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3F: Peds Final > Anteiror Seg In Peds II > Flashcards

Anteiror Seg In Peds II Flashcards

1
Q

More than 2mm difference in pupil size

A

Anisocoria

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2
Q

Unequal pupil diameter, but less than or equal to 1mm differnece in both dim and bright

A

Physiological anisocoria

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3
Q

Aides tonic pupil

A
  • abnormal larger pupil
  • anisocoria greater in bright
  • sluggish pupil with segmental repsosne to light
  • But more response at near
  • Greater than normal response/constriction with pilocarpine
  • slower tonic re-dilation is diagnostic
  • repsosne at near > response to light
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4
Q

Horners syndrome

A
  • abnormally smaller pupil
  • anisocoria greater in dim (unaffected eye dilates more)
  • ptosis secondary to paralysis of the muller muscle
  • congenital cases have iris heterochromia (affected pupil is lighter)
  • miosis, ptosis, anhidrosis (loss of hemifacial sweating)
  • congential or acquired
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5
Q

When is cocaine not necessary in horners

A

If common features are present

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6
Q

Confirming horners

A

Confirming diagnosis with topical cocaine (2-10%)
-horners pupil will not dilate

Apraclonidine (0.5% or 1%) can also be used
-horners pupil will dilate

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7
Q

What could cause horners

A

Trauma, surgery, or a neuroblastoma, affecting the sympathetic chain in the chest

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8
Q

Acquired horners

A

Need imaging of the brain, neck, and chest

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9
Q

Acquired corneal conditions

A

Keratitis

  • epithelial
  • stromal
  • peripheral
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10
Q

Punctuate epithelial erosions

A

Seen in children with

  • lagophthalmos
  • dry eye
  • CL overwear
  • floppy eyelid syndrome
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11
Q

Ophthalmia neonatorum

A
  • conjunctivitis occurring in the 1st month of life
  • form viral, bacterial, and chemical agents
  • prophylaxis has reduced the occurrence in developed countries, but still an issue in some areas of the world
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12
Q

Where is ophthalmia neonatorum found

A

Areas of high prevalence of sexually transmitted diseases and poor health care

  • infant infected through direct contact after passage through he birth canal
  • if the infection ascends into the uterus, even a cesarean infant can be infected
  • silver nitrate was once used as widespread prophylaxis, but erythromycin is not used for coverage against chlamydia or N gonorrhea
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13
Q

Neisseria gonorrhea

A
  • can cause ophthalmic neonatrum
  • seen int he first 3-4 days of life
  • mild conjunctival hyperemia and discharge, or even marked chemosis, copious discharge, potential for corneal ulceration
  • treatment with systemic antibiotics and topical saline irrigation
  • topical antibiotics if corneal invovlemtn
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14
Q

Congential herpes simplex infection

A
  • due to HSV 2
  • presents inthe 2nd week of life
  • conjunctivitis, keratitis (epithelial or stromal), cataracts
  • vesicular lesions, CNS invovlemt, retinal necrosis
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15
Q

Bacterial conjunctivitis

A
  • copious discharge
  • diagnosis is by clinical presentation
  • culture for the agent not necessary in mild cases, but in severe cases
  • topical agents such as plymyxin cominbations. Erythromycin, bacitracin and FQs are effective
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16
Q

Trachoma

A
  • caused by poor hygiene and poor sanitation
  • spreads from eye to eye
  • acute purulent conjunctivitis, follicular reaction, tarsal scarring, papillae hypertrophy, vascularization of the cornea
  • culture for diagnosis
  • treatment with topical and systemic erythromycin
  • tetracycline can be used in chidlren older than 8 years
17
Q

EKC

A
  • highly contagious in epidemic outbreaks
  • acute, bilateral follicular conjunctivitis
  • preauricular adenopathy
  • initial symptoms are FB sensation nand periorbital pain
  • diffuse SPK and the focal epithelial lesions
  • after 11 to 15 days, subepithelial opacities form under focal epithelial infiltrates
  • opacities can last for 2 years
  • conjunctival membranes can form in severe cases with marked eyelid swelling. Differentials are orbital and preseptal cellulitis
  • complications include persistent subepithelial opacities and conjunctival scarring
  • diagnosis is by clinical presentation, confirmed by rapid culture
  • supportive treatment: AT and cool compresses
  • topical steroids may be used with caution in severe cases with decreased vision from subepithelial opacities
18
Q

Molluscum contagiosum

A
  • caused by DNA poxvirus
  • shiny dome-shaped waxy umbilical skin papule
  • seen at or near the lid margin
  • spontaneous resolution can take months or years
19
Q

Blepharitis

A
  • less common in kids
  • causes chronic conjunctivitis in kids
  • signs and symptoms are similar to adults. Ocular irritation, morning crusting, eyelid erythema, meibomian gland obstruction
  • intermittent blur
  • inferior keratitis in severe cases
  • recurrent chalazion
20
Q

Treatment for blepharitis

A
  • warm compresses
  • eyelid scrubs with baby’s shampoo
  • topical antibiotic ointment
  • oral erythromycin or tetracycline (caution because of dental staining) in severe cases
  • caution with steroids in patients withcorneal disease
21
Q

Blepharokeratoconjunctivitis

A

Secondary to chronic meibomian gland disease

-affects the lids and cornea

22
Q

Ocular allergy

A
  • common in children
  • could be associated with asthma, allergic rhinitis, atopic dermatitis
  • itching
  • bialteral chronic conjunctival inflammation
  • tearing, burning, photophobia
  • immediate response to allergens
23
Q

Seasonal allergic conjunctivitis

A
  • seen in spring and fall
  • triggered by environmental allergens (pollens, trees). Red, watery eyes, itching, blue-gray/purple discoloration of lower eye lids
  • treatment: removal of allergens, topical or oral meds
24
Q

Treatment for seasonal allergic conjunctivitis

A
  • topical meds are mast cell stabilizers (alamide, alamast)
  • mast cell stabilizers and H1 blocker combo (pataday, bepreve)
  • vasoconstriction
  • steroids (FML, lotemax, Alex, pred)
  • NSAID (Acura) or combo drugs
25
Q

VKC

A
  • due to immediate and delayed hypersentivity reactions
  • common in males in the first 2 decades of life
  • spring and fall
  • severe itching
  • limbal and bulbar form
  • limbal form common in chidlren of African and Asian decent. Limbal more prevalent in hitter climates
26
Q

VKC appearance

A
  • commonly affects tarsal conjunctiva of the upper eyelid
  • initially there is diffuse injection with little discharge
  • papillae multiply, cover the tarsal with flat papules
  • thick, ropy whitish discharge may develop
27
Q

Limbal VKC

A
  • thickening and opacification of the conjunctiva at the limbus, usually marked at the upper margin of thecoenea
  • the limbal nodules are gray, jelly-like, elevated bumps
  • a whitish center may appear to the raised filled with eosinophils
  • they persist as long as the season exacerbates it
  • horners trantas dots (mostly upper limbus, but can be all over limbus)
28
Q

Cornea and VKC and treatment

A
  • could be invovled with punctate epithelial erosions
  • eye drops with mast cell stabilizers and H1 receptor blockers can be used
  • severe cases get topical steroids
29
Q

Papillomas

A
  • benign epithelial proliferation’s that look like masses at the limbus or as pedunculated lesions of the caruncle, fornix or palpebral conjunctiva.
  • transparent or pale color
  • resolve spontaneously
30
Q

Conjunctival epithelial inclusion cyst

A
  • clear
  • fluid filled conjunctival cyst
  • excision only for irritation
31
Q

Conjunctival nevus

A
  • common in kids
  • flat or elevated
  • can be brown, non pigmented or pink
  • can be noted at birth, develops more in childhood to puberty
  • removal is there is significant growth
  • rarely transforms into a malignancy
32
Q

Ocular melanocytosis

A
  • congenital

- unilateral gray or bluish patchy discoloration of the sclera

33
Q

Preseptal cellulitis

A
  • inflammation of tissues anterior to the orbital septum
  • eyelid edema: can extend to brow and forehead
  • no proptosis, no globe involvement
  • full EOMs with no pain-unlike orbital cellulitis
  • could occur due to: truama, laceration, insect bite, EKC, skin infection like herpes zoster, sinus infection
34
Q

Treatment for preseptal cellulitis

A

Can do oral antibiotics as outpatients

Impatient care for very young kids and sicker kids

Need cultures, imaging of issues and orbits, IV abx

35
Q

Orbital cellulitis

A
  • infection of the globe involving tissue posterior to orbital septum
  • commonly associated with sinusitis
36
Q

Orbital cellulitis could offater

A

Penetrating injuries

37
Q

Signs and symptoms of orbital cellulitis

A 
Fever
Eyelid edema
Orbital pain
Headache 
Proptosis 
Chemosis 
Limited EOMs because of orbital involvement 
Venous congestion could cause an increase in IOP
38
Q

Treatment for orbital cellulitis

A
  • need imaging to confirm orbital involvement, rule out FB, view sinus involvement and rule out bone tumors
  • requires impatient care and IV abx to prevent complications

3F: Peds Final (11 decks)

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