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By T. Gonzales. Jarvis Christian College.

Three-dimensional ultrasound of the female urethra: Comparing transvaginal and transrectal scanning cialis 5mg without a prescription. Three-dimensional ultrasound: A novel technique for investigating the urethral sphincter in the third trimester of pregnancy generic cialis 10 mg free shipping. Correlating structure and function: Three-dimensional ultrasound of the urethral sphincter buy generic cialis 20 mg line. Maximum urethral closure pressure and sphincter volume in women with urinary retention. Three-dimensional ultrasound of the urethral sphincter predicts continence surgery outcome. The urethral motion profile: A novel method to evaluate urethral support and mobility. Ultrasound imaging of the lower urinary system in women after Burch colposuspension. Evaluation of urethrovesical angle by ultrasound in women with and without urinary stress incontinence. Examination of the urethrovesical junction using perineal sonography compared to urethrocystography using a bead chain. Reproducibility of ultrasonic measurements of pelvic floor structures in women suffering from urinary incontinence. Perineal assessment of urethrovesical junction mobility in 564 young continent females. Perineal ultrasound in the study of urethral mobility: Proposal of a normal physiological range. Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: An imaging panel and practical approach. Transvaginal endosonography: A new method to study the anatomy of the lower urinary tract in urinary stress incontinence. Applicability of perineal sonography in anatomical evaluation of bladder neck in women with and without genuine stress incontinence. Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. Effectiveness of Burch colposuspension in females with recurrent stress incontinence—A urodynamic and ultrasound study. Inter-observer reliability of three different methods of measuring urethrovesical mobility. Establishing a mean postvoid residual volume in asymptomatic perimenopausal and postmenopausal women. Application of portable ultrasound scanners in the measurement of post-void residual urine. Determining the reliability of ultrasound measurements and the validity of the formulae for ultrasound estimation of postvoid residual bladder volume in postpartum women. Immediate postvoid residual volumes in women with symptoms of pelvic floor dysfunction. Manual versus automatic bladder wall thickness measurements: A method comparison study. Anatomical and functional changes in the lower urinary tract following spontaneous vaginal delivery. Displacement and recovery of the vesical neck position during pregnancy and after childbirth. Direction sensitive sensor probe for the evaluation of voluntary and reflex pelvic floor contractions. Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. A prospective observational trial of pelvic floor muscle training for female stress urinary incontinence. The pelvic floor muscles: Muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. The assessment of levator muscle strength: A validation of three ultrasound techniques. Comparison of transperineal and transabdominal ultrasound in the assessment of voluntary pelvic floor muscle contractions and functional manoeuvres in continent and incontinent women. Validation of new ultrasound parameters for quantifying pelvic floor muscle contraction. The reliability of puborectalis muscle measurements with 3-dimensional ultrasound imaging. Pelvic floor function in nulliparous women using three-dimensional ultrasound and magnetic resonance imaging. Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Interobserver repeatability of three- and four-dimensional transperineal ultrasound assessment of pelvic floor muscle anatomy and function. Levator ani thickness variations in symptomatic and asymptomatic women using magnetic resonance based 3-dimensional color mapping. Direct imaging of the pelvic floor muscles using two-dimensional ultrasound: A comparison of women with urogenital prolapse versus controls. Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Paravaginal defects: A comparison of clinical examination and 2D/3D ultrasound imaging. Use of 3D ultrasound as a new approach to assess obstetrical trauma to the pelvic floor. Three-dimensional ultrasound imaging of the pelvic floor: The effect of parturition on paravaginal support structures. Interrater reliability of assessing levator ani muscle defects with magnetic resonance images. The prevalence of major abnormalities of the levator ani in urogynaecological patients. The assessment of levator trauma: A comparison between palpation and 4D pelvic floor ultrasound.

Secretory IgA can neutralize viruses the number of effector cells and their killing by similar mechanism on mucosal surfaces buy cialis 10mg otc. Immunity in Parasitic cialis 10mg free shipping, Viral purchase cialis paypal, Bacterial and Fungal Infections 249 In some cases, antibodies may block viral limiting the spread of the infectious particles penetration by binding to epitope that are nec- and forming a complex that is readily phago- essary, to mediate fusion of the viral envelope cytosed. Antibodies also function as an opsonizing agent to facilitate can work at stages after penetration. Uncoat- Fc or C3b receptor-mediated phagocytosis of ing with its release of viral nucleic acid, into the viral particles. If the induced antibody tective role in polio and in number of other is of complement-activating isotypes, lysis of viral infections. Antibody can body can protect humans against several in- also cause aggregation of virus particles, thus, fections including measles, hepatitis A and B Fig. Both pathways thus result in the inhibition of protein synthesis and thereby effectively block viral replication. The best example is influenza virus, produced that interfere at various levels with which undergoes antigenic variation, produc- specific and non-specific defenses. The antibody produced vantage of such proteins is that they enable against earlier strain becomes ineffective. Some viruses, of the organisms are low, they can be elimi- directly destroy the lymphocytes and mac- nated by phagocytic cells of the innate de- + fense system. In of the inoculums is larger and the organisms other cases, the immunosuppression may be are more virulent, then the role of specific due to cytokine imbalance. In most cases, the immune reponse is generated against the components Antibody can interfere the normal func- of the bacteria and the molecules secreted tioning of bacteria, if in various ways when it by them. Direct binding af- ated against the organ of motility (flagella), fects the activity of specific transport systems, the organ of adhesion (fimbriae) and also the there by depriving the bacteria of its energy capsules. Inva- fimbriae also affect their ability to function sion of the bacteria can also be inhibited by properly. Antibodies also can inactivate vari- restricting the motility, when antiflagellar an- ous bacterial enzymes and toxins. Specific antibody can The bacteria after successfully evading agglutinate the bacteria, thus restricting the the innate defense mechanisms (mechanical dissemination of the organism. C3b component of complement, act as an The resulting increased vascular permeability opsonin and increases the phagocytosis and leads to the exudation of serum, which con- clearance of the bacterium (Fig. Anaphyla- Antibody-mediated complement activation toxins (C3a, C5a) generated by complement also produce certain localized effector mol- activations, further increase the vascular per- ecules, which help to amplify the inflamma- meability increasing blood flow to the area. For example, the complement Two types of adaptive immunity play split products (C3a, C4a and C5a) act as ana- roles against bacterial infection. Attachment and invasion are important pro- cesses, which pathogenic bacteria adopt to Cell-mediated Immunity establish the infection. Certain antibodies Ultimately, all bacteria will be engulfed by such as secretory IgA, interfere with the at- macrophages either to kill the bacteria or tachment molecule (agresin) and prevent to remove after extracellular killing. Many microbial products (muramyl dipeptide organisms produce disease through their and trehalose dimycolate) and chemotactic exotoxins (diphtheria, tetanus, botulism, etc). Complement activation on bacterial surface leads to complement-mediated lysis of bacteria; 3. Antibody and the complement split product C3b bind to bacteria, serving as opsonins to increase phagocytosis; 4. C3a and C5a, generated by antibody-initiated complement activation, in- duce local mast cell degranulation, releasing substances that mediate vasodilation and extravasation of lymphocytes and neutrophils; 5. The endotoxin present in the cell wall cella species can also survive intracellularly. In case of mycobacterial species, there is While innate immunity as well as humor- a waxy cell wall, which is resistant to lyso- al immunity are not very effective against in- somal enzymes. Intracellular bacteria induce a cell- sides the cell wall of both the mycobacterial mediated immune response, specifically de- species contain lipoarabinomannan, which layed type of hypersensitivity. How- ever, the fungi can cause, sometimes, serious The bacteria, which can survive and repli- life-threatening illness. The fungi can exist as: cate inside the cell are in an advantageous condition, because the antibodies have no 1. Liste- sue as a yeast (or yeast-like form such as spher- riosis occurs mostly in immunocompromised ules and endospores). T cell-mediated specific immune re- promised subjects [patients with untreated sponses. Immunity to mycoses is prin- (including dermatophytes and most systemic cipally cellular, involving neutrophils, mac- mycoses such as C. The phagocytes coccidioidomycosis, the type of immune (neutrophils and macrophages) kill the fungi. Cryptococcus neoformans, ordinar- ated molecular patterns in the fungal cell wall ily, inhibits phagocytosis because of by either soluble or cell bound pattern recog- its polysaccharide capsule, but can be nition molecules. Discuss the effector mechanism involved h activity plays dominant role in eliminating in the elimination of parasites from the fungal pathogens. Heart Disease hypertensive or arteriosclerotic cardiovascular disease typically show evidence of prior infarction and interstitial Heart disease leading to ventricular irritability and fatal fbrosis. Both fndings also predispose to abnormalities in cardiac arrhythmia is the most signifcant cause of death the conduction system, predisposing to myocardial irrita- in this category. Ventricular Complications other than tachyarrhythmia and tachyarrhythmias are most commonly seen within 12 pump failure of myocardial infarctions can result in hours of a myocardial infarction. Critical coronary ath- sudden cardiac death; the most common include the erosclerosis and hypertension are by far the leading causes myocardial rupture syndromes, including ventricu- of these processes. Typically, these erosclerosis and arteriosclerosis formation include hyper- insults occur approximately 1 week following a myocar- lipidemia, high blood pressure, diabetes mellitus, obesity, dial infarction, the point at which there is removal of cigarette smoking, stress, and sedentary lifestyle. Hemopericardium Having 75% or greater blockage in any of the epicar- with ensuing cardiac tamponade can occur following dial vessels is considered critical stenosis and is consistent ventricular free wall rupture; this scenario is rapidly with being alive 1 second and having loss of conscious- fatal in most cases, causing decreased venous return to ness leading to death the next. Fatal arrhythmia occurs causes of hypertension include many types of kidney dis- during or following exercise. Tese patients can be asymp- ease, including adult polycystic kidney disease and renal tomatic prior to the sudden event or may have past episodes artery stenosis. High blood pressure is macroscopic heart evaluation shows cardiac hypertrophy also associated with small-vessel coronary artery disease, with signifcant asymmetry of the subaortic septal region, as is diabetes mellitus, which is a reasonable cause of death which poses as an outfow obstruction. Once people reach a pivotal point of myocardial tions from this region show variable degrees of myocyte irritability and go into ventricular fbrillation, they usually disarray, fbrosis, myocyte hypertrophy, and small-vessel have approximately 15 seconds of consciousness lef. Te disease is due to an autosomal dominant to losing consciousness, decedents may reach up to chest mutation in the cardiac sarcomere apparatus, most com- or neck and mention a futtering sensation in the chest. Ventricular irritability associated with coro- defned, it has been described with a spectrum of change nary artery ischemia is due to lack of oxygen and nutrients ranging from asymmetry of the lef ventricle, in classical reaching the conducting system of the heart. If the heart presentation, to the rarely described variant with no car- is not cardioverted back to a normal rhythm within 4–6 diac hypertrophy at all. Arrhythmogenic right ventricular cardiomyopathy Another major cause of ventricular irritability lead- can present with sudden unexpected death. Concentric lef the right ventricle is thinned, with microscopic evalu- ventricular hypertrophy, usually defned at autopsy as ation showing signifcant transmural infltration by having a lef ventricular wall thickness greater than fbrofatty tissue. Lef ventricular thickness is bacterial, fungal, parasitic, autoimmune, and hypersensi- best measured approximately 2 cm below the mitral valve tivity, can present as sudden death.

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We wish to construct the sampling distribution of the sample mean buy cialis master card, x generic 2.5mg cialis visa, based on samples of size n ¼ 2 drawn from this population buy cialis no prescription. Samples Above or Below the Principal Diagonal Result When Sampling Is Without Replacement. In general, when sampling is with replacement, the n number of possible samples is equal to N. We may construct the sampling distribution of x by listing the different values of x in one column and their frequency of occurrence in another, as in Table 5. It was stated earlier that we are usually interested in the functional form of a sampling distribution, its mean, and its variance. We now consider these characteristics for the sampling distribution of the sample mean, x. Sampling Distribution of x: Functional Form Let us look at the distribution of x plotted as a histogram, along with the distribution of the population, both of which are shown in Figure 5. We note the radical difference in appearance between the histogram of the population and the histogram of the sampling distribution of x. Whereas the former is uniformly distributed, the latter gradually rises to a peak and then drops off with perfect symmetry. Sampling Distribution of x: Mean Now let us compute the mean, which we will call mx, of our sampling distribution. Thus, P xi 6 þ 7 þ 7 þ 8 þÁÁÁþ14 250 mx ¼ n ¼ ¼ ¼ 10 N 25 25 We note with interest that the mean of the sampling distribution of x has the same value as the mean of the original population. It is of interest to observe, however, that the variance of the sampling distribution is equal to the population variance divided by the size of the sample used to obtain the sampling distribution. That is, s2 8 2 sx ¼ ¼ ¼ 4 n 2 pffiffiffi2 pffiffiffi The square root of the variance of the sampling distribution, sx ¼ s= n is called the standard error of the mean or, simply, the standard error. These results are not coincidences but are examples of the characteristics of sampling distributions in general, when sampling is with replacement or when sampling is from an infinite population. To generalize, we distinguish between two situations: sampling from a normally distributed population and sampling from a nonnormally distributed population. Sampling Distribution of x: Sampling from Normally Distrib- uted Populations When sampling is from a normally distributed population, the distribution of the sample mean will possess the following properties: 1. The mean, mx, of the distribution of x will be equal to the mean of the population from which the samples were drawn. The variance, s2 of the distribution of x will be equal to the variance of the population x divided by the sample size. Sampling from Nonnormally Distributed Populations For the case where sampling is from a nonnormally distributed population, we refer to an important mathematical theorem known as the central limit theorem. The importance of this theorem in statistical inference may be summarized in the following statement. The Central Limit Theorem Given a population of any nonnormal functional form with a mean m and finite variance s2, the sampling distribution of x, computed from samples of size n from this population, will have mean m and variance s2=n and will be approximately normally distributed when the sample size is large. Note that the central limit theorem allows us to sample from nonnormally distributed populations with a guarantee of approximately the same results as would be obtained if the populations were normally distributed provided that we take a large sample. The importance of this will become evident later when we learn that a normally distributed sampling distribution is a powerful tool in statistical inference. In the case of the sample mean, we are assured of at least an approximately normally distributed sampling distribution under three conditions: (1) when sampling is from a normally distributed population; (2) when sampling is from a nonnormally distributed population and our sample is large; and (3) when sampling is from a population whose functional form is unknown to us as long as our sample size is large. The logical question that arises at this point is, How large does the sample have to be in order for the central limit theorem to apply? There is no one answer, since the size of the sample needed depends on the extent of nonnormality present in the population. One rule of thumb states that, in most practical situations, a sample of size 30 is satisfactory. In general, the approximation to normality of the sampling distribution of x becomes better and better as the sample size increases. Sampling Without Replacement The foregoing results have been given on the assumption that sampling is either with replacement or that the samples are drawn from infinite populations. In general, we do not sample with replacement, and in most practical situations it is necessary to sample from a finite population; hence, we need to become familiar with the behavior of the sampling distribution of the sample mean under these conditions. The sample means that result when sampling is without replacement are those above the principal diagonal, which are the same as those below the principal diagonal, if we ignore the order in which the observations were drawn. In general, when drawing samples of size n from a finite population of size N without replacement, and ignoring the order in which the sample values are drawn, the number of possible samples is given by the combination of N things taken n at a time. There is, x however, an interesting relationship that we discover by multiplying s2=n by ð N À n = N À 1. That is, s2 N À n 8 5 À 2 Á ¼ Á ¼ 3 n N À 1 2 4 This result tells us that if we multiply the variance of the sampling distribution that would be obtained if sampling were with replacement, by the factor N À n = N À 1 , we obtain the value of the variance of the sampling distribution that results when sampling is without replacement. When sampling is without replacement from a finite population, the sampling distribu- tion of x will have mean m and variance s2 N À n 2 sx ¼ Á n N À 1 If the sample size is large, the central limit theorem applies and the sampling distribution of x will be approximately normally distributed. The Finite Population Correction The factor N À n = N À 1 is called the finite population correction and can be ignored when the sample size is small in comparison with the population size. When the population is much larger than the sample, the difference between s2=n and s2=n N À n = N À 1 will be negligible. Imagine a population of size 10,000 and a sample from this population of size 25; the finite population correction would be equal to 10; 000 À 25 = 9999 :9976. Most practicing statisticians do not use the finite population correction unless the sample is more than 5 percent of the size of the population. The Sampling Distribution of x: A Summary Let us summarize the characteristics of the sampling distribution of x under two conditions. Sampling is from a normally distributed population with a known population variance: (a) mx ¼ m pffiffiffi (b) sx ¼ s= n (c) The sampling distribution of x is normal. Sampling is from a nonnormally distributed population with a known populationvariance: (a) mx ¼ m pffiffiffi (b) sx ¼ s= n; when n=N :05 rffiffiffiffiffiffiffiffiffiffiffiffi pffiffiffi N À n sx ¼ s= n ; otherwise N À 1 (c) The sampling distribution of x is approximately normal. Applications As we will see in succeeding chapters, knowledge and understanding of sampling distributions will be necessary for understanding the concepts of statistical inference. The simplest application of our knowledge of the sampling distribution of the sample mean is in computing the probability of obtaining a sample with a mean of some specified magnitude. What is the probability that a random sample of size 10 from this population will have a mean greater than 190? Solution: We know that the single sample under consideration is one of all possible samples of size 10 that can be drawn from the population, so that the mean that it yields is one of the x’s constituting the sampling distribution of x that, theoretically, could be derived from this population. When we say that the population is approximately normally distrib- uted, we assume that the sampling distribution of x will be, for all practical purposes, normally distributed. We also know that the mean and standard deviation of the sampling distribution are equal to 185. We assume that the pop- ulation is large relative to the sample so that the finite population correction can be ignored. We learn in Chapter 4 that whenever we have a random variable that is normally distributed, we may very easily transform it to the standard normal distribution. Our random variable now is x, the mean of its distribution is mx, pffiffiffi and its standard deviation is sx ¼ s= n. By appropriately modifying the formula given previously, we arrive at the following formula for transforming the normal distribution of x to the standard normal distribution: x À mx z ¼ pffiffiffi (5.

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Anti-seborrheic treatment of scalp in case Congenital ptosis may be familial buy cialis without prescription, transmitted as a of seborrheic blepharitis is warranted discount 20mg cialis amex. Ptosis may often be accom- Infection of the glands of the eyelid order genuine cialis line, usually due to panied by squint and/or anisometropia, eventually ending Staphylococcus aureus, manifests as tender focal swelling up with amblyopia. External hordeolum (stye) when glands of Zeis or es, early correction to prevent amblyopia is recommended. Here the abscess is large and points Complete closure of the eyelids over the globe may be dif- through skin or conjunctival surface. Treatment is fcult because of paralysis (facial palsy involving orbicularis frequent warm compresses, topical antibiotic appli- muscle), spasm (thyrotoxicosis), structural (scarring/atrophy cations and if necessary, surgical incision and drain- secondary to burns or injury), or physiologic (during sleep). If left untreated, hordeolum may be complicated Management consists of protecting the eye by artifcial tear by cellulitis. Recurrent hordeolum signals reinfection, preparations, eye ointment, moisture chambers and surgical underlying allergy or an immunologic defect. Chalazion Eyelid Retraction Unlike internal hordeolum, chalazion is a granulomatous It means that the upper eyelid rests above the upper limbus. Te lesion is a It may be myogenic (thyrotoxicosis), neurogenic (anterior chronic, frm, nontender nodule in the eyelid. If it does not 800 subside spontaneously and is large enough, it should be defect (isolated or in association with aplasia of cranial excised. Else, it may cause astigmatism by pressure on the nerves, familial dysautonomia or Riley–Day syndrome, eyeball in addition to a cosmetic defect. It is a cleft-like deformity, often accompanied by a dermoid Treatmentconsists of frequent instillation of an artifcial cyst, dermolipoma and extensive facial malformations tear preparation. In case of unsatisfactory response, (mandibulofacial dysostosis in the form of Treacher occlusion of the lacrimal puncta and even tarsorrhaphy Collins syndrome). Tumors such as retinoblas- terial (Hemophilus infuenzae, Neisseria gonorrhoeae, Chla- toma, neuroblastoma and rhabdomyosarcoma may also mydia, Pseudomonas, Streptococcus pneumoniae, Staphylo- involve the eyelids. Ophthalmia neonatorum (neonatal conjunctivi- the nasolacrimal duct with a residual membrane at the tis) is described in Chapter 17 (Neonatology). Manifestations include excessive tearing, ranging Subconjunctival Hemorrhage from wetness of the eye to frank overfow of tears Bright or dark-red hemorrhages in bulbar conjunctiva, of (epiphora), accumulation of mucoid or mucopurulent discharge, crusting, erythema and maceration of the skin varying shape and size, may be encountered as a result and, in some instances, refux of fuid or discharge on of violent coughing (pertussis), sneezing, injury, infam- massaging the nasolacrimal sac. Diferential diagnosis mation or blood dyscrasia (leukemia, scurvy, idiopathic is from intraocular infammation, glaucoma, or external thrombocytopenic purpura). Chemosis Treatment consists of giving nasolacrimal massage, 2–3 times/day, along with cleansing of the eyelids with Conjunctival edema/swelling may occur in orbital cellu- warm water. In case of signifcant mucopurulent discharge, litis, cavernous sinus thrombosis, angioneurotic edema, topical antibiotics are indicated. A very small proportion of subjects failing to respond to repeated probing, need placement of tubes or extensive reconstructive surgery in the form of dacryocystorhinostomy. Alacrima (Dry Eye) Noteworthy defciency of tears, leading to dryness of eyes, Fig. Note the marked hypertrophy and corneal ulceration and scarring, may occur as a congenital increased pigmentation of the conjunctiva at the limbus. Pingueculum Dendritic Keratitis 801 It is somewhat raised mass on bulbar conjunctiva, usually Te branching tree-like lesion, due to herpes simplex virus, in interpalpebral region, representing elastic and hyaline is accompanied by conjunctivitis, pain, photophobia, tear- degenerative changes of the conjunctiva. Pterygium Interstitial Keratitis It is a feshy triangular conjunctival lesion, which classi- Infammation of corneal stroma, usually secondary to cally occurs in the nasal interpalpebral region and tends syphilis and less often tuberculosis or leprosy, manifests to encroach on the cornea. Encroachment far onto cornea with pain, photophobia, tearing circumcorneal congestion warrants surgical removal. Dermoid Cyst/Dermolipoma Tese similar lesions are smooth, elevated, round or oval, Phlyctenules and vary in color from yellowish-white to a feshy pink. Small, yellowish, somewhat raised lesions, located at the Conjunctival Nevus limbus and encroaching onto cornea, often with an ulcer at the advancing head, may well be an allergic reaction to Tis usually a benign lesion varies in pigmentation from tuberculin protein. Tis is a cicatricial adhesion between the globe and usually the conjunctiva of the lower eyelid. It follows surgery, injury Corneal Ulcers (burns from acids or molten metal), or as a complication Corneal ulcers may result from trauma (foreign body), mal- of Stevens–Johnson syndrome. Manifestations include nutrition (xerophthalmia), adjoining ophthalmic infection diplopia and interference with mobility of the eyeball. Megalocornea Manifestations include corneal haziness, hyperemia, A cornea of more than 13 mm diameter, often familial eyelid edema, pain, photophobia, tearing and and associated with other developmental disorders blepharospasm. Pus may accumulate in the anterior (osteogenesis imperfecta, Marfan syndrome), is usually chamber (hypopyon). In adults, there is high Pathogens causing corneal ulcers include Pseudomonas incidence of glaucoma, subluxation of lens and premature aeruginosa, Neisseria gonorrhoeae and some fungi. Diferential diagnosis is from Prompt treatment, both local and systemic, with attention pathologic corneal enlargement from glaucoma. Microcornea (Anterior Microphthalmia) Peters Anomaly An abnormally small cornea may be familial or a feature of a developmentally microphthalmic eye. Colobomata, Tis is a congenital corneal opacity (leukoma) with congenital cataract, glaucoma, aniridia and microphakia corresponding defects in the anterior chamber and iris. Iris coloboma is a developmental hole, notch or defect Sclerocornea in the iris, that may occur alone or together with other A sclera-like vascularized and ill-defned tissue, usually coloboma or other anomalies. Anisocoria, meaning inequality of the pupils may It usually accompanies pauciarticular rheumatoid occur as a normal variation in healthy children or arthritis, Kawasaki disease and sarcoidosis. It may also secondary to local causes (adhesions or synechiae, follow trauma or infective conditions in the vicinity. It may occur as a congenital Strabismus (Squint) defect (Waardenburg syndrome) or from trauma, hemorrhage, infammation, retinoblastoma, foreign Strabismus (Greek word, meaning, to look obliquely) body, glaucoma, iris atrophy and Horner syndrome. Orthophoria is the internal ophthalmoplegia (central or peripheral ideal state of perfect oculomotor balance. Heterotropia means that the eye deviation Constricted pupil is due to miotic drugs (pilocarpine, is apparent (not latent as in heterophoria) and does not opium), barbiturate, pontine hemorrhage or Horner need any special situation. Clinical Types Rhythmic dilatation and constriction of pupil (hip- Two major categories are recognized nonparalytic and pus), a normal phenomenon in some individuals, may paralytic. Nonparalytic strabismus (concomitant) accounts for Leukocoria (Cat’s eye refex, white pupil) may be sec- a vast majority of the cases of strabismus. Here, indi- ondary to cataract, persistent hyperplastic primary vidual extraocular muscles are normal. Paralytic strabismus (non-concomitant) is due to sis, retinoblastoma, vitreous hemorrhage, leukemia, a palsied or paretic eye muscle(s). Treatment is addressed to surgical removal Tird, fourth and sixth nerve palsies may well be congen- of lens, correction of resultant aphakia, and correction of ital or acquired. Te term, strabismus syndromes, refers to special forms of strabismus with unusual clinical features.