogenic cause
plus dermatochalasis
in general appraoch and surgery choice
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49 diabetic retinopathy
This document discusses diabetic retinopathy, beginning with risk factors like long diabetes duration and poor control. It describes the progression from early background changes to more advanced preproliferative and proliferative stages. Clinically significant macular edema is defined and treatment with laser photocoagulation is outlined. Proliferative diabetic retinopathy is discussed along with its laser treatment, panretinal photocoagulation. Vitreoretinal surgery criteria are listed.
47 hereditary choroidal dystropathies
This document summarizes four hereditary choroidal dystrophies: choroideremia, gyrate atrophy, central areolar choroidal dystrophy, and diffuse choroidal atrophy. Choroideremia is X-linked recessive and presents in the first decade with night blindness, gradually spreading from the periphery to the center while sparing the fovea late. Gyrate atrophy is autosomal recessive, presents in the first decade with myopia and night blindness, and is caused by a deficiency of ornithine keto-acid aminotransferase. Central areolar choroidal dystrophy is dominant and presents as a bilateral circumscribed maculopathy in the fifth decade. Diffuse choroidal at
45 drug related retinopathies
This document discusses three categories of drug-related retinopathies: 1) antimalarials such as hydroxychloroquine and chloroquine, 2) phenothiazines like chlorpromazine and thioridazine, and 3) crystalline maculopathies from tamoxifen and canthaxanthin. Antimalarials can cause bull's-eye maculopathy, with hydroxychloroquine posing a very small risk and chloroquine risking toxicity over 300g cumulative dose. Phenothiazines may cause plaque-like pigmentation or focal/diffuse loss of retinal pigment epithelium and choroid. Tamoxifen can deposit crystalline rings in the macula while canth
41 principles retinal detachment surgery
This document outlines principles of retinal detachment surgery, including scleral buckling procedures, pneumatic retinopexy, and vitrectomy. Scleral buckling involves configuring scleral buckles, localizing retinal breaks, applying cryotherapy, and inserting an explant. Pneumatic retinopexy uses gas injection and postoperative positioning. Vitrectomy is used for giant retinal tears, proliferative vitreoretinopathy, and diabetic tractional retinal detachments to release traction and unfold retinal flaps. The causes and techniques addressed aim to reattach the retina and prevent early failure.
29 primary angle closure glaucoma
Intermittent angle-closure glaucoma occurs when the iris temporarily blocks the drainage angle, causing a spike in eye pressure. Acute congestive angle-closure glaucoma is a medical emergency characterized by a sudden, complete blockage of the drainage angle and severe symptoms. Treatment involves lowering eye pressure with medications, hyperosmotic agents, or YAG laser iridotomy. Post-congestive angle-closure glaucoma develops after an acute attack and is marked by iris and corneal changes. Chronic angle-closure glaucoma has similar visual field loss and optic nerve damage as open-angle glaucoma but the drainage angle is partially blocked.
26 ectopia lentis
Ectopia lentis refers to displacement of the lens from its normal position. It can be acquired through trauma or tumors, or inherited through isolated familial forms or associated with systemic syndromes like Marfan syndrome, Weill-Marchesani syndrome, and Homocystinuria. Treatment options depend on the cause and symptoms but may include spectacle correction, laser zonulysis to displace the lens, or surgical removal of the lens.
25 abnormal lens shape
This document discusses three abnormalities of lens shape: 1) Lenticonus, which is an axial bulge of the posterior or anterior lens that can be unilateral and sporadic or bilateral and familial/associated with Lowe syndrome. 2) Coloboma, which is a defect in the iris, choroid, or retina that can be associated with giant retinal tears. 3) A small lens, which can be microphakia with a small diameter or microspherophakia with a small spherical diameter, and may be familial or associated with Lowe or Weill-Marchesani syndrome.
23 congenital cataract
This document discusses congenital cataracts, including their classification, causes, and important facts. Cataracts can be idiopathic (33%), inherited (33%), or associated with systemic disease (33%). The classification includes anterior polar, posterior polar, coronary, cortical spoke-like, lamellar, central pulverulent, sutural, and focal dot cataracts. Causes in healthy neonates include hereditary factors and being idiopathic. In unwell neonates, causes include intrauterine infections like rubella or toxoplasmosis, and metabolic disorders like galactosemia.
12 conjunctival tumours
This document categorizes and describes various conjunctival tumors including:
1. Benign tumors such as naevus, papilloma, epibulbar dermoid, and lipodermoid.
2. Pre-malignant tumors including primary acquired melanosis and intraepithelial neoplasia.
3. Malignant tumors like melanoma, squamous cell carcinoma, Kaposi sarcoma, and lymphoma. It provides details on signs, locations, risk factors, and treatments for each type of tumor.
20 corneal surgery
This document summarizes various corneal surgery procedures:
1. Penetrating keratoplasty is used to treat optical, tectonic, therapeutic, or cosmetic corneal issues and involves excision of the host corneal tissue and fixation of donor tissue.
2. Keratoprosthesis involves insertion of an artificial lenticule into the corneal stroma for patients with bilateral blindness from conditions like ocular pemphigoid.
3. Refractive surgeries like radial keratotomy, photorefractive keratectomy, laser in-situ keratomileusis, and non-contact laser thermal keratoplasty are used to treat refractive errors by reshaping the cornea using techniques like exc
19 congen corneal anoms
The document describes 5 types of congenital corneal anomalies: 1) Microcornea, which is a very rare hereditary condition where the corneal diameter is 10mm or less. It can be associated with glaucoma, cataract, cornea plana and iris abnormalities. 2) Megalocornea, which is a rare hereditary condition where the corneal diameter is 13mm or more, causing high myopia and astigmatism. It has been associated with Marfan, Apert and Ehlers-Danlos syndromes. 3) Sclerocornea, a very rare usually bilateral condition where the peripheral cornea becomes opaque and vascularized, making the cornea appear smaller. 4) Cornea
18 corneal ectasias
This document discusses three corneal ectasias - keratoconus, keratoglobus, and pellucid marginal degeneration. Keratoconus is classified based on the shape of the cone into nipple, oval, or globus types. It is usually bilateral but asymmetrical and signs include oil droplet reflex, Vogt striae, and Fleischer ring. Systemic associations include Marfan syndrome, Ehlers-Danlos syndrome, and Down syndrome. Keratoglobus is a bilateral protrusion and thinning of the entire cornea, often associated with Leber congenital amaurosis. Pellucid marginal degeneration causes bilateral crescent-shaped inferior corneal thinning with onset between ages 20
17 corneal dystrophies
This document summarizes various types of corneal dystrophies:
- Anterior corneal dystrophies include Cogan microcystic, Reis-Bucklers, Meesmann, and Schnyder dystrophies.
- Stromal dystrophies include lattice types I-III and granular types I-III (Avellino).
- Posterior dystrophies include Fuchs endothelial and posterior polymorphous dystrophies. Each dystrophy is described in terms of inheritance, onset, symptoms, signs, treatment or progression.
03 diffuse eyelid diseases
This document discusses various diffuse eyelid diseases categorized into allergic, infectious, and miscellaneous causes. Allergic causes include acute edema from insect bites or urticaria/angioedema, contact dermatitis from topical medications, and atopic dermatitis which is associated with asthma/hay fever and causes chronic itching/scratching. Infectious causes involve preseptal cellulitis from skin trauma/insects, herpes simplex causing vesicles/crusting, herpes zoster ophthalmicus causing painful vesicles/pustules, impetigo causing golden-yellow crusting, erysipelas causing acute spreading cellulitis, and necrotizing fasciitis causing
14 peri corn thin & ulcer
This document discusses various causes of peripheral corneal thinning and ulceration. It is divided into conditions that present without systemic disease such as dellen, Terrien marginal degeneration, and Mooren ulcer, and those associated with systemic diseases like rheumatoid arthritis, Wegener granulomatosis, and polyarteritis nodosa. For each condition, the document describes signs, causes, progression, and recommended treatments.
13 peripheral corneal inflam
Marginal keratitis, rosacea keratitis, phlyctenulosis, and acute stromal keratitis are forms of peripheral corneal inflammation. Marginal keratitis causes a circumferential subepithelial infiltrate near the limbus and is treated with short-term steroids. Rosacea keratitis results in a chronic, bilateral peripheral inferior vascularization and thinning requiring steroids and antibiotics. Phlyctenulosis presents as transient pinkish-white nodules near the limbus, typically in children. Acute stromal keratitis is rare and unilateral, associated with scleritis, and treated with steroids and NSAIDs.
10 allergic conjunctivitis
This document discusses three types of allergic conjunctivitis: allergic rhinoconjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis. Allergic rhinoconjunctivitis involves a hypersensitivity reaction to airborne antigens and is associated with nasal and eyelid swelling. Vernal keratoconjunctivitis commonly affects children and males in warm climates and involves itching, discharge, and tearing, with papillae forming on the eyelids that can rupture and form giant papillae. Atopic keratoconjunctivitis typically affects young patients with atopic dermatitis and causes red, thickened, fissured eyelids, with
11 immunobullous diseases
This document discusses several immunobullous diseases:
1) Cicatricial pemphigoid is a chronic, progressive disease typically affecting elderly women with oral mucosal lesions and less common skin lesions. It can lead to complications affecting the eyes including ankyloblepharon.
2) Stevens-Johnson syndrome is an acute, self-limiting disease typically affecting young men with oral and eye lesions that are often hemorrhagic and necrotic. Eye complications can include symblepharon.
3) Other diseases discussed include toxic epidermal necrolysis, epidermolysis bullosa, pemphigus vulgaris, and linear IgA bullous dermatosis
09 conjunctival infections
This document describes various infectious conjunctival diseases including bacterial, viral, and chlamydial causes. Bacterial conjunctivitis can be caused by simple bacteria or gonorrhea. Viral conjunctivitis can be caused by adenovirus, molluscum contagiosum, herpes simplex virus, or chlamydia. Adenoviral conjunctivitis may cause pharyngoconjunctival fever in children or epidemic keratoconjunctivitis in adults. Chlamydial conjunctivitis includes adult and neonatal forms as well as trachoma, a chronic infection caused by Chlamydia trachomatis. Each disease is characterized by signs and symptoms and discussed
08 infection lacrimal
1. The document discusses various infections of the lacrimal passages including congenital nasolacrimal duct obstruction, congenital dacryocele, chronic canaliculitis, and acute and chronic dacryocystitis.
2. Treatment for congenital nasolacrimal duct obstruction includes massage, antibiotic drops, and probing if no improvement by 12-18 months, with a 90% cure rate from first probing.
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Proposal: The Ark Project and The BEEP Inc
1.) Introduction
Our Movement is not new; it is the same as it was for Freedom, Justice, and Equality since we were labeled as slaves. However, this movement at its core must entail economics.
2.) Historical Context
This is the same movement because none of the previous movements, such as boycotts, were ever completed. For some, maybe, but for the most part, it’s just a place to keep your stable until you’re ready to assimilate them into your system. The rest of the crabs are left in the world’s worst parts, begging for scraps.
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Our movement has started and implemented everything needed for the advancement of the economic system. There are positions for only those who understand the importance of this movement, as failure to address it will continue the degradation of the people deemed less fortunate.
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Different game formats will be played in groups in parallel. Examples are an ice-breaker to get people talking about psychological safety, a constellation where people take positions about aspects of psychological safety in their team or organization, and collaborative card games where people work together to create an environment that fosters psychological safety.
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Webinar Speaker: Prof. Claudio Gallicchio, Assistant Professor, University of Pisa
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Pro-competitive Industrial Policy – OECD – June 2024 OECD discussion
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This presentation was uploaded with the author’s consent.
ServiceNow CIS-ITSM Exam Dumps & Questions [2024]
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07 ptosis
- 1. CLASSIFICATION OF PTOSIS • Third nerve palsy 1. Neurogenic • Third nerve misdirection • Horner syndrome • Marcus Gunn jaw-winking syndrome • Myasthenia gravis • Myotonic dystrophy • Ocular myopathies • Simple congenital 2. Myogenic 3. Aponeurotic 4. Mechanical • Blepharophimosis syndrome
- 2. PTOSIS • Pseudoptosis • True ptosis 1. Evaluation • Neurogenic ptosis • Myogenic ptosis • Aponeurotic ptosis • Mechanical ptosis 2. Classification 3. Treatment options
- 3. Causes of pseudoptosis Ipsilateral hypotropia Brow ptosis - excessive eyebrow skin Dermatochalasis - excessive eyelid skin Lack of lid support Contralateral lid retraction
- 4. Marginal reflex distance • Distance between upper lid margin and light reflex (MRD) • Mild ptosis (2 mm of droop) • Moderate ptosis (3 mm) • Severe ptosis (4 mm or more)
- 5. • Reflects levator function • Normal (15 mm or more) • Good (12 mm or more) • Fair (5-11 mm) Upper lid excursion • Poor (4 mm or less)
- 6. • Distance between upper and lower lid margins • Normal upper lid margin rests about 2 mm below upper limbus • Normal lower lid margin rests 1 mm above lower limbus • Amount of unilateral ptosis is determined by comparison Vertical fissure height
- 7. Upper lid crease • Distance between lid margin and lid crease in down-gaze • Normals - females 10 mm; males 8 mm • Absence in congenital ptosis indicates poor levator function • High crease suggests an aponeurotic defect • Distance between lash line and skin fold in primary position of gaze Pretarsal show crease fold
- 8. Bell’s phenomenon Upward rotation of globe on lid closure Good Poor - risk of postoperative corneal exposure
- 9. Left third nerve palsy Severe unilateral ptosis and defective adduction Normal abduction Defective elevation Defective depression
- 10. Right third nerve misdirection • Rare, unilateral • Aberrant regeneration following acquired third nerve palsy • Pupil is occasionally involved • Bizarre movements of upper lid accompany eye movements Right ptosis in primary position Worse on right gaze Normal on left gaze
- 11. Horner syndrome • Caused by oculosympathetic palsy • Usually unilateral mild ptosis and miosis • Slight elevation of lower lid • Normal pupillary reactions • Iris hypochromia if congenital or longstanding • Anhydrosis if lesion is below superior cervical ganglion
- 12. Important causes of Horner syndrome Central (first order neurone) • Brainstem disease (vascular, demyelination) • Spinal cord disease (syringomyelia, tumours) Pre-ganglionic (second order neurone) • Intrathoracic lesions (Pancoast tumour, aneurysm) • Neck lesions (glands, trauma) Post-ganglionic (third order neurone) • Internal carotid artery disease • Cavernous sinus mass Posterior hypothalamus Ciliospinal centre of Budge( C8 - T2 ) Superior cervical ganglion
- 13. Marcus Gunn jaw-winking syndrome • Accounts for about 5% of all cases of congenital ptosis • Retraction or ‘wink’ of ptotic lid in conjunction with stimulation of ipsilateral pterygoid muscles Opening of mouth Contralateral movement of jaw
- 14. Myasthenia Gravis • Uncommon, typically affects young women 1. Clinical features • Edrophonium (Camiston) test 2. Investigations • Medical - anticholinesterases, steroids and azathioprine 3. Treatment options • Weakness and fatiguability of voluntary musculature • Three types - ocular, bulbar and generalized • Antibodies to acetylcholine receptors • CT or MRI for presence of thymoma • Electromyography to confirm fatigue • Thymectomy
- 15. Ocular myasthenia • Insidious, bilateral but asymmetrical • Worse with fatigue and in upgaze Ptosis • Ptotic lid may show ‘twitch’ and ‘hop’ signs • Intermittent and usually vertical Diplopia
- 16. Edrophonium test • Measure amount of ptosis or diplopia before injection • Inject i.v. atropine 0.3 mg • Inject i.v. test dose of edrophonium (0.2 ml-2 mg) • Inject remaining (0.8 ml-8 mg) if no hypersensitivity Before injection Positive result
- 17. Myotonic dystrophy Facial weakness and ptosis • Involvement of tongue and pharyngeal muscles • Ophthalmoplegia - uncommon • Muscle wasting • Hypogonadism • Frontal baldness in males • Intellectual deterioration • Presenile stellate cataracts Release of grip difficult
- 18. Ocular myopathies • Isolated • Oculopharyngeal dystrophy • Kearns-Sayre syndrome (pigmentary retinopathy) • Ptosis - slowly progressive and symmetrical • Ophthalmoplegia - slowly progressive and symmetrical (no diplopia) Clinical types Ocular features
- 19. Simple congenital ptosis • Developmental dystrophy of levator muscle • Occasionally associated with weakness of superior rectus Unilateral or bilateral ptosis of varying severity In downgaze ptotic eyelid is slightly higher Frequent absence of upper lid crease Usually poor levator function
- 20. Blepharophimosis syndrome • Rare congenital disorder • Dominant inheritance • Moderate to severe symmetrical ptosis • Short horizontal palpebral aperture • Telecanthus (lateral displacement of medial canthus) • Epicanthus inversus (lower lid fold larger than upper) • Lateral inferior ectropion • Poorly developed nasal bridge and hypoplasia of superior orbital rims
- 21. Aponeurotic ptosis • Weakness of levator aponeurosis • Causes - involutional, postoperative and blepharochalasis High upper lid crease Good levator function Absent upper lid crease Deep sulcus Mild Severe
- 22. Mechanical ptosis Causes Dermatochalasis Large tumours Severe lid oedema Anterior orbital lesions
- 23. Fasanella-Servat procedure Excision of upper border of tarsus, lower border of Muller muscle and overlying conjunctiva Indicated for mild ptosis with good levator function ..
- 24. Levator resection Shortening of levator complex Indicated for any ptosis provided levator function is at least 5 mm Amount determined by levator function and severity of ptosis
- 25. Frontalis brow suspension Attachment of tarsus to frontalis muscle with sling Main indications • Severe ptosis with poor levator function ( 4 mm or less ) • Marcus Gunn jaw-winking syndrome