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Blepharospasm
- It is relieved by thorough anesthesia cf photophobia which is partially relieved by cycloplegia.
- It is relieved by thorough anesthesia cf photophobia which is partially relieved by cycloplegia.
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Corneal sensation : reduced
- Herpetic keratitis
- Acute attack of Angle closure glaucoma
- Keratomalacia
- Leprosy
- Neurotrophic keratitis (fifth nerve damage)
- Post corneal surgery
- Long standing corneal edema
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Corneal vascularisation
- Corneal ulcer
- Trachoma
- Interstitial keratitis
- Leprosy
- Diabetes
- Post penetrating keratoplasty
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Effects of block (Local anesthesia)
- Anesthesia of intra ocular structures e.g. iris
- Akinesia of all extra ocular muscle except superior oblique
- Mydriasis
- Hypotony : due to loss of tone of extra ocular muscles & bulbar massage
- Proptosis
- Decreased oculo cardiac reflex
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Enucleation
- It is the surgical removal of the eyeball with a portion of the optic nerve from the orbit.
Absolute Indication:
i. MOST COMMON ” EYE DONATION”
ii. Retinoblastoma
iii. Malignant melanoma
iv. Severely traumatised eye with no Light perception to prevent sympathetic ophthalmitis of the fellow eye.
Relative Indication:
i. Painful : a. absolute glaucoma, b. chronic iridocyclitis c. intra ocular hemorrhage
ii. Blind & disfigured eyes : Anterior Staphyloma & Ciliary Staphyloma
iii. Phthisis bulbi with calcification
iv. Endophthalmitis, not responding medically
v. Sympathetic ophthalmitis
- It is the surgical removal of the eyeball with a portion of the optic nerve from the orbit.
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Hyphema
- Contusion
- Penetrating injury
- Intra ocular surgery
- Neo vascularisation of iris
- Intra ocular Lens
- Tumors
-
Miosis
- Aged patients
- Bright light
- Opium addiction
- Morphine intoxication
- Pontine hemorrhage
- Acute iritis
- During sleep
- Use of miotics
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Mydriasis
- In dark
- Optic atrophy
- Acute attack in angle closure glaucoma
- Absolute glaucoma
- Comatose patient
- Head injury
- Third nerve palsy
- Use of mydriactics
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Oculo Cardiac reflex
- Traction on extra ocular muscle or pressure on eyeball elicit variety of cardiac arrythmias.
- Afferent : Trigeminal nerve
- Efferent : Vagus nerve
- Management :
- Temporary cessation of surgical stimulation until heart rate increases
- Confirmation of adequate ventilation, oxygenation & depth of anesthesia.
- i.v. Atropine 10 microgm/kg
- if recalcitrant, infiltrate rectus muscle with local anesthetist
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Pale disc : D/D
- Non- pathological:
- infants
- Axial myopia
- Elderly with nuclear sclerosis – temporal pallor with large physiological cup.
- Pathological:
- Optic atrophy
- Hypoplasia
- Congenital pit
- Coloboma
- Non- pathological:
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Paracentis : Indications
- Diagnostic
- Intra ocular malignancy : cytology & LDH assay
- Intra ocular parasite infestation
- Therapeutic
- massive hyphema to control secondary glaucoma & to prevent blood staining of the cornea
- Corneal ulcer with massive hypopyon to improve corneal nutrition
- Impending corneal perforation
- Central retinal arterial occlusion
- Control secondary glaucoma following : iridocyclitis & traumatic cataract with soft lens matter in A/C.
- Diagnostic
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Principle of PIN HOLE
- It masks peripheral aberrations
- It focuses circle of least diffusion on retina
- Photoreceptors are sensitive to light falling perpendicular to it which is possible in light passing through pin hole.
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Shallow A/C
- Hypermetropia
- Hypermature cataract
- Intumescent cataract
- Angle closure glaucoma
- Iris bombe
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Tubular Vision
- Advanced stage of glaucoma
- High myopia
- Retinitis pigmentosa
- Central retinal arterial occlusion with sparing of cilio retinal artery
- Quinine toxicity.
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Vitreous Adhesions
- Normal:
- Vitreous base
- Optic base
- Around fovea, weak except in vitreo macular traction & macular hole formation
- Abnormal:
- Posterior border of island of lattice degeneration
- Retinal pigment clumps
- Peripheral paravascular condensations
- White without pressure & white with pressure areas.
- Normal: