BVP - Paediatric Ocular and Systemic Conditions - Week 10

Question 1

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.

Answer 1

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

Question 2

List 7 general management options available to presentations typical of paediatric populations.

Answer 2

Spectacle/CL correction
Medical therapy
Vision therapy
Referral coordination and follow-up
Monitor and review
Reassurance and routine review
Professional advice and recommendations

Question 3

List the guidelines most helpful in screening for amblyogenic potential for the following conditons:
Hyperopia
Myopia
Astigmatism (including oblique axis (2))
Anisometropia

Answer 3

Hyperopia
>+3.50D
Myopia
>-3.00D
Astigmatism
>1.50D at 90/180
>1.00 at oblique axes
Anisometropia
>1.50D

Question 4

Are babbies born hyperopic or myopic?

Answer 4

Hyperopic

Question 5

What is the guideline for managing hyperopic refractive error for children aged 1-4 (2)?

Answer 5

If the refractive error is >+3.50, prescribe 1D less

Question 6

What is the guideline for managing hyperopic refractive error for children aged 4-5 (2)?

Answer 6

If the refractive error is >+2.50, prescribe 1D less

Question 7

What is the guideline for managing myopic and hyperopic refractive error for children aged 5+ (3)?

Answer 7

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

Question 8

What is the guideline for managing anisometropic refractive error for children age 3.5+?

Answer 8

If >1.00 anisometropic, prescribe in full

Question 9

What is the guideline for managing astigmatic refractive error for children age 4+?

Answer 9

If >1.50 astigmatic, prescribe in full

Question 10

What is a retinoblastoma? Is it malignant or benign?

Answer 10

Malignant tumour of embryonic retinal cells

Question 11

What can be seen during the first two years of life with retinoblastoma?

Answer 11

Leukocoria (white milky pupillary reflex)

Question 12

How serious is retinoblastoma?

Answer 12

Very serious, requiring immediate referral

Question 13

How does cataract appear paediatrically? Describe the red reflex, vision, and what it might appear to look like.

Answer 13

Limited or no red reflex
Poor sight
May look like leukocoria

Question 14

What is ectopia lentis and what is it associated with?

Answer 14

Connective tissue defect often associated with Marfan syndrome

Question 15

What is aniridia? What is often seen with this condition (2)? What is vision like, and is it uni- or bilateral?

Answer 15

No iris
Cataracts oftenseen
Nystagmus
Poor vision
Bilateral

Question 16

What is microphthalmos? What is also seen with this condition (2)?

Answer 16

Small globe
Marked hyperopia
Macular hypoplasia

Question 17

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?

Answer 17

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

Question 18

What is retinopathy of prematurity? What can be seen with this condition (4)?

Answer 18

Incomplete retinal vessel growth leading to vascular changes
Retinal detachment
Vessel tortuosity
Neovascularisation
Haemorrhage

Question 19

List three risk factors for retinopathy of prematurity.

Answer 19

Prematurity (<30 weeks)
Low birth weight (<1.5kg)
Supplemental O2 at birth

Question 20

What is papilloedema? Is it uni- or bilateral? What is the vasculature like? List three causes.

Answer 20

Bilateral swelling of the disc
Vascular tortuosity seen
Possible causes are brain tumours, hydrocephalus, and acute disseminated encephalomyelitis

Question 21

Describe optic nerve head drusen, the percentage incidence in children, what the deposits are, and a possible cause. What can it give rise to?

Answer 21

0.4%
Acellular calcified deposits with a lumpy bumpy appearance
Causes unknown but potentially high hyperope
Can give rise to VF defects

Question 22

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).

Answer 22

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

Question 23

Describe static lesions and progresive lesions in toxoplasmosis. Note which is active and inactive inflammation.

Answer 23

Static - chorioretinitis pigmented - inactive

Progressive - has a foggy headlight appearance - active

Question 24

What does toxocariasis typically cause and what is it carried by? What age is it usually seen in?

Answer 24

Typically cases posterior uveitis
Worm-like parasite infection living in the retina, spread by dog faeces
Typically seen in ages 4-8

Question 25

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?

Answer 25

Stargardt's disease - fundus flavimaculatus Bilateral, quite rare Autosomal recessive Loss of central vision in school age or first 20 years

Question 26

How does congenital glaucoma appear (3) and in what ages is it typically seen?

Answer 26

Enlarged, swollen, hazy eyes in 0-3 years of age

Question 27

List 4 symptoms of congential glaucoma. Is it uni- or bilateral? Is it common or rare? Which gender is more affected?

Answer 27

``` Photophobia Excessive tearing Blepharospasm Elevated IOP Bilateral, rare, males>females ```

Question 28

List 7 factors that may place an infant, toddler, or child at significant risk for visual impairment or reduced visual functioning.

Answer 28

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

Question 29

List 4 general conditions considered special needs.

Answer 29

Down syndrome Cerebral palsy Autism Juvenile idiopathic arthritis

Question 30

What is downs syndrome?

Answer 30

A genetic condition | Trisomy of chromosome 21, 47 chromosomes in place of 46

Question 31

When does downs syndrome occur and does it have a social or ethnic pattern?

Answer 31

Occurs at conception with no social or ethnic pattern

Question 32

List 6 ocular manifestations of downs syndrome.

Answer 32

``` Strabismus Amblyopia Hyigh refractive error Sensitivity to medications (including eyedrops) Reduced accommodation function Vision impairment (cataract) ```

Question 33

What is the most common disability in australia?

Answer 33

Cerebral palsy

Question 34

Is cerebral palsy permanent?

Answer 34

Yes

Question 35

Is cerebral palsy progressive?

Answer 35

Non-progressive

Question 36

Do individuals with cerebral palsy have a normal lifespan?

Answer 36

Yes

Question 37

Is cerebral palsy hereditary? Note the mode of inheritance if so.

Answer 37

No

Question 38

What is thought to account for up to 75% of cerebral palsy cases?

Answer 38

Prenatal trauma/event

Question 39

What increases the risk of cerebral palsy?

Answer 39

Low birth weight

Question 40

What is cerebral palsy caused by?

Answer 40

Damage to the developing brain

Question 41

List 4 ocular manifestations of cerebral palsy.

Answer 41

Visual impairment (ocular and cortical) High refractive error Strabismus Cataract

Question 42

What is cerebral visual impairment and what is it caused by? Where is the area of interest in relation to the LGN?

Answer 42

A deficit of visual function caused by damage to or malfunctioning of retro-geniculate visual pathways posterior to the LGN

Question 43

What percentage of individuals with cerebral palsy also manifest cerebral visual impairment?

Answer 43

60-70%

Question 44

Why are the pathways (note which) involved with cerebral palsy common?

Answer 44

The lesions that most frequently underlie this condition also affect the visual areas of the brain

Question 45

Is it possible to have normal VA with cerebral visual impairment?

Answer 45

Yesd

Question 46

Is autism lifelong?

Answer 46

Yes

Question 47

List 4 characteristics of autism.

Answer 47

Difficulty with social interaction Impaired communication Restricted and repetitive interests and behaviours Sensory sensitivities

Question 48

List 6 ocular manifestations of autism.

Answer 48

``` Avoidance of eye contact Excessive blinking Visual motor/sequencing problems common Accommodation dysfunction common Astigmatism common Visual processing very well developed ```

Question 49

What three ocular conditions have a higher incidence with autism?

Answer 49

Strabismus Amblyopia Anisometropia

Question 50

What is juvenile idiopathic arthritis?

Answer 50

Inflammation of joints in children

Question 51

What is required for juvenile idiopathic arthritis?

Answer 51

Blood test workup

Question 52

List ocular manifestations of juvenile idiopathic arthritis.

Answer 52

Uveitis (8%) | Bilateral non-granulomatous iridocyclitis

Question 53

What is the most common identified cause of childhood uveitis?

Answer 53

Juvenile idiopathic arthritis

Question 54

Do children with juvenile idiopathic arthritis typically present with or without pain? What is this called?

Answer 54

Dont present with pain - insdious

Question 55

Below what age are children with juvenile idiopathic arthritis at risk of ocular manifestations? What is required?

Answer 55

Under 12 years of age, must have an eye exam

Question 56

List 4 ocular complications of juvenile idiopathic arthritis.

Answer 56

Cataract Glaucoma Band keratopathy Phthisis bulbi

Question 57

Describe phthisis bulbi.

Answer 57

Shrunken non-functioning eye-post inflammation

Question 58

List 7 paediatric learning disabilities.

Answer 58

``` Intellectual delay Language delay Motor delay Auditory delay Visual processing delay Dyslexia ADHD ```

Question 59

Is excessive blinking common or rare in children? Is it benign? What age is most common?

Answer 59

A very common presenting complain, mostly benign and presents mostly between ages 3-5

Question 60

Does excessive blinking cause functional impairment?

Answer 60

No

Question 61

What can excessive blinking develop into and what should be done in these cases?

Answer 61

Blepharospasm, should be referred if patient is symptomatic

Question 62

Describe psychogenic vision loss (give its alternate name) and list 4 characteristics of this condition.

Answer 62

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

Question 63

List 3 features typical of a psychogenic vision loss presentation. Explain if applicable.

Answer 63

7-12 years of age Female > male Coexisting external emotional disturbance such as learning issues, self esteem, famiry clisis

Question 64

Why is psychogenic vision loss tricky to diagnose?

Answer 64

Need to rule out any sinister or pathological cause (like stargardts disease)