DISORDERS OF THE EYES (based on T) Flashcards
What are normal developmental milestones for a newborn’s vision?
Appears uncoordinated or strabismic, appears cross-eyed although normal at this stage, stares at objects or faces less than 1 foot, vision is 20/400.
What are normal developmental milestones for a 1-month-old?
Looks at faces and pictures with contrasting black-and-white or RBW (red, black, white) images. Sustained eye contact by 6-8 weeks.
What are normal developmental milestones for a 2-3-month-old?
Looks at hands, follows light, faces, and objects.
What are normal developmental milestones for a 4-5-month-old?
Reaches for objects, recognizes milk bottle, looks at own hands, looks at self in the mirror.
What are normal developmental milestones for a 7-11-month-old?
Stares at small objects, develops pincer grasp, interested in pictures.
What are normal developmental milestones for an 11-12-month-old?
Watches fast-moving objects, recognizes self in mirror, familiar objects, pictures in books. Develops stranger anxiety, places shapes in proper holes, points at objects, observes gestures.
What is a red flag sign for autism at 11-12 months?
Unestablished pointing.
What are normal developmental milestones for an 18-24-month-old?
Focuses on near and far objects, points to body parts when asked, scribbles with crayon or pencil, imitates drawing lines or circles.
What are normal developmental milestones for a 3-4-year-old?
Vision nears 20/20, recognizes and copies shapes, names colors, draws stick figures.
What are normal developmental milestones for a 4-6-year-old?
Recognizes and recites the alphabet, uses eyes and hands together with increasing skill.
What are conditions requiring urgent referral within 24 hours?
Abnormal red-orange reflex (ROR), severe eye injury, severe eye pain, sudden loss of vision.
What are conditions requiring semi-urgent referral?
New onset strabismus or diplopia, visual acuity of 20/200 or worse, severe or new ptosis, anisocoria.
What are conditions requiring standard referral?
Abnormal visual acuity for age, strabismus, children who are untestable, amblyopia.
What is ophthalmia neonatorum?
An inflammatory condition of the ocular surface caused by a chemical or bacterial pathogen.
What is the chemical cause of ophthalmia neonatorum?
Silver Nitrate (AgNO3).
What bacterial pathogen can cause ophthalmia neonatorum?
Neisseria gonorrhoeae.
What are the signs and symptoms of gonococcal ophthalmia neonatorum?
Chemosis and copious discharge causing rapid ulceration and perforation of the cornea. Can lead to sepsis, meningitis, or arthritis.
What is the diagnostic method for ophthalmia neonatorum?
Gram staining and culture of eye discharge. Pathognomonic finding: Gram-negative diplococci.
What is the treatment for gonococcal ophthalmia neonatorum?
Ceftriaxone.
What are the signs and symptoms of Chlamydia trachomatis ophthalmia neonatorum?
Mild swelling, hyperemia, papillary reaction with minimal to moderate discharge.
What is the treatment for Chlamydia trachomatis ophthalmia neonatorum?
Erythromycin (eye ointment).
What is the Mandatory Ocular Prophylaxis for Newborn Act of 2011?
A law in the Philippines requiring ocular prophylaxis for newborns. Failure to comply may lead to fines or imprisonment.
What is the triad for congenital toxoplasmosis?
Retinochoroiditis, intracranial calcifications, hydrocephaly.
What is the triad for congenital rubella?
Cataract, microcephaly, congenital heart defect.
What are other features of congenital rubella?
Glaucoma (salt-and-pepper retinopathy), IUGR, jaundice, hepatosplenomegaly, rash.
What is the triad for congenital cytomegalovirus?
Retinochoroiditis, microphthalmos, optic nerve anomalies.
What is the most common defect in congenital cytomegalovirus?
Sensorineural hearing loss.
What are manifestations of congenital herpes simplex?
Conjunctivitis, keratitis, cataracts, retinochoroiditis.
What is Hutchinson’s triad in congenital syphilis?
Interstitial keratitis, Hutchinson teeth, 8th nerve deafness.
What are eye manifestations in congenital syphilis?
Corneal edema, deep stromal vascularization (salmon patch), keratitis.
What is the treatment for congenital syphilis?
Penicillin G.
What does TORCH stand for?
T- Toxoplasmosis, O- Others: HIV, Hepatitis B, Syphilis, R- Rubella, C- Cytomegalovirus (CMV), H- Herpes simplex virus (HSV).
What is Retinopathy of Prematurity (ROP)?
A complex disease of the developing retinal vasculature in premature infants.
What are the two phases of ROP?
- Acute Phase: Cessation of vasculogenesis with abrupt termination of vessels marked by a line in the retina.
- Chronic Phase: Peripheral hypoxia, VEGF production, abnormal vasculogenesis, and potential neovascularization.
What are the risk factors for ROP?
Prematurity (<32 weeks AOG),
birth weight <1,500 grams,
prolonged oxygen use,
prolonged use of cardiorespiratory support.
What are the stages of ROP?
Stage 1: Demarcation line.
Stage 2: Ridge.
Stage 3: Ridge with extraretinal fibrovascular tissue.
Stage 4: Subtotal retinal detachment.
Stage 5: Total retinal detachment.
What is the treatment of choice for ROP?
Laser photocoagulation.
What are the clinical features of congenital glaucoma?
Buphthalmos, corneal edema, Haab’s striae, tearing, elevated intraocular pressure.
What is primary congenital glaucoma?
Neuropathy of the optic nerve with increased intraocular pressure, visual field loss, and potential end-stage blindness.
What is amblyopia?
A reversible loss of vision in one or both eyes that does not improve with glasses and does not involve a pathology of the fundus.
What is strabismus?
A misalignment of the eyes from the visual axis due to congenital or acquired structural anomalies of the extraocular muscles.
What are the types of horizontal strabismus?
Esotropia and Exotropia.
What are the types of vertical strabismus?
Hypertropia and Hypotropia.
What is Moebius Syndrome?
A congenital condition with bilateral facial nerve paralysis, horizontal gaze palsy, and absent abduction, often presenting with esotropia.
What is Duane’s Syndrome?
Congenital absence of CN VI (Abducens) with aberrant regeneration of CN III (Oculomotor), characterized by lid fissure narrowing, globe retraction, and associated with fetal alcohol syndrome or thalidomide exposure.
What is retinoblastoma?
The most common intraocular malignancy , typically presenting with leukocoria (‘white pupil’), strabismus, or a white-grayish retinal mass.
What is the treatment for retinoblastoma?
Cryotherapy, laser photocoagulation, enucleation for tumors >50%, external beam radiation, chemotherapy, or brachytherapy.
What is acute bacterial conjunctivitis?
A conjunctival infection <3 weeks in duration with hyperemia, mucopurulent discharge, morning eyelid sealing, and foreign body sensation.
What pathogens commonly cause acute bacterial conjunctivitis?
S-M-H (SO MUCH HATE)
Streptococcus pneumoniae,
Moraxella sp.
Haemophilus sp.,
What is the treatment for acute bacterial conjunctivitis?
Topical antibacterial drops.
What is hyperacute bacterial conjunctivitis?
A severe conjunctivitis with explosive onset, copious discharge, and morning eyelid sealing caused by pathogens like N. gonorrhea or N. meningitidis.
What is the treatment for hyperacute bacterial conjunctivitis?
Ceftriaxone.
What is blepharokeratoconjunctivitis?
A syndrome involving anterior/posterior lid blepharitis, conjunctivitis, and keratopathy (keratitis, phlyctenules, punctate erosions, marginal ulceration).
What is the treatment for blepharokeratoconjunctivitis?
Lid hygiene, topical antibacterial and/or steroids, and erythromycin.
What is allergic conjunctivitis?
A type 1 hypersensitivity reaction with acute pale conjunctival edema, tearing, photophobia, pruritus, and minimal discharge.
What is the most common presenting symptom of allergic conjunctivitis?
Pruritus.
What is an emmetropic eye?
An eye that is naturally in focus for distance. The focus of the object falls on the retina. Also referred to as a normal eye.
What is an ametropic eye?
An abnormal refractive condition where images fail to focus upon the retina , requiring corrective lenses for proper focus.
What are the types of ametropia?
- Myopia (nearsightedness): The object falls before or in front of the retina
- Hyperopia (farsightedness): The object falls outside or beyond the retina
- Astigmatism: Abnormal shape of the globe or the lens.
What is the correction for myopia (nearsightedness)?
The use of a diverging (concave) lens to make light diverge before reaching the cornea, ensuring focus on the retina.
What is the correction for hyperopia (farsightedness)?
The use of a converging (convex) lens to focus light on the retina.
What is accidental eye trauma due to birth and prenatal trauma?
Descemet’s rupture (Haab striae)
typically secondary to forceps delivery, resulting in a hazy cornea
What is the treatment for Descemet’s rupture?
Amblyopia treatment.
What is a common mechanism of eyelid ecchymosis?
Secondary to blunt trauma.
What are the clinical findings for eyelid ecchymosis?
Redness of the eyelids.
What is the treatment for eyelid ecchymosis?
Cold compress within 24 hours
and
warm compress beyond 24 hours
What is the common cause of lid lacerations?
Sharp objects, animal bites, or strong blows by blunt objects.
What is the treatment for lid lacerations?
Evaluate for globe injury and perform primary edge-to-edge closure of the laceration.
What is the common mechanism of blow-out fractures of the orbital floor?
Objects larger than the globe causing trauma.
What are the clinical findings for orbital blow-out fractures?
Diplopia, limitation of upward gaze, and enophthalmos.
What is the treatment for orbital blow-out fractures?
Urgent referral to an ophthalmologist.
What is subconjunctival hemorrhage?
Bleeding under the conjunctiva caused by blunt trauma.
What is the treatment for subconjunctival hemorrhage?
Ice compress initially and warm compress later.
What is traumatic hyphema?
Accumulation of blood in the anterior chamber of the eye, often caused by blunt trauma, slingshots, or baseball injuries.
What are the clinical findings for traumatic hyphema?
Pain and blurring of vision.
What is the treatment for traumatic hyphema?
Refer to an ophthalmologist.
What is conjunctival laceration?
A tear in the conjunctiva caused by sharp objects, often associated with subconjunctival hemorrhage.
What is the treatment for conjunctival laceration?
Refer to an ophthalmologist.
What is the mechanism of lens injuries?
Blunt trauma.
What are the clinical findings for lens injuries?
Blurring of vision.
What is the treatment for lens injuries?
Refer to an ophthalmologist.
What is hyphema Grade I?
≤ ⅓ of the anterior chamber volume is filled with blood.
What is hyphema Grade II?
⅓ to ½ of the anterior chamber volume is filled with blood.
What is hyphema Grade III?
> ½ of the anterior chamber volume is filled with blood.
What is hyphema Grade IV?
The entire anterior chamber is filled with blood, referred to as ‘Eight Ball Hyphema.’
What are the common sports-related causes of traumatic hyphema?
Baseball/softball (15%), tennis (6%), racquetball (6%), hockey (5%), football (1%).
What are other common causes of traumatic hyphema?
Thrown objects (29%), punches (10%), sticks/branches (4%), BB/gunshot injuries (3%).
