BCSC 6. Pediatric Ophthalmology and Strabismus Flashcards
Alignment measurement when paretic or restricted eye is fixating
Secondary deviation
Deviation measured when nonparetic eye is fixating
Primary deviation (less than secondary deviation)
Deviation in strabismus that is in directino opposite to one that thte patient had originally
Consecutive deviation
Strabismus that is the same size in all positions of gaze
Comitant deviation
Only extraocular muscle whose origin is on medial orbital wall
Inferior oblique
Only extraocular muscle that passes through the trochlea
Superior oblique
Primary action of inferior oblique
extorsion
Innervates the MR, IR, and IO muscles
inferior division of CN III
Primary component of the extraocular muscle pulleys
Elastin (and smooth muscle and collagen)
Form of b/l symmetric refractive error at 3.5D would place greatest risk for isoametropic amblyopia
Astigmatism -> isoametropic amblyopia
Primary synergistic (yoke) muscles used for gazing up and to the right
Left IO and right SR
Term for positions of gaze in which single extraocular muscle is prime mover
Cardinal positions (6)
Sensory adaptation to manifest strabismus most commonly seen in patients
Peripheral suppression - eliminates diplopia
Best test for measuring amount of strabismus in patient who has amblyopic eye with VA 20/400 and eccentric fixation
Krimsky test - does not depend on sensory or motor response. (Lancaster test depends on subjective localization of targets)
What is the most appropriate initial therapy for high accomodative convergence/accomodation (AC/A) esotropia
Bifocals - reduce need for accomodation at near and allow for development of fusion and stereopsis. Overminus increase accomodation
Eye motility abnormality commonly associated with infantile esotropia?
Dissociated vertical deviation (DVD).
Asymmetric smooth pursuit, better in temporal to nasal direction
Infantile esotropia
Exodeviation most commonly seen in general population
intermittent exotropia
Exodeviation in which orthoptic exercises are most appropriate initial therapy
Convergence insufficiency
Pseudostrabismus in which eyes appear exotropic but visual axes are optically aligned
Positive angle kappa
A-pattern exotropia with compensatory head posture
Chin-down
Clinical finding that accompanies upward movement of the eye in DVD
Extorsion of globe - (extorsion and exodeviation of elevating eye)
DVD is seen in
infantile strabismus
Finding most suggestive of bilateral rather than unilateral SO muscle palsy
Large V pattern - extorsion well over 10 degrees in downgaze, esotropic shift in downgaze, head posture chin down to avoid cyclodiplopia in downgaze
Finding on exam of esotropic patient that makes type 1 Duane retraction more likely than 6th nerve palsy
Limited adduction of affected eye
Most helpful in distinguishing congenital motor nystagmus (infantile nystagmus syndrome) from acquired nystagmus
abnormal head position - (CMN; inflantile nystagmus syndrome) adopt abnormal hed position to take advantage of the better vision possible at null point
Exponential decrease in velocity of slow phase and fast-phase direction that reverses with change in fixation
latent nystagmus (fusion maldevelopment nystagmus syndrome)
4 weeks after b/l MR muscle recession, patient presents with new exotropia of 15 prism diopters iwth limited adduction of right eye..
Slipped muscle
Beneficial effect on visual field can occur as a result of strabismus surgery
Expansion of binocular visual field following surgery for esotropia. (surgery for exotropia constricts binocular visual field)
Visual field following surgery for exotropia
constricts binocular visual field
Refractive condition true for most infants during first year of life
Hyperopic refractive error that decreases over time
Eye movement abnormality can occur in healthy infants in first months of life
intermittent esotropia
Congenital ocular disorder most commonly a/w paradoxical pupils
Inherited retinal dystrophy
Age infant should be able to maintain fixation and react to facial expression
6-8 weeks
Best initial treatment for 11-mo old F with epiblepharon
Observation - often resolves
Condition of affected eye a/w pseudoptosis
Hypotropia (upper eyelid “follows” eye in upgaze and downgaze - eyelid moves in same direction)
Congenital eyelid malformation that requires early repair
Eyelid coloboma (eyelid cleft, eyelid notch) risk for significant exposure keratopathy and early closure of eyelid defect is often required.
Vision threatening periocular hemangiomas
Oral propranolol
Orbital cellulitis can be distinguished from preseptal cellulitis by this clinical finding
Chemosis - suggests orbital involvement
Most common location of bloackage in congenital NLDO
Valve of hasner
Curvilinear tears in Descemet membrane
Primary congenital glaucoma - Haab striae seen b/c of rapid stretching of cornea. (forceps are linear, not curvilinear)
Linear tears in descemet membrane
Forceps injury during delivery
Congenital iris ectropion is most commonly seen in
Neurofibromatosis 1, Prader-Willi syndrome, or facial hemihypertrophy
Most important associated medical condition to exclude in patient with sporadic aniridia
Wilms tumor - renal U/S, repeated until molecular genetic analysis rules out an 11p13 deletion and confirms an intragenic PAX6 mutation
Iris abnormality + horner syndrome
neuroblastoma
Heterochromia in child
Waardenburg syndrome
Treatment for infant with ophthalmia neonatorum 2/2 chlamydia trachomatis
Erythromycin - systemic c trachomatis may cause PNA and otitis media
Most severe ocular complication of SJS
Corneal ulcer
Finding predisposes child to glaucoma following surgery for congenital cataract
Microcornea - a/w higher incidence of glaucoma
Inheritance of primary congenital glaucoma
SPORADIC - but may be inherited as AR
Genetic disorder that pupillary block glaucoma is most likely to occur
Weill-Marchesani syndrome a/w microspherophakia
Type of uveitis most common in children
Anterior uveitis - 1) idiopathic 2) related to trauma 3) JIA
Most significant risk factor for developing ROP
Gestational age and birth weight
Preferred imaging for Rb
MRI and U/S - high risk for secondary radiation induced tumors
Moyamoya
dx with abnormalities of carotid circulation - Morning glory disc
Morning glory disc
A/w basal encephalocele in patients with midfacial anomolies, PHACE syndrome (posterior fossa malformations, hemangiomas, arterial lesions, cardiac and eye anomolies) and carotid circulation (moya moya)
Pseudopapilledema a/w
hyperopia - small C:D ratio resembling papilledema
African american child with hyphema
Sickle cell testing must be performed.
Management of white-eyed blowout fx in child
presents with marked vertical motility restriction in both directions, minimal soft tissue findings requires early surgical repair of fx, (IR muscle and associated nerve may become permanently damaged.)
Most common cause of visual impairment in children with head trauma
Cortical or cerebral visual impairment
Mode of inheritance in incontinentia pigmenti
X-linked dominant - lethal effect on hemizygous male fetus
Most common inheritance of NF1
Autosomal dominant in 50%, 50% with no FHx (high rate of new mutations)
