BVP - Paediatric Ocular and Systemic Conditions - Week 10 Flashcards
List 5 general paediatric ocular conditions optometrists might need to manage? Note which role, optometrist or ophthalmologist, manages each case best. Also note the most and second most common conditions.
Refractive error - most common
-optometry
Accommodation-vergence dysfunction - second most common
-optometry
Strabismus or BV dysfunction
-optometry/ophthalmology
Amblyopia
-optometry/ophthalmology
Anterior/posterior eye conditions
-optometry/ophthalmology
List 7 general management options available to presentations typical of paediatric populations.
Spectacle/CL correction
Medical therapy
Vision therapy
Referral coordination and follow-up
Monitor and review
Reassurance and routine review
Professional advice and recommendations
List the guidelines most helpful in screening for amblyogenic potential for the following conditons:
Hyperopia
Myopia
Astigmatism (including oblique axis (2))
Anisometropia
Hyperopia
>+3.50D
Myopia
>-3.00D
Astigmatism
>1.50D at 90/180
>1.00 at oblique axes
Anisometropia
>1.50D
Are babbies born hyperopic or myopic?
Hyperopic
What is the guideline for managing hyperopic refractive error for children aged 1-4 (2)?
If the refractive error is >+3.50, prescribe 1D less
What is the guideline for managing hyperopic refractive error for children aged 4-5 (2)?
If the refractive error is >+2.50, prescribe 1D less
What is the guideline for managing myopic and hyperopic refractive error for children aged 5+ (3)?
If the refractive error is >+1.50, give the full prescription
If the prescription is myopic (any magnitude), give the full prescription
If myopic with esophoria, give near add
What is the guideline for managing anisometropic refractive error for children age 3.5+?
If >1.00 anisometropic, prescribe in full
What is the guideline for managing astigmatic refractive error for children age 4+?
If >1.50 astigmatic, prescribe in full
What is a retinoblastoma? Is it malignant or benign?
Malignant tumour of embryonic retinal cells
What can be seen during the first two years of life with retinoblastoma?
Leukocoria (white milky pupillary reflex)
How serious is retinoblastoma?
Very serious, requiring immediate referral
How does cataract appear paediatrically? Describe the red reflex, vision, and what it might appear to look like.
Limited or no red reflex
Poor sight
May look like leukocoria
What is ectopia lentis and what is it associated with?
Connective tissue defect often associated with Marfan syndrome
What is aniridia? What is often seen with this condition (2)? What is vision like, and is it uni- or bilateral?
No iris
Cataracts oftenseen
Nystagmus
Poor vision
Bilateral
What is microphthalmos? What is also seen with this condition (2)?
Small globe
Marked hyperopia
Macular hypoplasia
What is optic nerve hypoplasia? What is vision like? Is it easy to determine a mild case? Is it uni- or bilateral? How is it defined?
Small grey optic nerve
Reduced or normal vision
Difficult to detect if mild
May be uni- or bilateral
Defined by size of the disc relative to distance from the disc to the macula
What is retinopathy of prematurity? What can be seen with this condition (4)?
Incomplete retinal vessel growth leading to vascular changes
Retinal detachment
Vessel tortuosity
Neovascularisation
Haemorrhage
List three risk factors for retinopathy of prematurity.
Prematurity (<30 weeks)
Low birth weight (<1.5kg)
Supplemental O2 at birth
What is papilloedema? Is it uni- or bilateral? What is the vasculature like? List three causes.
Bilateral swelling of the disc
Vascular tortuosity seen
Possible causes are brain tumours, hydrocephalus, and acute disseminated encephalomyelitis
Describe optic nerve head drusen, the percentage incidence in children, what the deposits are, and a possible cause. What can it give rise to?
0.4%
Acellular calcified deposits with a lumpy bumpy appearance
Causes unknown but potentially high hyperope
Can give rise to VF defects
What is toxoplasmosis? List an additional condition typical of this and is it self limiting or does it require intervention? Describe what it looks like (4).
Infection carried from cat faeces
Posterior uveitis, which is self limiting generally
Atrophic scarr and a round pigmented edge at the posterior pole and macula
Describe static lesions and progresive lesions in toxoplasmosis. Note which is active and inactive inflammation.
Static - chorioretinitis pigmented - inactive
Progressive - has a foggy headlight appearance - active
What does toxocariasis typically cause and what is it carried by? What age is it usually seen in?
Typically cases posterior uveitis
Worm-like parasite infection living in the retina, spread by dog faeces
Typically seen in ages 4-8
What is the most common form of macula degeneration in children? Is it uni- or bilateral? Is it common or rare? What is the mode of inheritance? What is vision like?
Stargardt’s disease - fundus flavimaculatus
Bilateral, quite rare
Autosomal recessive
Loss of central vision in school age or first 20 years
How does congenital glaucoma appear (3) and in what ages is it typically seen?
Enlarged, swollen, hazy eyes in 0-3 years of age
List 4 symptoms of congential glaucoma. Is it uni- or bilateral? Is it common or rare? Which gender is more affected?
Photophobia
Excessive tearing
Blepharospasm
Elevated IOP
Bilateral, rare, males>females
List 7 factors that may place an infant, toddler, or child at significant risk for visual impairment or reduced visual functioning.
Prematurity/low birth weight/oxygen at birth
Family history of retinoblastoma, congenital cataract or other genetic disease
Infection of the mother during pregnancy
Difficult or assisted labour
High refractive error
Strabismus
Anisometropia
Known or suspected central nervous system dysfunction
List 4 general conditions considered special needs.
Down syndrome
Cerebral palsy
Autism
Juvenile idiopathic arthritis
What is downs syndrome?
A genetic condition
Trisomy of chromosome 21, 47 chromosomes in place of 46
When does downs syndrome occur and does it have a social or ethnic pattern?
Occurs at conception with no social or ethnic pattern
List 6 ocular manifestations of downs syndrome.
Strabismus
Amblyopia
Hyigh refractive error
Sensitivity to medications (including eyedrops)
Reduced accommodation function
Vision impairment (cataract)
What is the most common disability in australia?
Cerebral palsy
Is cerebral palsy permanent?
Yes
Is cerebral palsy progressive?
Non-progressive
Do individuals with cerebral palsy have a normal lifespan?
Yes
Is cerebral palsy hereditary? Note the mode of inheritance if so.
No
What is thought to account for up to 75% of cerebral palsy cases?
Prenatal trauma/event
What increases the risk of cerebral palsy?
Low birth weight
What is cerebral palsy caused by?
Damage to the developing brain
List 4 ocular manifestations of cerebral palsy.
Visual impairment (ocular and cortical)
High refractive error
Strabismus
Cataract
What is cerebral visual impairment and what is it caused by? Where is the area of interest in relation to the LGN?
A deficit of visual function caused by damage to or malfunctioning of retro-geniculate visual pathways posterior to the LGN
What percentage of individuals with cerebral palsy also manifest cerebral visual impairment?
60-70%
Why are the pathways (note which) involved with cerebral palsy common?
The lesions that most frequently underlie this condition also affect the visual areas of the brain
Is it possible to have normal VA with cerebral visual impairment?
Yesd
Is autism lifelong?
Yes
List 4 characteristics of autism.
Difficulty with social interaction
Impaired communication
Restricted and repetitive interests and behaviours
Sensory sensitivities
List 6 ocular manifestations of autism.
Avoidance of eye contact
Excessive blinking
Visual motor/sequencing problems common
Accommodation dysfunction common
Astigmatism common
Visual processing very well developed
What three ocular conditions have a higher incidence with autism?
Strabismus
Amblyopia
Anisometropia
What is juvenile idiopathic arthritis?
Inflammation of joints in children
What is required for juvenile idiopathic arthritis?
Blood test workup
List ocular manifestations of juvenile idiopathic arthritis.
Uveitis (8%)
Bilateral non-granulomatous iridocyclitis
What is the most common identified cause of childhood uveitis?
Juvenile idiopathic arthritis
Do children with juvenile idiopathic arthritis typically present with or without pain? What is this called?
Dont present with pain - insdious
Below what age are children with juvenile idiopathic arthritis at risk of ocular manifestations? What is required?
Under 12 years of age, must have an eye exam
List 4 ocular complications of juvenile idiopathic arthritis.
Cataract
Glaucoma
Band keratopathy
Phthisis bulbi
Describe phthisis bulbi.
Shrunken non-functioning eye-post inflammation
List 7 paediatric learning disabilities.
Intellectual delay
Language delay
Motor delay
Auditory delay
Visual processing delay
Dyslexia
ADHD
Is excessive blinking common or rare in children? Is it benign? What age is most common?
A very common presenting complain, mostly benign and presents mostly between ages 3-5
Does excessive blinking cause functional impairment?
No
What can excessive blinking develop into and what should be done in these cases?
Blepharospasm, should be referred if patient is symptomatic
Describe psychogenic vision loss (give its alternate name) and list 4 characteristics of this condition.
Also called streff syndrome - unexplained vision loss
-bilateral
-psychogenic origin
-able to pass some psychopysical tests that should not be able to pass with true vision loss
-no evidence of pathology/refractive/amblyogenic cause
List 3 features typical of a psychogenic vision loss presentation. Explain if applicable.
7-12 years of age
Female > male
Coexisting external emotional disturbance such as learning issues, self esteem, famiry clisis
Why is psychogenic vision loss tricky to diagnose?
Need to rule out any sinister or pathological cause (like stargardts disease)
