in this presentation, we discussed about thyroid gland and their hormone briefly , TED, interpretation of thyroid test report , sign and symptoms , classification systems and grading system and management
This document discusses visual field testing and perimetry. It defines the visual field and describes common visual field defects. It then covers the indications, methods, and terminology of visual field testing. Specific details are provided on threshold testing strategies, reliability indices, and how to interpret visual field printout maps and global indices. Criteria for diagnosing glaucomatous visual field loss and detecting progression over time are also outlined.
This document provides color coding guidelines for documenting corneal conditions. Black is used to outline structures and indicate scars, thinning, and nerves. Red denotes blood vessels, growths, lacerations, and congestion. Brown is used for pigmentation, rings, and old conditions. Yellow indicates pigmentation, deposits, infiltrates, and cataracts. Green represents defects, filaments and edema. Blue shows overall edema, folds, and blisters. Precise documentation using these color codes allows for standardization, easy follow-up and teaching regarding various corneal pathologies.
Therapeutic contact lenses are used for therapeutic, diagnostic and cosmetic purposes to treat various ocular surface diseases and conditions. They provide mechanical protection and support to the cornea, maintain corneal epithelial hydration, and can be used to deliver medications to the eye. The type of therapeutic contact lens chosen depends on the specific condition being treated and should aim to maximize oxygen to the cornea unless the eye has no vision. Common complications include ocular redness, minor corneal edema and lens deposits which require regular follow up visits.
The document outlines the anatomy, blood supply, evaluation methods, and appearance of the optic nerve head. It discusses the anatomy in detail, including the components and organization of nerve fibers in the optic nerve head. Evaluation methods covered include clinical examination, structural analysis using slit lamp biomicroscopy, HRT, GDx, OCT, and functional analysis using visual field testing. The normal appearance and variations of structures like the neuroretinal rim, optic cup, and blood vessels are described. Changes in glaucoma like cupping, notching, and rim thinning are also outlined.
This document discusses the corneal endothelium and techniques for assessing its health and function. The corneal endothelium is a single layer of hexagonal cells that maintains corneal clarity by pumping fluid out of the stroma. Assessment techniques described include specular microscopy, which allows analysis of endothelial cell density, morphology, and patterns under high magnification; confocal microscopy; anterior segment OCT; and ultrasound pachymetry to measure corneal thickness as an indicator of endothelial function. Common indications for assessment include pre- and post-operative evaluation, and evaluation of donor corneas for transplantation.
This document discusses visual field testing and perimetry. It defines the visual field and describes common visual field defects. It then covers the indications, methods, and terminology of visual field testing. Specific details are provided on threshold testing strategies, reliability indices, and how to interpret visual field printout maps and global indices. Criteria for diagnosing glaucomatous visual field loss and detecting progression over time are also outlined.
This document provides color coding guidelines for documenting corneal conditions. Black is used to outline structures and indicate scars, thinning, and nerves. Red denotes blood vessels, growths, lacerations, and congestion. Brown is used for pigmentation, rings, and old conditions. Yellow indicates pigmentation, deposits, infiltrates, and cataracts. Green represents defects, filaments and edema. Blue shows overall edema, folds, and blisters. Precise documentation using these color codes allows for standardization, easy follow-up and teaching regarding various corneal pathologies.
Therapeutic contact lenses are used for therapeutic, diagnostic and cosmetic purposes to treat various ocular surface diseases and conditions. They provide mechanical protection and support to the cornea, maintain corneal epithelial hydration, and can be used to deliver medications to the eye. The type of therapeutic contact lens chosen depends on the specific condition being treated and should aim to maximize oxygen to the cornea unless the eye has no vision. Common complications include ocular redness, minor corneal edema and lens deposits which require regular follow up visits.
The document outlines the anatomy, blood supply, evaluation methods, and appearance of the optic nerve head. It discusses the anatomy in detail, including the components and organization of nerve fibers in the optic nerve head. Evaluation methods covered include clinical examination, structural analysis using slit lamp biomicroscopy, HRT, GDx, OCT, and functional analysis using visual field testing. The normal appearance and variations of structures like the neuroretinal rim, optic cup, and blood vessels are described. Changes in glaucoma like cupping, notching, and rim thinning are also outlined.
This document discusses the corneal endothelium and techniques for assessing its health and function. The corneal endothelium is a single layer of hexagonal cells that maintains corneal clarity by pumping fluid out of the stroma. Assessment techniques described include specular microscopy, which allows analysis of endothelial cell density, morphology, and patterns under high magnification; confocal microscopy; anterior segment OCT; and ultrasound pachymetry to measure corneal thickness as an indicator of endothelial function. Common indications for assessment include pre- and post-operative evaluation, and evaluation of donor corneas for transplantation.
This document summarizes a journal article on toxic anterior segment syndrome (TASS). TASS is a non-infectious inflammatory reaction caused by a toxic substance entering the anterior segment during eye surgery. Common causes include preservatives inadvertently injected into the eye, detergents or residues left on instruments, and contaminated water or solutions. TASS presents with pain, blurred vision, eye redness, and severe anterior segment inflammation including corneal edema and hypopyon. Treatment involves topical steroids, but prevention through proper sterilization and use of preservative-free solutions is key to avoiding this complication.
Gonioscopy: gonioscopic lenses, principle and clinical aspectsDr Samarth Mishra
This document discusses gonioscopy, which is used to examine the anterior chamber angle. It begins by explaining that the angle cannot be viewed directly due to total internal reflection at the cornea. Gonioscopic lenses eliminate this effect by matching the cornea's refractive index. There are two main types of lenses - indirect lenses use mirrors and direct lenses refract light. The document then describes various gonioscopic lenses and techniques like indentation gonioscopy. It outlines the clinical uses of gonioscopy and provides examples of gonioscopic findings. In summary, the document provides an in-depth overview of gonioscopy equipment, techniques, and applications.
Pigmentary glaucoma - Dr Shylesh B DabkeShylesh Dabke
Pigment Dispersion Syndrome (PDS) involves abnormal amounts of pigment released from the iris that deposit throughout the eye. It can sometimes progress to Pigmentary Glaucoma (PG). PDS is more common in young, white, myopic males and has genetic links. Theories for its pathogenesis include mechanical abrasion between the iris and lens zonules or abnormal iris cell degeneration. Over time, PDS can cause increased eye pressure and vision loss from PG if not properly treated with medications, laser procedures, or surgery.
This document discusses using optical coherence tomography (OCT) to analyze the macula, retinal nerve fiber layer (RNFL), and optic nerve head in patients with glaucoma or suspected glaucoma. It describes how OCT can measure macular thickness, RNFL thickness, and optic disc parameters. Five case studies are presented showing how structural changes seen on OCT correlate with functional defects on visual field tests or clinical findings. The document concludes by mentioning Doppler OCT may help understand the role of blood flow in glaucoma and other optic neuropathies.
Dr. Monika Soni presented on the topic of tear film at the upgraded department of ophthalmology at MGMMC & MYH Indore. The presentation discussed the anatomy and physiology of tear film, including the three layers of the tear film, mechanisms of tear secretion and distribution, functions of the tear film, tests to evaluate tear film such as tear breakup time, Schirmer's test, and osmolarity. A variety of glands contribute secretions to form and maintain the tear film, which is essential for maintaining a clear cornea and proper vision.
Corneal physiology in relation to contact lens wearHira Dahal
This document discusses corneal physiology in relation to contact lens wear. It describes the layers of the cornea and its blood, nerve and oxygen supply. Maintaining corneal transparency requires adequate oxygen and metabolism. Contact lenses reduce oxygen levels, which can cause swelling, hypoesthesia, and structural changes if levels fall below what the cornea requires. The minimum oxygen needed varies from 5-17.9% depending on the activity. Soft lenses induce more swelling than RGP lenses. Hypoxia affects epithelial healing, sensitivity and metabolism.
The document discusses Keratoconus, a degenerative eye disorder where the cornea becomes cone-shaped. It describes types and related diseases of Keratoconus and available treatment options including contact lenses, collagen cross-linking, and surgery. Specific contact lens options for Keratoconus are discussed in detail, including Rose K lenses, ClearKone lenses, and scleral lenses. Fitting approaches and considerations are provided for each lens type.
Special contact lenses include:
Daily-wear lenses are removed nightly and replaced on an individualized schedule. Extended-wear lenses are worn overnight but removed at least weekly for cleaning. Disposable lenses are removed nightly and replaced daily, weekly, biweekly, or monthly.
Colored lenses change eye color appearance and circle lenses make the iris appear bigger, but over-the-counter colored contacts pose health risks. Toric lenses correct astigmatism but sometimes not as well as rigid gas permeable lenses. Bifocal or multifocal lenses correct nearsightedness, farsightedness, astigmatism, and presbyopia but visual quality is often not as good as
Keratoconus is a non-inflammatory thinning of the cornea that causes it to take on a conical shape. It typically develops in adolescence and causes vision impairment due to irregular astigmatism. It is classified into four stages based on refractive error, corneal thickness and shape. While the exact cause is unknown, theories include genetic and enzymatic factors. It is often associated with eye rubbing and connective tissue disorders. Clinical features include corneal thinning, Fleischer's ring, Munson's sign, and scarring in advanced cases. Diagnosis involves topography, pachymetry and biomicroscopy to detect corneal shape changes.
This document provides an overview of different types of corneal dystrophies, including their classification, clinical features, histopathology, and management. It discusses epithelial and subepithelial dystrophies, corneal dystrophies of Bowman's layer, stromal corneal dystrophies, and Descemet membrane and endothelial dystrophies. The key points are that corneal dystrophies are inherited, bilateral, and slowly progressive disorders that begin early in life and are characterized by corneal opacification without relationship to environmental factors. Diagnosis involves classification based on the anatomical layer affected and treatment typically involves managing symptoms although surgery may be needed if vision is impaired.
This document provides information on anterior ischemic optic neuropathy (AION), which is the most common cause of acute optic neuropathy in older age groups. It can be divided into two types: arteritic AION, which is due to giant cell arteritis; and non-arteritic AION, which makes up most cases. Both types present with sudden painless vision loss and optic disc swelling. Arteritic AION carries a worse prognosis and requires high-dose steroid treatment to prevent loss of vision in the fellow eye. Non-arteritic AION has a variable course but generally a poor rate of recovery without any proven effective treatments.
Gonioscopy refers to techniques for examining the anterior chamber angle of the eye to evaluate and classify normal and abnormal angle structures. It involves using specialized lenses and lights to view the iridocorneal angle. There are two main methods: direct gonioscopy uses large contact lenses requiring saline, while indirect uses smaller lenses with mirrors or prisms that utilize tear film. Gonioscopy is used to diagnose angle-closure glaucoma and other conditions by allowing visualization of the trabecular meshwork, scleral spur, and other angle structures. Indentation gonioscopy, where the lens is pressed against the cornea, can differentiate appositional from synechial angle closure. Proper technique and
Diplopia, or double vision, occurs when more than one image of an object is seen simultaneously. It can be caused by abnormalities in the eyes themselves or issues with eye movement coordination. A diplopia chart is used to evaluate the type and location of double vision by having the patient report the appearance of light sources in different gaze positions. Interpretation of the chart provides clues to which eye muscles may be affected and whether the cause is neurogenic, restrictive, or myogenic in nature. Treatment options include glasses, prisms, eye patching, or strabismus surgery depending on the deviation and goal of eliminating diplopia.
This document discusses various types of corneal dystrophies presented by Dr. Puneet Sharma. It defines corneal dystrophies as a group of progressive, genetically determined disorders that cause non-inflammatory opacification of the cornea. It then describes several specific corneal dystrophies categorized by the layer of the cornea they affect (epithelial, stromal, endothelial). For each dystrophy, it covers inheritance pattern, histology, onset, signs/symptoms, and treatment. The document provides detailed information on Cogan dystrophy, Meesmann dystrophy, Reis-Bucklers dystrophy, granular dystrophy types 1 and 2, lattice dystrophy types 1 and 2, and Fuchs endothelial
This document discusses watering eye (epiphora) and its causes including hyperlacrimation and obstruction of tear outflow. It describes various mechanical obstructions that can cause epiphora such as punctal, canalicular, lacrimal sac or nasolacrimal duct obstructions. Clinical evaluation methods are outlined. Dacryocystitis, an infection of the lacrimal sac, is discussed including its congenital and acquired forms. Congenital dacryocystitis presents in newborns with epiphora, positive regurgitation test and swelling. Acquired dacryocystitis can be chronic or acute, with chronic forms including catarrhal dacryocystitis, lacrimal
This document discusses perimetry and visual field testing. It defines visual field as the area that can be seen at a given moment. There are various methods of visual field testing including kinetic and static perimetry. Automated static perimetry tests like Humphrey and Octopus are now commonly used and test the threshold light intensity that can be detected at different points in the visual field. The results are analyzed based on total deviation plots, pattern deviation plots and global indices to detect and monitor glaucomatous visual field defects. Common patterns of visual field defects seen in different conditions are also described.
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 document discusses amblyopia, including its classification, pathophysiology, clinical characteristics, evaluation, and management. It defines amblyopia and outlines its prevalence. Amblyopia can be classified as functional or organic, and further divided into types such as strabismic, anisometropic, and stimulus deprivation amblyopia. Clinical signs may include reduced visual acuity, abnormal fixation, impaired stereopsis, and altered contrast sensitivity. Evaluation involves assessing visual acuity, fixation, binocularity, and refractive error. Management is focused on occlusion therapy to treat the amblyopic eye.
1. Differential diagnosis of disc edema includes conditions like papilledema, optic neuritis, ischemic optic neuropathy, diabetic papillopathy, and hypertensive retinopathy.
2. Papilledema is caused by increased intracranial pressure and presents with bilateral disc swelling and normal vision, while optic neuritis typically causes unilateral vision loss and eye pain.
3. Diabetic papillopathy presents as transient unilateral or bilateral disc edema that resolves within months without vision loss, while malignant hypertension can lead to bilateral disc edema and vision changes as part of hypertensive retinopathy.
Various Soft Contact Lens- designs and their indications Urusha Maharjan
The document discusses various designs and material properties of soft contact lenses, describing 19 different types of soft contact lenses categorized by their water content, oxygen permeability, and FDA group. It provides details on common lens materials like polymacon, alphafilcon A, and etafilcon A as well as specific lenses from brands like Bausch & Lomb, Johnson & Johnson, and Ciba Vision. The document compares silicone hydrogel lenses to conventional hydrogel lenses and their differences in oxygen transmissibility and compatibility with care solutions.
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.
- Evaluation involves assessing thyroid function and signs of orbital involvement. Severity is classified using Werner's or EUGO
Hyperthyroidism is a condition where the thyroid gland produces excess thyroid hormones, leading to thyrotoxicosis or hypermetabolism. It is more common in women and the clinical types include diffuse toxic goiter (Graves' disease), toxic nodular goiter, and toxic nodule. Symptoms include fatigue, emotional changes, heat intolerance, weight loss and palpitations. Signs include tachycardia, sweaty palms, eye signs like lid retraction, and goiter. Treatment options are antithyroid medications, surgery, or radioactive iodine, with the goal of restoring normal thyroid hormone levels. Complications after thyroid surgery can include bleeding, respiratory issues, nerve injury, thyroid dysfunction,
This document summarizes a journal article on toxic anterior segment syndrome (TASS). TASS is a non-infectious inflammatory reaction caused by a toxic substance entering the anterior segment during eye surgery. Common causes include preservatives inadvertently injected into the eye, detergents or residues left on instruments, and contaminated water or solutions. TASS presents with pain, blurred vision, eye redness, and severe anterior segment inflammation including corneal edema and hypopyon. Treatment involves topical steroids, but prevention through proper sterilization and use of preservative-free solutions is key to avoiding this complication.
Gonioscopy: gonioscopic lenses, principle and clinical aspectsDr Samarth Mishra
This document discusses gonioscopy, which is used to examine the anterior chamber angle. It begins by explaining that the angle cannot be viewed directly due to total internal reflection at the cornea. Gonioscopic lenses eliminate this effect by matching the cornea's refractive index. There are two main types of lenses - indirect lenses use mirrors and direct lenses refract light. The document then describes various gonioscopic lenses and techniques like indentation gonioscopy. It outlines the clinical uses of gonioscopy and provides examples of gonioscopic findings. In summary, the document provides an in-depth overview of gonioscopy equipment, techniques, and applications.
Pigmentary glaucoma - Dr Shylesh B DabkeShylesh Dabke
Pigment Dispersion Syndrome (PDS) involves abnormal amounts of pigment released from the iris that deposit throughout the eye. It can sometimes progress to Pigmentary Glaucoma (PG). PDS is more common in young, white, myopic males and has genetic links. Theories for its pathogenesis include mechanical abrasion between the iris and lens zonules or abnormal iris cell degeneration. Over time, PDS can cause increased eye pressure and vision loss from PG if not properly treated with medications, laser procedures, or surgery.
This document discusses using optical coherence tomography (OCT) to analyze the macula, retinal nerve fiber layer (RNFL), and optic nerve head in patients with glaucoma or suspected glaucoma. It describes how OCT can measure macular thickness, RNFL thickness, and optic disc parameters. Five case studies are presented showing how structural changes seen on OCT correlate with functional defects on visual field tests or clinical findings. The document concludes by mentioning Doppler OCT may help understand the role of blood flow in glaucoma and other optic neuropathies.
Dr. Monika Soni presented on the topic of tear film at the upgraded department of ophthalmology at MGMMC & MYH Indore. The presentation discussed the anatomy and physiology of tear film, including the three layers of the tear film, mechanisms of tear secretion and distribution, functions of the tear film, tests to evaluate tear film such as tear breakup time, Schirmer's test, and osmolarity. A variety of glands contribute secretions to form and maintain the tear film, which is essential for maintaining a clear cornea and proper vision.
Corneal physiology in relation to contact lens wearHira Dahal
This document discusses corneal physiology in relation to contact lens wear. It describes the layers of the cornea and its blood, nerve and oxygen supply. Maintaining corneal transparency requires adequate oxygen and metabolism. Contact lenses reduce oxygen levels, which can cause swelling, hypoesthesia, and structural changes if levels fall below what the cornea requires. The minimum oxygen needed varies from 5-17.9% depending on the activity. Soft lenses induce more swelling than RGP lenses. Hypoxia affects epithelial healing, sensitivity and metabolism.
The document discusses Keratoconus, a degenerative eye disorder where the cornea becomes cone-shaped. It describes types and related diseases of Keratoconus and available treatment options including contact lenses, collagen cross-linking, and surgery. Specific contact lens options for Keratoconus are discussed in detail, including Rose K lenses, ClearKone lenses, and scleral lenses. Fitting approaches and considerations are provided for each lens type.
Special contact lenses include:
Daily-wear lenses are removed nightly and replaced on an individualized schedule. Extended-wear lenses are worn overnight but removed at least weekly for cleaning. Disposable lenses are removed nightly and replaced daily, weekly, biweekly, or monthly.
Colored lenses change eye color appearance and circle lenses make the iris appear bigger, but over-the-counter colored contacts pose health risks. Toric lenses correct astigmatism but sometimes not as well as rigid gas permeable lenses. Bifocal or multifocal lenses correct nearsightedness, farsightedness, astigmatism, and presbyopia but visual quality is often not as good as
Keratoconus is a non-inflammatory thinning of the cornea that causes it to take on a conical shape. It typically develops in adolescence and causes vision impairment due to irregular astigmatism. It is classified into four stages based on refractive error, corneal thickness and shape. While the exact cause is unknown, theories include genetic and enzymatic factors. It is often associated with eye rubbing and connective tissue disorders. Clinical features include corneal thinning, Fleischer's ring, Munson's sign, and scarring in advanced cases. Diagnosis involves topography, pachymetry and biomicroscopy to detect corneal shape changes.
This document provides an overview of different types of corneal dystrophies, including their classification, clinical features, histopathology, and management. It discusses epithelial and subepithelial dystrophies, corneal dystrophies of Bowman's layer, stromal corneal dystrophies, and Descemet membrane and endothelial dystrophies. The key points are that corneal dystrophies are inherited, bilateral, and slowly progressive disorders that begin early in life and are characterized by corneal opacification without relationship to environmental factors. Diagnosis involves classification based on the anatomical layer affected and treatment typically involves managing symptoms although surgery may be needed if vision is impaired.
This document provides information on anterior ischemic optic neuropathy (AION), which is the most common cause of acute optic neuropathy in older age groups. It can be divided into two types: arteritic AION, which is due to giant cell arteritis; and non-arteritic AION, which makes up most cases. Both types present with sudden painless vision loss and optic disc swelling. Arteritic AION carries a worse prognosis and requires high-dose steroid treatment to prevent loss of vision in the fellow eye. Non-arteritic AION has a variable course but generally a poor rate of recovery without any proven effective treatments.
Gonioscopy refers to techniques for examining the anterior chamber angle of the eye to evaluate and classify normal and abnormal angle structures. It involves using specialized lenses and lights to view the iridocorneal angle. There are two main methods: direct gonioscopy uses large contact lenses requiring saline, while indirect uses smaller lenses with mirrors or prisms that utilize tear film. Gonioscopy is used to diagnose angle-closure glaucoma and other conditions by allowing visualization of the trabecular meshwork, scleral spur, and other angle structures. Indentation gonioscopy, where the lens is pressed against the cornea, can differentiate appositional from synechial angle closure. Proper technique and
Diplopia, or double vision, occurs when more than one image of an object is seen simultaneously. It can be caused by abnormalities in the eyes themselves or issues with eye movement coordination. A diplopia chart is used to evaluate the type and location of double vision by having the patient report the appearance of light sources in different gaze positions. Interpretation of the chart provides clues to which eye muscles may be affected and whether the cause is neurogenic, restrictive, or myogenic in nature. Treatment options include glasses, prisms, eye patching, or strabismus surgery depending on the deviation and goal of eliminating diplopia.
This document discusses various types of corneal dystrophies presented by Dr. Puneet Sharma. It defines corneal dystrophies as a group of progressive, genetically determined disorders that cause non-inflammatory opacification of the cornea. It then describes several specific corneal dystrophies categorized by the layer of the cornea they affect (epithelial, stromal, endothelial). For each dystrophy, it covers inheritance pattern, histology, onset, signs/symptoms, and treatment. The document provides detailed information on Cogan dystrophy, Meesmann dystrophy, Reis-Bucklers dystrophy, granular dystrophy types 1 and 2, lattice dystrophy types 1 and 2, and Fuchs endothelial
This document discusses watering eye (epiphora) and its causes including hyperlacrimation and obstruction of tear outflow. It describes various mechanical obstructions that can cause epiphora such as punctal, canalicular, lacrimal sac or nasolacrimal duct obstructions. Clinical evaluation methods are outlined. Dacryocystitis, an infection of the lacrimal sac, is discussed including its congenital and acquired forms. Congenital dacryocystitis presents in newborns with epiphora, positive regurgitation test and swelling. Acquired dacryocystitis can be chronic or acute, with chronic forms including catarrhal dacryocystitis, lacrimal
This document discusses perimetry and visual field testing. It defines visual field as the area that can be seen at a given moment. There are various methods of visual field testing including kinetic and static perimetry. Automated static perimetry tests like Humphrey and Octopus are now commonly used and test the threshold light intensity that can be detected at different points in the visual field. The results are analyzed based on total deviation plots, pattern deviation plots and global indices to detect and monitor glaucomatous visual field defects. Common patterns of visual field defects seen in different conditions are also described.
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 document discusses amblyopia, including its classification, pathophysiology, clinical characteristics, evaluation, and management. It defines amblyopia and outlines its prevalence. Amblyopia can be classified as functional or organic, and further divided into types such as strabismic, anisometropic, and stimulus deprivation amblyopia. Clinical signs may include reduced visual acuity, abnormal fixation, impaired stereopsis, and altered contrast sensitivity. Evaluation involves assessing visual acuity, fixation, binocularity, and refractive error. Management is focused on occlusion therapy to treat the amblyopic eye.
1. Differential diagnosis of disc edema includes conditions like papilledema, optic neuritis, ischemic optic neuropathy, diabetic papillopathy, and hypertensive retinopathy.
2. Papilledema is caused by increased intracranial pressure and presents with bilateral disc swelling and normal vision, while optic neuritis typically causes unilateral vision loss and eye pain.
3. Diabetic papillopathy presents as transient unilateral or bilateral disc edema that resolves within months without vision loss, while malignant hypertension can lead to bilateral disc edema and vision changes as part of hypertensive retinopathy.
Various Soft Contact Lens- designs and their indications Urusha Maharjan
The document discusses various designs and material properties of soft contact lenses, describing 19 different types of soft contact lenses categorized by their water content, oxygen permeability, and FDA group. It provides details on common lens materials like polymacon, alphafilcon A, and etafilcon A as well as specific lenses from brands like Bausch & Lomb, Johnson & Johnson, and Ciba Vision. The document compares silicone hydrogel lenses to conventional hydrogel lenses and their differences in oxygen transmissibility and compatibility with care solutions.
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.
- Evaluation involves assessing thyroid function and signs of orbital involvement. Severity is classified using Werner's or EUGO
Hyperthyroidism is a condition where the thyroid gland produces excess thyroid hormones, leading to thyrotoxicosis or hypermetabolism. It is more common in women and the clinical types include diffuse toxic goiter (Graves' disease), toxic nodular goiter, and toxic nodule. Symptoms include fatigue, emotional changes, heat intolerance, weight loss and palpitations. Signs include tachycardia, sweaty palms, eye signs like lid retraction, and goiter. Treatment options are antithyroid medications, surgery, or radioactive iodine, with the goal of restoring normal thyroid hormone levels. Complications after thyroid surgery can include bleeding, respiratory issues, nerve injury, thyroid dysfunction,
Thyroid disorders are common in endocrinology. The document discusses the anatomy and functions of the thyroid gland, as well as the regulation of hormone production and classification of thyroid disorders. It provides an overview of hyperthyroidism (thyrotoxicosis) and hypothyroidism, including their causes, signs, symptoms, and treatment approaches. Graves' disease is described as the most common cause of thyrotoxicosis. Treatment options for hyperthyroidism discussed include beta-blockers, antithyroid medications, radioactive iodine, and thyroidectomy.
Thyroid eye disease (TED) is an autoimmune inflammatory disorder affecting the eye muscles and surrounding tissues. It is commonly associated with Graves' disease. Symptoms include eye pain, swelling of eyelids, and issues with eye movement. Examination may reveal eyelid retraction, proptosis, and restrictive myopathy. Management involves medications like steroids to reduce inflammation during active phases, with surgery to correct eye muscle issues and proptosis during inactive phases. The goal is to improve symptoms, eye health, and appearance.
Hyperthyroidism, also known as overactive thyroid, results from excessive thyroid hormone production and secretion. Graves' disease, the most common cause, is an autoimmune disorder where antibodies stimulate the thyroid. It is characterized by diffuse thyroid enlargement, ophthalmopathy, and pretibial myxedema. Symptoms include palpitations, heat intolerance, weight loss and tremors. Diagnosis involves low TSH and high T4 levels and presence of thyroid autoantibodies. Treatment options include antithyroid medications, radioactive iodine ablation, or surgery. Thyroid storm is a medical emergency characterized by severe hyperthyroid symptoms that requires urgent beta-blockers, antithyroid drugs and supportive
This document provides an overview of thyroid ophthalmopathy (TED), also known as Graves' ophthalmopathy. It discusses the epidemiology, etiology, risk factors, pathogenesis, clinical signs and symptoms, diagnosis, and management of the autoimmune disease. TED is caused by inflammation and accumulation of fluids in the orbit, raising pressure and causing enlargement of the extraocular muscles and adipose tissue. Symptoms include eye bulging, double vision, and dryness. Management involves treating any thyroid abnormalities, using corticosteroids, radiation, or surgery to address eye involvement and symptoms.
Anaesthetic mgt for pt with hyperthyroidism pritamhavalprit
This document provides information on hyperthyroidism caused by Graves' disease. It discusses the epidemiology, clinical manifestations, diagnostic evaluation and treatment options for Graves' disease. Some key points include:
- Graves' disease accounts for 60-80% of cases of hyperthyroidism and typically occurs in women aged 20-50.
- Clinical manifestations can include nervousness, tremor, eye signs like proptosis, and hyperfunction of multiple organ systems due to excess thyroid hormones.
- Diagnostic evaluation involves testing thyroid function through measurements of TSH, FT4 and FT3 levels. Imaging with ultrasound and thyroid scanning may also be used.
- Treatment options include antithyroid medications, radioactive i
TED (thyroid eye disease) or Graves' ophthalmopathy is an autoimmune disorder where the eyes and area around the eyes become inflamed and swollen. It is commonly associated with Graves' hyperthyroidism but can also occur in euthyroid or hypothyroid patients. Common symptoms include eye dryness, pain, and bulging of the eyes. Signs include eyelid retraction, muscle weakness, and in severe cases, optic nerve compression. Treatment involves supportive care, medications like steroids to reduce inflammation, and in some cases orbital decompression surgery or eye muscle surgery to correct muscle weakness and eye alignment issues.
CLINICOPATHOLOGICAL CONFERENCE ON Thyroid eye diseaserabia farooq
- The patient presented with bilateral proptosis, diplopia, and right-sided headache for 2 years. Examination found axial proptosis of 4-5mm in both eyes with lid lag and retraction. Orbital imaging showed thickened extraocular muscles.
- Thyroid function tests and antibodies were positive for hyperthyroidism. A diagnosis of thyroid eye disease (TED) was made. The patient was previously treated for hyperthyroidism and TED but discontinued medications one month ago.
- TED is an autoimmune condition associated with Graves' disease. It involves inflammation and swelling of the extraocular muscles and orbital tissues causing proptosis, diplopia, and optic neuropathy.
Thyrotoxicosis, or hyperthyroidism, is caused by excessive thyroid hormones. It can be primary, resulting from conditions like Graves' disease, or secondary, from a toxic multinodular goiter or toxic adenoma. Graves' disease is an autoimmune disorder caused by antibodies that stimulate the thyroid. Symptoms include hypermetabolism, nervousness, and eye changes. Diagnosis involves thyroid function tests, ultrasound, and radioactive iodine uptake. Treatment options are antithyroid medications, radioactive iodine therapy, or surgery. Complications can include thyroid storm, which is a medical emergency requiring aggressive treatment.
This document discusses hyperthyroidism and Graves' disease. It provides details on:
- The causes of hyperthyroidism including circulating thyroid stimulators and thyroidal autonomy.
- The pathogenesis, clinical manifestations, and laboratory findings of Graves' disease. Common signs include diffuse goiter, ophthalmopathy, and localized dermopathy.
- The treatment options for hyperthyroidism including antithyroid drugs like methimazole, radioactive iodine, and surgery. Antithyroid drugs are usually the first line treatment.
This document summarizes a case presentation of a 40-year-old male with thyroid eye disease. He presented with protrusion of both eyeballs that had worsened over two years along with recent double vision. Examination found lid retraction, congestion, and proptosis in both eyes. The patient had a history of hyperthyroidism treated with medication. Imaging found thickened extraocular muscles and increased orbital fat. He was diagnosed with active thyroid eye disease and underwent orbital decompression surgery on the left eye, with plans for the right eye. His condition improved after surgery and medication. The presentation reviewed the diagnosis and management of thyroid eye disease, including identifying the active stage, treatments, and role of surgery.
3.clinical diagnosis & investigation in a case of thyroid swellingArkaprovo Roy
This document provides details on properly examining a patient presenting with a thyroid swelling. It outlines the important components of history taking including symptoms related to the swelling, pain, pressure symptoms, and features of hyperthyroidism or hypothyroidism. The physical exam section describes in depth how to inspect, palpate, percuss, and auscultate the thyroid gland and surrounding area. It also discusses evaluating lymph nodes, looking for signs of hyperthyroidism, and conducting a full systemic exam. Investigations that may be performed are listed, including fine needle aspiration biopsy, laboratory tests, imaging studies, and managing the case.
Thyroid ophthalmopathy is an autoimmune condition that can cause mild to severe and potentially sight-threatening eye disease. Graves' disease is the most common associated thyroid abnormality. Symptoms include eyelid retraction, proptosis, and restrictive myopathy. Signs include eyelid retraction in 91% of patients, proptosis in 62%, and restrictive myopathy in 42%. The condition is classified in several ways, including the Wernicke, CAS, VISA, and EUGOGO systems, which grade severity based on symptoms and signs.
Thyroid eye disease is a condition in which the eye muscles, eyelids, tear glands and fatty tissues behind the eye become inflamed. Also known as:-
Graves ophthalmopathy
Thyroid associated ophthalmopathy
Thyrotoxic exophthalmos and several other terms.
Hyperthyroidism is a hypermetabolic state caused by increased thyroid secretion. There are several types, including Graves' disease (the most common cause), toxic nodular goitre, and toxic adenoma. Clinical features include symptoms like fatigue, heat intolerance, and weight loss, as well as signs like tachycardia, eye changes, and thyroid swelling. Diagnosis involves clinical evaluation, thyroid function tests, and scans. Treatment options are antithyroid drugs, surgery, and radioactive iodine.
Hyperthyroidism is a hypermetabolic state caused by increased thyroid secretion. There are several types, including Graves' disease (the most common cause), toxic nodular goitre, and toxic adenoma. Clinical features include symptoms like fatigue, heat intolerance, and weight loss, as well as signs like tachycardia, eye changes, and thyroid swelling. Diagnosis involves clinical evaluation, thyroid function tests, and scans. Treatment options are antithyroid drugs, surgery, and radioactive iodine.
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traubleshooting in PALs,Brands and special design of PALs
Spectacle dispensing in Pediatric patient Anurag Shukla
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This document discusses ocular biometry and ultrasound. It begins with definitions of biometrics and ultrasound terminology. It then describes the different modes of ultrasound - A-scan, B-scan and M-scan. Key components of ultrasound devices like transducers, amplifiers and velocities of sound through ocular tissues are explained. Factors affecting ultrasound reflection and penetration are outlined. The document concludes with an introduction to ocular biometry procedures and a brief history.
In this ppt included:-
Color definition
Visual spectrum of light
MUNSELL SYSTEM
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Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
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Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
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Diagnosis and Staging
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Treatment Options
Endocrine Therapy
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Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
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Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
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STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
2. Contents..
THYROID GLAND :
Largest gland in the body
Shape : Butterfly like structure
Position : in the front of the neck.
Function : controls the hormones and metabolic
activity in the body.
Release hormone: T3 , T4 ( T1+T2+Iodine)
3. Contents..
THYROID GLAND :
Hypothyroidism:
the thyroid produces too little hormones. If the
body doesn’t get enough hormones, you may get
tired, experience depression, have dry skin, gain
weight, become forgetful, and become weak.
Hyperthyroidism :
In this disorder, the thyroid gland produces too
much. These conditions can cause a fast heart
rate, no ability to rest, feeling too hot and the
need to poop often. Hyperthyroidism is more
common in women than in men.
Excess iodine may cause hyperthyroidism.
4. TRH : senses the body needs thyroid hormone.
(Hypothalamus to Pituitary gland)
TSH : to produce thyroid hormones including both T3 & T4.
(Pituitary gland to Thyroid gland)
Thyroxine ( T4 ) : storage hormone
Triiodothyronine ( T3) : active hormone
Reverge T3 : block T3 cellular receptor sites and inhibit
conversion of T4 to T3
5. Thyroid hormones
• Thyroid hormones target almost every body cell
• Can enter cells & bind to intracellular receptors on mitochondria & in
nucleus
• Effects include:
• increased ATP production
• increased cellular metabolism, energy utilization & oxygen consumption ,
increase blood flow
• increased body temperature
• growth & development of skeletal, muscular & nervous system in fetus &
children
6. Epidemiology
• unilateral and bilateral
• Higher prevalence in women than men (16 per 100,000 vs. 3 per 100,000,
respectively)
• A positive family history of TED is noted in 61% of TED patients.
• associated with both genetic and environmental factors such as cigarette
smoking, and stress.
13. Ocular Sign
1. Upper eyelid retraction – the most common presenting sign of TED
• Up to 90% of patients affected (bilateral or unilateral)
• Physical exam:
• Dalrymple’s sign : scleral show inf. & sup.
• Lagophthalmos
• Temporal flare : elevation of the temporal
portion of the upper eyelid.
14. Sign of TED
2. Exophthalmos:
• the second most common sign associated with TED
• 60% of patients are affected
• Globe subluxation: anterior displacement of the globe
• Anoxic destruction of the optic nerve can cause
irreversible visual loss
15. 3. EXTRAOCULAR MYOPATHY:
• 40% of patients affected
• Inferior and medial rectus muscles
most commonly affected, leading to
hypotropia and esotropia, respectively
Sign of TED
16. Sign of TED
Other common signs:
– eyelid lag
– Pain with eye movement
– optic neuropathy
– Chemosis
– conjunctival injection
– RAPD
17. Severity of TED: NO-SPECS
THE WARNER’S GRADING :
• Class 0: No sign or symptoms
• Class 1: Only signs (lid retraction, stare ± lid lag)
• Class 2: Soft tissue involvement
• Class 3: Proptosis
• Class 4: Extraocular muscle involvement
• Class 5: Corneal involvement
• Class 6: Sight loss (optic nerve involvement)
18. CLINICAL ACTIVITY SCORE : INITIAL VISIT
3
2
1
6
4
7
Conjunctival injection
Active*
Chemosis
Inflammation of caruncle
Add your words here
Eyelid swelling
Gaze evoked orbital pain
orbital pain
in the last 4 weeks
Active*
DISEAES
ACTIVITY
Eyelid erythema
5
in the last 4 weeks
19. CLINICAL ACTIVITY SCORE
FOLLOW UP VISIT
At follow‐up visits, add the 3 following criteria for a potential CAS score of 10
• Increase of ≥ 2 mm in proptosis
• Decrease in uniocular motility in any one direction of ≥ 8 degrees
• Decrease in visual acuity equivalent to 1 Snellen line
TED is considered “active” if the CAS ≥ 3 at the initial visit or ≥ 4 at follow‐up visits.
ACTIVE PHASE STABLE PHASE
20. VISA Classification
• Developed by Dolman and Rootman in 2006
• modifications by the International Thyroid Eye Disease Society (ITEDS)
• The system assesses 4 severity parameters:
V = vision
I = inflammation or congestion
S = strabismus/motility restriction
A = appearance/exposure
21. VISA
Classification
maximum score is 20 points
Vision : 1 point
Inflammation : 10 points
Strabismus /motility : 6 point
Appearance /exposure : 3
23. inflammation/congestion
(VISA Classification)
Inflammatory index :
• Score less than ≤ 4 : managed conservatively. (cool compresses, nocturnal head elevation,
and NSAID)
• Score ≥ 5 : aggressive therapy (oral / IV corticosteroids, radiotherapy, immunosuppressive agents.)
24. Inflammatory grading
• Chemosis grading :
grade I - behind the gray line of lid.
grade II- extend anterior to the grey line.
• Lid edema:
grade I -present but without redundant tissues
grade II -bulging in the palpebral skin + lid festoon.
VISA inflammatory
Score: 9/10
Post IV 1 gm
methylprednisolone:
VISA inflammatory
score = 3/10
25. Strabismus /motility
(VISA Classification)
•Accurate assessment of changes in ocular ductions : identify progression , management,
and response to therapy assessment.
•change of ≥12 degree : considered progression
26. • Ocular ductions : can be graded from 0 to 45 in four directions using the
Hirschberg principle.
• Strabismus can be measured objectively by prism cover testing.
• Management of strabismus:
• Manage the progression & inflammation first is present.
• management of strabismus might include prisms or surgical alignment
Strabismus/ocular motility
27. appearance/exposure
(VISA Classification)
•Appearance : bulging eyes, eyelid retraction, and fat pockets
•ocular exposure : gritting sensation, photophobia, dryness, and secondary tearing
•Signs include measurements : eyelid retraction, scleral show , levator palpebrae superioris function,
proptosis.
•Signs of corneal exposure : punctate epithelial erosions, ulcerations, and, in severe cases corneal thinning
and risk of perforation.
28. Management of appearance and exposure
• depend on the inflammatory stage of the disease.
• lubricant drops and ointments can relieve ocular
irritation.
• Tarsorrhaphy / orbital decompression
Pre & post orbital decompression
29. EYELID RETRACTION
• Normally, upper eyelid- 2mm below limbus
lower eyelid-inferior limbus.
• When retraction occurs, the sclera (white)
can be seen
• Due to increased sympathetic stimulation
of Müller’s muscle by thyroid hormone.
• Scleral show between corneal limbus and
either eyelid margin
Eyelid retraction +
Scleral show
30. Upper eyelid position : MRD- I
• Distance between the upper Eyelid
margin to CLR.
• Normal : 4 – 4.5 mm
31. PROPTOSIS EVALUATION
• the Hertel’s exophthalmometer is the most
commonly used instrument to measure
proptosis.
• The distance between the lateral orbital rim
and the corneal apex is used as a measure for
proptosis.
• Normal values vary between 10 and 21 mm
and are symmetrical in both eyes.
32. Method
• Pt to look stright ahead
• Palpate the bony ridge
– Locating deepest angle of the orbit.
• Loose the lock
– slide mirrors or prisms along the horizontal bar to adjust
footplates with corresponding lateral orbital rims
• • Bring Hertel forward toward pt, keeping it parallel
to floor with crossbar scale visible in front
• • pt eye should be closed
33. • Position footplates against each lateral orbital
rim independently
• pts eye open widely & at your eye level
• Look at the mirror
– Take mm measurement where apex of cornea(lower)
is superimposed on the mm scale (upper)
• corneal reflex lower mirror & mm scale upper
mirror.
• Read of the cross bar scale (near BASE)
34. interpretation
• Relative :
• comparison of readings b/t two eyes
– normal: </= 2mm
• Absolute :
• comparison of readings to norms
• whites 12 to 20 mm1 (10-22mm)
– average 15 -17mm
• blacks 12 to 24 mm
– average 2mm higher than whites
35. • Test for tear quantity (aqueous level)
• Based on wetting length of the strip 5x35mm Whatman
41 filter paper
• Placed in the lower fornix 2/3rd from medial canthus and
1/3rd from lateral
• 2 variations :
– Schirmer 1(with anaesthetic) – basal secretion
– Schirmer 2(without anaesthetic) – basal + reflex secretion
Schirmer’s test
36. • Measures total tear secretion (basic and reflex)
• Open eye technique
• Normal :10-30 mm at the end of 5min
• If wetting >30mm before 5 min
– Reflex tearing overactive/ insufficient tear drainage
• Value < 5mm Hyposecretion
Interpretation
37. • Determine by the lid excursion caused by LPS muscle.
• METHOD:
• Asked to pt look down
• Place the thumb against the eyebrow (to block frontalis)
• Then look up
• Amount of upper lid excursion Measure with the ruler.
• Result:
– 15 mm Normal
– ≥ 8 mm good
– 5-7 mm fair
– ≤ 5 mm poor
LEVATOR FUNCTION TEST
38. • Distance between the upper and lower lid margin.
• Normal :
– Male : 7-10 mm
– Female : 8-12 mm
• Normally : upper lid 2mm below the sup. Limbus.
lower lid just below the inf. limbus
Palpebral fissure height
39. • Inability to complete close of eyelid.
• Method :
• Asked to pt close the eye gently.
• Measure the exposed area with ruler.
complication :
Corneal exposure , dryness,
corneal abberation
Lagophthalmos measurement
Lagophthalmos +