DISORDERS OF THE EYE PART2 Flashcards
What is congenital esotropia and when does it develop?
Congenital esotropia, also known as infantile esotropia, is a convergent strabismus that develops during the first 6 months of life.
What is the prevalence of congenital esotropia?
It represents 8.1% of all esodeviations and has been reported in 1 of 403 live births.
What are the characteristics of infantile esotropia?
Infantile esotropia is characterized by a constant large-angle esotropia, usually around 40 prism diopters.
How does cross-fixation manifest in congenital esotropia?
Cross-fixation occurs when the infant looks at objects on the left side with the right eye and uses the left eye for objects on the right.
What percentage of infants with congenital esotropia develop amblyopia?
Amblyopia is present in 20% to 70% of infants with congenital esotropia.
What systemic conditions are associated with congenital esotropia?
Conditions include Down syndrome, albinism, cerebral palsy, and neurologic or developmental issues.
What is the primary management for congenital esotropia?
Strabismus surgery, typically bilateral medial rectus recessions, is the definitive management.
At what age is surgery recommended for congenital esotropia?
Surgery is recommended between 6 months and 18 months of age.
What is congenital nasolacrimal duct (NLD) obstruction?
It is an obstruction of the nasolacrimal duct present at birth, affecting 5% of term babies.
What are the signs of congenital NLD obstruction?
Signs include epiphora, increased tear lake, and mucous discharge.
How is congenital NLD obstruction confirmed?
The dye disappearance test is used, where fluorescein dye retention after 5 minutes indicates obstruction.
What is the conservative treatment for NLD obstruction?
Conservative treatment includes Crigler massage and topical antibiotics for conjunctivitis.
What is the success rate of probing for NLD obstruction?
Probing is effective and has a higher success rate when done promptly at 12 months of age.
What is amblyopia?
Amblyopia is a reversible loss of vision in one or both eyes not improved by glasses and without pathology of the fundus.
What are the critical ages for amblyopia susceptibility?
Children are susceptible from birth to 7 or 8 years of age.
What are the types of amblyopia based on causative factors?
Types include deprivational, strabismic, anisometropic, and ammetropic amblyopia.
What is the prevalence of amblyopia in developed countries?
The prevalence ranges from 1% to 5%.
How is amblyopia diagnosed clinically?
It is diagnosed by poor vision not improving with glasses and no organic pathology in the retina or optic nerve.
What is occlusion therapy for amblyopia?
Occlusion therapy involves patching the better eye to force use of the amblyopic eye.
How does atropine penalization work for amblyopia?
Atropine blurs the better eye to make it visually inferior, encouraging use of the amblyopic eye.
What is strabismus?
Strabismus is any misalignment of the eyes from the visual axis. It can be horizontal (esotropia or exotropia) or vertical (hypertropia or hypotropia).
What is esotropia?
Esotropia is the inward deviation of the eye.
What is exotropia?
Exotropia is the outward deviation of the eye.
What is hypertropia?
Hypertropia is the upward deviation of the eye.
What is hypotropia?
Hypotropia is the downward deviation of the eye.
What is the pathophysiology of strabismus due to thyroid eye disease?
Mechanical restriction of one or more extraocular muscles causes the eyes to drift towards the restricted muscles.
Which conditions are associated with a high incidence of strabismus?
Cerebral palsy and Down syndrome.
Which type of strabismus is more common in Caucasians?
Esotropia is more common than exotropia.
Which type of strabismus is more common in Asians?
Exotropia is 2.5 times more common than esotropia.
What is comitant esotropia?
It is esotropia where the degree of crossing remains the same in all gaze directions.
What are examples of comitant esotropia?
Congenital esotropia and accommodative esotropia.
What is accommodative esotropia?
It is a convergent strabismus that occurs in children aged 2–3 years, caused by the synkinetic reflex of accommodation and convergence.
What is the treatment for persistent crossing in accommodative esotropia?
Eyeglasses correction, atropine penalization, and possibly surgery.
What is pseudoesotropia?
Pseudoesotropia is a false appearance of esotropia caused by prominent epicanthal folds, especially in Asian children.
What is the cause of incommitant esotropia?
It is caused by weak lateral rectus muscles or medial rectus restriction and may present with diplopia.
What are key features of CN VI palsy?
Weakness of the lateral rectus muscle, esotropia on the affected side, and abduction deficit.
What is Duane’s syndrome?
A congenital absence of CN VI with aberrant regeneration of CN III, often presenting with lid fissure narrowing on adduction and face turn.
What is Möebius syndrome?
It is bilateral facial nerve paralysis with horizontal gaze palsy, presenting with esotropia and no facial expression.
What is intermittent exotropia?
It is a divergent strabismus with both phoric and trophic phases, initially seen in distance vision and progressing to constant deviation.
What is the treatment for intermittent exotropia?
Early surgery to prevent loss of depth perception; non-surgical options include over-minus lenses and orthoptic exercises.
What is convergence insufficiency?
It is the inability to maintain convergence on near objects, with symptoms of reading difficulty, blurred vision, and diplopia.
What causes sensory strabismus?
Loss of vision due to optic or retinal pathology, amblyopia, or uncorrected refractive errors.
What is retinoblastoma?
The most common primary intraocular tumor in children in the Philippines, caused by mutations in retinal cells.
What is the inheritance pattern of heritable retinoblastoma?
It is passed in an autosomal dominant pattern with complete penetrance.
What is the most common presentation of retinoblastoma?
Leukocoria (white pupil or cat’s eye reflex).
What are key imaging findings in retinoblastoma?
Presence of intraocular calcium deposits on B-scan ultrasound, CT, or MRI.
What is the treatment for small retinoblastoma tumors?
Cryotherapy and laser photoablation.
What is the treatment for retinoblastoma occupying more than 50% of the eye?
Enucleation of the affected eye.
What is brachytherapy used for in retinoblastoma?
To treat small to medium-sized tumors, though it may cause radiation optic neuropathy.
What are the stages of retinoblastoma?
Stage 1: Intraocular;
Stage 2: Intraocular far advanced;
Stage 3: Intraorbital/metastatic spread.
How should retinoblastoma patients’ families be counseled?
Genetic counseling is essential, particularly for heritable retinoblastoma cases.
What is the typical duration of acute bacterial conjunctivitis?
Less than 3 weeks.
What are the most common etiologic organisms in acute bacterial conjunctivitis?
S. pneumoniae, Haemophilus sp., and Moraxella spp.
What are the key symptoms of acute bacterial conjunctivitis?
Unilateral or bilateral conjunctival hyperemia, mucopurulent discharge, morning lid sealing, and foreign body sensation.
What is the recommended treatment for acute bacterial conjunctivitis?
Topical antibacterial drops.
What is the duration of symptoms for hyperacute and chronic bacterial conjunctivitis?
Hyperacute: 24 hours to a few days; Chronic: More than 4 weeks.
What are the possible pathogens for hyperacute bacterial conjunctivitis?
N. gonorrhea, N. meningitidis, Streptococcus, and Staphylococcus.
What is the treatment for hyperacute bacterial conjunctivitis without corneal perforation?
1 g IM ceftriaxone.
What is the treatment for hyperacute bacterial conjunctivitis with corneal perforation?
1 g IV ceftriaxone every 12 hours for 3 days.
What syndrome is associated with blepharokeratoconjunctivitis?
Anterior or posterior lid margin blepharitis, conjunctivitis, and keratopathy.
What are the symptoms of blepharokeratoconjunctivitis?
Recurrent episodes of chronic red eye, tearing, photophobia, blepharitis, and keratitis.
What are the treatment options for blepharokeratoconjunctivitis?
Lid hygiene, topical antibacterials, steroids, and macrolides like erythromycin.
What characterizes allergic conjunctivitis?
Type 1 hypersensitivity reaction with acute, bilateral pale conjunctival edema, tearing, photophobia, and marked itchiness.
What conditions are associated with allergic conjunctivitis?
Asthma, atopic dermatitis, and allergic rhinitis.
What are the subtypes of allergic conjunctivitis?
Seasonal keratoconjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis.
What is the hallmark feature of vernal keratoconjunctivitis?
Intense itching with palpebral and bulbar conjunctival involvement.
What is the recommended treatment for atopic keratoconjunctivitis?
Topical antihistamines, mast cell stabilizers, NSAIDs, and steroid-containing eye drops.
What is the typical presentation of viral conjunctivitis?
Minimal conjunctival hyperemia and watery discharge lasting a few days.
What is the cause of epidemic keratoconjunctivitis (EKC)?
Adenovirus 18, 19, and 37.
What are the symptoms of pharyngoconjunctival fever (PCF)?
Conjunctival hyperemia, subconjunctival hemorrhage, edema, tearing, lid swelling, sore throat, fever, and preauricular lymphadenopathy.
What is the diagnostic stain for herpes simplex virus conjunctivitis?
Fluorescein or Rose Bengal stain.
What is the treatment for herpes simplex virus conjunctivitis?
Topical antivirals like trifluridine or vidarabine and oral acyclovir for recurrent cases.
What pathogens cause bacterial keratitis in children?
P. aeruginosa, S. aureus, and Streptococcus pneumoniae.
What differentiates preseptal cellulitis from orbital cellulitis?
Preseptal cellulitis has no proptosis or globe inflammation, and ocular motility is full.
What are the common causes of preseptal cellulitis in children?
S. aureus and S. pyogenes.
What is the treatment for preseptal cellulitis in children under 1 year old?
IV antibiotics.
What are the diagnostic methods for orbital cellulitis?
Cranial and orbital CT scans.
What is emmetropia?
A naturally focused eye for distance vision.
What is the correction for hyperopia?
Biconvex or plus lenses.
What is the correction for myopia?
Biconcave lenses.
What type of lens corrects astigmatism?
Cylindrical lenses.
What are the two broad classifications of causes for anterior uveitis in children?
“Infectious (e.g., herpes simplex, mumps) and noninfectious (e.g., juvenile idiopathic arthritis).”
What systemic condition is most strongly associated with noninfectious anterior uveitis in children?
“Juvenile idiopathic arthritis (JIA).”
What are common complications of JIA-associated uveitis?
“Band keratopathy, cataract, and glaucoma.”
What percentage of all cases of uveitis occur in children?
“Approximately 6%.”
What is the most frequent cause of chronic intraocular inflammation among children?
“JIA-associated uveitis.”
Which serologic tests may help evaluate the risk of uveitis in JIA patients?
“Antinuclear antibody, rheumatoid factor, and HLA-B27.”
What is the initial treatment for uveitis in children?
“Topical steroids and mydriatics.”
What percentage of eye injuries occur at home in the United States?
“40%.”
What is the most common cause of enucleation in children over 3 years of age?
“Trauma.”
What temporary protective measure can be used for eye injuries if an eye shield is unavailable?
“A disposable styrofoam coffee cup cut 2.5 cm from its base.”
What type of eye injury is strongly associated with shaken baby syndrome?
“Retinal hemorrhages.”
What are common mechanisms of injury for corneal foreign bodies?
“Inert or organic materials.”
What is the treatment for corneal abrasion?
“Look for occult foreign body, topical antibiotics, and eye patch.”
What clinical findings are associated with traumatic hyphema?
“Pain and blurring of vision.”
What are common signs of orbital blowout fractures?
“Diplopia, limitation of upward gaze, enophthalmos, lid ecchymosis, epistaxis, and hypesthesia of ipsilateral cheek.”
What condition is the hallmark finding in shaken baby syndrome?
“Retinal hemorrhages.”
What should always be considered in a child under 3 years with retinal hemorrhages?
“Non-accidental trauma or child abuse.”
What are the main treatment steps for lid lacerations caused by sharp objects?
“Evaluate for globe injury and perform primary edge-to-edge closure.”
Which study showed only 1 out of 56 visually impaired children had uveitis in the Philippines?
“National Survey of Blindness in the Philippines (2002).”
How can public education campaigns impact eye injuries?
“By reducing the incidence through appropriate safety equipment like protective eyewear.”
