LIMBUS… • The limbus forms the border between the transparent cornea and opaque sclera, contains the pathways of aqueous humour outflow, and is the site of surgical incisions for cataract and glaucoma
2. Anatomical Limbus: Circumcorneal transitional zone of the conjunctivocorneal & corneoscleral junction Conjunctivo-corneal junction: • Bulbar conjunctiva is firmly adherent to underlying structures • Substantia propria of the conjunctiva stops here but its epithelium continues with that of the cornea. Sclero-corneal junction: • Transparent corneal lamellae become continuous • With the oblique, circular and opaque fibres of sclera
3. CONTINUE…. • In the area near limbus, the conjunctiva, tenon’s capsule & the episcleral tissue are fused into a dense tissue which is strongly adherent to corneo scleral junction.It is preferred site for obtaining a firm hold of the eyeball during ocular surgery. • The limbus is a common site for the occurrence of corneal epithelial neoplasm. • The Limbus contains radially oriented fibrovascular ridge known as the palisades of Vogt that may harbour a stem cell population. The palisades of Vogt are more common in the superior and inferior quadrants around the eye
LIMBUS… • The limbus forms the border between the transparent cornea and opaque sclera, contains the pathways of aqueous humour outflow, and is the site of surgical incisions for cataract and glaucoma
2. Anatomical Limbus: Circumcorneal transitional zone of the conjunctivocorneal & corneoscleral junction Conjunctivo-corneal junction: • Bulbar conjunctiva is firmly adherent to underlying structures • Substantia propria of the conjunctiva stops here but its epithelium continues with that of the cornea. Sclero-corneal junction: • Transparent corneal lamellae become continuous • With the oblique, circular and opaque fibres of sclera
3. CONTINUE…. • In the area near limbus, the conjunctiva, tenon’s capsule & the episcleral tissue are fused into a dense tissue which is strongly adherent to corneo scleral junction.It is preferred site for obtaining a firm hold of the eyeball during ocular surgery. • The limbus is a common site for the occurrence of corneal epithelial neoplasm. • The Limbus contains radially oriented fibrovascular ridge known as the palisades of Vogt that may harbour a stem cell population. The palisades of Vogt are more common in the superior and inferior quadrants around the eye
Gives a very brief review of how to evaluate a case of squint in day to day clinical practice. How to diagnose a basic abnormality of the movement of eye.
Accommodation/ Accommodation of Eye, Measurement of Accommodation of Eye (hea...Bikash Sapkota
CLICK HERE TO DOWNLOAD FULL PPT ❤❤ https://healthkura.com/measurement-of-accommodation-of-eye/ ❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Measurement of Accommodation of eye:
Amplitude, Facility,
Relative Accommodation, Fatigue, Lag,
Dynamic Retinoscopy
Presentation Layout:
-Introduction to accommodation of eye
-Mechanism
-Components
-Measurement of accommodation of eye
- Amplitude
- Facility
- Relative accommodation
- Lag
-Dynamic Retinoscopy
Accommodation
-dioptric adjustment of the crystalline lens of the eye
- to obtain clear vision for a given target of regard
-process by which the refractive power of eye is altered
- to ensure a clear retinal image
For further reading
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates
Maddox Rod
Use of Maddox Rod
Method of Assessment MR
Double MR Test procedure
Recording procedure of MR Test
Heterophoria, Cyclophoria, Esophoria,Exophoria,Hyperphoria,Hypophoria
Direct Download Link ❤❤https://healthkura.com/eye-ppt/28/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com/eye-ppt/❤❤❤
anatomy of optic nerve and its blood supply and clinical corelation
Presentation Layout: optic nerve anatomy
Embryology of optic nerve
Introduction
Parts of optic nerve
Blood supply
Clinical significance
For Further Reading
Wolff’s Anatomy of the eye and orbit by Bron, Tripathi and Tripathi
Anatomy and Physiology of eye by A.K. Khurana 2nd edition
Comprehensive Ophthalmology by A.K. Khurana 5th edition
AAO- Fundamentals & Principles of Ophthalmology : sec 2
Walsh and Hoyt’s Clinical Ophthalmology
Internet
Gives a very brief review of how to evaluate a case of squint in day to day clinical practice. How to diagnose a basic abnormality of the movement of eye.
Accommodation/ Accommodation of Eye, Measurement of Accommodation of Eye (hea...Bikash Sapkota
CLICK HERE TO DOWNLOAD FULL PPT ❤❤ https://healthkura.com/measurement-of-accommodation-of-eye/ ❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Measurement of Accommodation of eye:
Amplitude, Facility,
Relative Accommodation, Fatigue, Lag,
Dynamic Retinoscopy
Presentation Layout:
-Introduction to accommodation of eye
-Mechanism
-Components
-Measurement of accommodation of eye
- Amplitude
- Facility
- Relative accommodation
- Lag
-Dynamic Retinoscopy
Accommodation
-dioptric adjustment of the crystalline lens of the eye
- to obtain clear vision for a given target of regard
-process by which the refractive power of eye is altered
- to ensure a clear retinal image
For further reading
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates
Maddox Rod
Use of Maddox Rod
Method of Assessment MR
Double MR Test procedure
Recording procedure of MR Test
Heterophoria, Cyclophoria, Esophoria,Exophoria,Hyperphoria,Hypophoria
Direct Download Link ❤❤https://healthkura.com/eye-ppt/28/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com/eye-ppt/❤❤❤
anatomy of optic nerve and its blood supply and clinical corelation
Presentation Layout: optic nerve anatomy
Embryology of optic nerve
Introduction
Parts of optic nerve
Blood supply
Clinical significance
For Further Reading
Wolff’s Anatomy of the eye and orbit by Bron, Tripathi and Tripathi
Anatomy and Physiology of eye by A.K. Khurana 2nd edition
Comprehensive Ophthalmology by A.K. Khurana 5th edition
AAO- Fundamentals & Principles of Ophthalmology : sec 2
Walsh and Hoyt’s Clinical Ophthalmology
Internet
The pupil is an opening located in the center of the iris that allows light to enter the retina. • Its function is to control the amount of light entering the eye and it does this via contraction (miosis) and dilation (mydriasis) under the influence of the autonomic nervous system
3. • The iris is a contractile structure, consisting mainly of smooth muscle, surrounding the pupil. Light enters the eye through the pupil, and the iris regulates the amount of light by controlling the size of the pupil.
4. The iris contains two groups of smooth muscles: a circular group called the sphincter pupillae. and a radial group called the dilator pupillae.
5. Parasympathetic pathway • First Order – Retina to Pretectal Nucleus in B/S (at level of Superior colliculus) Second Order – Pretectal nucleus to E/W nucleus (bilateral innervation!) Third Order – E/W nucleus to Ciliary Ganglion Fourth Order – Ciliary Ganglion to Sphincter pupillae (via short ciliary nerves) • • •
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
3. Why?
To find disorders of the pupillary function.
To detect disorders of the afferent visual system and
autonomic innervation of eye.
A systemic approach for interpretation of the findings.
The examination should be done in a logical order
since the pupillary system responds in a logically
predictable way
4. Pupil: Aperture in the centre of Iris
Number :
Normal : One pupil In each eye
Abnormal : More than one pupil in
each eye (polycoria)
5. True Polycoria:
Each Pupil will have its own, intact
sphincter muscle. Each pupil will
individually constrict and dilate.
False or pseudopolycoria:
Don’t have separate sphincter
muscles.
Holes in Iris look like
additional pupils
6. Location:
Normal: Almost in the centre (slightly nasal) of iris.
Abnormal: Placed Eccentrically (Eccentric Pupil)
(correctopia)
Sector Iris HypoplasiaColobomatous lesions
Correctopia+ Lens subluxation:
Ectopia lentis et pupillae
7. Shape:
Normal: Circular
Abnormal: Tadpole shaped Pupil
Hypersympathetic activity affects only a portion of the pupillary dilators, the pupil loses its normal, circular shape.
Irregular oval shape or a circle with a narrow segment that extends in the direction of the affected dilators.
10. Physiological changes in size:
Pupils tend to dilate during
emotional stress and constrict
during sleep.
Pupillary unrest:
Refers to the constant fluctuation
in pupillary diameter under
normal environmental condition.
Hippus(jumping Pupil);
Exaggeration of the pupillary
unrest i.e. fluctuation in
pupillary diameter which can be
easily detected on visual
inspection without
magnification.
11. Abnormal:
Congenital Miosis:
tapetoretinal degenrations can be isolated finding.
Persistent Mydriasis:
Develops during the second or third decade.
Anisocoria:
Difference in the size of two pupils (cor: pupil, aniso: difference)
13. Functions:
Limits the amount of light reaching the retina.
Controls the amount of chromaticand spheric aberration in the
retinal image.
Allows the passage of aqueous humor from the anterior to the
posterior chamber.
15. Pupillary light reaction
When light is shown in one eye, both pupils constrict.
Constriction of the pupil to which light is shown Direct Light Reflex
Constriction of the other pupil Consensual (indirect) light reflex
Why?
Pupillary constriction in response to light protects against excessive bleaching of the
visual pigment by reducing the amount of light entering the eye.
Helps in light and dark adaptation, thus maximises visual acuity at different light
levels.
18. Psychosensory reflex
Dilatation of pupil in response to sensory and psychic stimuli
Fully developed by six months of age
Pathways are unknown
Components:
Sympathetic discharge to dilator pupillae muscle
Inhibition of parasympathetic discharge to sphincter pupillae muscle
19. Performing the exam
Tip 1: Seating Position
Ask the patient to sit comfortably on a chair while you sit on one side of the patient & never directly in front
of the patient. Sit to the side to avoid obstructing the patient’s view when you ask the patient to fixate at a
distant target.
20. Tip 2: Fixation
Ask the patient to maintain fixation on a distant target. The pupils constrict when
the eyes focus at near. The patient must look at a distant target in order to prevent
accommodation associated miosis that can confound your pupil exam.
21. Tip 3: Room Lighting
Examination of pupil should be done in a room with dim illumination in order to avoid
constriction caused by a brightly lit room.
22. Tip 4: Illumination
Use an evenly bright source of illumination for examining the light reflexes. Lights
with uneven illumination patterns may cause variable constriction of the pupils.
23. Tip 5: Dark Irises
It is often difficult to view a consensual pupillary response in patients with dark
irises in dark rooms. In these cases, you can use a dim secondary light held below
the pupils in addition to your bright primary light that you use to elicit the pupillary
response. If your secondary light is too bright it will cause undesirable constriction
of the pupil.
24. Systemic Examination Of the Pupils
Step 1: Confirm that the pupils respond to light
Dim Light
Ask the patient to look into distance to limit intrusion by miosis of the near reflex.
Using a strong light source, stimulate both the eyes simultaneously.
Both pupils will constrict symmetrically.
Step 2: Compare the Pupillary diameters to one another.
Determines whether the autonomic (efferent) innervation of the eye is intact.
If there is anisocoria, repeat testing of both pupil’s responses to a strong, binocular
light stimulus.
25. Step 3: Swinging flashlight test
Compares the afferent pupillary responses of one eye to the other.
26. Step 4: Examination of the pathologic findings
Pathologic states are:
A relative afferent pupillary defect (RAPD)
An anisocoria with normal responses to light in both eyes.
A monocular or bilateral deficit in light responses.
27.
28. Absolute/ Total Afferent Pathway Defect(TAPD)
or Amaurotic pupil
When the normal eye is stimulated,
both pupils react normally
In diffuse illumination, both pupils
are normal in size.
The near reflex is normal in both
eyes.
When the affected pupil is
stimulated by light-neither pupil
reacts.
• Absence of direct reflex on the
affected side.
• Absence of consensual reflex on
the normal side.
29. Cause:
Due to lesions of the optic nerve , the affected eye is completed
blind ( no perception of light)
Seen in: Complete optic nerve lesions( Optic atrophy)
• Ischaemic optic neuropathy
• Glaucomatous optic neuropathy
• Acute optic neuritis
• Traumatic optic nerve avulsion
30. Relative Afferent Pathway Defect (RAPD) or Marcus-Gunn Pupil
When the normal eye is stimulated, both pupils constrict.
When the affected eye is stimulated, both pupils dilate.
When the normal eye is again stimulated, both pupils constrict once more.
Cause:
When the light is swung to the diseased eye,
the stimulus delivered to the constriction
mechanism is reduced and both pupils
paradoxically dilate instead of constricting.
31.
32. Seen in :
Optic Nerve disorders:
Optic Neuritis
Ischemic optic neuropathies- AION/NAAION
Glaucoma: If severe and unilateral disc involvement.
Traumatic optic neuropathy
Compressive optic neuropathy
Surgical damage to Optic nerve
Heritable: LHON
Radiation optic nerve damage
Retinal Disorders:
RD (if macula is detached, or if atleast two quadrants of retina are detached)
OIS
Ischemic CRVO/Severe BRVO
CRAO
Unilateral Severe ARMD
Intraocular tumors
33. Grades of RAPD
Grades of RAPD Observation
I Weak initial constriction and greater redilatation.
II Initial stall and greater redilatation
III Immediate pupillary dilatation
IV Immediate pupillary dilatation following prolonged
illumination of the good eye for 6 seconds.
V Immediate pupillary dilatation with no secondary
constriction
RAPD
When an RAPD is found, the cause must be identified.
If the cause cannot be found, perimetric examination of both eyes is necessary
34. Wernicke’s Hemianopic Pupil
Light reflex( ipsilateral direct and contralateral consensual)
absent when light is thrown on the temporal half of the retina of the
affected side and nasal half of the retina of the opposite side.
Present when light is thrown on the nasal half of the affected side
and temporal half of the opposite side.
Cause:
The temporal visual field is larger than the nasal field.
Temporal retina has more pupillomotor sensitivity than nasal retina.
Seen in:
Lesions of Optic Tract
35.
36.
37.
38. To differentiate:
In afferent (sensory Lesions), the pupils are equal in size
Anisocoria ( inequality in pupil size) implies disease of
the efferent(motor ) nerve, iris or muscles of pupil.
Lesion of the short ciliary
nerve/ Ciliary ganglion
Affected Pupil
Large
Reaction to light : absent
Near reflex: slow and tonic
Accommodative paresis
Cholinergic supersensitivity of denervated muscle
(constricts with 0.125% pilocarpine)
Seen in:Local tonic pupil:
Viral ciliary ganglionitis
Orbital or choroidal trauma or tumors
Blunt trauma to the globe
Neuropathic tonic pupil:
Part of spectrum of peripheral neuropathy
of DM, alcoholism
39.
40.
41.
42. Testing with pilocarpine 1% and 0.1%
Pilocarpine 0.1%
Indication: Diagnosis of a
tonic pupil is suspected
The tonic pupil has a
characteristic denervation
hypersensitivity to a
cholinergic stimulus, which
can be associated with adie’s
syndrome or a paresis of the
oculomotor nerve.
Pilocarpine 1%
Indications:
Light
Maximal accommodative effort or
Weak pilocarpine will not cause the
pupil to constrict.
Providing a drug induced
mydriasis, if an anticholinergic
drug( such as atropine or
scopolamine) has produced a
pharmacologic dilatation.
Fails to constrict pupil
Problem within the iris and pupil
itself
Pupillary miosis
Oculomotor palsy
43. Pupillary involvement in oculomotor paralysis
Cause: Damage to the third cranial nerve at locations between the oculomotor nucleus and the ciliary
ganglion.
Pupillary mydriasis: Internal ophthalmoplegia
Compressive mechanism, such as by a tumour or an aneurysm
No pupillary company with a progressive loss of third nerve function : primary aberrancy
Sign of a slowly growing mass lesion in the cavernous sinus.
44.
45.
46.
47. Adie’s Tonic pupil Argyll Robertson pupil
Unilateral Bilateral
Dilated pupil Small, irregular pupils
Accommodation reflec slow and prolonged Accommodation reflex present
Absent or sluggish light reflex Absent light reflex
Cholinergic hypersensitivity No such phenomenon
48.
49. Horner syndrome
Monocular loss of sympathetic innervation to the eye.
Loss of function in all of the ocular structures that are sympathetically controlled.
Pupil is smaller, but the light reaction remains normal.
A ptosis of the upper lid, caused by paresis of muller’s muscle.
A small elevation of the lower lid.
Apparent enophthalmos due to narrowing of the palpebral fissure.
Impaired sweating and temperature regulation in the face: if the site of damage
to the sympathetic path lies proximal to the branching of the fibres.
50. 1% Hydroxyamphetamine, 2.5% tyramine test
Stimulating the release of noradrenalin into the
synaptic cleft at the terminus of the end neuron of the
sympathetic chain.
Measure diameter of both pupils:
Before 45 min after instillation of the drops.
Unaffected pupil dilates well and the affected pupil
dilates by 0.5mm or less.
Site of damage
Third (terminal) neuron of the sympathetic pathway, i.e.
at or above the ganglion cervicale superius of the
sympathetic chain.
(post ganglionic)
Affected pupil dilates as well or better than its
contralateral partner.
Site of Damage
Below the level of the ganglion cervicale superius, i.e. in the first
or second order neurons of the sympathetic pathway. (pre
ganglionic)
56. Constriction
Recheck For Tonic Pupil
Constriction
3rd Cranial Nerve
Palsy
Drug Induced
No Response
1% Pilocarpine
No Response
0.125% Pilocarpine
No Light Near Dissociation
59. TAKE HOME MESSAGE
• Examination of the pupils and pupillary reflexes are crucial
in obtaining an accurate diagnosis of an ophthalmological
problem and many other systemic conditions.
• It is a relatively simple examination that can be performed
at most patients’ bedsides and is a skill all clinicians should
have.
• Familiarise yourself with the variations of normal pupils
and their reflexes.
• Anisocoria of more than 1mm should always be questioned
/ investigated further.
• Have a low threshold for further testing and imaging.