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.
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.
The presentation I have made and uploaded provides you with an in-depth insight into the patterns the strabismus may take following anomalies of extraocular muscles, deformities of the orbital structures,innnervational disturbances.
The author does not assume responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
No copyright infringement, or plagiarism intended.
Amrit Pokharel
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.
The presentation I have made and uploaded provides you with an in-depth insight into the patterns the strabismus may take following anomalies of extraocular muscles, deformities of the orbital structures,innnervational disturbances.
The author does not assume responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
No copyright infringement, or plagiarism intended.
Amrit Pokharel
This presentation is primarily based on an article Titled "Rehabilitation of Unilateral Spatial Neglect: New Insights from Magnetic Resonance Perfusion Imaging" by Argye E Hillis., Arch Phys Med Rehabil 2006;87(12 Suppl 2):S43-9.
Aim of this presenattaion was to give an insight to my students about Rehabilitation of Unilateral Spatial neglect
It is one of the most viewed document from Pgblaster India website: Disorders of ocular motility with an emphasis on squint. In this document I have tried to give some important concepts of the different types of squints in simple words.At a glance, it is a much harder and complex topic of ophthalmology but I had made it as simpler as I could. Hope it will help you..
Corneal topographer is a useful tool for our clinical investigations on patient's with corneal problem. Knowing about its principle, function and interpretation is important.
Cataract management in children from optometrist perspectiveAnis Suzanna Mohamad
Congenital and childhood cataracts are uncommon but regularly seen in the clinics of most paediatric ophthalmology teams in the UK. They are often associated with profound visual loss and a large proportion have a genetic aetiology, some with significant extra-ocular comorbidities. Optimal diagnosis and treatment typically require close collaboration within multidisciplinary teams. Surgery remains the mainstay of treatment. A variety of surgical techniques, timings of intervention and options for optical correction have been advocated making management seem complex for those seeing affected children infrequently.
National Ocular Biometry Course (NOBC) 2015 An echoslide presentation Anis Suzanna Mohamad
This powerpoint presentation is basically about ocular biometry. Echo presentation is one of the method to deliver infomation that obtain from the course we attend to other staff in our Ophthalmology Department.
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How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
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7. • Look at the smaller field
• The greatest inward displacement represents the
primary underaction
• The greatest outward displacement indicates an
overaction
• Look at the larger field
• The greatest outward displacement is the main
overaction and is usually of the contralateral
synergist
8. 1. Is Hess chart useful in all cases of
strabismus?
No. It is useful only for incomitant strabismus.
9. • The patient must possess NRC and central
fixation
• Should always be considered together with
assessment of ocular movements
• May be performed on a Hess screen or a
Lees Screen
10. 2. What features of the Hess chart are used
for interpretation?
The position, size, shape are compared between the two
eyes. The deviation between the two eyes can also be
calculated.
11. 3. What does the position of fields in Hess
chart indicate?
POSITION = DEVIATION
The central dot in each field indicates the deviation in
the primary position.
Each small square subtends an angle of 5 degrees at
the 50 cm working distance.
The displacement of the pointer from the dot is a
measure of the size of the deviation.
12.
13. 4. What information can be obtained from
the size of the Hess chart?
The eye with the small field is the effected eye.
Presence of a compressed field indicates a mechanical
cause.
14. • Mechanical
• Compressed fields
• Limited muscle
sequelae
• Binocular single vision
is often present in the
primary position
• Neurogenic
• Less compressed
• Muscle sequelae not
limited and eventually
become concomitant
• Deviation in primary
position reflects
extent of palsy
15. 5. What can be obtained from the shape of
Hess chart?
Charts with sloping fields indicates the presence of A
and V patterns.
Look at the separation of the inner filed in up and down
gaze.
16. 6. In neurogenic strabismus, the muscle
sequelae make the Hess charts between
the two eyes become more similar in
size. What laws govern the muscle
sequelae?
Hering’s law of equal innervation
Sherrington’s law of reciprocal innervation
17. • Innervation to the extraocular muscles is equal to both
eyes.
• Thus, when a nervous impulse is sent to an ocular
muscle to contract, an equal impulse is sent to its
contralateral synergist to contract.
18. • The contraction of a muscle is accompanied by
simultaneous and proportional relaxation of its
antagonist.
• For example, if the superior oblique muscle contracts, its
antagonist, the inferior oblique muscle, relaxes.
19. 7. What are the three stages in the
development of muscle sequelae?
1. Overaction of contralateral synergist according to
Hering’s law.
2. Overaction of the ipsilateral antagonist as its action is
unopposed by the paralysed muscle.
3. Secondary underaction of the contralateral antagonist.
20. 8. Using the information in Q7, can you
predict the muscle sequelae in left
superior oblique?
1. Overaction of contralateral synergist according to Hering’s law.
RIR o/a
2. Overaction of the ipsilateral antagonist as its action is unopposed
by the paralysed muscle. LIO o/a
3. Secondary underaction of the contralateral antagonist. RSR u/a
S
R
L
R
IR
IO
MR
SO
IO S
R
MR
SO IR
L
R
21.
22.
23. 1) Which muscle are underacting?
• The right and the left superior oblique muscles
• The left SO is effected more than right
2) Which muscles are overacting?
• The right and the left inferior rectus
• The right and the left superior rectus
3) What is the diagnosis?
• Bilateral asymmetrical fourth nerve palsy
24.
25. 1) What type of strabismus is this?
• A mechanical one. The field are compressed vertically.
2) Is the eye straight in the primary position?
• The field indicates that the patient is likely to have convergent
squint as the dot on the central field is move nasally.
3) What is the diagnosis?
• Left Duane’s Syndrome of the type A (according to Brown’s
classification): with limited abduction> limited adduction.
26.
27. 1) What type of strabismus is this?
• A mechanical one. The right field is compressed.
2) Is the eye straight in the primary position?
• The right eye is hypotropia and exotropia (down and out).
3) What is the diagnosis?
• Right third nerve palsy
28.
29. 1) What type of abnormality is seen in this patient?
• A mechanical one. The left field is compressed.
2) In which direction is the affected eye likely to be
restricted?
• Left upgaze and downgaze.
3) What is the diagnosis?
• Left orbital floor fracture causing restriction of the inferior rectus
movement.
30.
31. 1) Which is the abnormal eye?
• The left eye (note the smaller field).
2) Which muscle is underacting ?
• The left superior oblique muscle.
3) Which muscle is overacting ?
• The right inferior rectus muscle.
4) Is the long-standing palsy ?
• No, the muscle sequelae have not fully developed.
5) What is the diagnosis
• Left superior oblique palsy.
32.
33. 1) Which is the abnormal eye?
• The right eye (note the smaller field).
2) Which muscle is underacting ?
• The right lateral rectus muscle.
3) Which muscle is overacting ?
• The left medial rectus muscle.
1) What is the diagnosis
• Right sixth nerve palsy.
34.
35. 1) Which is the abnormal eye?
• The right eye (note the compressed field).
2) Which muscle is underacting ?
• The right superior oblique muscle.
3) Which muscle is overacting ?
• The right superior rectus muscle.
4) What type of abnormality is seen in this patient ?
• A mechanical one.
5) What is the diagnosis
• Right Brown’s Syndrome.
• The Hess chart is typical with abnormal field superior but
normal inferior field.
36.
37. 1) What is the primary position of the affected eye?
• LE hypotropia as the affected left central dot is below the centre on
the chart.
2) In which direction is the affected eye likely to be
restricted?
• Left upgaze and abduction (note the inward displacement of
the left lateral rectus .
3) What is the diagnosis?
• Left Thyroid Eye Disease.
38.
39. • Underactions and overactions
• Affected eye
• A or V Patterns
• Type of deviation in primary position
• Size of deviation – each box = 5°
• Muscle sequelae
• Differential diagnosis between recent and
longstanding
• Differential diagnosis between neurogenic and
mechanical defects
Hess charts are common questions in the OSE and final MRCOphth. A short tutorials on its principles and some exercises should help every candidate to answer the most commonly encountered cases
Secondary underaction of the contralateral antagonist.
-This occurs for two reasons:-
1) As the ipsilateral antagonist action is unopposed, less impulse is needed to move it into its desired position and subsequently according to Hering’s law, its contralateral synergist receives less impulse and therefore underact.
2) Overaction of the contralateral synergist means that its ipsilateral antagonist will receive equal impulse to relax according to the Sherrington’s law.
Secondary underaction of the contralateral antagonist.
-This occurs for two reasons:-
1) As the ipsilateral antagonist action is unopposed, less impulse is needed to move it into its desired position and subsequently according to Hering’s law, its contralateral synergist receives less impulse and therefore underact.
2) Overaction of the contralateral synergist means that its ipsilateral antagonist will receive equal impulse to relax according to the Sherrington’s law.