Case presentation-congenital & developmental cataractSivarathana
this case presentation is about congenital & developmental cataract, which is seen by me in our routine camp.and in this discussion many of things were dealt only theoretically not practically the case was seen in a camp as well.
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Ischemic optic neuropathy constitutes one of the major causes of blindness or seriously impaired vision among the middle-aged and elderly population.
Ischemic optic neuropathy is due to acute ischemia of the optic nerve. it can be classified into two, depending upon the part of the optic nerve involved:
1.Anterior ischemic optic neuropathy (AION)
-AION is due to acute ischemia of the front (anterior) part of the optic nerve (also called optic nerve head), which is supplied mainly by the posterior ciliary arteries.
-AION is divided into two types, depending on what causes it:
1.Arteritic AION: This is the most serious type and is due to a disease called giant cell arteritis or temporal arteritis.
2. Non-arteritic AION: This is the usual, most common type, with many different causes but not associated with giant cell arteritis.
2.Posterior ischemic optic neuropathy (PION). -
-PION is a much less common type. It is due to acute ischemia of the back (posterior) part of the optic nerve, located some distance behind the eyeball; this part of the optic nerve is NOT supplied by the posterior ciliary arteries
(Hayreh, 2009)
Neuro-ophthalmic Diagnoses You Don't Want To Miss !neurophq8
The presentation will discuss common life-threatening of vision-threatening neuro-ophthalmic emergencies.
Target: Ophthalmologists/Neurologists/Family Physicians/Internists/Emergency Physicians.
Case presentation-congenital & developmental cataractSivarathana
this case presentation is about congenital & developmental cataract, which is seen by me in our routine camp.and in this discussion many of things were dealt only theoretically not practically the case was seen in a camp as well.
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Ischemic optic neuropathy constitutes one of the major causes of blindness or seriously impaired vision among the middle-aged and elderly population.
Ischemic optic neuropathy is due to acute ischemia of the optic nerve. it can be classified into two, depending upon the part of the optic nerve involved:
1.Anterior ischemic optic neuropathy (AION)
-AION is due to acute ischemia of the front (anterior) part of the optic nerve (also called optic nerve head), which is supplied mainly by the posterior ciliary arteries.
-AION is divided into two types, depending on what causes it:
1.Arteritic AION: This is the most serious type and is due to a disease called giant cell arteritis or temporal arteritis.
2. Non-arteritic AION: This is the usual, most common type, with many different causes but not associated with giant cell arteritis.
2.Posterior ischemic optic neuropathy (PION). -
-PION is a much less common type. It is due to acute ischemia of the back (posterior) part of the optic nerve, located some distance behind the eyeball; this part of the optic nerve is NOT supplied by the posterior ciliary arteries
(Hayreh, 2009)
Neuro-ophthalmic Diagnoses You Don't Want To Miss !neurophq8
The presentation will discuss common life-threatening of vision-threatening neuro-ophthalmic emergencies.
Target: Ophthalmologists/Neurologists/Family Physicians/Internists/Emergency Physicians.
Headache: Neuroophthalmic Aspects for Med Studentsneurophq8
A review of the primary causes of headaches, which have a neuro-ophthalmic significance and are vision-threatening. Med Students are expected to recognize and refer these cases appropriately after completing this presentataion.
Transient loss of vision is common clinical problem that ophthalmologists and neurologists can face. This presentation will highlight clinical approach and important causes with management.
In this talk , we discuss the assessment and evaluation for patients presenting for cosmetic upper and lower lid blepharoplasty along with surgical technique.
Optic Neuritis and OCT in Multiple Sclerosis neurophq8
An overview of the update in optic neuritis and the utility of OCT in multiple sclerosis presented at the MS perceptorship in Dasman Institute in April 13 , 2017
Optic Neuritis and OCT in Multiple Sclerosis neurophq8
This talk was given in the MS preceptorship day in Dasman Institute . It discusses the advances in the diagnosis of optic neuritis and value of optical coherence tomography in MS patients.
This was a presentation given in the Kuwait Oculoplastic and Orbit meeting and will discuss the clinical approach and the diagnostic challenges associated with orbital IgG-4 RD and the recent diagnostic criteria with therapeutic options.
Optical Coherence Tomography in Multiple Sclerosisneurophq8
OCT is a non-invasive technology used in ophthalmology to assess retinal diseases and glaucoma. In recent years , OCT has been used to assess axonal loss and neurodegeneration in MS. This presentation will highlight the main uses of the OCT in MS and review of the literature.
Optic neuritis is a common presentation of MS. Physicians need to be aware of the typical presentation of ON and also be aware of the atypical signs and features that should incite a search for alternative diagnosis.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
4. Case
• 78 year old man with acute diplopia, and
headache.
• Headache and nausea .
• Diabetes, hypertension, atrial tachycardia.
• Limitation in adduction , elevation and
depression in the right eye.
5.
6.
7.
8. Pupil-involving 3rd
Nerve Palsy
• Posterior communicating artery
aneurysm, or mass.
• Appropriate neuro-imaging is (MRI/MRA,
MRI/CTA,Angiogram is the gold standard
for aneurysm detection).
• CTA is better for detecting aneurysms.
• MRI is better to rule out masses .
9. Risk of Aneurysm and
“Rule of Pupil”
Ophthalmoplegia Pupil Aneurysm Risk
Complete/Partial Complete 86%-100%
Partial Spared 30%
Complete Spared very low
If signs of sub-arachnoid hemorrhage present (headache, photophobia, nausea) “rule
10.
11. Acute Painful loss of
Vision
• A 30 year old lady presents with acute
“grey” vision in the left eye .
• Dull pain with eye movements .
• Visual acuity : 20/20 OD Count fingers OS
• Color vision : 13/13 OD 0/13 OS
• Pupils : Left RAPD
• Fundus : Normal
12. “Typical” Optic
Neuritis
• Women (77%)
• 20-50Year Age Group
• Pain with eye movements .
• Normal optic disc appearance (2/3 cases)
• Improvement over several weeks.
13. “Atypical” Optic Neuritis
• Bilateral onset in an adult.
• No pain.
• Ocular findings : uveitis, exudate, retinitis.
• Severe disc swelling and Hemorrhages
• No improvement after 6 weeks.
• Age > 50 years.
• Pre-existing diagnosis of a systemic disease.
23. Case
• A 70 year old woman with sudden loss of
vision in the right eye.
• Transient loss of vision and jaw pain.
• Feeling unwell lately with, and loss of
appetite ( 10 Kg) , malaise and myalgias.
• Hypertension on Metoprolol.
• Visual acuity: Count finger right , 20/30 left.
• Pupils : Right RAPD.
27. Temporal Arteritis
• Systemic vasculitis (Aortitis in 20% consider
PET/MRA).
• New onset of headache (temporal) , acute or
transient loss of vision, jaw claudication, weight loss,
fever, and myalgias.
• Age usually over 60.
• Occult GCA ( No systemic symptoms, transient diplopia
or transient visual loss).
• A true neuro-ophthalmic emergency (54-95% second eye
involvement if untreated) !
29. GCAVisual loss
Management
• Stat ESR , CRP and CBC (platelets).
• CRP and CBC have 97% sensitivity and specificity.
• Start high dose systemic steroids (IV or Oral)
immediately upon suspicioun ( AAION or CRAO can
develop in fellow eye within days if untreated !)
• Arrange for temporal artery biopsy within 2 weeks ,
while patient is on steroids.
32. • A 67 year old man presents with pain in his right eye
for 5 days associated with neck pain after
chiropractic treatment.
• Hypertension and ischemic heart disease on treatment.
• No double vision.
• VA : 20/30 OU.
• Right partial ptosis (1 mm with right pupil smaller then
left more in dark than light)
Case
34. Evaluation of Horner’s
• Misois, and ptosis (upper and lower lid).
• Dilatation lag, anisocoria worse in dark.
• Topical Cocaine test-> Horner’s pupil will
not dilate (Greater Anisocoria)
• Hydroxyamphetamine test – distinguish
pre- from post-ganglionic
• Apraclonidine Reversal of Anisocoria.
35. Acute Horner’s
Syndrome
• Painful Horner’s syndrome is a neurologic
emergency.
• Although can be seen in many types of
headaches (Cluster, Migraine etc).
• Rule out ICA dissection.
• MRI/MRA of the head/neck/upper
mediastinum is indicated.
40. Case
• 52-year-old previously healthy presents
with severe headache and blurred vision in
both eyes.
• Visual acuity 20/80 OD and 20/60 OS.
• Confrontation visual fields : Bitemporal
Hemianopia.
44. Pituitary Apoplexy
• “Worst headache in my life”.
• Visual field loss, and/or ophthalmoplegia ( uni- or
bilateral).
• Patients usually present 2 weeks after ictus.
• > 80% did not have history of pituitary tumor
• Life threatening (hypotension, shock) because of
hypo-pituitarism, and low cortisol levels, and diabetes
insipidus.
46. Case
• A 24 year old woman with blurred vision
and mild headache for the last 6 weeks.
• Headaches are severe 10/10 scale , worse in
the morning and leaning forward.
• Weight gain of 15 kilos over the last 3
months
• Visual acuity : 20/20 OU
50. Papilledema
• Bilateral disc edema due to raised ICP.
• Normal visual acuity.
• Visual fields : enlarged blind spots (early)
51. Case
• CT with contrast and MRI/MRV - normal.
• Lumbar puncture – Opening CSF pressure
of 500 mm/Hg.
• Normal CSF analysis.
52. Idiopathic Intracranial
Hypertension
1.1. Signs and symptoms of increased ICP.Signs and symptoms of increased ICP.
2.2. No localizing neurological signs (except uni/bilateral VINo localizing neurological signs (except uni/bilateral VI
nerve palsy)nerve palsy)
3.3. No evidence of an intracranial mass lesionNo evidence of an intracranial mass lesion
4.4. Normal CSF compositionNormal CSF composition
55. Malignant Hypertesnion
• Accelerated hypertension with target organ
damage.
• Papilledema must be present for diagnosis !
• Dysfunction of cerebral blood flow
autoregultaion causing cerebral edema.
• Pre-eclampsia .
• Encephalopathy can be present.
57. • A 55 year old woman with with painful
proptosis in the left eye .
• Medical History : Rheumatoid Arthritis
treated by NSAID.
• Visual acuity : 20/20 Both eyes.
• Anterior Segment : Conujnctival hyperemia
• Exophthalmometry : 24 mm and 20 mm OS
• Normal pupils, ocular motility and fundus
examination.
Case
60. Graves Disease
• Female with underlying thyroid disease .
• Typically bilateral but can be unilateral.
• Lid retraction , lid lag , and chemosis .
• CT : extraocular muscle enlargement , fat
expansion .
62. Treatment
• Medical : tears and cold compressors , IV
Steroids, Rituximab.
• Surgical (inactive phase) : Orbital
decompression , strabismus surgery , eyelid
repositioning , Blepharoplasty .
• Orbital radiation
63. Orbital Inflammatory
Disease
• Males = Females
• Acute onset , no eyelid lag or retraction .
• CT : enlarged and irregular muscles , often
unilateral.
• Can be associated with systemic disease
(SLE , Crohn’s , GPA , Rheumatoid Arthritis).
66. Orbital Cellulitis
•Fever and leukocytosis , patient is ill.
•Sinusitis , dacryocystitis, dycryoadenitis.
•Less common is trauma or endogenous
speread.
•Beware in diabetes mellitus and
immunocompromised patients (mucormycosis)
!
70. Periorbital Necrotizing Fasciitis
• Severe, potentially vision-threatening or life-
threatening bacterial infection involving the
subcutaneous soft tissues, and superficial and deep
fasciae.
• Group A beta-hemolytic Streptococcus , other
gram positive and gram negative organisms.
• Immunocompromised (diabetes) and
immunocompetent patients.
• Initial presentation (pre-septal cellulitis , shock like
syndrome) hypotension, renal failure, and adult
respiratory distress syndrome.
71. Orbital Cellulitis
• Treatment : IV antibiotics , anti-fungal agents.
• Close monitoring for complications
(intracranial extension , or cavernous sinus
involvement)
• Additional debridement : Mucormycosis,
Necrotizing Fasciitis.
• ENT consultation for drainage of sinuses
(FESS) or abscess drainage .