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Toxic Anterior Segment Syndrome
Toxic anterior segment syndrome is an acute, sterile anterior segment inflammation following generally uneventful cataract and anterior segment surgery. One of the main factors in differentiating toxic anterior segment syndrome from an infectious endophthalmitis is the rapid onset. Most patients with toxic anterior segment syndrome will develop symptoms within 12 to 24 hours of the surgery. Common findings on anterior segment slit lamp examination include increased cell and flare with associated fibrin and possible hypopyon formation. Patients may show signs of diffuse corneal edema, and they may also show signs of iris atrophy with pupillary abnormalities and eventual increased intraocular pressure. It is important to differentiate sterile postoperative inflammation from infectious endophthalmitis because the treatments of these patients are markedly different. Patients with toxic anterior segment syndrome will often respond rapidly to treatment with topical corticosteroids, w ...
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Anterior Segment
The anterior segment or anterior cavity is the front third of the eye that includes the structures in front of the vitreous humour: the cornea, iris, ciliary body, and lens.Cassin, B. and Solomon, S. ''Dictionary of Eye Terminology''. Gainesville, Florida: Triad Publishing Company, 1990."Departments. Anterior segment."
Cantabrian Institute of Ophthalmology.
Within the anterior segment are two fluid-filled spaces: * the anterior chamber between the posterior surface of the cornea (i.e. the ) and the iris. * the

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Iris (anatomy)
In humans and most mammals and birds, the iris (plural: ''irides'' or ''irises'') is a thin, annular structure in the eye, responsible for controlling the diameter and size of the pupil, and thus the amount of light reaching the retina. Eye color is defined by the iris. In optical terms, the pupil is the eye's aperture, while the iris is the diaphragm. Structure The iris consists of two layers: the front pigmented fibrovascular layer known as a stroma and, beneath the stroma, pigmented epithelial cells. The stroma is connected to a sphincter muscle ( sphincter pupillae), which contracts the pupil in a circular motion, and a set of dilator muscles (dilator pupillae), which pull the iris radially to enlarge the pupil, pulling it in folds. The sphincter pupillae is the opposing muscle of the dilator pupillae. The pupil's diameter, and thus the inner border of the iris, changes size when constricting or dilating. The outer border of the iris does not change size. The constr ...
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Anesthetic
An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two broad classes: general anesthetics, which result in a reversible loss of consciousness, and local anesthetics, which cause a reversible loss of sensation for a limited region of the body without necessarily affecting consciousness. A wide variety of drugs are used in modern anesthetic practice. Many are rarely used outside anesthesiology, but others are used commonly in various fields of healthcare. Combinations of anesthetics are sometimes used for their synergistic and additive therapeutic effects. Adverse effects, however, may also be increased. Anesthetics are distinct from analgesics, which block only sensation of painful stimuli. Local anesthetics Local anesthetic agents prevent the transmission of nerve impulses without ...
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Balanced Salt Solution
A balanced salt solution (BSS) is a solution made to a physiological pH and isotonic salt concentration. Solutions most commonly include sodium, potassium, calcium, magnesium, and chloride. Balanced salt solutions are used for washing tissues and cells and are usually combined with other agents to treat the tissues and cells. They provide the cells with water and inorganic ions, while maintaining a physiological pH and osmotic pressure. Sometimes glucose is added as an energy source and phenol red is used as a pH indicator. In medicine, balanced salt solutions can be used as an irrigation solution such as during intraocular surgery and to replace intraocular fluids. Balanced salt solutions * Alsever's solution * Earle's balanced salt solution (EBSS) * Gey's balanced salt solution (GBSS) * Hanks' balanced salt solution (HBSS) * (Dulbecco's) Phosphate buffered saline (PBS) * Puck's balanced salt solution * Ringer's balanced salt solution (RBSS) * Simm's balanced ...
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Intraocular Pressure
Intraocular pressure (IOP) is the fluid pressure inside the eye Eyes are organs of the visual system. They provide living organisms with vision, the ability to receive and process visual detail, as well as enabling several photo response functions that are independent of vision. Eyes detect light and conv .... Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg). Physiology Intraocular pressure is determined by the production and drainage of aqueous humour by the ciliary body and its drainage via the trabecular meshwork and uveoscleral outflow. The reason for this is because the Vitreous body, vitreous humour in the Posterior segment of eyeball, posterior segment has a relatively fixed volume and thus does not affect intraocular pressure regulation. An important quantitative relationship (Goldmann ...
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Antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the common cold or influenza; drugs which inhibit viruses are termed antiviral drugs or antivirals rather than antibiotics. Sometimes, the term ''antibiotic''—literally "opposing life", from the Greek roots ἀντι ''anti'', "against" and βίος ''bios'', "life"—is broadly used to refer to any substance used against microbes, but in the usual medical usage, antibiotics (such as penicillin) are those produced naturally (by one microorganism fighting another), whereas non-antibiotic antibacterials (such as sulfonamides and antise ...
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Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior. Some common naturally occurring steroid hormones are cortisol (), corticosterone (), cortisone () and aldosterone (). (Note that cortisone and aldosterone are isomers.) The main corticosteroids produced by the adrenal cortex are cortisol and aldosterone. Classes * Glucocorticoids such as cortisol affect carbohydrate, fat, and protein metabolism, and have anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive effects. Anti-inflammatory effects are mediated by blocking the action of inflam ...
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Atrophy
Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, excessive amount of apoptosis of cells, and disuse or lack of exercise or disease intrinsic to the tissue itself. In medical practice, hormonal and nerve inputs that maintain an organ or body part are said to have ''trophic'' effects. A diminished muscular trophic condition is designated as ''atrophy''. Atrophy is reduction in size of cell, organ or tissue, after attaining its normal mature growth. In contrast, hypoplasia is the reduction in the cellular numbers of an organ, or tissue that has not attained normal maturity. Atrophy is the general physiological process of reabsorption and breakdown of tissues, involving apoptosis. When it occurs as a result of disease or loss of trophic support because of other diseas ...
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Corneal Hydrops
Corneal hydrops is an uncommon complication seen in people with advanced keratoconus or other corneal ectatic disorders, and is characterized by stromal edema due to leakage of aqueous humor through a tear in Descemet's membrane. Although a hydrops usually causes increased scarring of the cornea, occasionally it will benefit a patient by creating a flatter cone, aiding the fitting of contact lenses. Corneal transplantation is not usually indicated during corneal hydrops. Signs and symptoms The person experiences pain and a sudden severe clouding of vision, with the cornea taking on a translucent milky-white appearance known as a corneal hydrops. Diagnosis Patients are recommended to take a Sodium Chloride eye drop solution as well as a Dexamethasone solution for a period of 4-6 weeks, timeframes may vary depending on the severity of a patients condition. Once the medication cycle is complete and the cloud clears, scarring will be left on the cornea. Management The effect is n ...
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Inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair. The five cardinal signs are heat, pain, redness, swelling, and Functio laesa, loss of function (Latin ''calor'', ''dolor'', ''rubor'', ''tumor'', and ''functio laesa''). Inflammation is a generic response, and therefore it is considered as a mechanism of innate immune system, innate immunity, as compared to adaptive immune system, adaptive immunity, which is specific for each pathogen. Too little inflammation could lead to progressive tissue destruction by the harmful stimulus (e.g. b ...
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Hypopyon
Hypopyon is a medical condition involving inflammatory cells in the anterior chamber of the eye. It is an exudate rich in white blood cells, seen in the anterior chamber, usually accompanied by redness of the conjunctiva and the underlying episclera. It is a sign of inflammation of the anterior uvea and iris, i.e. iritis, which is a form of anterior uveitis. The exudate settles at the dependent aspect of the eye due to gravity. It can be sterile (in bacterial corneal ulcer) or not sterile (fungal corneal ulcer). Differential diagnosis Hypopyon can be present in a corneal ulcer. It can occur as a result of Behçet's disease, endophthalmitis, panuveitis/ panophthalmitis, or adverse reactions to some drugs (such as rifabutin). Hypopyon is also known as ''sterile pus'' because it occurs due to the release of toxins and not by the actual invasion of pathogens. The toxins secreted by the pathogens mediate the outpouring of leukocytes that settle in the anterior chamber of th ...
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Fibrin
Fibrin (also called Factor Ia) is a fibrous, non-globular protein involved in the clotting of blood. It is formed by the action of the protease thrombin on fibrinogen, which causes it to polymerize. The polymerized fibrin, together with platelets, forms a hemostatic plug or clot over a wound site. When the lining of a blood vessel is broken, platelets are attracted, forming a platelet plug. These platelets have thrombin receptors on their surfaces that bind serum thrombin molecules, which in turn convert soluble fibrinogen in the serum into fibrin at the wound site. Fibrin forms long strands of tough insoluble protein that are bound to the platelets. Factor XIII completes the cross-linking of fibrin so that it hardens and contracts. The cross-linked fibrin forms a mesh atop the platelet plug that completes the clot. Fibrin was discovered by Marcello Malpighi in 1666. Role in disease Excessive generation of fibrin due to activation of the coagulation cascade leads to ...
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