Extraocular Structures Inside the Orbit of the Eye

Extraocular Structures Inside the Orbit of the Eye INTRODUCTION The Retrobulbar block injection is commonly practised around the world(2).In the beginning, regional anaesthesia of the eye consisted of retrobulbar anaesthesia (RBA), with the surgeon performing the block(6). This anaesthesia can be administered with an intraconal block(1). It consists of an equal mixture of lidocaine (2%-4%) and bupivacaine (0.75%) with up to 15 units of hyaluronidase (1). A sharp needle with 27 gauge 31mm is inserted in the interolateral border of the orbit(3). The needle passes through all the rectus and oblique muscles of the eye(2). The rectus muscles include superior rectus muscle, interior rectus muscle, lateral rectus muscle and medial rectus muscle(2). The two oblique muscles are interior and superior oblique muscles(2). The optic nerve and arteries should be avoided(2). This essay explains the extraocular structures inside the orbit of the eye. Anatomy Orbital openings The lateral wall of the orbit consists of superior orbital fissure and the floor of the orbit involves the inferior orbital fissure (2). The superior orbital fissure brings the frontal, lacrimal, oculomotor, trochlear, nasociliary, abducent nerves and superior ophthalmic vein(7). The superior orbital fissure is divided by annulus of zinn(7). The area inside the annulus is called oculomotor foramen(7). The inferior orbital fissure comprises the foramen rotundum which transmits the maxillary branch of the trigeminal nerve(7). This nerve passes from middle cranial fossa to the pterygopalatine fossa(7). The Globe Human eye vary in size(4). The eyeball is located in the anterior part of orbital cavity, which is closer to the roof than the floor, also nearer the lateral than the medial wall(7). The average anteroposterior diameter of the globe is 24.15mm(4). Normally it ranges from 21.7mm to 28.75mm(4). When the anteroposterior diameter of the eye is longer that is, the axial length of the myopic eye is more(2,4). So the risk of globe perforation increases particularly with a retrobulbar block(4). Staphyloma may occur when the eyes is highly myopic(7). Thinning of the sclera and posterior globe enlargement can occur(7).A bulge in This average globe diameter occupy approximately 7ml of the orbit where as the total structures are packed in 30ml space, so the remaining space is filled with fat, nerves, extraocular muscles, lacrimal gland, vascular structures and connective tissue(5). The needle is inserted in the fat filled areas inside the orbit(5). Needle trauma can occur with eyes with posterio r staphyloma(7). The cavity of the orbit has a posterior apex with a pyramid shape(6). The orbit is made up of mainly adipose tissue(6). Anteriorly, the 4 rectus muscles of the eye insert near the equator of the globe(6). Posteriorly, these four rectus muscles insert together at the apex on the tendinous annulus communis of Zinn, through which the optic nerve enters the orbit(6).The four rectus muscles define the retrobulbar cone of the orbit, that is not closed by any intermuscular membrane(6). Sensory innervation is supplied by the ophthalmic nerve first branch of the fifth nerve that is trigeminal nerve, which passes through the retrobulbar cone(6). The ophthalmic nerve and oculomotor nerve passes through the retrobulbar cone(6). Injection of local anaesthesia solution inside the retrobulbar cone will provide anesthesia(6). It also provides akinesia of the globe and the extraocular muscles(6). E The superior branch of the facial nerve gives motor supply to the orbicularis muscle of the eyelids whi ch has an extraorbital course(6). Many major structures are situated in the retrobulbar cone which gives rise to major risk factors in needle and injection injury(6). Many complications may occur when needle is inserted into the retrobulbar (intraconal) space, so doctors prefer to inject in the extraconal space(8). The rectus muscles are in close contact with the orbital bone so the extraconal space is only a minute space compared with the retrobulbar space(6). The retrobulbar space is located inside the extraocular muscle cone which is behind the globe(4). Comparatively avascular areas of the orbit are restricted to the anterior orbit in the inferotemporal (lower outer) and superotemporal (upper outer) quadrants(4). The superonasal quadrant is rich in blood supply and has limited space(4). Extraocular muscles The extraocular muscles of the eye includes four rectus and two oblique muscles which allow elevation, depression, adduction and abduction, medial and lateral rotation(7). The origin of the superior rectus muscle rises from the annulus of Zinn(7). It then passes forwards and laterally to be inserted into sclera which is about 7.7mm behind the corneoscleral junction(7). The superior rectus muscle is supplied by the superior division of the oculomotor nerve(7). This nerve crosses through the inferior surface of this muscle (intraconal)(7). The orgin of the inferior rectus muscle arises from the annulus of Zinn below the optic foramen(7). It then passes forwards and laterally to be inserted into the sclera which is about 6.5mm from the corneoscleral junction(7). It is supplied by the inferior division of the oculomotor nerve(7). The orgin of the lateral rectus muscle runs from the lateral part of tendinous ring(7). There is also a smaller head arising from sphenoid a little laterally(7) . The lateral rectus muscle is inserted into the sclera about 6.9mm from the corneosceral junction(7). It is supplied by the abducent nerve on its intraconal aspect(7). The orgin of the medial rectus muscle is from the medial aspect of the annulus of Zinn. This muscle passes along the medial orbital wall. It is inserted into the sclera about 5.5mm from the limbus. It is supplied by the inferior division of the oculomotor nerve on its intraconal aspect. The superior oblique muscle is the longest and the most slender muscle compared to the other eye muscles. It orginates from the body of the sphenoid bone superomedial to the optic canal. It passes forward and its long tendon passes through the trochlea which is attached to the trochlear fossa of the frontal bone. The tendon of the superior oblique muscle passes downwards, backwards and laterally. It then passes inferior to the superior rectus muscle. It is inserted posterior to the equator of the eyeball. It is supplied by the trochle ar nerve on its extraconal aspect. The origin of the inferior oblique muscle is very unique. It orginates from the floor posterior to the orbital margin. It is just lateral to the nasolacrimal duct. It passes laterally, posteriorly and superiorly. It passes inferiorly to inferior rectus muscle. It is inserted into the sclera at the posterolateral aspect of the eyeball. This muscle is supplied by inferior division of the oculomotor nerve. When you inject a local anaesthetic solution into the lateral adipose compartment from inferotemporal needle insertion. It normally blocks the nasociliary, lacrimal, frontal, supraorbital and supratrochlear branches of the ophthalmic division of the trigeminal nerve and the infraorbital branch of the maxillary division. But when u inject into the medial compartment through a needle placed between the caruncle and the medial canthal angle, it blocks the medial branches of the nasociliary nerve, the long ciliary nerves, the infratrochlear nerve and the medial components of the supraorbital and supratrochlear nerves. If an extra supplementary injection is required superiorly, it is important to be careful that the superomedial approach almost inevitably brings the needle into contact with a path filled and packed with nerves, blood vessels and muscles. BLOOD SUPPLY The main artery which supplies the globe and all the orbital contents is the ophthalmic artery which is a branch of the internal carotid artery. It passes into the orbit through the optic canal inferolateral to the optic nerve and within the meningeal sheath of that nerve. The artery tend to pierce the sheath to lie outside it as soon as it enters the orbit. The course of the ophthalmic artery takes an early intraorbital course superior to the optic nerve and inferior to the superior rectus muscle. It then courses towards the medial wall of the orbit from where it runs anteriorly above the medial rectus muscle. So very careful measures are to be taken when injecting needles in elderly and hypertensive patients, it can be tortuous and vulnerable to needle trauma when it bleeds profusely. Venous drainage is through the superior and inferior ophthalmic veins. The superior vein starts deep to the medial part of the upper eyelid from the confluence of the supraorbital and facial veins. It passes posteriorly within the orbit. It receives branches corresponding to those of the ophthalmic artery. The superior ophthalmic vein leaves the orbit through the superior orbital fissure within the annulus fibrosus. The inferior ophthalmic vein arises from a venous plexus on the anterior part of the floor orbit. It passes posteriorly on the inferior rectus muscle passing through the inferior part of the superior orbital fissure draining into the cavernous sinus. EYELIDS, LEVATOR PALPEBRA SUPERIORIS AND ORBICULARIS MUSCLES The function of the eyelids is to protect the eye from injury and excess light. It also distributes tear fluid over the anterior surface of the eyeball.

Four Horsemen

Jair Hayes Mr. Buckingham Horsemen Essay 1 December 2011 Series of Unfortunate Events The four horsemen of the apocalypse appear in the story â€Å"How Much Land does a Man Need? † because they are all symbolical. The four horsemen are the horse of Conquest (white), War (Red), Black (Famine), and Pale (Death). These four horsemen are all symbolical in some way and all connect in the story in a important way. They help explain the series of events in Pakhom’s journey to his demise. The first horseman is conquest which is a white horse. This is symbolic because Pakhom sets out on a conquest for so much land. He starts off with no land basically then he starts to get land. He next has 15 desyatins, and seems to be contempt with this land. Though, after a while he does set out to get to get more land which he acquires. Pakhom then realizes he can get even more land by going to these Indians to get as much land as he wants. Then he realizes that he has to pay 100 rubies a day to get as much as he wants. Before this though, we get introduced to the next horse which is war. The next being war comes in when Pakhom gets his land. He realizes that people are messing with his land and he doesn’t like it. Though, the irony in that is the fact that he did the same thing when he had little to no land himself. After these events Pakhom took people to court and lost and would try to put peasants on trial. This caused a dispute between Pakhom and most of the commoners, meaning they didn’t get along. People are in a war because naturally they don’t get along. Though, you have to make sacrifices in war which brings in the next horse. The next horseman is famine which is represented by black. This one is more metaphorical I feel then literal. For Pakhom to afford all this land he sold many things. Eventually he sold almost everything he had. He went into a personal need or possession famine. Pakhom also went into a morals famine. He basically left everything behind just for land and nothing else, which in hindsight makes no sense. If you don’t have money to even buy seeds, he why would you need land. He didn’t even have a horse anymore because he sold it. He could have used his horse to plow the fields. Pakhom became very greedy which leads to the final horse. The last horse is the horseman of death which is a pale color. This horse is obviously representing the death of the main character Pakhom. Pakhom became too greedy and unnecessarily needy. When he keeps going on at the end of the story for the land he should have realized he didn’t need that much land to begin with. If you have to walk more than a mile or three to plant or plow crops then you have too much land I personally feel. These are how these four horseman of the apocalypse connect in the story.

Roles and Responsibilities of a tutor

This assignment discusses the functions and duties of a coach in the womb-to-tomb acquisition sector. It highlights the chief standards required to be a good coach within the instruction environment and the restrictions for this function. The assignment will give clear positions on the classs and criterions in which coachs have to show abilities these include: Knowledge and understanding Planning, learning and category direction Monitoring and appraisal Record maintainingKnowledge and apprehension:Coachs must be confident in the topic cognition they are traveling to learn. This has to be the specialized topic you are qualified in.Planning, learning and category direction:Planing and planing of a lesson is a important and the? learning rhythm construct demand to be followed. These are: the purposes & A ; principle, program lesson & A ; expected result, bringing of lesson, assess larning against results, feedback & A ; rating. Zaf – you must be careful with how you express your ideas. Besides – although you have now mentioned the Aims and Rationale – it is still non truly clear why these are so of import in relation to each scholar group. The aims of the lesson and its result must be visualised before the topic is taught, and it must be appropriate for the group. Learner ‘s demands are non to be ignored, and a Tutor must concentrate on the issues of equality and diverseness in the schoolroom, and every kid affairs ( ECM ) . i In the delivering of the lesson, a coach needs to take into history the different backgrounds, larning demands, and disablements of the scholars, extra stuff should be made available to all persons when required.i The presentation and executing of the lesson plays a cardinal function in scholar ‘s acquisition, as each person have different ways of larning. iThe resources used in the lesson, for illustration, PowerPoint, Flip Chart, and Wipe Board should be to the full utilized. Visual, auditory and practical acquisition manners guarantee the scholar to hold equal chances in larning. Tutorials and quizzes get the pupil interested and their attending? in the lesson therefore should be portion of the lessons. Changing types of lesson programs can bring forth involvement for the scholars ; and make an chance to measure the scholars apprehension of the topic. Contemplations of the lesson during the undermentioned hebdomad will enable the coach to acquire a sense of what pupils have learned and if methods are effectual. iMonitoring and AppraisalThe initial interview and appraisal is the start of Learner / coach relationship. The Tutor will get down to larn what motivates the scholars to be a portion of this specific class. i The class and degree demands to be matched with the pupils ‘ abilities and the pervious accomplishment and cognition of the topic. The scholar ‘s ability should be assessed, in literacy, linguistic communication and numeracy accomplishments that may be applicable. This will assist place the strengths and failing of the scholar. i The Initial appraisal is besides used to inform the development of larning programs. iThe feedback from the assignments will besides assist measure the success of the lessons. It is really of import to do certain that the scholars inscribing for classs to the full understand what is required from them. iIt is a two manner system where the coach understands the scholar, and the scholar understands whether the class they are shiping on is the right 1 for them. ii Measuring the pupils larning against results, feedback and rating of the lesson is of import ; a coach could orient their following bringing in line with the feedback received from the pupils. iLessons including practical activities, tutorials, and quizzes are good manner to supervise scholar ‘s advancement throughout the class. i Coachs are committed to raise the criterion of scholars to accomplish better consequences. Assessment is the manner to guarantee the scholar ‘s advancement is on path, aid should be provided every bit shortly as the coach realises the scholar is holding troubles. i Marking is one signifier of supervising an appraisal, the twenty-four hours to twenty-four hours monitoring allows a coach to recognize when the pupils are holding troubles with the constructs a coach can so turn to these troubles. iThe appraisals of scholars must be continually monitored to analyze the advancement they are doing, and maintain the scholars informed, the feedback should be provided. iRecord Keeping:The administrative duties of the coach is to maintain a registry for of the pupil ‘s attending ; records of accomplishment and profiles. These are the chief grounds for maintaining records: To supervise and be after in front ; ( session program ) i To inform internal and external examining organic structures ; i To show that the processs are being decently followed ; i To look into the attending of the pupils ; ( legal demand ) i To track pupil ‘s advancement and demands for excess support, this is to supply grounds for funding organic structures. i In the position of, ( Gravells & A ; Simpson, pg.21. 2010 ) â€Å" All relevant information should be documented in the signifier of a program, normally called an person acquisition program ( ILP ) , this is besides known as action program † . i They note that the followers are good pattern when finishing an ILP. Involve your scholars, promote them to discourse their acquisition and support demands. Refer to the consequences of initial and diagnostic appraisals, and larning manners trials. Make sure they are single to each scholar ; there is no 1 size fits all. Express and communicate acquisition marks both verbally and in composing. iiRestrictions:There are restrictions to what a coach can make ; coachs should non supply reding or fiscal advice, for illustrations, lodging benefits, income support etc. They should mention scholars to an appropriate administration who deals with this sort of issues. i The limited clip and resources available to tutor hold to be considered. The cost of purchasing extra stuff makes it harder to assist the pupils in farther support in the lessons. As a coach, there are professional restrictions in topographic point such as non to supplying your phone figure ; the intent of these is to protect coachs from inappropriate contact. iDecision:It is clear that coachs have tonss of other duties other than merely fixing and learning. iTutors need to do certain every scholar demands are catered for, when planning, fixing and presenting the lesson. i All the records are on a regular basis checked, kept to day of the month, and are available to for analyzing and funding organic structures. Resources needed for the lesson are available to enable pupils to take part. i In the position of ( Tummons, 2007 pg.17 ) , â€Å" Much of the work done by the coach has to make with acquisition and instruction: preparing larning resource ; interceding with external testers ; taging assignment and entering the consequences. Then there are many things that do non truly look to be related to larning and learning at all, such as taking portion in selling and promotion activities, which besides come as portion of the coach ‘s function, as it is really important to procure enlisting for the undermentioned twelvemonth † . i Roles and Responsibilities of a Tutor The roles, responsibilities and boundaries of a tutor within the FE/adult education sector are ever progressing qualities which are reflected upon using the teaching cycle. This cycle can be used by both tutor and learner as discussed in ‘Prepare to teach in the lifelong learning sector' – Ann Gravells 3rd Edition. Roles 1. 0 The role of a tutor is to create a safe and healthy learning environment, where learners are able to work at their individual level. This is backed up by the use of initial assessment upon induction to the course. This will allow the tutor to pinpoint who may eed additional support through one to one support and extra tutorials. I, as the tutor will be teaching the subject effectively following the scheme of work, ensuring the aims and objectives are met. Continual assessment throughout the course will aid learner progression and also allow learners to re-evaluate their own development. Also by using learning style questionnaires like ‘Fleming 1987' the tutor is able to teach using various learning styles such as, visual, auditory and kinaesthetic. This allows inclusive teaching and will develop learners and cover all of their specific needs. The utor is able to adapt the lesson plan to incorporate all students giving them a chance to become involved. Planning and preparation are key issues ‘By Failing To Prepare, You Are Preparing To Fail' as quoted by Benjamin Franklin. You must decide what you want to achieve, plan and deliver you lesson accordingly. Targets need to be set, SMART targets should be used specific, measurable, achievable, realistic and time related. These targets will enhance learning and can be used by both learner and tutor. At the end of the session it is vital to evaluate the lesson with the learners, by re-capping the aims to see if they were fully chieved. Once this has been carried out it may mean a change to the following weeks session. My role is also an assessor, so I need to prepare learners for practical assessments and give thorough guidance on the set criteria. Learners are encouraged to self assess giving them the opportunity to evaluate their own progression. Feedback is given on a one to one, the learner is given praise regardless whether the result is a pass or fail. This is to ensure learners are encouraged and never feel downhearted, this in turn will boost moral and motivate the learners to succeed further. Responsibilities 2. My responsibilities are very important, I have a duty of care to provide a safe environment and conduct risk assessments on learners and follow them up with an action plan. During practical session enforcing the correct use of personal protective equipment. I must ensure I keep an up to date register every session, this is essential to check learner attendance, achievement and also monitor progression. The awarding and funding bodies also need a record for their own evidence. Safeguarding learners, we carry out reviews every ten weeks and this involves covering Every Child Matters. Encouraging the learners to say how they stay safe, healthy and how they enjoy and achieve. The safeguarding policy we have in place not only covers our learners but also covers tutors. Teaching all learners with equal respect regardless of their sex, race, religion or ability and promote equality and diversity to all learners within their lessons. This also allows the tutor to incorporate differentiation within the session. Planning, ensuring that I am following the scheme of work and the course content is clear but also meets the needs of the individual learner. This also means turning up efore the learners do and making sure all resources are prepared and you have taken into account any materials being used are suitable for all learning styles. Data protection is an essential part of my responsibility as learners upon induction give information about themselves and this is to remain confidential at all times. Information about other staff members must not be passed on to learners as part of the data protection act. Standardising practise with other colleagues through attending standardisation meetings are vital to ensure practises are met and that all work is being marked to the correct standard. Homework handed in, is marked and returned within a reasonable time and any feedback and praise is constructive. Above all self control is extremely important, be prepared for confrontation and negativity but to answer or handle the issues calmly. Acting, dressing and speaking in an appropriate manner at all times as learners look to you as a role model to follow. Boundaries 3. 0 As tutors,we have professional boundaries which we must work within and it is very important not to over step those boundaries. You must be able to identify where the role of a tutor stops and remain there. As a tutor I must keep to standards and work within egulations set by the awarding body. Contact with learners should be kept to a professional level at all times, this means when contacting learners for assessments or to provide information to them it should be done using company mobiles or emails. Safeguarding yourself while using social networking sites having no learners on your profile, this protects both you as a tutor and the learner. Confidentiality of learners should be treated with respect, but the learner needs to be informed that although they have told you this information, you may have to refer it to a professional. Conclusion 4. 0  This is a brief description of my roles, responsibilities and boundaries as a tutor within the FE/adult education sector. These are the most important issues to be able to carry out the role successfully and help learners progress. By using a skills audit for my own work I am able to identify that I can demonstrate my skills effectively and should use the audit to reflect, although I know personally that within the areas of numeracy and literacy skills my weakest skill is numeracy. I have been using BBC Skills Wise website to help me develop my skills and give me the confidence to guide learners through their own issues with numeracy.

Liberty Coun 501 Ethics Comparison - 1591 Words

Ethics Codes Comparison Paper H Michele Wallach Liberty University Online Abstract These publications regarding ethics, American Counseling Association: Code of Ethics (2005) and the American Association of Christian Counseling: Code of Ethics (2004), are available as a reference for use. The purpose of this paper is to compare general and specific elements of the two publications. There are two areas of general exploration: 1) relation to their format for retrieval of specific data, 2) their value or standards basis, if any, from which the publications are written. More specifically three specific areas will be compared. First, the area of informed consent as it relates to the client and the counselor. Second, codes relating to†¦show more content†¦The code also extends to include â€Å"former clients, their romantic partners, or their family members†. The code simply states that the counselor cannot have professional contact with the client within 5 years before or after a relationship. The counselor must also â€Å"demonstrate forethought and d ocument†, in writing, the possibilities of exploitation, or potential harm to the former client. If either of these elements is present, then the counselor avoids the interaction or relationship. The code is AACC: Code of Ethics (2004) is defined as â€Å"Marriage with Former Clients/Patients† and the stipulations are explained that this type of relationship is allowed with three provisions. (p 8) First, the counseling sessions had to have been terminated without the influence of a relationship or potential relationship, also within the proper guidelines of termination as defined in the AACC: code of ethics guidelines. Secondly, the client must understand unequivocally that any further counseling must be by someone other than the counselor-spouse. Thirdly, there must be no harm to the client or the client’s family as a result in the change of the relationship between the client and the counselor. Lastly, the counseling or helping relationship must be terminated at least two calendar years prior to marriage. There are occasions where an ethical standard is addressed by the AACC: Code of Ethics (2004) and not addressed at all by the ACA: Code of Ethics (2005). The AACC: Code of