Eyelid Movements Research Articles

Familial Marcus Gunn Phenomenon Without Ptosis in Resting Position in 2 Successive Generations: A Case Report and Review of Literature

BACKGROUND Marcus Gunn Syndrome is a rare congenital disorder. The major symptoms are congenital ptosis and the synkinetic movement of the affected eyelid mandibular movements, cases with the absence of the ptosis symptom, even rarer, were also recorded. The aim of this article was to present 2 cases of Familial Marcus Gunn Jaw-Winking Synkinesis (MGJWS) without ptosis in resting position in two successive generations. CASE PRESENTATION Upon routine examination, the 41-year-old female patient was diagnosed with MGJWS, with the synkinetic movement of the upper left eyelid only observed during the downward, forward, and lateral mandibular movements. Ptosis wasn't observed in the resting position. The patient's 12-year-old daughter, who didn't have any significant medical history, was also diagnosed with MGJWS, with the same symptoms. No surgical or conservative intervention was performed on the patients and they are currently under regular follow-up. CONCLUSION The synkinetic movement being observed during masticatory movements presents a diagnostic opportunity for the dental clinician and surgeon, since it will be observed during a routine examination. Thus the authors think that it's important for dental clinicians and surgeons to be informed about the syndrome. To the best of our knowledge, our study is the first clinical case study of MGJWS without ptosis in resting position observed in two successive generations.

Evaluation of efficacy of peribulbar block with the combination of 2% lidocaine and 0.5% bupivacaine in comparison with 2% lidocaine and 0.75% ropivacaine in cataract surgery.

Cataract surgery is performed under peribulbar or retrobulbar block. Majority of the patients posted for cataract have some form of medical diseases like diabetes, hypertension, angina, ischaemic heart disease etc. Lidocaine and bupivacaine are the most commonly used local anesthetic for the block procedure. Here we compare the efficacy of peribulbar block in cataract surgery using the combination of 1:1 mixture of 2% lidocaine with 0.5% bupivacaine and 1:1 mixture of 2% lidocaine with 0.75% ropivacaine. It is a prospective, randomized, double blinded study including 60 patients were devided into two groups of 30 each, Group-R received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0.75% ropivacaine and 15 IU/ml of hyaluronidase and group-B received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0. 5% bubivacaineand 15 IU/ml of hyaluronidase. Peribulbar block was performed as per Bloomberg's modification of the Davis and Mandel technique where 5 ml of local anesthetic was injected in the infero temporal region and 3 ml of drug was injected in the superi nasal area. Patients were assessed for sensory block, eyelid and occular movements at an interval of 2 minutes. Systolic, diastolic and mean arterial pressures, heart rate, oxygen saturation, ECG were monitored non invasively at 1,3,5,8,10,15 and then every 10 minutes till the end of the surgery. Mean time for the onset of sensory blockade was 2.70 ± 6.5 minutes in Group B and 2.63 ± 0.57 minutes in group R with P-value 0.671, showing no significant difference in the onset of sensory blockade. Onset of motor blockade was 6.53 ± 1.81 minutes in group B, and 7.57 ± 1.46 minutes in the group R, the P-value being 0.018 was statistically significant. Regarding the duration of analgesia, our study showed mean time for analgesia lasted for 295 ± 54.63 minutes in group B and 414.67 ± 99.47 in group R with P value 0.001 showing statistically significant prolongation of duration of analgesia with group R. We observed a significant increase of mean IOP in bupivacaine group from 13.333 ± 1.582 mm Hg to 21.966 ± 2.697 mm Hg, whereas in ropivacaine group it increased from 12.766 ± 1.222 mm Hg to 13.0 ± 1.341 mm Hg after peribulbar anaesthesia.

A Microfluidic Contact Lens to Address Contact Lens-Induced Dry Eye.

The contact lens (CL) industry has made great strides in improving CL-wearing experiences. However, a large amount of CL wearers continue to experience ocular dryness, known as contact lens-induced dry eye (CLIDE), stemming from the reduction in tear volume, tear film instability, increased tear osmolarity followed by inflammation and resulting in ocular discomfort and visual disturbances. In this article, to address tear film thinning between the CL and the ocular surface, the concept of using a CL with microchannels to deliver the tears from the pre-lens tear film (PrLTF) to the post-lens ocular surface using in vitro eye-blink motion is investigated. This study reports an eye-blink mimicking system with microfluidic poly(2-hydroxyethyl methacrylate) (poly(HEMA)) hydrogel with integrated microchannels to demonstrate eye-blink assisted flow through microchannels. This in vitro experimental study provides a proof-of-concept result that tear transport from PrLTF to post-lens tear film can be enhanced by an artificial eyelid motion in a pressure range of 0.1-5kPa (similar to human eyelid pressure) through poly(HEMA) microchannels. Simulation is conducted to support the hypothesis. This work demonstrates the feasibility of developing microfluidic CLs with the potential to help prevent or minimize CLIDE and discomfort by the enhanced transport of pre-lens tears to the post-lens ocular surface.

Feedback inhibition underlies new computational functions of cerebellar interneurons.

The function of a feedback inhibitory circuit between cerebellar Purkinje cells and molecular layer interneurons (MLIs) was defined by combining optogenetics, neuronal activity recordings both in cerebellar slices and in vivo, and computational modeling. Purkinje cells inhibit a subset of MLIs in the inner third of the molecular layer. This inhibition is non-reciprocal, short-range (less than 200 μm) and is based on convergence of one to two Purkinje cells onto MLIs. During learning-related eyelid movements in vivo, the activity of a subset of MLIs progressively increases as Purkinje cell activity decreases, with Purkinje cells usually leading the MLIs. Computer simulations indicate that these relationships are best explained by the feedback circuit from Purkinje cells to MLIs and that this feedback circuit plays a central role in making cerebellar learning efficient.

Analysis of the kinetics of the eyelids of little owl Athene noctua

AbstractThis study gives a comprehensive description of eyelids movement in little owl and discusses the impact of some surrounding conditions in their kinetic performance. The present study used the video's recording technique to record the kinetic activity of eyelids, besides the anatomical and histological studies of the eyelid's structure. The fundamental eyelid movements can be uniquely and reliably characterized by their anatomical relationship that was confirmed via video recording for their kinetic activity. The levator palpebrae muscle is considered a main generating motor for the upper eyelid; in the little owl, this muscle splits into multiple directions and is distinguished from the levator palpebrae superioris (Lps) and the levator anguli oculi (Lao) muscle. That anatomical pattern of insertion increases the movement of the upper lid. On the other side, the contraction of depressor palpebrae inferioris (Dpi) muscle and the active upward forces of levator palpebrae muscle help in increasing the opening of the eye's fissure. However, the closure process is produced from the passive downward forces and relaxation of the levator palpebrae superioris (Lps), levator anguli oculi (Lao), and depressor palpebrae inferioris muscle, as well as the contraction of retractor anguli oculi lateralis (Raol) and medialis (Raom) muscle. The present results also recorded that nictitating membrane's (Nm) movement is reversely proportionate to the level of kinetic of other eyelids. The mobility of Nm in little owl occurs under the effect of artificial external stress. These anatomical data and sequence video recordings have confirmed that the upper eyelid moves more compared to other eyelids. The authors also suggest that the mobility of eyelids may get stimulated through external pressure force of some surrounding structure like the periorbital sheet. Also, the histological study exhibited that the structure of two eyelids is very similar in the little owl and the variability is showing in the number of cell layers that forms their epithelium of skin and palpebral surfaces, the distribution of pigment granules, and degree of keratinization on their surface. That variability in the histological characters of eyelids may counteract the abrasive forces occurring during the opening and closing processes.

A Multimodal Fusion Fatigue Driving Detection Method Based on Heart Rate and PERCLOS

Existing visual-based fatigue detection methods usually monitor drivers’ fatigue by capturing their facial features, including eyelid movements, yawn frequency and head pose. However, these approaches typically do not take drivers’ biological signals into consideration. An accurate model for fatigue detection requires combining both facial behavior and biological data. This paper proposes a novel non-intrusive method for driver multimodal fusion fatigue detection by extracting eyelid features and heart rate signals from the RGB video. The multimodal feature fusion method could significantly increase the accuracy of fatigue detection. Specifically, we established two fatigue detection models based on heart rate and the PERCLOS value respectively with one-dimensional Convolutional Neural Network (1D CNN), where the PERCLOS refers to the percentage of eyelid closure over the pupil. Finally, the outputs of the two models are weighted to achieve the multimodal fusion fatigue detection. Simulation results show that our method yield better performance than traditional methods.

Ayurvedic management of Vartma sthambha (ptosis) with Panchakarma (bio purificatory measures) and Netrakriyakalpa (ocular therapies)

This is to report a case of ophthalmoplegia developed after transsphenoidal surgery for pituitary adenoma, which was treated effectively with Ayurvedic Panchakarma (~bio purificatory measures) and Netrakriyakalpa (~ocular therapeutic procedures). Ophthalmoplegia refers to paralysis of both extrinsic and intrinsic muscles of the eyes. It is an uncommon complication after transsphenoidal surgery for pituitary adenoma and recovers spontaneously in most of the cases. If not resolved even after 6-12 months, surgery is done to correct the squint and ptosis. In this case, as the patient was apprehensive about surgery, Ayurvedic Panchakarma and Netrakriyakalpa procedures were prescribed. An Indian female aged 69 years reported with drooping of the left upper eyelid, deviation, and restricted eye movements in the left eye, and double vision for one year. It was a diagnosed case of postsurgical ophthalmoplegia due to third (oculomotor) and sixth (abducens) cranial nerve palsy. She was administered Panchakarma and Netrakriyakalpa. Oral medicines, Dhanadanayanadi kashaya and Ekangavira rasa, were prescribed for one month. After treatment, there was a remarkable improvement in ptosis. However, squint, restricted eye movements, and diplopia persisted. Ayurveda treatment, including Panchakarma and Netrakriyakalpa, is safe and effective in managing postsurgical ptosis, especially in patients who are apprehensive about surgery. This treatment plan could be further tried in ptosis of other etiologies as well. In Ayurveda, treating squint, restricted eye movements, and diplopia is challenging, and further research needs to be done.

Giggles: Development of a New Eye Covering Device Used During Neonatal Phototherapy

About 10 % of all neonates worldwide develop jaundice needing phototherapy (PT) during which an eye covering device (ECD) is used. The existing ECDs made of fabric are tight bands preventing the baby from opening his eye lids, are a source of discomfort and are not aesthetic. The major emphasis of new ECD named Giggles was to use a dome like design allowing free eye lid movements. It was also important to ensure complete light blockage, a good fit to prevent dislodgement, easy to clean, non-fabric material, reusable while maintaining good hygiene, soft, not causing skin irritation, mouldable, light, medically acceptable, durable, affordable and aesthetic. An open label randomized control trial was conducted to compare the efficacy of giggles vs the existing ECD. All neonates needing PT who were >35 weeks G.A. and B.W. >2.0 kg were eligible for the study. Babies in the control group (n-30) were treated with the standard ECD while those in the study group (n-30) were treated with Giggles. Primary outcomes were baby’s comfort level and irritability, the number of spontaneous dislodgements needing reapplication and the aesthetics. Babies in the study group did better during breast or the cup feeding. Babies in the study group were more comfortable and easier to take care of. Episodes of dislodgement needing reapplication were similar. Care givers and the parents alike loved the aesthetics of giggles.

Comparison of Efficacy and Safety of Subtenon’s Anaesthesia with and without Hyaluronidase in Bilateral Cataract Patients

Background: The effect of subtenon’s block with the usage of hyaluronidase in terms of analgesia and akinesia was studied in different sets of people and the results were not satisfactory in all of them .This study eliminates bias and mitigates the confounding factors such as age, sex, pain threshold of a person, anatomical variations when done on different individuals. Objectives: To evaluate the efficacy of subtenon’s anaesthesia with hyaluronidase in group A patients and without use of hyaluronidase in group B undergoing cataract surgery in terms of Globe and lid akinesia, analgesia, onset and duration of anaesthesia intra operatively and to document complications related to subtenon’s anaesthesia. Methods : 39 patients (78 eyes) who fulfil inclusion criteria were selected and subtenon’s anaesthesia with hyaluronidase during the first eye cataract surgery followed by other eye subtenon’s anaesthesia without hyaluronidase was adopted. the study is done at RLJH, Kolar in ophthalmology department which is a teritiary setting hospital. In both groups Analgesia was graded between 0-4 grades and globe akinesia was graded between 0-3 grades and lid movements was graded between 0-2 grades. Study design used is non randomized study. Results: Analgesia (p = 0.008), globe akinesia (p = 0.002)at 15 mins ,lid akinesia (p=0.027) at 10 mins were good in Group A and it was statistically significant. The rate of onset of akinesia, patient and surgeon satisfaction were better in case of Group A . Complications were equal in both the groups showing no role of hyaluronidase in the complications and relating them to subtenon’s. Conclusions: Hyaluronidase has shown better onset of akinesia, good intraoperative analgesia , good globe and lid akinesia. Keywords: Subtenon’s block , Hyaluronidase, Akinesia, Analgesia.

Posttraumatic locked-in syndrome from combined brainstem and upper cervical injury in childhood: A case report

Locked in syndrome (LIS) is a condition characterized by quadriplegia, lower cranial nerve palsies and mutism in which only vertical eye movements and upper eyelid movements are preserved while the patient's state of consciousness is intact. The most common cause of LIS is pontine infarction after vertebrobasilar system occlusion. We hereby present a case report of LIS secondary to cervicomedullary contusion after head trauma. Due to the possibility of neurological recovery, early and accurate diagnosis is important in posttraumatic nonvascular LIS cases and aggressive neurological and other systemic treatment and early neurological rehabilitaion options should also be eveluated. Neurological rehabilitaion of these ventilator dependent patients is difficult and should be improved.

Management of Tolosa-Hunt syndrome with Ayurveda therapeutic measures and interventions

BACKGROUND: Tolosa-Hunt syndrome (THS) is a rare disorder characterized by episodic periorbital pain associated with paralysis of either one or more of the III, IV, or VI cranial nerves. It is usually self-resolving, but relapse may be seen. In Ayurveda, a clinical condition “Vatahata Vartma” is narrated, resembling THS. Based on the resemblance, a diagnosed case of THS was treated by Ayurveda measures and treatment described for the management of Vatahata Vartma. MATERIALS AND METHODS: A 50-year-old man, who was previously diagnosed and underwent treatment for THS, presented with complaints of increased drooping and swelling at his left upper eyelid along with strenuous eyeball movements since February 2021. Drooping of the eyelids was measured by the amount of ptosis, margin-reflex distance, and the function of the levator palpebrae superioris. The patient was treated with Ayurveda oral medicines (herbal decoctions, herbal clarified butter, herbal powders, and herbal tablets), biopurification (therapeutic purgation and retention of medicine in the buccal cavity), and external Ayurveda ocular therapy (ocular irrigation, bolus sudation, eye drops, herbal paste over the eyelids, retention of herbal clarified butter over the eyes, collyrium, paste over the head, and irrigation over the head). The total duration of therapy was 11 months. RESULTS: Swelling and ptosis of the left upper eyelid were reduced, and the patient could do the normal movement of the left upper eyelid. CONCLUSION: THS can be treated with Ayurveda measures and interventions narrated in Ayurveda under Vatahata Vartma. A clinical study on large sample size is required to validate the result obtained in the present case study.

Medical management and resolution of perinatal bilateral exophthalmia and secondary corneal ulcers in an Antillean manatee (Trichechus manatus manatus) neonate from Puerto Rico

AbstractObjectiveTo present a novel case of perinatal bilateral exophthalmos and corneal ulcers in a neonate Antillean manatee and describe the medical treatment that led to the resolution of the observed clinical signs and vision restoration.Animal studiedA manatee stranded alone in Puerto Rico on July 5, 2020.ResultsThe manatee was found in critical condition with pronounced exophthalmos, lagophthalmos, and corneal opacification of both eyes (OU). Vision impairment was evident due to the lack of ocular menace reflex and bumping into the tank's walls. Biomicroscopy revealed conjunctival hyperemia and chemosis, limited third eyelid movement, but had viscous tears present OU. Dense, full‐thickness, white to cream‐colored cellular infiltrates affected 70% of the cornea with peripheral active vascularization OU. Rubeosis iridis was also present OU. Treatment consisted of supportive medical management, including nutritional support and topical treatment for ulcerative keratitis. Resolution of the corneal ulcers and functional vision were achieved after 6 weeks of therapy. Currently, bilateral, mild, intermittent exophthalmos is observed with no adverse clinical signs, and the calf is in good health.ConclusionsThe extent of bilateral corneal disease on a neonatal calf may be a result of an intrauterine infection or possible trauma at or right after birth. While the latter may have led to exophthalmia and consequent corneal disease, the exact cause could not be determined. Supportive therapy and medical management of infectious keratitis were successful and led to vision recovery. This is the first report of ocular pathology in a neonatal manatee.

Conjoint Fascial Sheath Suspension for Severe Blepharoptosis through Palpebral Margin Incision.

Conjoint fascial sheath suspension can achieve pleasing surgical efficacy and dynamic eyelid movement in the treatment of severe ptosis. In recent years, the palpebral margin incision technique has been applied for double-eyelid blepharoplasty, which is characterized by inconspicuous scarring, short convalescence, and natural-looking outcome. However, studies of the application of this technique in the treatment of ptosis are scarce. This article aims to evaluate the efficacy and safety of conjoint fascial sheath suspension for treating severe blepharoptosis through palpebral margin incision. From March 2019 to January 2021, 32 patients (37 eyelids) underwent treatment with the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 were documented. Correction effects, symmetry results, and complications were also evaluated postoperatively. Adequate or normal correction was achieved in 33 eyelids (89.2%), and 31 patients (96.9%) obtained good or fair symmetry results. Common complications were undercorrection and conjunctival prolapse, which were both observed in four eyelids (10.8%), followed by overcorrection and hematoma. The modified technique provides physical eyelid elevation and inconspicuous scarring and is effective for treating severe ptosis. Satisfactory functional and esthetic results could be obtained simultaneously without severe complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of upper eyelid third-degree burns by dispersed implantation of very small autologous columnar skin grafts: A pilot study of a new method

ObjectiveThis retrospective study compared the effectiveness of dispersed implantation of very small autologous columnar skin (SCS) grafts and full-thickness skin grafts (FTSGs) for treating upper eyelid third-degree burns. MethodsFourteen patients and 26 eyes with granulation tissue formed by third-degree upper eyelid burns were enrolled in the study from August 2017 to June 2020. The experimental group of 6 patients with 11 eyes was treated with SCS grafts. The control group of 8 patients with 15 eyes was treated with FTSGs. The survival rate of the grafts, healing time, SCS diameter, upper eyelid movement distance (ULMD), visual analogue scale (VAS) score for patient satisfaction, and Vancouver Scar Scale (VSS) score were evaluated. ResultsThe difference in the survival rate between the two groups was not statistically significant (P = 0.06). The ULMD and VAS scores in the experimental group were higher than those in the control group (P < 0.05). The healing time was longer in the experimental group than in the control group (P < 0.05). The VSS scores of the donor site and the skin grafting site in the experimental group were lower than those in the control group (P < 0.05). ConclusionUnlike classical skin grafts, SCS implantation surgery can restore the appearance of the upper eyelid, and there is no obvious scar at the donor site. This can be a viable alternative to traditional FTSGs with potential benefits

Diagnosis of hypomimia in Parkinson's disease

A clinical approbation of a proprietary method for evaluation of the diagnostic value of computer video analysis of hypomimia in patients with Parkinson's disease (PD). The study included 31 patients diagnosed with PD and 31 healthy people. The method consists in contactless recognition of 68 reference points on the face that are used to determine the movement of eyebrows, eyelids and the mouth during diagnostic tests: smiling, drawing of the letter "O", winking, eyebrow raising, frowning, and text reading. Comparison of the results obtained with characteristics of healthy subjects has revealed statistically significant difference in the amplitude and speed of eyebrow, eyelid and mouth movement in PD patients. The method offers prospects for screening of patients with suspected PD and evaluation of therapy efficacy.

Stupor resolving into rapidly deteriorating locked-in syndrome

Locked-in syndrome (LiS) is a rare condition characterized by quadriplegia, lower cranial nerve paralysis, and mutism with preservation of consciousness, vertical gaze, and upper eyelid movement. Here, we present a case that had initial mild neurological symptoms, stupor, fully conscious state, and computed tomography-brain showing old cerebral infarcts. There was a rapid deterioration of the condition into LiS and magnetic resonance imaging (MRI) brain showing infarcts bilaterally in the cerebellum, pons, midbrain, and thalami and finally leading to death. Relevant studies for discussion are presented. This case highlights the importance of MRI brain at the earliest even for cases with initial mild neurological symptoms and stupor to make an early diagnosis.

Novel approach in iris shade matching: mobile photography and custom ocular shade guide

Introduction: Custom ocular prosthesis have several advantages such as even distribution of pressure on the eye socket, highly esthetic iris, better comfort and eyelid movements, but this prosthesis requires a long fabrication time. The fabrication step that spent time the most is the iris shade matching. Case: A 19 years-old woman with a defect in her left eye reported to Dental Hospital Universitas Sumatera Utara. The patient revealed history of infection of the left eye due to measles leading to surgical enucleation when she was one year old. Clinical examination shows healthy conjuctiva with no sign of infection or inflammation covering the posterior wall of the anopthalmic socket. Management: The iris shade matching was done using mobile photography and custom ocular shade guide, allowing the fabrication of iris button in the same day with shade matching appointment. The mobile photography eliminated the need for the operator painting skill and save the fabrication time significantly. The custom occular shade guide compensated the color biased during the photo taking procedure. Conclusion: The novel approach using mobile photography and custom ocular shade guide simplified the iris shade matching, provide highly esthetic results, eliminate the needs for operator painting skills, and save a significant amount of time in fabrication.

Comparative Blink Analysis in Patients With Established Facial Paralysis Using High-Speed Video Analysis.

This study analyzed the blink characteristics of patients with incomplete and complete facial paralysis. The authors measured and compared the palpebral distance, eyelid movement distance, and the eye-closing ratio of blinks in 55 patients with Bell's palsy or Ramsay Hunt syndrome (Bell & Hunt group) and 14 with complete paralysis (Complete Paralysis group). in the Bell & Hunt group, the palpebral distance (7.94 mm) was smaller on the paralyzed side than on the non-paralyzed side (9.61 mm). The eyeclosing ratio and the upper eyelid movement were reduced on the paralyzed side (65.3% versus 93.7%, 4.61 versus 7.97 mm) and in the Complete Paralysis group (25.3% versus 94.7%, 2.10 versus 8.49 mm). In the Bell & Hunt group, movement of the upper eyelid on the paralyzed side was weakened despite palpebral contracture. The Complete Paralysis group exhibited highly reduced movement in both the upper and lower eyelids.

Bilateral carotid cavernous fistula after trauma: a case report and literature review

BackgroundCarotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures. The traumatic bilateral carotid cavernous fistula are significantly rarer.Case presentationsWe report a case of a 61-year-old man presenting with unilateral exophthalmos, swollen eyelids, conjunctival congestion, and edema etiologically associated with severe trauma. Thereafter, the patient demonstrated symptoms of contralateral oculomotor nerve injury caused by skull base fracture, such as ptosis of eyelid, dilated pupils, and eye movement disorder, and was diagnosed with bilateral carotid cavernous fistula.ConclusionsThe patient recovered after undergoing endovascular embolization of bilateral cavernous sinus fistulas. The patient demonstrated the classic symptoms of an extremely rare condition known as bilateral carotid cavernous fistula, in only one eye. Reporting and analyzing this case will help us elucidate the underlying mechanisms of this disease.

Comprehensive investigations of mixed convection of Fe\u2013ethylene-glycol nanofluid inside an enclosure with different obstacles using lattice Boltzmann method

In the present paper, nanofluid mixed convection is investigated in a square cavity with an adiabatic obstacle by using the Lattice Boltzmann method (LBM). This enclosure contains Fe–ethylene-glycol nanofluid and three constant temperature thermal sources at the left wall and bottom of the enclosure through a lateral wall. The fluid is incompressible, laminar, and Newtonian. The obtained results are presented in the constant Ra = 104 and a Pr = 0.71 for different Ri = 0.1, 1, and 10. The effects of the slope of the enclosure, volume fraction of nanoparticles left( varphi right), the location of adiabatic obstacles, and nanoparticle diameter in the fluid are investigated on the value of heat transfer. A change in the attack angle of the enclosure leads to changes in the movement distance for fluid between hot and cold sources and passing fluid through case E, which affects the flow pattern strongly. In each attack angle, on colliding with an obstacle, the fluid heat transfers between two sources, which leads to uniform heat transfer in the enclosure. By increasing the velocity of the lid, the Richardson number decreases leading to improvement of the convective heat transfer coefficient and Nusselt number enhancement. The results so obtained reveal that by augmenting varphi value the effect of Richardson number reduction can augment Nusselt number and the amount of absorbed heat from the hot surface. Consequently, in each state where a better flow mixture and lower depreciation of fluid velocity components, due to the penetration of lid movement and buoyancy force, occurs higher heat transfer rate is accomplished. Furthermore, it is shown that when Ri = 0.1, the effect of cavity angle is more important but when Ri = 10, the effect of the position of obstacle is more visible.