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3F: Peds Final > Anterior Seg In Peds > Flashcards

Anterior Seg In Peds Flashcards

1
Q

Purpose of 4 BO test

A

To detect a small central scotoma secondary to a microstrabismus. Patients often have mildly reduced VA without an apparent underlying ocular etiology

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2
Q

Microstrabismus

A

Deviation of less than 10PD that is not visible on cover test or other standard tests of visual misalignment

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3
Q

Administration of 4BO test

A

Pateitn views a distance target and a 4BO prism is introduced while the examiner observes the movement of both eyes

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4
Q

Result interpretation of 4BO in front of OD

A
  • no suppression (normal): OD and OS move to the left, then OS refixates on the target
  • suppression OS: OS makes an outward movement, fails to refixate
  • suppression OD: OS does not make an outward movement or refixate
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5
Q

Purpose of visuoscopy

A

To detect eccentric fixation

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6
Q

Administration of visuoscopy

A

The patient is asked to look at the center of the grid ophthalmoscope under MONOCULAR conditions. The examiner views the location of the fovea light reflex in relation to the center of the grid

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7
Q

Result interpretation of visuoscopy

A
  • FLR is centered within the grid-NO EF
  • FLR is superior to the grid=superior EF
  • FLR is temporal to the grid=temporal EF

The VA decreases as the degree of EF increases

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8
Q

Tests for EF

A

Visuoscopy
Haidinger brushes
Maxwell spot
Hirschberg (monocular)

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9
Q

Congenital eyelid conditions can be

A

Isolated
Associated with orbital malformations
Due to a syndrome

Need proper evaluation of lids, ocular adnexa, and PD

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10
Q

Greater than normal distance between the inner canthi.

A

Telecanthus

Seen in many conditions
Distance between the medial orbital walls is normal

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11
Q

Large distance between the medial orbital walls because of the lateralization of the orbits

A

Hypertelorism

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12
Q

Epicanthis

A
  • crescent shaped vertical skin folds overlying the medial canthi
  • seen in prominent epicanthal folds
  • from immature facial bones
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13
Q

A rare condition that is due to a failed differentiation of lid and anteiror eye structures. The skin is fused over the eye and blends into the anomalous cornea

A

Cryptophthalmos

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14
Q

Eyelid coloboma

A
  • congenital
  • usually a cleft or notching of upper lid
  • ranges from small notch to larger defect
  • eyelid can fuse to the globe
  • in goldenhar syndrome
  • unrelated to other coloboma
  • exposure keratopathy
  • surgery to close the lid defect in most cases
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15
Q

Congenital ectropion

A
  • eversion of the eyelid margin; usually lower lid
  • lateral tarsorrhaphy could be necessary in some cases
  • skin flap or graft in more severe cases
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16
Q

Congential entropion

A

Eyelid eversion at birth
Rare
Surgery if there are concerns about the corneal integrity

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17
Q

Partial or complete eyelid fusion

A

Anyloblepharon

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18
Q

Epiblepharon

A
  • congential redundant fold of skin at the lower or upper lid margin
  • common lower lid
  • lashes turn inward on the cornea
  • cornea tolerates this better than entropion
  • could resolve spontaneously
  • lubricants; repair if there is chronic irritation to cornea
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19
Q

Partial or complete extra row of lashes at or posterior to meibomian glands.

A

Distichiasis

  • thinner, shorter, less pigmented lashes-so patients could tolerate them
  • treatment if there is irritation
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20
Q

Palpebral fissure is tight, and shortened horizontally and vertically

A

Blepharophimosis/congenital eyelid syndrome

  • sporadic or AD
  • there is poor levator function
  • delay in repair because the epicanthus and telecanthus can improve with age
  • ptosis repair could be frontalis suspension procedures
  • repair to allow bridge to fully develop
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21
Q

Congential ptosis

A
  • blepharoptosis is eyelid droop
  • poor levator function
  • congential or acquired. Can run in families
  • anisometropic amblyopia and strab can be associated
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22
Q

Congenital ptosis classification

A

Crease may be absent in severe congenital ptosis

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23
Q

Acquired ptosis classification

A
  • myogenic ptosis: MG, progressive external ophthalmiplegia, muscular dystrophies
  • neurogenic ptosis: Horner syndrome, CN III palsy
  • mechanical ptosis
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24
Q

Ptosis eval

A
  • assess upper lid crease
  • measure amount of ptosis by measuring palpebral fissure height, margin reflex distance (MRD: distance from upper lid margin to the corneal reflex when eye is in primary)
  • levator function
  • also asses tear function and corneal sensitivity because of exposure that could occur after ptosis repair
  • bells phenomenon is poor
  • determine if the globe is microphthalmic or if there is a hypotropia that could cause pseudoptosis
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25
Q

How to assess levator function

A

Hold the brow to block frontalis muscle action, and measure the distance the upper lid can move when patient looks from up to downgaze

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26
Q

Correction for ptosis

A
  • mild to moderate ptosis repair can be delayed for several years-especially if patient has chin up position
  • severe ptosis can obstruct vision leading to form deprivation amblyopia. Early correction is required
  • repair may include levator resection, levator tuck, frontalis suspension
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27
Q

Marcus Gunn jaw winking syndrome

A
  • due to congenital synkinesis of the jaw and levator muscles
  • ptotic eyelid elevates with opening of the mouth or jaw movement
  • can be seen when infant sucks bottle or pacifier
  • treatment could be ptosis repair or combination of surgery with frontalis suspension
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28
Q

Infectious and inflammatory eyelid disorders

A

Chalazion
Hordeolum
Pyogenic granuloma
Molluscum contagiosum

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29
Q

Blocked meibomian gland that evolved from a hordeolum

A

Chalazion

30
Q

Blocked meibomian gland

A

Hordeolum

31
Q

Treatment for chalazion and hordeolum

A

Warm compresses, blepharitis managemtn, surgical for large painful and/or chronic lesion

32
Q

Pink growth of granulated tissue rapidly from the conjunctiva over a chalazion or site of a trauma

A

Pyogenic granuloma

33
Q

Caused by DNA pox virus, a shiny dome shaped wavy umbilicated skin papule.

A

Molluscum contagiosum

  • seen at or near the lid margin
  • can release viral particles onto the conjunctiva causing follicular conjunctivitis
  • most lesions do not require treatment because resolves spontaneously
  • spontaneous resolution can take months or years
34
Q

Malignant eyelid tumors

A

More common in adults than in kids

-BCC, SCC, melanoma

35
Q

Neoplasms of eyelid in children are more likely in

A

Children with systemic disorders that predispose them to malignancy (like xeroderma pigmentosum)

36
Q

Capillary malformation

A
  • port wine stain
  • congenital malformation that manifests as a flat red or pink cutaneous lesion
  • could fade, but more likely to get darker
  • more nodular with time
  • associated with sturge Weber syndrome
  • glaucoma could occur
37
Q

Congenital nevi of the skin

A
  • on eyelids
  • could cause deprivation amblyopia or have malignant transformation. Transformation risk increases with the size
  • observe small (<1.5cm) and moderate lesions (<20cm)
38
Q

Trichotillomania

A

Pulling out of ones own hair, eyebrows, lashes

  • associated with OCD
  • characterized by loss of lashes, broken hairs, regrowth of hairs of varying lengths
  • chidlren can also pull out their hair
39
Q

Atresia of puncta or canaliculi

A
  • failure of canalizations during development of lacrimal structures
  • patient presents with overflow of clear tears
  • no infection because bacteria cannot get to the lacrimal sac
40
Q

Congenital lacrimal fistula

A
  • an epithelium lined tract extending from the lacrimal sac overlying the skin surface
  • small dimple, medically and difficult to detect if three are no symptoms
  • no treatment if asymptomatic
  • discharge could be present in the presence of NLDO and could resolve after probing
41
Q

Dacryocele

A
  • congential, present at birth or within a few days after birth
  • distal blockage causes distinction of the lacrimal sac
  • kinking at the canaliculus doe snot allow back flow of secretion
  • seen below and nasal to the medial canthus-Classic
  • imaging is not required
  • symptoms associated with NLDO
42
Q

Differentials for dacryocele

A

-hemangioma (not usually at birth, vascular and less firm), dermoid cyst (Above medial canthus)

43
Q

Dacryocele and infections

A

Prone to infections (mild to severe)
-acute dacryocystitis when dacryocele is infected-redness in the area with possible reflux of purulent discharge with pressure

44
Q

Complications of dacryocele

A
  • respiratory symptoms if large intranasal involvement because babies are nose breathers
  • early treatment to prevent complications
  • infants are more at risk of local and or systemic spread of infection
  • could resolve with careful digital massage or probing
  • if no resolution in 1-2 weeks of birth or if infected, surgery is indicated
45
Q

NLDO

A
  • most common lacrimal disorder in peds
  • in about 5% of full term babies
  • usually because of a thin membrane at the lower end of the NLD
  • present in the 1st month of life with epiphora and/or recurrent periorbital crusting
  • symptoms are intermittent or chronic, and bialteral is common
  • digital pressure over sac can lead to discharge of mucopurulent material
  • culture shows multiple strains of bacteria
  • culture not necessary for managment
46
Q

NLDO differentials

A
  • infantile glaucoma (enlarged cornea, photophobia, corneal clouding with or without enlargement and Haag striae)
  • conjunctivitis (conjunctival injection)
  • epiblepharon (corneal irritation only severe) and other corneal disorders. (Injection)
  • eyelid abnormalities
  • ifconcerns about photophobia, cornea, or conjunctiva, consider differentials
47
Q

Infants with NLDO

A
  • not bothered
  • clear cornea and conj
  • perform full eval with cycloplegic refraction to rule out other isues
  • about 90% of the patients will have spontaneous resolution by 12 months of age
  • PCP tend to refer when there is no resolution
48
Q

Initial treatment for NLDO

A
  • lacrimal massage over the lacrimal sac and the medial canthus a few times a day-to empty the sac to reduce infection AND to apply pressure to the obstruction to potentially open it. Make sure massaging the correct spot
  • topical ABX-for significant discharge (not to cure obstruction). Any board spectrum abx can be used because any bacteria, even Norma flora, can cause an infection. No need to culture. Dosing for a number of days for an acute infection and then as needed
49
Q

NLD probing

A
  • very common
  • done after initial conservative treatments give no resolution
  • done later because there could be resolution in many of the cases
50
Q

Megalocornea

A
  • non progressive enlargement of the cornea
  • diameter > or = to 13mm
  • rare, congenital
  • could be X linked or AR or AD
  • more in males, late associations include glaucoma, cataracts
  • lubrication for exposure keratitis
51
Q

Microcornea

A
  • clear and normal thickness cornea
  • diameter < 9mm in newborn, <10mm after age 2
  • AR or AD
  • globe has normal dimensions
  • accompanied with other abnormaliteis (Cataracts, coloboma, cornea plana, persistent fetal vasculature, Ehler-Danlos sybdrome
52
Q

Microphthalmos

A

Small malformed eye. Isolated or seen with syndromes

53
Q

Nanophthalmos

A

Normal small eye

  • seen in high hyperopia
  • shallow AC so angle closure glaucoma possible
54
Q

Keratoconnus

A
  • central or paracentral cornea bulges and progressive corneal thinning (becomes cone shaped)
  • present and progresses into puberty
  • hereditary
  • can be in Down syndrome, atopic disease, chronic eye rubbing
  • Vogt striae (iron, stress lines) and apical scarring seen-unlike keratoglobus
  • tears in descemets give hydrops
55
Q

Keratoglobus

A
  • bialteral non-inflamamtory thinning of the entire cornea
  • present at birth
  • steep corneal curvature with thinning in the periphery and deep AC
  • rare, AR, generalized thinning
  • spontaneous breaks in descemets leading to acute edema
  • corneacan rupture with minor blunt trauma
  • protective wear and scleral lenses
56
Q

Posterior embryotoxin (prominent schwalbe line)

A
  • a thickening and anterior displacement of the schwalbe line
  • irregualr white line anterior to the limbus
  • isolated finding (10-15% of pop) or seen with axenfeld-Rieger syndrome
  • visible on slit lamp
57
Q

Peters anomaly (iridocorneal adhesions)

A
  • posterior corneal defect with an overlying stromal opacity with iris strands
  • size and density of opacity ranges from mild to dense
  • strands to the defect vary in number and density
  • central opacity could get vascularized and protrude
  • it could also be the adhesion of the lens to the cornea
  • seen in different diseases-axenfeld-rieger
  • will be bilateral like systemic diseases and will need genetics work up
58
Q

Epibulbar dermoid (limbal dermoid)

A
  • fibrofatty tissue covered with epithelium.
  • present at birth with very little growth afterwards
  • could contain hair follicles, sebaceous glands, sweat glands
  • straddles the limbus and could be as big as 10mm in diameter
  • could extend to corneal stroma and adjacent sclera
  • mainly inferior limbus
59
Q

Complications of epibulbar dermoid

A
  • it can induce astigmatism leading to amblyopia
  • removal for ocular irritation or amblyopia risk
  • but excision could lead to scarring, astigmatism, and amblyopia
  • a graft should not be required but just in case
  • seen in goldenhar syndrome
60
Q

Sclerocornea

A
  • total corneal opacification and resembles the sclera
  • difficult to see the limbus
  • central cornea clearer than peripheral
61
Q

Persistant pupillary membrane

A
  • common
  • not visually significant
  • if prominent, can adhere to anteiror lens capsule and produce an anterior polar cataract
  • remnants seen in adults
62
Q

Iris hypoplasia

A
  • iris staroma is underdeveloped
  • if posterior pigment epithelium is also underdeveloped, there is iris transillumination
  • when both stroma and pigment epi are involved: if focal, it is iris coloboma, if diffuse: it is aniridia
63
Q

Iris transillumination

A
  • seen in albinism because of the absence of pigment in the posterior epithelial layers
  • can be seen in marfans syndrome, trauma, surgery, or uveitis
64
Q

Iris coloboma

A
  • due to failure of the embryonic fissure (typically found in the inferonasal quadrant)
  • looks like an inverted teardrop
  • typically can also involve the lens, CB, choroid, retina, and ON
  • could be AD and family could have small undetected defects
65
Q

Aniridia

A
  • binocular
  • photophobia complaints
  • degrees of iris ranges from mild hypoplasia to complete absence of iris
  • other problems could include: nystagmus, fovea hypoplasia, VA less than 20/100, anterior polar cataracts, or some persistent pupillary membranes
  • hereditary-many chidlren with aniridia have a parent with it
  • sporadic aniridia can be seen in wilms tumor
  • all sporadic cases have to undergo kidney ultrasound to r/o wilms tumor development. Also need genetic eval
66
Q

Congential iris ectropion

A
  • ectropion of the posterior pigment epi onto the iris surface
  • could be seen in NF, Prader-Willi syndrome
67
Q

Dyscoria

A

Abnormality of the pupil shape, especially congenital malformations like iris coloboma, sectoral hypoplasia

68
Q

Corectopia

A

Displacement of the pupil

69
Q

Plycoria

A

Multiple iris holes (multiple pupils)

70
Q

Axenfeld-Rieger

A
  • common cause of iris stromal hypoplasia
  • represents a spectrum of developmental disorders characterized by posterior embryotoxon with iris strands, iris hypoplasia, and significant chance of glaucoma (50%)
  • smooth, cryptless iris surface with high iris insertion with possible iris transillumination
  • hypoplasia can be mild stromal thinning to marked atrophy with holes, corectopia, and ectropion uveae
  • non ocular associations include abnormal teeth, anomalies of pituitary gland region. Differnt genetic mutations can give this presentation
71
Q

It is heterochromia

A

Difference of iris color

Seen in congential horners, Fuchs henterochromia

72
Q

Lisch nodules

A

In NF

3F: Peds Final (11 decks)

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