Anterior Seg Flashcards
Capillary Hemangioma
- What is it?
- Most common ___
- Ratio females to males
- Location
- Appearance?
- __% present at birth, ___% by 6 months.
- Rapid growth in the first ___ years of life.
- Most have spontaneous regression. When to expect 30% regression and 70% regression.
Benign, soft tissue tumor composed of blood vessels.
Most common orbital tumor in childhood.
Females: males 3:2
Located on palpebral conj or upper lid.
Bright red mass, blanch on pressure. May bleed spontaneously.
30% present at birth, 100% by 6 months.
Rapid growth in first 5 years.
Regresses 30% by age 3. 70% by age 7 without tx.
What visual concerns should we worry about with capillary hemangioma?
Amblyopia. 25-60%. cased by occlusion of visual axis by lid or induced corneal astigmatism.
Capillary Hemangioma Tx
Correct ref error and tx for amblyopia.
steroid injection?
Oral beta blocker? For vasoconstriction.
Surgery
How to tx chalazion/Hordeolum
Topical steroid
Oral antibiotics
or surgery
Hot compress 6-8x per day. Do not pop–> infection.
Chronic: omega 3
1kg = how many lbs
2.2 lbs
1tsp = how many ml
5ml
Preseptal cellulitis
Infection of anterior portion of the eyelid.
S pneumonias most common.
Will see normal VA, EOMs, and pupils.
Oral antibiotic.
Orbital cellulitis
Will see decreased VA, APD and EOM restrictions. Proptosis with swollen lid.
IV antibiotics.
Pediatric cataract. Better to be anterior or posterior?
Anterior= better VA Posterior= poorer VA
pediatric cataract. What is a visually significant size?
larger than 3mm in central visual axis.
Cause of bilateral pediatric cataract
idiopathic (60%)
Hereditary without systemic disease. Most AD. 30%
Metabolic systemic disease such as galactosemia.
Maternal infection
Galactosemia- oil droplet cataract. Not a true cataract. Remove galacitol from diet.
Cause of unilateral pediatric cataract
Idiopathic (80%)
Ocular anomalies such as uveitis 20%
Trauma 10%
Types of anterior cataracts
Anterior polar- small.
anterior pyramidal-conical.
Nuclear cataract
Located in the embryonic/fetal nucleus between the Y sutures.
Unilateral or bilateral
Often AD
Poor visual outcome. Central and big.
Posterior lenticonus cataract
Similar to keratoconus
Congenital thinning of posterior capsule with bowing of thinned area. Most unilateral.
Some may develop irreg astigmatism. Could lead to amblyopia.
Cortex cataract- Cerulean (blue dot)
Blueish white opacities SCATTERED throughout lens cortex. Specks. AD Genetic mutation found Associated with down syndrome No sx. Can be risky
Peds cataract work up for unilateral and bilateral
Unilateral- may not require extensive systemic work up. History and physical. TORCHS titers. Toxo, rubella, HSV, syphalis.
Bilateral- Refer to pediatric ophthalmologist for surgery. More work up if no family history.
- Urine testing
- TORCHs titers
- Metabolic disorder testing
Infant Aphakia Treatment study
Infants with unilateral cataract studying.
tested IOL vs CL.
Grating acuity at 12 months, HOTV at 4.5 years.
Results: more complications with IOL- usually glaucoma. Pt should be left aphakic until full growth.
Pediatric cataract treatment
Infants
Toddlers
School age
Infants- surgery. Earlier intervention is better.
Todders- Do surgery if vision is bad. If VA is ok, dilate pupil with Phenylephrine.
School age- If congenital and no prior tx, poor prognosis. If acquired, more conservative tx.
AKA make judgement call. Adults? Surgery if VA is worse than 20/40
After cataract removal in peds
CLs after and IOL when older.
Amblyopia tx especially if unilateral.
Monitor for glaucoma.
Ectopia lentísimo
Lens subluxation due to disorders that disrupt the microfibrils of the zonules.
May have reduced VA.
Marfans- mutation for fibrillin 1 gene. Cardiac complications. Pt is usually greater than a -3.00 myope. Polycarb lenses, avoid sports!
Homocystinuria- dsisroder or methionine catabolism. Can test for in urine.
Congenital glaucoma
- percentage
- What causes it?
- Symptoms
- Percentage bilateral
- Tx
50-70%
infant up to 2 years
Angle structures block aqueous outflow. Ciliary body and iris more anterior.
Tearing, photophobia, blepharospasm. Bulged eyes, myopia, corneal changes such as opacifications increased IOP.
66% bilateral
Tx with surgery or eye drops for life.
Signs of childhood glaucoma(primary)
High IOP. Over 21. Reproducible visual field deficit. Enlarged corneal diameter 11+ in new borns 12+ in infants 13+mm in children older than 1
Increased ON cupping
Asymmetric CD ratio
Focal rim thinning
Signs of traumatic glaucoma(secondary)
Chronic iritis. Glaucoma secondary to inflammation
