It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
This presentation is a detailed description of how a patient should be examined in an oprthoptic clinic. it lists down all the investigations sequentially. the order of investigations mentioned is the best way to investigate a squint case.
This presentation is a detailed description of how a patient should be examined in an oprthoptic clinic. it lists down all the investigations sequentially. the order of investigations mentioned is the best way to investigate a squint case.
you will get knowledge about the ptosis, its different types, its examination, its measurement, its treatment in detail.
different eyelid muscles such as LPS, Orbicularis oculi and frontalis are also explained.
Ptosis is known as the drooping of the upper eyelid, and the patient usually presents with the complaint of the defect in vision and cosmesis. It can be congenital or acquired, or it can be neurogenic, myogenic, aponeurotic, mechanical, or traumatic in origin.
Ptosis: Clinical Anatomy, Diagnosis and Management Orangzeb Khatri
A descriptive and authentic ppt on lid anatomy, ptosis: its clinical evaluation and management taken from Yanoff, Kanski, and Oxford Ophthalmology. videos and photos are included. made from scratch, no slide is copied from any other ppt.
Congenital third ( oculomotor )nerve palsyVinitkumar MJ
Ask about pregnancy & birth history due to the association with birth trauma & perinatal complications.
Inquire whether the patient is meeting their developmental milestones or if they are exhibiting any other neurologic signs or symptoms. Although additional focal neurologic abnormalities or generalized delays in development have been described in these patients, their presence may increase concerns of other neurologic etiologies.
Determine whether they have signs of oculomotor synkinesis, such as asking the parents if they notice eye or eyelid movement during feeding.
Question if they have any family history of strabismus.
Heritability may suggest other forms of strabismus with known genetic associations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
2. PTOSIS
Ptosis is a Greek word which means: act of falling
Abnormal drooping of the upper eyelid is called ptosis.
Normally, upper lid covers about upper one-sixth of
the cornea i.e., about 2 mm.
In ptosis it covers more than 2 mm.
Normal Eyelids
Bilateral Congenital Ptosis
3. Congenital ptosis
Types and etiology
It is associated with congenital weakness (maldevelopment) of the levator palpebrae superioris
(LPS). It may occur in the following forms:
1. Simple congenital ptosis (not associated with any other anomaly)
2. Congenital ptosis with associated weakness of superior rectus muscle.
3. As a part of blepharophimosis syndrome, which comprises congenital ptosis,
blepharophimosis,telecanthus and epicanthus inversus.
4. Congenital synkinetic ptosis (Marcus Gunn jawwinking ptosis). In this condition there occurs
retraction of the ptotic lid with jaw movements i.e., with stimulation of ipsilateral pterygoid
muscle.
4. Simple congenital ptosis
1.Pathogenesis: Probably failure of neuronal migration or development with muscular sequelae;
a minority are hereditary.
2.Signs
•Unilateral or bilateral ptosis of variable severity.
•Absent upper lid crease and poor levator function.
•In downgaze the ptotic lid is higher than the normal because of poor relaxation of the levator
muscle. This is in contrast to acquired ptosis in which the affected lid is either level with or lower
than the normal lid on downgaze.
•Following surgical correction the lid lag in downgaze may worsen.
5. 3.Associations:
•Superior rectus weakness may be present because of its close embryological association with
the levator.
•Compensatory chin elevation in severe bilateral cases.
•Refractive errors are common and more frequently responsible for amblyopia than the ptosis
itself.
4.Treatment should be carried out during the preschool years once accurate measurements can
be obtained, although it may be considered earlier in severe cases to prevent amblyopia. Most
cases require levator resection (see below).
6.
7. Blepharophimosis syndrome
(Blepharophimosis ptosis and epicanthusinversus syndrome)
1.Inheritance is usually AD. BPES 1 (with premature ovarian failure) and BPES 2
(without premature ovarian failure) are caused by type 1 mutations in FOXL2 gene on
chromosome 3.
2. Signs
•Moderate to severe symmetrical ptosis with poor levator function.
•Telecanthus and epicanthus inversus
•Poorly developed nasal bridge and hypoplasia of the superior orbital rims.
3. Treatment initially involves correction of epicanthus and telecanthus, followed a few months
later by bilateral frontalis suspension. It is also important to treat amblyopia, which is present in
about 50% of cases.
8.
9. Marcus Gunn jaw-winking syndrome
About 5% of all cases of congenital ptosis manifest the Marcus Gunn jaw-winking phenomenon.
The vast majority are unilateral. Although the exact aetiology is unclear, it has been postulated
that a branch of the mandibular division of the 5th cranial nerve is misdirected to the levator
muscle.
1.Signs
•Retraction of the ptotic lid in conjunction with stimulation of the ipsilateral pterygoid muscles
by chewing, sucking, opening the mouth or contralateral jaw movement.
•Less common stimuli to winking include jaw protrusion, smiling, swallowing and clenching of
teeth.
•Jaw-winking does not improve with age, although patients may learn to mask it.
10. 2.Surgery should be considered if jaw-winking
or ptosis represents a significant functional or
cosmetic problem. Although no surgical
treatment is entirely satisfactory possible
approaches include:
a.Unilateral levator resection for mild cases
with levator function 5 mm or better.
b.Unilateral levator disinsertion and part
resection with ipsilateral brow (frontalis)
suspension for more severe cases.
c.Bilateral levator disinsertion and part
resection with bilateral brow suspension to
produce a symmetrical result.
11.
12. Clinical evaluation
Following scheme may be adopted for work up of a ptosis patient:
I. History. It should include age of onset, family history, history of trauma, eye surgery and variability
in degree of the ptosis.
II. Examination
1. Exclude pseudoptosis (simulated ptosis) on inspection. Its common causes are: microphthalmos,
anophthalmos, enophthalmos and phthisis bulbi.
2. Observe the following points in each case:
i. Whether ptosis is unilateral or bilateral.
ii. Function of orbicularis oculi muscle.
iii. Eyelid crease is present or absent.
iv. Jaw-winking phenomenon is present or not.
v. Associated weakness of any extraocular
muscle.
vi. Bell’s phenomenon (up and outrolling of the
eyeball during forceful closure) is present or
absent.
13. 3. Measurement of amount (degree) of ptosis. In unilateral cases, difference
between the vertical height of the palpebral fissures of the two sides indicates
the degree of ptosis (Fig. 14.33). In bilateral cases it can be determined by measuring
the amount of cornea covered by the upper lid and then subtracting 2 mm.
Depending upon its amount the ptosis is graded as
Mild 2 mm
Moderate 3 mm
Severe 4 mm
4.Margin–reflex distance is the distance between the upper lid margin and the
corneal reflection of a pen torch held by the examiner, at which the patient is
directly looking ; normal is 4–4.5 mm.
14.
15. 5.Levator function (upper lid excursion) is measured by placing a thumb firmly
against the patient’s brow to negate the action of the frontalis muscle, with
the eyes in downgaze (Fig. 1.51A). The patient then looks up as far as possible
and the amount of excursion is measured with a rule (Fig. 1.51B). Levator
function is graded as normal (15 mm or more), good (12–14 mm), fair (5–11
mm) and poor (4 mm or less).
16.
17. 6. Photographic record of the patient should be maintained for comparison.
Photographs should be taken in primary position as well as in up and down
gazes.
Anatomy of the Eyelid
1.The levator aponeurosis fuses with the orbital septum about 4 mm above the
superior border of the tarsus (Fig. 1.57). Its posterior fibres insert into the lower
third of the anterior surface of the tarsus. The medial and lateral horns are
expansions that act as check ligaments. Surgically, the aponeurosis can be
approached through the skin or conjunctiva.
18. 2.Müller muscle is inserted into the upper border of the tarsus and can be
approached transconjunctivally.
3.The inferior tarsal aponeurosis consists of the capsulopalpebral expansion
of the inferior rectus muscle and is analogous to the levator aponeurosis.
4.The inferior tarsal muscle is analogous to Müller muscle.
19.
20. Treatment
I. Congenital ptosis. It almost always needs surgical correction. In severe ptosis,
surgery should be performed at the earliest to prevent stimulus deprivation
amblyopia. However, in mild and moderate ptosis, surgery should be delayed until
the age of 3-4 years, when accurate measurements are possible.
Congenital ptosis can be treated by any of the
following operations:
1. Conjunctiva–Müller resection
Indications include mild ptosis with levator function of at least 10 mm. This
includes most cases of Horner syndrome and very mild congenital ptosis. The
maximal lift is 2–3 mm.
Technique. Müller muscle and overlying conjunctiva are excised (Fig. 1.58A)
and the resected edges reattached (Fig. 1.58B).
21.
22. Levator resection
1.Indications are ptosis of any cause provided levator function is at least 5 mm.
The extent of resection is determined by the amount of levator function and the
severity of the ptosis.
2.Technique involves shortening of the levator complex through either an anterior
(skin – Fig. 1.59) or posterior (conjunctival) approach.
25. Brow suspension
1.Indications
•Severe ptosis (>4 mm) with very poor levator function (<4 mm).
•Marcus Gunn jaw-winking syndrome.
•Ptosis associated with aberrant regeneration of the 3rd nerve.
•Blepharophimosis syndrome.
•Ptosis associated with 3rd nerve palsy.
•Unsatisfactory result from previous levator resection.
2.Technique involves suspension of the tarsus from the frontalis muscle with a sling
consisting of autologous fascia lata (Fig. 1.60) or non-absorbable material such as
prolene or silicone.