lecture 23-26 paediatric pathology Flashcards
What does neonatal eye examination consist of?
-redness
-size and symmetry of globe, corneas, pupils
-clarity of cornea and lens
-FH (inherited disorders)
- What is the epicanthus?
2.What is the telecanthus?
3.What is hypertelorism?
- vertical fold of skin over inner canthus
- increased distance between inner canthi
- increased inner and outer canthal distances (orbits wider apart)
How can you classify a potsis?
-congenital
-neurogenic (3rd CNP, Horners, Marcus Gunn)
-myogenic (myasthenia, progressive external -opthalmoplegia)
-mechanical (meiobomian bump)
What is the aetiology of congenital ptosis?
what are the features of congenital ptosis?
-dystrophy/dysgenisis of levator palpebrae superioris
-unilateral or bilateral
-absence of skin crease
-lid lag on down gaze
-SR weakness
What are the consequences of ptosis?
vision
can induce astigmatism
amblyopia
AHP
cosmesis
What happens in Marcus Gunn ptosis?
if child moves jaw, eyelid can shoot up
-known as jaw winking
-happens due to abnormal synkinesis between levator and lateral pterygoid muscle (3rd and 5th cn)
What are the features of Horner’s syndrome?
-ptosis (less than 2mm)
-heterochromia
-enophthalmos
-anhidrosis
-lower IOP
What is the management of ptosis?
-refer if pathology found
-correct refractive error and treat amblyopia
-urgent surgery if complete ptosis in baby as high risk of amblyopia
-surgery at 4-5 years old has better results
What eyelid bumps can children get?
-inflammatory (meibomian cyst, hordeolum, molluscum contagiosum)
-stasis
-tumour (benign or malignant)
-hamartoma
-hemangioma
What is a haemangioma?
benign vascular tumour
diffuclt to treat
resolves over 5-7 years
can use propranolol
How can you treat a meibomian cyst in children?
How can you treat a hordeolum?
How can you treat molluscum contagiosum?
-resolve over few weeks to many motnhs
can incsie and curette but this requires general anesthetic
-antibiotics
-best left alone. can be curretted.
What is a coloboma?
-tissue is misplaced during development
What causes epiphora in infancy?
what are the features?
what is the treatment?
-blocked nasolacrimal systems
-epiphora
-stickiness
-no redness
-resolve spontaneously by 12 months
-massage lacrimal sac
-if doesn’t resolve, consider syringe and probe under general anesthetic
When is the onset of ophthalmia neonatorum?
what can cause it
after 4 weeks of birth
Chlamydia trachomatis
– 7-28 days - peak in week 2
– Unilateral & bilateral
– Pseudomembranous (also strep)
- Neisseria gonorrhoea
– 4-7 days
-green pus spurts out when you open eyelid
– Massive bloodstained conjunctivitis – Corneal penetration - blindness - Herpes simplex
– As part of a generalised infection – Bilateral
What are the symptoms of conjunctivitis?
what is the aetiology?
Symptoms
* Bilateral, although one eye commences first
* Conjunctival redness & discharge
* Itchiness - not severe pain
* Vision unaffected
Aetiology
* Infection
– Bacterial or Viral (often involves cornea also) – Allergic (eg vernal)
– Trauma
What are the causes of red eye in infancy?
-infantile glaucoma
-conjunctivitis
-tumour of eyelid
What is phlyctenular conjunctivitis?
-few symptoms
-has staph lid disease
-allergic response
Who is vernal disease more common in?
what are the signs?
what is the treatment?
-boys
-atopic
-cobblestone appearance (papillae)
-looks like bacterial conjunctivitis
-igE and igG in tears
lodoxamide
What are limbal dermoids?
abnormal growths of abnormally located tissue
tissue was destined for skin
What are phthisical eyes (small) at a risk of developing?
Blind phthisical eyes are at risk of developing Band shaped keratopathy
What cellulitis issues can you get?
what is the treatment?
Preseptal cellulitis
– Associated eyelid infection or trauma
– Respiratory infection
- Orbital cellulitis
– Mostly >5 years
– 90% secondary to sinusitis (usually ethmoid)
– Sinus development - Maxillary @ birth; Sphenoid @ 2; Ethmoid & Frontal @ 7
- Subperiosteal abscess
– 10% orbital cellulitis - Treatment
– Admission for urgent systemic antibiotics
– Danger infection can spread back to the brain
What anterior segment developmental anomalies can you get?
-coloboma
-albinism
-anridia
-glaucoma
-anterior seg dysgenesis
What are some of the types of anterior segment dysgenesis disorders?
-posterior embryotoxon
-axenfield-reiger syndrome
-sclerocornea (opaque sclera encroaches onto cornea)
-peters anomaly (corneal opacity with or without adherent iris strands)
What is a coloboma?
failure of fetal fissure to close around 4-5 weeks fetal life
can present with microphthalmos
What is reiger’s anomaly?
what are the signs?
what are these children at risk of?
-defect of neural crest
-facial formation , iris abnormalities
-risk of glaucoma
What is aniridia?
-no iris
-sporadic
-associated with wilm’s tumour kidney
-glaucoma develops in 50%
-ectopia lentis can occur (displacement of lens)
-keratopathy later in life
What are the consequences of anterior segment developmental anomalies?
vision
glaucoma
cataract
strabismus
nystagmus
How can albinism effect eyes?
-neuroectodermal defect
-foveal hypoplasia
-strab
-nystagmus
What can cause a child to be photosensitive?
-albinism
anterior segment disorders:
-corneal problems
-uvieitis, aniridia
-glaucoma
-cataract
retinal conditions:
-achromatopsia (no colour vision)
-retinitis pigmentosa
CNS
-meningitis
-migraine
What can cause glaucoma in children?
what is a sign of congenital glaucoma?
primary: infantile, congenital, juvenile
secondary: anterior segment dysgenesis, aphakia, uveitis, downs syndrome
buphthalmos, breaks in descements membrane
What are the symptoms of infantile primary glaucoma?
what are the signs?
What is the management?
-photophobia
-red eye
-enlarged cornea
-corneal clouding
-surgery, amblyopia therapy, refraction (expected to be large)
What are the associations of cataract?
-intrauterine infections (rubella, toxoplasmosis)
-metabolic (diabetes)
-atopy
-steroids
-downs
-low birthweight
-CNS and hearing
What is the management of cataract?
unilateral: surgery before 9 years old
bilateral: surgery when vision compromised
What are the associations of ectopia lentis?
systemic:
-marfan’s syndrome
ocular:
-unstable refraction
-iridiodenisis (iris wobbles)
-stretched zonules
What are the associations of anterior uveitis?
-juvenile idiopathic arthirtis
-sarcoidosis
-TB
-Behcets disease
What is leukocoria?
what is it associated with?
white pupil
-cataract
-ROP
-coats disease
-trauma
vitreous hemorrhage
-coloboma
What electrophysiology tests are there?
ERG-
EOG- not possible for young children as child has to look left to right repeatedly
VEP-tells you if visual pathway is intact
How can a preterm birth effect the visual pathway?
exposure of immature tissues to light
some areas of retina will be avascular
Where does ROP develop on retina?
at junction of vascualrised and non-vascualrised retina
What are the stages of ROP?
stage 1-white line in retina
stage 2- white line becomes a ridge
stage 3-ridge with extraretinal fibrovascualr proliferation
stage 4+5- partial/total retinal detachement
What is the treatment of severe acute ROP?
-cryotheraphy
-laser
-antiVEFG
What is the ocular outcome of premature birth?
-no, mild or severe ROP
-strab
-higher incidence of refractive error
What can cause a dragged disc?
-ROP
-exudative vitreopathies
-norrie’s disease
-congenital folds
what can shaking babies cause?
subconjunctival/retinal haemorraghes
What does von hippie Linda syndrome cause?
-vascular tumours of retina and CNS
-inherited
-can be bilateral
what is sickle cell retinopathy?
-asymptomatic
-African or Mediterranean origin
-looks like pre retinal haemorraghe and white fuzz, ischaemic retina
What infections can you get that effect the retina?
-toxoplasmosis
-cytomegalovirus
-TB
rubella- lack of pigmentation in retina
-toxocara
what is one of the first signs of pigmentary retinopathy?
arteriolar attenuation
what inherited macular disorders are there?
stargardts
x-linked retinoschisis
bests disease
pattern dystrophy
What is retinoblastoma?
what are the signs?
whats the treatment?
-malignant ocular tumour
-leucocoria
-strabismus
-glaucoma
-chemo
-enucleation
what can cause proptosis?
sinus disease
tumours
TED
What does speed of nystagmus movement tells us about vision?
what causes sensory nystagmus?
the faster the movement, the better the vision
poor vision due to lesions In anterior visual pathway
What can cause asymmetrical nystagmus?
ocualr motor apraxia
monocular blindess
spasmus nutans
what nerve is the most vulnerable to damage?
6th nerve
-enters cavernous sinus at a right angle
what is light-near dissociation?
pupils don’t react to light but react to accommodation
what does macular sparring mean in terms of VF defect?
defect lies in occipital cortex
What can cause a swollen optic disc?
papilloedema
ischaemic optic neuropathy
optic neuritis
pseudopapilloedema
what is morning glory syndrome?
a coloboma
What is optic nerve hypoplasia?
what are the associations?
Early fetal damage to the visual system
- Associated with:
– Young maternal age
– First born
– Fertility & antidepressant drugs – Cocaine et al - rare
– Maternal diabetes - Structural abnormalities
– Absent septum pellucidum - Neuroendocrine associations
– Some children have growth – & other hormonal problems
