eye pedi

Question 1

When should a Red Reflex be checked?

Answer 1

at birth til age two

Question 2

What are you looking for in a red reflex?

Answer 2

Look for cataracts/pupil opacities

Question 3

What do we look for when looking in eye?

Answer 3

Any abnormality (blunting, absence, white reflex or dark areas must be referred to Ophthalmology

Question 4

What eye test is used to check red reflex?

Answer 4

Bruckners

Question 5

Who do we refer to pediatric opthamologist regardless of red reflex results?

Answer 5

infants and children with a positive family history of:–Cataracts (infant, juvenile or congenital)–Retinoblastoma–Glaucoma–Retinal Abnormalities

Question 6

Esotropia, Exotropia, hypotropia, hypertropia

Answer 6

in, out, down, up

Question 7

What eye test is used to check for tropias?

Answer 7

hirschburg-corneal light reflex

test ocular mobility and alignment

Question 8

when does normal tearing start in newborn?

Answer 8

2 weeks

Question 9

Sx of blocked tear ducts

Answer 9

watery eyes, matting, mucous, tear lakes are noted

Question 10

how to treat blocked tear duct?

Answer 10

massage

Question 11

what is blocked tear duct called?

Answer 11

Dacryostenosis

Question 12

most common cause of conjunctivitis in newborn?

Answer 12

Chlamydial conjunctivitis is the most common: 6.2:1000 live birth

Question 13

Prophylaxis for gonnorea conjunctivitis

Answer 13

Prophylaxis–A single dose of 1% silver nitrate, .5% erythromycin and 1% tetracycline are equally effective for ocular gonorrhea prophylaxis.Silver nitrate may be better in regions where penicillinase producing gonorrhea is prevalent

Question 14

What medications will reduce incidence of chlaymydia

Answer 14

Tetracycline and silver nitrate reduce the incidence of chlamydia, but do not eradicate nasopharyngeal colonization or pneumonia

Question 15

What are the lab testing for conjunctivitis

Answer 15

Lab testing:Conjunctival scraping: Gram stain
, Giemsa stain used for staining protozoan parasites such as Plasmodium and Trypanosoma
-culture on chocolate agar–Chocolate agar is used for growing fastidious respiratory bacteria, such as Haemophilus influenzae and Neisseria meningitidis.
Blood Culture–
HSV Culture

Question 16

presentation of chlamydia conjunctivitis-how many days?

Answer 16

5- 14 days

Question 17

clinical manifestations of chlamydial conjunctivitis

Answer 17

bilateral or bilateral watery discharge which can become purulent and copious–
Hyperemia, eye swelling, chemosis–
Pseudomembranes, thickened conjunctiva, corneal opacification can develop–
Concomitant pneumonitis, OM, pharyngeal and rectal colonization

Question 18

Tx for chlamydial conjunctivitis

Answer 18

Treatment: Oral erythromycin (50mg/kg/day divided qid)
Second course if often required
Topical erythromycin can be beneficial as an adjunctive therapy

Question 19

When does Gonococcal conjunctivitis appear?

Answer 19

presents within 48 hours of birth

Question 20

clinical manifestations of Gonococcal conjunctivitis

Answer 20

marked eyelid edema, chemosis and purulent discharge–A conjunctival membrane and/or a corneal ulcer which can lead to perforation of the globe

Question 21

systemic manifestations of Gonococcal conjunctivitis

Answer 21

systemic manifestations: septicemia, anorectal infection, arthritis, meningitis, rhinitis, stomatitis.

Question 22

Treatment for Gonococcal conjunctivitis

Answer 22

Treatment–Topical erythromycin ointment–Rocephin 30-50mg/kg/day in divided doses or single dose cefotaxime 100mg/kg/IV or IM–Frequent eye irrigation until discharge resolve

Question 23

When does Herpetic Conjunctivitis present

Answer 23

within two weeks of life

Question 24

Clinical presentation of Herpetic conjunctivitis

Answer 24

Lid edema, injection, serosanguinous discharge–Involves the corneal epithelium or peri-orbital skin vesicles

Question 25

What are the systemic manifestations of herpetic conjunctivitis?

Answer 25

Serious systemic issue - encephalitis

Question 26

Treatment for herpetic conjunctivitis

Answer 26

Systemic Acyclovir: 30mg/kg/day divided tid x14-21 day

Question 27

What are most common pathogens of Bacterial Conjunctivitis

Answer 27

–Staph, strep are the most common pathogens

Question 28

Clinical manifestations of Bacterial conjunctivitis

Answer 28

Lid edema, chemosis, drainage, injection

Question 29

Treatment pending lab results for bacterial conjunctivitis

Answer 29

Topical e-mycin- | IM/IV third generation cephalosporin

Question 30

causes of conjunctivitis

Answer 30

``` Bacterial & Viral – Allergy– Trauma & Foreign Bodies– Tumors– Blepharitis ```

Question 31

What do you check for when patient has conjunctivitis

Answer 31

IARM–Inspection–Acuity–Red Reflex–Motility

Question 32

Tx for conjunctivitis

Answer 32

Fluorescein Staining Treatment – topical abx Refer if ulcer, no improvement in 5-7 days

Question 33

Symptoms of allergic conjunctivitis

Answer 33

Symptoms–Itchy, watery eyesMay nasal symptoms as wel

Question 34

Tx for allergic conjunctivitis

Answer 34

Treatment–Mast Cell Stabilizer/Antihistamine drops–Oral antihistamines–Steroids only for severe case

Question 35

Corneal abrasion clinical symptoms and treatment. referral?

Answer 35

``` History of trauma to eye Pain, photosensivity, tearing Topical antibiotics Ophthalmology consultation ```

Question 36

when is retinoblastoma usually discovered

Answer 36

before 4 years of age

Question 37

Sx of retinoblastoma

Answer 37

Infants with familial disease-monitoringSymptoms–Leukocoria -Cat eye reflex– Strabismus– Pain

Question 38

management of retinoblastoma

Answer 38

% no reoccurrence and survival rate–Enucleation, radiation, brachytherapy, cryosurgery, , chemotherapy

Question 39

Definition of sinusitis

Answer 39

URI symptoms lasting more than 10 days, but fewer than 30

Question 40

symptoms of sinusitis

Answer 40

Cough–Nasal Drainage–Halitosis–Fever–Headache/Facial Pain–Orbital redness/swellingrythema/Swelling of nasal mucosa Pale, boggy mucosa Sinus tenderness upon palpation

Question 41

Sinusitis treatment:

Answer 41

Treatment– Antimicrobials– Antihistamines/Decongestants– Saline drops/spray

Question 42

What are the systemic manifestations of chlamydial conjunctivitis

Answer 42

Concomitant pneumonitis, OM, pharyngeal and rectal colonization

Question 43

hsv-what can you see in eye that you dont see in chlamydia and gonorrhea

Answer 43

dendrites

Question 44

sx of chlamydial infection

Answer 44

When newborns get a chlamydial infection from their mothers, they may develop eye inflammation (conjunctivitis) with redness, swelling, and discharge, with or without pneumonia. The pneumonia often causes cough and rapid breathing. If illness is present, it typically begins after an incubation period of 1 to 3 weeks.

Question 45

what is the white reflex on retina called

Answer 45

leukokoria (white reflex)

Question 46

what is strabismus

Answer 46

Defect in ocular alignment, one or both eyes appear crossed, persistent squinting, head tilting. Intermittent extropia normal in kids 6mo-4yr when tired. Dx: Corneal light reflection, cover-uncover test Tx: Refer to ophthalmologist if >4months, occlude unaffected eye (2hrs/day), corrective lenses, monitor siblings.