Children and Squint

Question 1

Conjunctivitis of the newborn

• epidemiology
• presentation
• causative agents and differentiating between them
• management

Answer 1

Common in babies U4wks
-acquired during delivery from vaginal infection/birth environment

Bilateral OR unilateral
Lid swelling
Discharge
Ulcerated cornea
Conjunctival injection

Conjunctival swab
Chlamydia - white discharge
Gonorrhea - rapid progression, corneal ulcer
Staph - yellow discharge

No Hx of vaginal infection => lid hygiene, chloramphenicol eye drops
Hx of vaginal infection => OPTHALMOLOGY REFERRAL

Question 2

Non accidental injury

• epidemiology
• history
• systemic signs

Answer 2

Normally U2 - deliberate harmful acts, neglect

Hx

• none, vague, changes
• inconsistent with injuries
• mismatch between parent and child
• delay in seeking treatment

Systemic signs

• head, skull injuries
• bruises on face
• bone fractures
• SDH, SAH
• fearful, aggressive child

Question 3

Shaken baby syndrome

• cause
• presentation
• management

Answer 3

Violent shaking, head injury => occipital cortex damaged

• encephalopathy
• SDH
• retinal hemorrhage

Ext eye swelling/bruising
Conjunctival hemorrhage
Corneal perforation
Misshapen pupil
Cataracts
Vitreous hemorrhage
Retinal hemorrhage/detachment
Papilledema

REFER TO CONS OPTHALMOLOGIST AND PAEDS
Clearly and accurately record history from child and parent
Document all eye signs with drawings and photos
Date, time and sign for legal investigations

Question 4

Leucocoria

• possible causes
• assessment and management

Answer 4

White pupil
-in children => URGENT OPTHALMOLOGY

Possible causes

• congenital cataracts
• retinoblastoma

Assessed via red reflex

Question 5

Squint

• types
• direction of squint
• assessment and examination

Answer 5

Latent squint - misalignment of eyes controlled subconsciously
Manifest squint - misalignment of eyes cannot be controlled => eyes deviate

Inwards - esotropia
Outwards - exotropia
Upwards - hypertropia
Downwards - hypotropia

Hx

• age first noticed
• glasses
• birth trauma
• childhood illness/maternal infection
• FHx of squint

Exam

• VA
• leucocoria
• red reflex
• eye mv
• cycloglegic refraction - assess need for glasses

Question 6

Retinopathy of prematurity

-pathophysiology

Answer 6

Retina has no vessels until 4th month
-O2 supplied to premature => ocular complications

Screened if under 1.5kg or U32wks

Cryotherapy/laser photocoagulation to immature retina
Scleral buckling - tractional retinal detachment

Long term review advised for all babies with S3+