Eye Problems Flashcards
test vision in infant/young child
Infant and younger child - have the child look at and follow the expression and movement of the caregiver’s face.
test vision in kids 3-4 years
Child (> 3-4yrs) Allen cards (pictures of familiar objects) and the HOTV test can be used to assess acuity
test vision in kids age 4-6
Child (4-6 yrs) the tumbling E test can be used; Snellen eye chart may be considered when the alphabet is mastered
amblyopia
a functional reduction in visual acuity caused by abnormal visual development early in life
Strabismic — Caused by abnormal alignment of the eyes
Refractive — Caused by unequal focus between eyes
Deprivational — Caused be structural abnormalities of the eye that obscure incoming images
referral to ophtho
Visual acuity worse than 20/40 in a child 3-5 yrs
Visual acuity worse than 20/30 in a child ≥6 years
Visual acuity difference of ≥2 lines between eyes
Abnormal ocular alignment (i.e., strabismus)
Abnormal red reflex
Asymmetry of vision (eye preference)
Unilateral ptosis or other lesions obstructing the visual axis (i.e., eyelid hemangioma)
strabismus phoria
“Phoria” − Latent strabismus present only when binocular fusion is disrupted
Latent deviations are rarely associated with amblyopia.
strabismus tropia
“Tropia” − Manifest strabismus is present when there is no disruption of binocular fusion; can be intermittent, occurring only when fusional capabilities are exceeded (e.g., when the child is tired)
Manifest strabismus can be monocular, when deviation always involves the same eye, or alternating, when either eye may deviate.
Manifest deviations have a greater potential to cause amblyopia, caused by disuse or misuse of vision during the critical period of visual development.
presenting signs of retinoblastoma
strabismus most common finding
after leukocoria (white pupil), esotropia is the most common presenting sign of retinoblastoma (eyes turn inward)
Dacryostenosis
unilateral or bilateral obstruction of lacrimal duct, usually at nasal punctal opening.
Congenital nasolacrimal obstruction (dacryostenosis)
6 percent of newborns
Most common cause of persistent tearing and ocular discharge in infants and young children.
90% resolve spontaneously by 12 months
Due to failure of duct canalization.
Conjunctival erythema is not typical. On physical examination, there is often an increase in the size of the tear meniscus. Palpation of the lacrimal sac may cause reflux of tears and/or mucoid discharge onto the eye through the puncta.
Acute Dacrocystitis
bacterial infection of lacrimal sac that may spread to surrounding soft tissues resulting in cellulitis.
dacroadenitis
Dacryoadenitis. The lacrimal gland has become swollen and inflamed and is visible beneath the lateral aspect of the upper eyelid. The swelling is frequently accompanied by symptoms of pain and tenderness.
primary juvenile glaucoma
Dx after 4-5 years
Patients typically are asymptomatic, and optic nerve damage is occult.
Elevations of IOP usually are unrecognized unless optic nerve cupping is noticed.
The diagnosis generally is made because of coexisting ocular or systemic disease or because of a positive family history.
secondary glaucoma
Secondary Glaucoma – juvenile – usually acquired through retinopathy of prematurity, intraocular inflammation, ocular tumors, trauma, and glucocorticoids, Sturge Weber.
Clinical Findings: (Listen to parents)
Classic Triad: tearing, photophobia, excessive blinking (30%)
Hazy corneas, enlarged corneas or edema, ocular enlargement, bulbar conjunctival erythema
Secondary Glaucoma more likely to present with: pain, vomiting, blurred vision, tunnel vision, pupillary dilation, optic nerve cupping.
newborn conjunctivitis (chemical)
Chemical -presents several hours following opthalmic drop/ointment instillation; mild injection of conjunctiva, minimal lid edema, scanty drainage - lasts 3-4 days
no treatment necessary; resolves without sequella
newborn.conjunctivitis
gonococcal
Gonococcal – chemosis, significant lid edema, acute PURULENT discharge 2-4 days after birth
HOSPITALIZE – Irrigate eye w nl saline q 10-30 min gradually decreasing until purulent dx cleared; ceftriaxone 20-50 mg/kg/d/IV or IM not to exceed 125 mg as single dose or Cefotaxime 100 mg/kg/d IV or IM as single dose
newborn conjunctivits- chlamydia
Chlamydia – usually presents with mild mucopurulent discharge, minimal lid edema, a 5-14 days after birth – concomitant pneumonia ( afebrile, repetitive staccato cough, tachypnea, rales)
Other bacteria – purulent dx normally seen on 5th day, lid edema, chemosis
-pneumonia somtimes occurs with
Rales (but no wheeze and no fever) helps to distinguish from RSV
Chlamydia conj and/or pneumonia – oral erythromycin 50 mg/kg/d in 4 divided doses for 10-14 days. 20% require second course (assoc w pyloric stenosis)
organisms- infectious conjunctivitis (pink eye)
Bacterial causes - 60-70% Non type H Flu 42% (Jan, Feb, Mar) Associated with ipsilateral otitis media Strep Pneumoniae 15% Viral – 10-20% Adenovirus 15-20% (pharyngitis)
viral vs bacterial conjunctivits
Age: Bacterial – Younger; mean age 3.6 yr. Viral – Older ( 8.5 yrs) Seasonality – Bacteria in winter Discharge – Purulent, thick color = bacteria Conjunctival Response: (slit lamp) papillary =bacteria; follicular = viral Concurrent Disease: otitis media? (H Flu) Pre-auricular nodes? PCF triad? Adenovirus 3,8,19; Sinusitis? Response to therapy: Bacteria= 2-5 day with antibiotic Viral – self limiting 7-10 days with no treatment
hsv viral conjunctivits
Mainstay of tx of bacterial is topical antibiotics.
Common choices: erythromycin oint; trimethoprim sulfate/polymyxin gtts; sulfacetamide gtts
(Polytrim) - + + H Flu and S pneumonia; seldom hypersensitivity, approved as young as 2yr; comfortable
never corticosteroid
allergic conjunctivitis
Red, watery, itchy eyes.
Part of larger allergic picture (hay fever) or direct contact with airborne allergen
Bilateral usually, but one eye could be inoculated with dander etc.
Nasal salute, allergic rhinitis, shiners – grey boggy, papillary conjunctiva
Avoidance, Avoidance, Avoidance
chalazion
Obstruction of meibomian glands lining posterior margins of upper and lower lids.
Cause – unknown
S/S – progressive swelling of lid, slight discomfort, minimal redness.
DD: Blepharitis? Hordeolum? Sebaceous cell carcinoma ( rare)
PE - Firm, non-tender non moveable nodule often on palpebral surface of lid
Small chalazions may resolve w/o tx.
Warm compresses 2-3 x day for 2-3 days
If large, recurrent or infections lesions, local antibacterial drops or ointment for 1 week
If persistent or large, refer for surgical excision or corticosteroid injections.
blepharitis
granulation of eyelids
bacterial infection of lash follicles
tx: Symptomatic, warm moist compresses to lid margins several x a day; Daily mechanical scrubbing and cleansing of lid margins w dilute baby shampoo, topical antibiotic ointment in lid margins
Treat coexisting seborrhea of scalp
periorbital vs orbital cellulitis
Orbital – inflammation of orbital contents posterior to orbital septum; often decreased visual acuitiy
Peri-orbital – inflammation/infection of skin and subcutaneous tissue surrounding eye; often associated with trauma, septicemia, sinusitis and bacteremia/infection near the eye
-usually normal visual acuity
Ophthalmoplegia= paralysis of eye muscles and proptosis – classic findings distinguish orbital from periorbital cellulitis
common causes / organisims periorbital / orbital cellulitis
Most common causes in children: paranasal sinuses and ethmoiditis
Others: insect stings, bites, impetigo, FB
Most common Organisms: Staph aureus, Strep pneumoniae, H Flu
s/sx cellulitis
Orbital Cellulitis: Insidious onset Orbital pain, headache Decreased Vision Fever Peri-orbital Acute onset unilateral eyelid swelling Warmth, swelling, tenderness of overlying skin Eye itself and vision usually normal
hyphema
Accumulation of blood in anterior chamber
Etiology:
Due to blunt or perforating trauma (fists, balls, sticks) leading to rupture of iris or ciliary body blood vessels
May also occur with bleeding disorders (sickle cell)
Usually lasts 5-6 days; high risk of ocular complications
tx: Refer: Reduce activity for several days; bed rest in supine, with hob elevated, eye patch (No pressure on globe)
cataracts sx
Partial or complete opacity of lens
Physical FindingsStrabismus – may be initial sign
Absent red reflex, black dot surrounding red reflex or white plaque-like opacity.
Signs of other systemic disease or ocular abnormalities
Differential Diagnosis:
Retinoblastoma?
Glaucoma?
