Lecture 5 - Paediatrics Flashcards
What is normal in infants?
- Vision poor at birth
- Rapid development in first 6 months of life
- No binocular vision evident at birth
- Present between 3 – 5 months
- Asymmetry of Optokinetic Nystagmus (OKN) until 3 months
- Better for patterns moved from temporal to nasal
- Poor or absent for patterns moved from nasal to temporal
- Asymmetry persists in amblyopia
testing: 0 – 5 years of age
Main goals
1. Detection & management of strabismus and amblyopia
2. Detection & correction of moderate/high refractive error
Main priorities for examination
- Vision and VA
– Measurement and management - Binocular status
- Accommodation
- Ocular health
Risk Factors for baby
- Prematurity
- Family History
– Refractive error
– Strabismus - Birth
– Forceps delivery
– Hypoxia
Prematurity
– Refractive error especially myopia (anterior
segment)
– Cerebral Palsy
– Cerebral Visual Impairment
– Retinopathy Of Prematurity (ROP)
What 5 questions can be asked during history for visually guided behavior?
- Is your child aware of himself in a mirror? If so, at what distance?
- Is your child aware of a spoonful of food approaching?
- Does your child return a silent smile?
- Does your child reach for a bottle/drink?
- Does your child follow your movements around the room (when you have given him no sound clues)?
What are the age norms for cardiff cards? (Months)
- 12 – 18: Binoc 6/48 – 6/12, Monoc 6/48 – 6/15
- 18 - 24: Binoc 6/24 – 6/7.5, Monoc 6/30 – 6/7.5
- 24 - 30: Binoc 6/15 – 6/7.5, Monoc 6/19 – 6/7.5
- 30 - 36: Binoc 6/12 – 6/6, Monoc 6/12 – 6/6
When should Cycloplegic refraction be done?
– All cases where accommodative squint is suspected
– Latent hypermetropia
– Pseudomyopia
– More plus on ret than subjective
– H + S indicates accommodative problems
– Unable to achieve a satisfactory ret using Mohindra
What drug is used for cycloplegic refraction?
- Cyclopentolate 0.5% or 1.0%
– Adequate cycloplegia in 30-60 min
– Duration of cycloplegia ≈ 12 hours
– Duration of mydriasis ≈ 24-48 hours
No BV evident at birth:
- Intermittent squints common in newborns
- Squints after 3-4 months should be referred
- Urgent referral required if
change in VA and retinoblastoma suspected
Cover Test
- Use toys or stickers on a stick
- Unlikely to be successful with distance cover test in
infants
- Unlikely to be successful with distance cover test in
- May use thumb in very small children
Hirschberg Test
- Reflex at pupil margin (as here) ≈15o (30 Δ)
- Reflex at centre of iris ≈ 30o (60 Δ)
- Reflex at limbus ≈ 45o (90 Δ)
Motility
Use interesting target
May need to attract
attention and wait for
response
May need to ask
parent/carer to gently hold
head still
Stereopsis
Best tests for infants don’t
require filters
* Lang - random dots
* Frisby - real depth
Field Assessment
- Modified confrontation
- Gross test only
- often binocular
- Interesting target
