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opthalmology > clinical reasoning in p ophthalmology > Flashcards

clinical reasoning in p ophthalmology Flashcards

1
Q

what is neonatal conjunctivitis ?

A

conjunctival inflammation in thee first month of life
also called ophthalmia neonatorum

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2
Q

what are the causes of ophthalmia neonatorum ?

A

organisms acquired during vaginal delivery :
C. trachomatis
N. gonorrhea
HSV-2
also : streptococci, staphylococci, h.influenza

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3
Q

what are the signs associated with ophthalmia neonatorum ?

A

sticky eye
discharge features :
watery in HSV infection
Mucopurulent in chlamydial infection
purulent in bacteerial infection
severe purulent in gonococcal conjunctivitis

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4
Q

how is a diagnosis of ophthalmia neonatorum made ?

A

mainly a clinical diagnosis
STI symptoms of parents
conjunctival scraping are taken for PCR

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5
Q

what is the management for ophthalmia neonatorum ?

A

referral to a genitourinary specialist for the parents
saline irrigation
chlamydial infection : azithromycin

gonococcal : 3rd generation cephalosporins - ceftriaxone

herpes simplex : topical acyclovir

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6
Q

what is the risk associated with IV acyclovir ?

A

risk of developing encephalitis

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7
Q

what is the most common aetiological factor associated wiith congenital cataract ?

A

autosomal dominant

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8
Q

what are the other different causes of congenital cataract ?

A

cataract associated with metabolic disorders
associated with intra-uterine infections
associated with chromosomal abnotrmalotiies

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9
Q

what are the metabolic disorders that can cause congential cataract ?

A

galactosemia - absence of GPUT enzyme
Lowe syndrome - problem with amino acid metabolism
Mannosidosis - mannosidase defeciency

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10
Q

what is the mode of inheritance of each of the metabolic disorders that cause congenital cataract ?

A

lowe syndrome - x-linked recessive
galactosemia - autosomal recessive
mannosidosis - autosomal recessive

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11
Q

what is the characteristic image of thee cataract associated with galactosemia ?

A

oil droplet cataract

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12
Q

what type of diseases are associated with lowe’s syndrome ?

A

occulocerebrorenal

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13
Q

what type of cataract is associated with lowe’s syndrome ?

A

cortical cataract
also associated with 2ry congenital glaucoma

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14
Q

what is the presentation of the cataract associated with mannosidosis ?

A

punctuate lens opacity arranged in a spoke like pattern in the posterior lens cortex

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15
Q

what are thee intrauterine infections associated with congenital cataract ?

A

rubella
varicella
toxoplasmosis
CMV

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16
Q

what are the other associated chromosomal abnormalities that can present with congenital cataract ?

A

Down’s
edwards syndrome

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17
Q

what are the ocular manifestation in Down’s syndrome ?

A

brushfield spots
myopia
strabismus
keratoconus
congenital cataract

18
Q

what are the ocular manifestations associated with Edward syndrome ?

A

ptosis
microphthalmous
disc coloboma

19
Q

what is the most common cause of leukocoria in thee pediatric age group ?

A

congenital cataract
retinoblastoma
ROP

20
Q

what are thee different types of “spots” associated in ophthalmology ?

A

bitot spots - vitamin A deficiency
brush field spots - Downs syndrome

21
Q

what are the investigations that should be done in cases of congenital cataract ?

A

US
urine analysis
visual evoked potential
screening for intra uterine infections
refer to a paediatrician

22
Q

what is the significance of a urine analysis in congenital cataract ?

A

reducing substance after drinking milk in galactosemia
amino acid chromatography for Lowe’s syndrome

23
Q

what is the treatment for congenital cataract ?

A

depending on the density and visualization of the red reflex :
bilateral dense : surgery between 4-10 weeks of age
bilateral partial : consider careful monitoring
unilateral dense : urgent surgery between 4-6 weeks followed by aggressive anti-ambylopia therapy
partial unilateral : usually treated non surgically with papillary dilatation and part time contralateral occlusion

24
Q

what does thee surgery for congenital cataract include?

A

removal of the lens matter and insertion of an IOL

25
Q

when can we diagnose congenital ptosis ?

A

drooping of the eyelid where it covers more than 2 mm of the upper limbus

26
Q

what are the types of congenital ptosis ?

A

primary myogenic congenital ptosis
secondary/acquired congenital ptosis

27
Q

what is the etiology in myogenic congenital ptosis ?

A

poor levator function due to replacement by fatty tissue
absent/poorly developed lid crease

28
Q

what aree thee different causes associated with acquired congenital ptosis ?

A

neurogenic
myogenic
mechanical

29
Q

what are the neurogenic causes of acquired congenital ptosis ?

A

congenital 3rd CN palsy
congenital Horner syndrome
Marcus Gunn jaw winking syndrome

30
Q

what are the myogenic causes associated with acquired congenital ptosis ?

A

myasthenia gravis

31
Q

what is meeant by mechanical ptosis ?

A

ptosis cause by heaviness in the upper eyelid caused by a mass or swelling e.g upper lid hemangioma

32
Q

what are the points that should be examined in ptosis assessment ?

A

uni or bilateral
lid crease
Marginal reflex distance norm - 4mm
Levator function norm 15 mm

33
Q

what are the indications for surgery in congenital ptosis ?

A

psychological affection
head tilt / chin up position ( abnormal head posture)
severity of risk of amblyopia
other than that wait till age 4-5 y/o

34
Q

what are the types of correctivee surgeries in congenital ptosis ?

A

levator resection ( good levator function )
frontalis suspension ( poor levator function )

35
Q

what are the 2 main causes of epiphora ?

A

either increased production
or reduced drainage

36
Q

what are the causees of increased tear productoin ?

A

congenital glaucoma
FB , cornal abrasion
Corneal/ conjuncctival infections

37
Q

what are the causes off decreased drainage ?

A

congenital nasolacriimal duct obstruction
obstruction of haasneer valve (NLDO)

38
Q

what are the signs and symptoms of NLDO ?

A

epiphora and increased tear lake
matting of lashes
infections of the lacrimal gland
lacrimal sac swelling

39
Q

what is the management for NLDO ?

A

musct first exclude congenital glaucoma
conservative : sac compression , warm compresses , erythromycin for associated infections
surgery if conservative fails

40
Q

what are the type of surgeries associated with NLDDO ?

A

probing and dilatation
steent insertion

opthalmology (14 decks)

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