Children and squint

Question 1

What is ophthalmia neonatum?

Answer 1

Conjunctivitis in babies under 4 weeks old (common)

Question 2

Treating neonatal conjunctivitis:

Answer 2

Broad spectrum abx: chloramphenicol drops QDS 1 week and life-threatening hygeine if no vaginal infection

Question 3

Chlamydial ophthalmia neonatum?

Answer 3

Creamy white discharge 5-12 days after birth

Question 4

Gonorrhoeal ophthalmia neonatum?

Answer 4

2-5 days after birth
Rapid progression
Risk of corneal ulceration

Question 5

Staphylococcal ophthalmia neonatum?

Answer 5

Yellow discharge

Question 6

Cause of secondary neonatal conjunctivitis:

Answer 6

Failure of nasolacrimal duct to canalise by birth

Question 7

Systemic signs of non-accidental injury:

Answer 7

Head injuries/skull fractures
Bruises on face
Subdural and subarachnoid haemorrhage

Question 8

Hallmark triad of shaken baby syndrome:

Answer 8

Encephalopathy
Subdural haemorrhages
Retinal haemorrhages (most common - posterior pole to retinal periphery)

Question 9

What causes blindness in survivors of shaken baby syndrome?

Answer 9

Occipital trauma > ocular trauma

Question 10

Sign of NAI in ocular presentation:

Answer 10

Eyelashes infested with pthirius pubis (pubic crabs)
Conjunctival/vitreous haemorrhage
Scarred/perforated cornea and mishapen pupil
Papilloedema due to raised ICP
Retinal detachment

Question 11

What is leucocoria?

Answer 11

White pupil in children

Urgent referral

Question 12

Causes of leucocoria:

Answer 12

Coats disease - unilateral retinal telangiectasia
Persistent hyperplastic primary vitreous - failure of embryonic vitreous to regress
Toxicariasis - worm infection unilateral post/periph granuloma
Retinoblastoma

Question 13

Tests for retinoblastoma:

Answer 13

Red reflex: diminished with focal black areas and lens spokes

Question 14

Definition of a manifest squint/tropia:

Answer 14

Underlying misalignment cannot be controlled and the eyes deviate

Question 15

Types of squint:

Answer 15

ESO = convergent
EXO = divergent
HYPER = upward
HYPO = downward

Question 16

What is the cover test?

Answer 16

Covering the good eye will make the ‘tropia’ squint correct

Question 17

What will a cross-cover test reveal?

Answer 17

‘Phoria’ squint

Question 18

Difference between tropia and phoria?

Answer 18

Tropia is unilateral and reveals by cover test
Phoria is both eyes slightly converge/diverge some of the time and is revealed by breaking fusion between the eyes with the cross cover test

Question 19

What is retinopathy of prematurity?

Answer 19

Abnormal retinal changes in premature babies ranging from mild peripheral vascular changes to advanced retinal scarring
Due to growth of vasculature and can be caused by supplementary O2

Question 20

Stage 1 of ROP:

Answer 20

Demarcation line

Question 21

Stage 2 of ROP:

Answer 21

Formation of 3D ridge

Question 22

Stage 3 of ROP:

Answer 22

Fibrovascular proliferation at the ridge

Question 23

Stage 4 of ROP:

Answer 23

Partial retinal detachment +/- macula

Question 24

Stage 5 of ROP:

Answer 24

Total retinal detachment

bonus stage 6 is aggressive posterior ROP

Question 25

What does ‘Pius disease’ refer to?

Answer 25

Characteristic vascular changes of congestion and tortuosity at the posterior pole

Question 26

Screening or ROP:

Answer 26

For babies <1501 g/born before 32 gw

(50% babies <1000g have ROP)

Question 27

Treatment of ROP:

Answer 27

Cryotherapy/laser photocoagulation to immature retina

Scleral buckling therapy for traditional retinal detachment

Question 28

What is ROP associated with?

Answer 28

Refractive errors
Amblyopia
Cerebral visual impairment

Question 29

What is amblyopia?

Answer 29

Decreased VA due to underdeveloped visual system
Needs to be corrected before 7 years old or never corrects
One eye - patch good eye to correct
Happens due to refractive error, squint or cataract