Medicalnotes384

CORNEAL ULCER

CORNEAL ULCER

All right so today we are dealing yet

very important topic and that is the

corneal ulcers frequently we get this

problem that how to differentiate

between the different ulcers when it is

bacterial.

when it is viral where it is

fungal what are the most prominent

features and how to decide the treatment

of choice so all right we'll be starting

with first the most common also and that

is the bacterial answer the ulcer is the most common as we

know now what is the most important

cause of this answer as you know the

most important cause of this also is the

epithelial erosion. whenever there is a

patil erosion due to any of the reason

secondary bacterial infection is very

commonly occurring and the most common

bacteria is actually the staph aureus.

Staph aureus is most common in the world

streptococcus pneumoniae so we have most

common in the word as well as we have

most common in pakistan as well as the most

common factor which is actually

responsible for the corneal ulcer is the

epithelial erosion now because most of

the bacteria are not able to invade the

intact epithelium that is why epithelial

erosion is actually the most common

cause of the secondary bacterial

infection but I will say that some

bacteria are much virulence and those

bacteria which are virulent enough which

are aggressive enough which can invade

the intact epithelium they have the risk

of causing corneal ulcers even when

there is conjunctivitis so for example

if I talk about gonococcus guna gokul

conjunctivitis which is most commonly

the purulent conjunctivitis whenever a

patient this systemic type of gonococcal

conjunctivitis which has systemic

features also like we have urethritis. we

have arthritis in all these cases there

is always a risk of the bacterial

infection in the cornea also there is a

risk of corneal involvement also because

it can invade the intact corneal

epithelium now let us see a list which

can invade the intact corneal epithelium

the first important is the Corney

bacterium tip 3 the first important

bacteria is the Corney bacterium def 3

the second one second is the nazaria go

nori nazaria go nori the third important

is the nazaria meningitidis nazaria

meningitidis then the fourth one is the

Listeria food is the Listeria and fifth

is the H influenza and finally we have

the Shigella now this is again I

important mcq all those bacteria which

can invade the internal epithelium are

these and apart from this they will

always cause corneal ulcers whenever

there is epithelial erosion all right

now because there is lot of vascular

ization which is present in the

bacterial corneal ulcer a very important

complaint of this patients these

patients is the pain in fact I can say

that pain is the most dominant feature

as well as most prominent feature of

those patients who are having the

bacterial corneal ulcer and both is due

to the vascularization because it is so

red like why it is so painful both of

them is occurring due to the

vascularization lot of vascularization

reading lot of pain and lot of

congestion

now these bacteria when they are

invading and they are going inside in

the different layers of the cornea as

they reach inside they can also cause

the uveitis uveitis means are ido site

light

when the inflammation is going to the

deeper layers there is active ulceration

from the superficial layers to the

deeper layers this keratitis which could

have started from conjunctivitis also so

this conjunctivitis then keratitis

is going to the deeper layers also it is

involving the iris and ciliary body it

is causing a reduce eye cleitus and that

is why photophobia

photophobia is again a very important

symptom of these patients plus the

inflammatory cells now these

inflammatory cells when they're

collected inside the anterior chamber

because of their happiness the accidents

will always settle at the bottom now

whenever the exudates are settling at

the bottom.

ANATOMY OF THE LENS

ANATOMY OF THE LENS

let's see anatomy of the lens there's no

blood supply or innervation so it

depends on aqueous for nutrient delivery

and waste removal.

we know that what it

does reflects like some interesting

concept. I guess you look at it with

aging terms of changes sometimes there's

a myopic shift sometimes there's a hyper

optic shift. we know it's always

increasing in curvature but the very

changes in index of refraction can alter

the actual refractive effect of that

Size at birth

versus size in adults so those are sort

of important anatomic considerations if

you're cataract surgeon just remembering

that in adult size is really about five

millimeters thick at most so you got

about five millimeters of depth before

you're puncturing a posterior capsule

with whatever instrument you're using

all right the capsule elastic membrane

type for collagen just remember its

thinnest posterior to four microns

pretty impressive how strong it is

despite its thin nature there. you

can see it's thickest equatorial and

centrally about 14 microns as annuals

microfibrils composed of elastic tissue

they originate for the non pigmented

epithelium of the ciliary body the

insert in a continuous fashion

equatorial region you can see they

insert just a little bit more central

anteriorly versus posteriorly and with

age of course the fibers regress the

equatorial fibers will progressively

they mostly just an tear in poster

fibers lenz epithelium is a single layer and of course there's active replication and

the anterior equatorial region as we all

know the newly formed cells as we know

they migrate equatorially and posterior

lis forming new lines fibers losing

their organelles that through that

process and of course because they have

no organelles they depend on glycolysis

class let's see

so those highlights here of course no

cells are lost from the lens the oldest

form the nucleus so you'll see that

fetal or embryonic suture pattern and

newest form the outermost aspect at the

you know the cortex we've seen the lens

sutures onyx those who have looked on

slit lamp exam major digitation z--

their the apical and basal cells. we see

optical zones when you look at a lens so

you might notice that there's sort of

this delineation of an endo nucleus a

central lens component versus the EPI

nucleus or cortical material when you

look at cataracts or a similar finding

except it's not a clear lens obviously

it's a cloud at the some degree there's

no morphologic distinction between the

cortex and nucleus though you know we

have these surgical delineations that we

talk about or discuss when you actually

look at it from a pathology assessment

histologically there's really no

differentiation lens up to the Lens cells

those lens cells look the same

let's see crystalline proteins that make

up a lot of what is left over once the

lens has eliminated its organelles you

see some fascinating concepts about it

and

maybe you should read about this

sometime it's not super exciting as

that I know as you age you start to lose

some of the it says here maybe it's the

next slide here membrane structural

proteins and skeletal proteins or

anything highlight that I could take off

of here while you're reading it here it

is the increase of water with age this is actually you

know important to understand as we get

older protein aggregates into large

particles they become water insoluble

that's going to result in opacity Claire

reduce clarity or cataract so scatter

they scatter lights of course certain

amount of this process appears to be

normal with maturation of lens cells the

seeing clear lenses with the excess of

it results in the cataract formation.

BUMP OF UPPER EYE LID

BUMP OF UPPER EYE LID

it's the typical history is the bump

developed over a period of days or weeks the eyelid is not red.

It's not inflamed but there's definite tenderness. Where the bump is located the bump is typically a non-infected occluded oil gland the name of the oil gland is the meibomian gland there are about 50 meibomian glands in each of our upper lids and about 25 meibomian glands in each of our lower eyelids if these glands become obstructed. where the oil that's made in the eyelid. This oil normally produces an oil slick for our tear film to slow down the evaporation rate of our natural tear layer on our eye surface but if these oil glands become obstructed then it's of great concern to the patient the most common treatment that i recommend if the meibomian gland has only been there for a week or less is to apply heat and massage to the eyelid it can take one of two forms if you do it twice a day for about five minutes you can either let hot water from the shower head flow onto the bump and as you massage it you'll liquefy the trapped oil which is semi-solid in the eyelid the heat will liquefy that oil and as you massage it the oil will flow out through the orifices that are just behind the row of eyelashes if you have a shellacean on your lower lid you massage upward if you have a shilazin on your upper lid you massage downward you let the hot water from the hot shower head flow over your eyelid while you're massaging and the eyelid is being heated up if you do that twice a day for a week usually the chalazion will go away similarly another treatment is to take a hard-boiled egg that's cooked and it's still hot but just not quite hot enough to burn your skin you apply the hard-boiled egg to the upper lid if the chalazin's there or the lower lid if that's where the chalazion is located massage it and again just like hot water it should liquefy the contents of the chalazion and the oil should drain on its own i find there's about a 90% success rate with this treatment if the

has been present for one week or less if you're in the 10 percent that the chalazion does not go away with that treatment that chalazion may kind of just stay with you and so in this particular instance we're going to talk about the patient who contacted us about a month ago she tried the heat but the heat did not make the chalazion go away . okay so what it is is a blocked oil gland so in your eyelid there are oil glands that run vertically on each lid glands empty through orifices that are just behind your row of eyelashes so you have a blocked oil gland back there the reason why we wanted you to apply heat was the heat would liquefy the trapped oil that's semi-solid in your eyelid and if you massage it a lot of times it empties through the pores if it's not able to do that we can drain it so we inject the eyelid with an anesthetic you feel that for 10 seconds.

EYE LID DISORDERS

EYE LID DISORDERS

we'll approach some disorders of the

eyelid here I wanted to do a quick

overview of the anatomy just to orient

ourselves we'll talk about the three

inflammatory disorders - focal

inflammatory disorders known as clays

Ian and horny olam and then a more

diffuse inflammatory disorder called

blepharitis.

which has many causes and

then some other eyelid conditions which

are a little bit less tested the entropion ectropion and trichiasis certainly though you will

encounter these in clinical practice

especially if we work with a geriatric

population but I would say that these

first three year plays II and cordial

and blepharitis are the most commonly

tested . we're going to talk about and

then tumors these are tumors that occur

elsewhere on the body especially the

skin but I just wanted to briefly talk

about them because they do occur on the

eyelid.So the external I hear some

obvious points the upper lid lower lid

lateral canthus kind of hard to see this

is the right I hear this is the nasal

bridge right here and then the medial

canthus so the lateral medial canthus

are just the ends of the words where the

eyelids come together on the lateral

medial side and this little pink spot

here is probably carbuncle the lacrimal

carbuncle and that's where the tears

come out what you can't see here are

inside is the lacrimal duct which

ultimately empties into the nose and

then the lacrimal gland which is on the

superior and medial aspect of the orbit

orbital septum is just the hole in the

skull where the orbits it's roughly

you'd have to palpate but it's roughly

this area here going a little deeper

you've got the orbital septum as we just

showed the superior and inferior tarsal

flakes the tarsal plates are what give

the eyelid its characteristic structure

and this is just dense connective tissue

then you have the medial and lateral

palpebral ligament and this kind of

holds the eyelid in place then you've

got a laughable sac which ultimately

drains into that carnival

you got three muscles here all the way

are innervated by the facial nerve the

orbicularis oculi muscle muscle which is

traditionally divided up into two parts

and there's the orbital part which is

responsible for forced closure that's

کیلیفورنیا

کیلیفورنیا میں فلمی ستاروں اور ڈزنی لینڈ کے علاوہ بھی بہت کچھ ہے۔

یہ ایک ایسی ریاست ہے جہاں حیرت انگیز قدرتی پرکشش مقامات کی ایک بڑی تعداد اس میں شامل ہے۔

خوبصورت ساحل ، پرسکون صحرا اور شاہی پہاڑ۔

کیلیفورنیا میں متعدد دلچسپ شراب خانے موجود ہیں۔

دنیا کی بہترین شراب ان شراب خانوں میں دستیاب ہے۔

کیلیفورنیا میں دیکھنے کے لئے بہترین مقامات ہیں۔

بگ سور

کارمیل ہائ لینڈز اور سان سیمون کے درمیان واقع ، بگ سور ایک بڑا ، پتھراؤ والا راستہ ہے۔ کیلیفورنیا کے ساحلی علاقے کی کوئی سرکاری حدود نہیں ہے ، لیکن یہ کیلیفورنیا کے 70 میل دور ہے۔

مشہور ہائی وے ون۔

یہ علاقہ روڈ ٹرپ پر جانے والے مسافروں کے لئے مقناطیس کی حیثیت رکھتا ہے ، جو زبردست ریڈ ووڈ کی طرف راغب ہوتے ہیں۔ راستے میں درخت اور دم توڑنے والے ساحل ہیں ۔ ڈرائیونگ کے لئے صرف خوبصورت مناظر سے زیادہ ، یہ علاقہ کافی مقدار میں خشگوار ماحول بھی فراہم کرتا ہے۔ گھومنے پھرنے کے سرفہرست مواقع جو کئی ریاستوں کے پارکوں میں شامل ہیں۔

کاتالینا جزیرہ۔

یہ دلکش جزیرہ لاس بحر الکاہل کے قریب 22 میل کے فاصلے پر واقع ہے۔

یہ ایل اے کے سیاحوں کے لئے ایک پسندیدہ جگہ ہے جہاں دن کا سفر بہت خشگوار ہوتا ہے۔

سہاگ رات کی جگہ.

سانٹا کتالینا ایک چھوٹا جزیرہ ہے جس کی آبادی کے دو اہم مراکز یہاں دوسرے علاقوں سے آنے والے نۓ شادی شدہ لوگ سہاگ رات منانے کو ترجیح دیتے ہیں۔

اوولون۔

جزیرے کے زیادہ تر مسافر بنیادی طور پر اوولون کے علاقے میں رہتے ہیں۔

حیرت کی بات یہ ہے کہ جزیرے میں امریکی بایسن کی ایک چھوٹی سی آبادی بھی موجود ہے ۔ ایک فلم کی شوٹنگ کے دوران جزیرے کا سارا علاقہ دیکھایا گیا ہے۔ مسافر نجی کشتی ، گھاٹ ، ہیلی کاپٹر یا چھوٹے طیاروں کے ذریعے جزیرے تک پہنچ سکتے ہیں۔

اس جزیرے پر ، نقل و حمل صرف سائیکلوں ، ٹیکسیوں اور گولف کارٹس تک محدود ہے۔

جھیل طاہو۔

جھیل طاہو نہ صرف امریکہ کی دوسری گہری جھیل ہونے کے لئے متاثر کن ہے ، بلکہ اس کے ساحل کی لمبائی جو بہت اچھا قدرتی نظارہ پیش کرتی ہے۔

میٹھے پانی کی جھیل کیلیفورنیا اور نیواڈا دونوں جگہوں پر پھیلی ہوئی ہے اور یہ سال بھر کا ایک اعلی مقام ہے۔

1960 کی دہائی کے سرمائی اولمپکس کے انعقاد کے بعد یہ جھیل موسم سرما کے کھیلوں کا مرکز بن گئی۔

شمالی ساحل پر وادی اسکوا میں۔

موسم گرما میں پہاڑوں میں پیدل سفر اور جھیل پر کشتی کے سفر کے دوران لوگ گہری اور پر سکون خاموشی سے لطف اندوز ہوتے ہیں۔

ساحل پر لیزنگ ، تیراکی ، اور بی بی کیو کا بھی وسیع انتظام کیا گیا ہے۔

سیکوئیا اور کنگز وادی نیشنل پارکس۔

یہ دونوں قومی پارکس جنوبی صحرا میں ایک دوسرے کے آمنے سامنے واقع ہیں۔

نیواڈا پہاڑ اور دیو سیکوئیا دونوں اپنے بہت بڑے درختوں کی وجہ سے مشہور ہیں۔

یہ درخت 300 فٹ سے زیادہ لمبے ہیں۔ اور ان کے تنوں میں 100 فٹ تک کی لمبائی ہوسکتی ہے۔

سیکوئا نیشنل پارک ، جو 1890 میں قائم کیا گیا تھا ، پہاڑ ی چوٹیوں کا بھی ایک گھر ہے ، جو متفقہ ریاستہائے متحدہ کا سب سے بلند مقام ہے۔

دلچسپ بات یہ ہے کہ کنگز وادی امریکہ میں گہری وادی ہے۔

پارکس میں وائلڈ لائف چڑیا گھر ہے ، بشمول بوبکیٹس ، سرمئی لومڑی ، ریچھ

اور خچر ہرن بھی موجود ہیں۔

اگر وہ خوش قسمت ہیں ، تو شاید سیاح بھیڑ بکریوں یا پہاڑی شیروں کو تلاش کرسکیں۔

دونوں پارکس بیک پیکر اور پیدل سفر کے لئےمشہور ہیں۔اور یہاں 14 کیمپ گراؤنڈ سیاحوں کے لئے دستیاب ہیں۔

وادی ناپا۔

ریاستہائے متحدہ میں شراب سے محبت کرنے والوں کے لئے وادی ناپا ایک اولین منزل ہے۔

اس کی الکحل دنیا کی بہترین الکحل مانا جاتا ہے۔

بہت ٹریول ایجنٹ سیاحوں کو ایڈجسٹ کرنے کے لئے بہترین سہولیات مہیا کرتے جو ناپا کا سفر کرتے ہیں ۔اس علاقے میں بہت سے ایسے مقامات ہیں جہاں دلکش نظارے اور بہترین ہوٹلز ہیں۔جہاں سیاح آرام کیلیے رکتے ہیں۔

تھوڑی رقم بچانے میں دلچسپی رکھنے والوں کے لئے کیمپنگ گراؤنڈ بھی موجود ہیں

اس کے علاوہ ، نپا ویلی میں بہت سارے عالمی معیار کے اسپاس بھی موجود ہیں جہاں سیاح لاڈ پیار کرسکتے ہیں اور لطف اٹھا سکتے ہیں۔

مختلف طرح کی تفریحی سرگرمیاں ، بشمول گرم ہوا کے غبارے کی سواریوں اور رہنمائی شدہ موٹر سائیکل وغیرہ۔

سان ڈیاگو.

حیرت انگیز ساحل ، مثالی آب و ہوا اور پرکشش نظاروں کے ساتھ ، یہ تعجب کی بات نہیں ہے کہ کیلیفورنیا میں دیکھنے کے لئے سان ڈیاگو ایک مشہور مقام ہے۔

میکسیکن کی سرحد کے بالکل شمال میں واقع ، سان ڈیاگو ایک چھوٹا سا ساحلی شہر ہے۔ شہر کا ماحول۔

Meibomian Glands

DRY EYE TREATMENT

lipiflow is one of the most advanced dry eye treatments that someone can get at an eye clinic

people have had amazing results to help them with a dry condition but the tricky part

is that it can be a costly procedure with no insurance coverage

so the question is is lipiflow worth it let's focus in and your vision clear and i make videos all about the eyes like this one to help you with those tough decisions you have to make about your eyes so consider subscribing for my future videos when they come out now let's focus on lipiflow lipiflow is one of the most advanced fda approved dry eye treatments that you can have done at your eye doctor's office if they have it it targets and treats the oil glands in your eyelids specifically if you have meibomian gland dysfunction the oil glands in your eyelids are called meibomian glands and they run vertical up and down your eyelids top and bottom now they're responsible for pumping and pushing out oil over the top layer of your tears if you don't have enough oil or the wrong type of oil then your tears will evaporate leaving your eyeball exposed to the air causing them to get dry and inflamed and causing dry ice symptoms that you might expect now if your oil glands are clogged or they're shortened or they're at your feet or you don't have the right type of oil or their plane not functioning very well then you have what's called meibomian gland dysfunction and it's one of the most common core issues to dry eye problems and that's exactly what lipiflow treats it treats the core issue it treats meibomian gland dysfunction now the actual lipiflow procedure is ran by a computer console and single use activators now before you actually do the procedure your eye doctor might do a little bit of prep work usually they'll put in an anesthetic eye drop to numb your eyes first and then they may also debride your eyelids or clean off any capped hardened oil from your oil glands and that will make the procedure more effective then they'll place the actual activators between your eyeball and your eyelids top and bottom now what's kind of neat about the activators especially the white bowl that you see here is that it serves two functions the inside will protect your cornea from the actual procedure the outside is where all the heat is applied and that's applied to the inner layer of the eyelids and that's part of what makes this procedure so effective is that it's applying that the heat to the inside of the eyelids and not the outside so once your activators are in place the device is turned on and the activators are heated up to exactly 42.5 degrees Celsius the heat that they found that works the best now each activator has these little bladders on there that will massage your oil glands and they massage in a peristaltic motion pretty much meaning that they start from the the beginning of the oil glands or the base of the oil glands and then they'll squeeze and massage trying to remove and push any obstruction or hardened oil out of the opening of the oil gland it's kind of like you're pretty much just milking your own oil glands now with this combination where you have the heat applied to the inside of the eyelids and that peristaltic massage that combination works really well at cleaning and clearing out your oil glands to help them function better in the future now the procedure lasts exactly 12 minutes you do both eyes at the same time and then when you're done they're able to remove the activators really safely and then you're all finished now what to expect right after the procedure you may experience some redness itchiness maybe some more dryness or inflammation sometimes your eye doctor may prescribe a steroid eye drop to help.