Palpebral fissure

Ethanol readily passes across the placenta and into the fetal circulation. The fetal alcohol syndrome has three primary features microcephaly, prenatal growth deficiency, and short palpebral fissures Other characteristics include postnatal growth deficiency, fine motor dysfunction, cardiac defects, and anomalies of the external genitalia and inner ear. A definite risk of producing fetal abnormalities occurs when ethanol consumption by the mother exceeds 3 oz daily, the equivalent of about six drinks. 

Choanal atresia with scalp aplasia cutis, umbilical hernia, sacral pilonidal sinus, limb hypertonia, and down-slanting palpebral fissures affected the child of a woman who took methimazole 10 mg/day until the 8th week of gestation (96). 

The most disabling feature of this disorder is hypokinesia (sometimes called bradykinesia or akinesia) — a slowness of voluntary movement and a reduction in automatic movement, such as swinging the arms while walking. The patient s face is relatively immobile (masklike faces), with widened palpebral fissures, infrequent blinking, with certain fixity of facial expression, and a smile that develops and fades slowly. The voice is of low volume (hypophonia) and tends to be poorly modulated. Fine or rapidly alternating movements are impaired, but power is not diminished if time is allowed for it to develop. The handwriting is small, tremulous, and difficult to read. 

Munden PM, Kardon RH, Denison CE, et al. Palpebral fissure responses to topical adrenergic drugs. Am J Ophthalmol 1991 111 706-710. 

Because sympathetically innervated smooth muscle fibers also exist in the lower eyelid, oculosympathetic paresis can produce elevation of the lower lid (so-called upside-down ptosis). This condition is often subtle. However, this sign, along with ptosis of the upper lid, contributes to a narrowing of the palpebral fissure, giving the appearance of enophthalmos. 

Elevation of the lower eyelid ("upsidedown ptosis") Narrowed palpebral fissure (apparent enophthalmos) Ipsilateral miosis Dilation lag... 

Figure 32-9 The mean decrease in palpebral fissure of one eye as compared with pretreatment values in 14 patients receiving 10% guanethidine, two drops twice daily. Each point represents the mean ( SEM). Measurements were obtained by projecting the clinical photographs to eight times their original size. (Reprinted with permission from Sneddon JM, Turner P. Adrenergic blockade and the eye signs of thyrotoxicosis. Lancet 1966 2 525-527.)...

Fetal alcohol syndrome includes the following characteristics microcephaly, mental retardation with irritability in infancy, low body weight and length, poor coordination, hypotonia, small eyeballs and short palpebral fissures, lack of nasal bridge. ... 

The alkaloid dilates the pupil, contracts the nictitating membrane of the cat, and enlarges the palpebral fissure. In fact, cytisine possesses all the properties of nicotine. The principal differences between the two alkaloids is that the first is more hypertensive than nicotine but the latter is more active on the smooth muscle of the bladder. 

The stroke physician will also monitor the patient s breathing pattern for signs of airway obstruction or impaired ventilatory drive, air escaping from the side of the facial paresis, unequal palpebral fissure (as occurs with ptosis on the side of a Homer s), or impaired lid closure on the side of facial weakness. 

Fetal Alcohol Syndrome small size, shortened palpebral fissures, stub nose, hirsutism... 

Narrowing palpebral fissure 0/4 0 completely closed 1 narrowed no reaction to stimuli 2 narrowed half-closed eyelids 3 slightly narrowed open after stimulus 4 open... 

Some symptoms frequently observed in patients with thyrotoxicosis cannot be explained by increased secretion of thyroid hormone. Prominent among the unexplainable symptoms is exophthalmia (see Fig. 8-9). Most hyperthyroids have bulging eyes, with dilated pupils and widening of the palpebral fissure. The patient has a characteristic stare and rarely blinks. Exophthalmia may be severe, and the eyeballs may bulge out of their sockets. Severe exophthalmia is complicated by chemosis and edema of the eyelid. Exophthalmia probably does not result from excess thyroxine secretion because it occurs sometimes in the absence of hyperthyroidism. Hyperthyroidism is not always accompanied by exophthalmia, and thyroidectomy may worsen the exophthalmia. 

The drainage of the administered dose via the nasolacrimal system into the nasopharynx and the gastrointestinal tract takes place when the volume of fluid in the eye exceeds the normal lacrimal volume of 7-10 microliters. Thus, the portion of the instilled dose (1-2 drops, corresponding to 50-l(X) microliters) that is not eliminated by spillage from the palpebral fissure is quickly drained, and the contact time of the dose with the absorbing surfaces (cornea and sclera) is reduced to a maximum of 2 minutes. A pharmacokinetic scheme illustrating the precorneal fluid dynamics and the distribution/disposition of pilocarpine in rabbits is shown in Fig. 3. 

Moderate or mild irritation of throat, eyes, and nose runny nose severity f over time few had pharynx injection or palpebral fissures, t mucous secretion, inspiratory rales, altered pulmonary function. ... 

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