clinical reasoning in p ophthalmology Flashcards
what is neonatal conjunctivitis ?
conjunctival inflammation in thee first month of life
also called ophthalmia neonatorum
what are the causes of ophthalmia neonatorum ?
organisms acquired during vaginal delivery :
C. trachomatis
N. gonorrhea
HSV-2
also : streptococci, staphylococci, h.influenza
what are the signs associated with ophthalmia neonatorum ?
sticky eye
discharge features :
watery in HSV infection
Mucopurulent in chlamydial infection
purulent in bacteerial infection
severe purulent in gonococcal conjunctivitis
how is a diagnosis of ophthalmia neonatorum made ?
mainly a clinical diagnosis
STI symptoms of parents
conjunctival scraping are taken for PCR
what is the management for ophthalmia neonatorum ?
referral to a genitourinary specialist for the parents
saline irrigation
chlamydial infection : azithromycin
gonococcal : 3rd generation cephalosporins - ceftriaxone
herpes simplex : topical acyclovir
what is the risk associated with IV acyclovir ?
risk of developing encephalitis
what is the most common aetiological factor associated wiith congenital cataract ?
autosomal dominant
what are the other different causes of congenital cataract ?
cataract associated with metabolic disorders
associated with intra-uterine infections
associated with chromosomal abnotrmalotiies
what are the metabolic disorders that can cause congential cataract ?
galactosemia - absence of GPUT enzyme
Lowe syndrome - problem with amino acid metabolism
Mannosidosis - mannosidase defeciency
what is the mode of inheritance of each of the metabolic disorders that cause congenital cataract ?
lowe syndrome - x-linked recessive
galactosemia - autosomal recessive
mannosidosis - autosomal recessive
what is the characteristic image of thee cataract associated with galactosemia ?
oil droplet cataract
what type of diseases are associated with lowe’s syndrome ?
occulocerebrorenal
what type of cataract is associated with lowe’s syndrome ?
cortical cataract
also associated with 2ry congenital glaucoma
what is the presentation of the cataract associated with mannosidosis ?
punctuate lens opacity arranged in a spoke like pattern in the posterior lens cortex
what are thee intrauterine infections associated with congenital cataract ?
rubella
varicella
toxoplasmosis
CMV
what are the other associated chromosomal abnormalities that can present with congenital cataract ?
Down’s
edwards syndrome
what are the ocular manifestation in Down’s syndrome ?
brushfield spots
myopia
strabismus
keratoconus
congenital cataract
what are the ocular manifestations associated with Edward syndrome ?
ptosis
microphthalmous
disc coloboma
what is the most common cause of leukocoria in thee pediatric age group ?
congenital cataract
retinoblastoma
ROP
what are thee different types of “spots” associated in ophthalmology ?
bitot spots - vitamin A deficiency
brush field spots - Downs syndrome
what are the investigations that should be done in cases of congenital cataract ?
US
urine analysis
visual evoked potential
screening for intra uterine infections
refer to a paediatrician
what is the significance of a urine analysis in congenital cataract ?
reducing substance after drinking milk in galactosemia
amino acid chromatography for Lowe’s syndrome
what is the treatment for congenital cataract ?
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
what does thee surgery for congenital cataract include?
removal of the lens matter and insertion of an IOL
when can we diagnose congenital ptosis ?
drooping of the eyelid where it covers more than 2 mm of the upper limbus
what are the types of congenital ptosis ?
primary myogenic congenital ptosis
secondary/acquired congenital ptosis
what is the etiology in myogenic congenital ptosis ?
poor levator function due to replacement by fatty tissue
absent/poorly developed lid crease
what aree thee different causes associated with acquired congenital ptosis ?
neurogenic
myogenic
mechanical
what are the neurogenic causes of acquired congenital ptosis ?
congenital 3rd CN palsy
congenital Horner syndrome
Marcus Gunn jaw winking syndrome
what are the myogenic causes associated with acquired congenital ptosis ?
myasthenia gravis
what is meeant by mechanical ptosis ?
ptosis cause by heaviness in the upper eyelid caused by a mass or swelling e.g upper lid hemangioma
what are the points that should be examined in ptosis assessment ?
uni or bilateral
lid crease
Marginal reflex distance norm - 4mm
Levator function norm 15 mm
what are the indications for surgery in congenital ptosis ?
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
what are the types of correctivee surgeries in congenital ptosis ?
levator resection ( good levator function )
frontalis suspension ( poor levator function )
what are the 2 main causes of epiphora ?
either increased production
or reduced drainage
what are the causees of increased tear productoin ?
congenital glaucoma
FB , cornal abrasion
Corneal/ conjuncctival infections
what are the causes off decreased drainage ?
congenital nasolacriimal duct obstruction
obstruction of haasneer valve (NLDO)
what are the signs and symptoms of NLDO ?
epiphora and increased tear lake
matting of lashes
infections of the lacrimal gland
lacrimal sac swelling
what is the management for NLDO ?
musct first exclude congenital glaucoma
conservative : sac compression , warm compresses , erythromycin for associated infections
surgery if conservative fails
what are the type of surgeries associated with NLDDO ?
probing and dilatation
steent insertion
