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3F: Peds Final > ON Abnormalities In Children > Flashcards

ON Abnormalities In Children Flashcards

1
Q

Hypertropia

A

Describes an ocular misalignment where one eye is deviated above the fixating eye

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2
Q

Hypotropa

A

Ocualr misalignment where one eye is evicted below the fixating eye

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3
Q

Most common cause of vertical diplopia

A

CN IV palsy and thyroid related eye disease

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4
Q

Eye deviations may be

A

Paralytic (CN palsy) or non paralytic (childhood strab, decompensated phoria, mechanical restriction)

Remember to check comitancy and forced duction to differentiate paralytic strab vs other form

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5
Q

Dominant optic atrophy (Kjer)

A
  • bilateral central vision loss
  • begins before 10 years
  • VA between 20/40 and 20/100, could be worse as 20/200
  • VF shows central or cecocentral scotoma with normal peripheral field
  • focal wedge shaped temporal pallor seen OU
  • AD
  • blue yellow (tritanopia) deficnicy
  • imaging should be done
  • one treatment because there is stability and very little progression
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6
Q

LHON

A
  • mitochondrial disease-maternally inherited
  • typically boys and men aged 10-30 years
  • M»»F
  • acute painless bialteral loss of central or cecocentral field (seen onVF)
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7
Q

Classic presentation of LHON

A

Hyperemia and ONH elevation (no leakage on NaFL

  • peripapillary telangiectasia
  • tortuosity of medium retinal arteries
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8
Q

Lever hereditary optic neuropathy is an _________

A

ATROPHY

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9
Q

Findings of LHON

A

ONH findings before vision loss or appear completely normal

Imaging if there is a negative family Hx

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10
Q

Differentials for LHON

A

Optic neuritis
Compressive optic neuropathy
Infiltration optic neriopathy

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11
Q

Treatment for LHON

A

No prove treatemnt

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12
Q

Color deficiency and LHON

A

Acquire RG color deficiency

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13
Q

Things to make LHON worse

A

Tobacco use and excessive alcohol can further stress mitochondrial function, thereby contribute to vision loss

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14
Q

Optic neuritis

A
  • any optic nerve inflammation, affecting any part of the nerve
  • seen in kids after system infection. Like viral infections, can also be assocaited with immunizations or bee stings
  • mor elikely bilateral with edema (not unilateral in adutls)
  • severe vision loss
  • may have systemic symptoms-HA, nausea, vomiting, lethargy and malaise
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15
Q

Treatment for optic neuritis

A

Treatment in kids not studies, but IV steroids can be used

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16
Q

Neuroretinitis and optic neuritis

A

Neuroretinitis when there is a stellate pattern exudates in the macula
-due to toxocariasis, TB, syphilis, Lyme, sarcoidosis, viruses

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17
Q

Ppilledema

A
  • disc edema from elevated ICP
  • bialteral
  • VA, color vision and pupils could initally look normal
  • edema in kids could be due to any of the following: intracranial mass, meningitis, IIHTN, hydrocephalus
  • patons lines
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18
Q

Testing for papilledema

A

Neuroimaging and lumbar are needed

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19
Q

Symptoms of papilledema

A
  • Nausea, vomitting, HA
  • older chidlren may have transient visual obscurations
  • 6th nerve palsy could occur causing ET and diplopia. Usually resolves when pressure is reduced
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20
Q

Pseudotumor cerebri (idiopathic intracranial hypertension)

A
  • increases intracranial pressure with normal sized ventricles on imaging
  • seen in teen girls
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21
Q

Pseudotumor cerebri could be asscated with

A 
Viral infection
Tetras
Steroids 
Vitamin A
Down syndrome 
Thyroid medications 
Growth hormones 
Lithium 
BC
Obesity
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22
Q

Signs and symptoms of papilledema

A
  • HAs, vision loss, diplopia, transient visual obscurations
  • papilledema can be seen on an asymptomatic child
  • VF is able on a child (difficult to interpret)
  • 6th nerve palsy could occur
  • HA could get worse
  • HAs can worsen
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23
Q

Treatment for pseudotumor cerebri

A

Treat by stopping the cause

  • acetazolamide (diamond) or topiramate (topamax)
  • surgical treatment options include optic sheath fenestration or shifting (in the case of good VA, but severe HAs). Both surgical option are to prevent vision loss
24
Q

Prognosis of pseudotumor cerebri

A

Excellent due to spontaneous resolution after treatment (about 12 months)

25
Q

Vision loss and papilledema

A

Can occur if chronic

26
Q

Pseudopapilledema

A
  • resembles papilledema e.g. drusen, hyperopia, prominent glial tissue
  • there is NO DISC HYPEREMIA
  • NO RETINAL HEMORRHAGES
  • NO EXUDATES
  • there are NO SYSTEMIC FINDINGS assocaited with elevated ICP
  • can be seen in Down syndrome and RP
27
Q

ONH drusen

A
  • most common cause of pseudopapilledema in kids
  • frequently AD (look at parents)
  • elevated disc has irregualr borders and does not obscure retinal arterioles
  • no exudates or Hemes
  • if not completely buried, appears as translucent shiny refractile bodies
28
Q

Signs and symptoms of ONH drusen

A
  • VF defect (inferior nasal common, accurate or central defects occur) can slowly progress
  • VA IS STABLE AND UNAFFECTED
  • B scan to detect the bright calcific reflections
  • no systemic problems associated in these children
29
Q

Medication considerations in kids

A
  • Age of kid/weight
  • Metabolism
  • Blood brain barrier: not fully developed/thinner. Higher absorption into CNS, mroe concentrated, stays in bloodstream longer
  • Punctal occlusion to decrease systemic absorption
  • getting the drops in the yees: lids, lashes ar barriers
  • crying will dilute
  • beard not to hurt agitated kids
  • drains into the lacrimal duct
  • major site of drug metabolism: liver
  • major site for excretion: kidney (drug can stay longer)
  • both metabolism and exertion are at different rates than adult
30
Q

Aversion to drops in kids

A

Use ointment

31
Q

What should you always do before putting drops in

A

Always verify the medication, allergies and the expiration date before administration

32
Q

Bacitracin

A

Gram +

  • staph bleph
  • not 1st choice for conjunctiva
33
Q

Aminoglycosides

A

Broad spectrum
Significant hypersensitivity
Neomycin does not cover pseudomonas
Neo>genta>tobramycin
-tobramycin has less sensitivity with it
-FQs are the go to for broad coverage now

34
Q

Plymyxin B

A
  • gram negative

- usually coupled with gram positive

35
Q

Polysporin ung (polymyxin B and Bacitracin

A
  • go to for peds

- nighttime coverage

36
Q

News-Orin

A

Not common used because of the neomycin hypersensitivity

37
Q

FQs

A

Besivance
-suspension

Ciloxan

Vifamox/moxeza (Moxifloxacin)
-PF free, not for kids under 4months

Ocuflox
Zymaxid

38
Q

Drugs that can be used for pediatric under one year

A

Moxeza
Tobramycin
Poly trim
Erythromycin

39
Q

Erythromycin

A
  • gentle for peds
  • NLDO
  • ineffective against pseudomonas
  • some blurred vision
  • ung only
40
Q

NLDO

A

Topical Abx-for significant discharge (not to cure the obstruction)

  • any broad spectrum Abx can be used
  • dosing for a number of days for an acute infection and then as needed
  • polysporin ung, tobramycin ung or erythromycin BID ung
41
Q

Bacterial conjunctivitis

A
  • copious discharge
  • culture for the agent not necessary in mild cases, but in severe cases
  • topical agents such as a polymyxin combinations, erythromycin, bacitracin, and FQs are effective
42
Q

Medications not on the list for kids

A

Sulfacetamide
-SJS syndrome
Chloramphenicol
-can cause aplastic anemia and lead to death

43
Q

Gentamicin and kids

A

Don’t RX, too much hypersensitivity

44
Q

Acute preseptal hordeolum Tx

A

Oral antibiotics

  • cephalosporin (gram positive)
  • Keflex BID x 7 days (or augmentin, consider doxy, erythromycin, or a FQ if patient has PCN allergies)
  • warm compresses
  • can add tobradex (tobramycin and dexamethasone) BID
45
Q

Allergy meds

A
  • topical meds are mast cell stabilizers (alomide, alamast, crolom) may not work for immediate itch relief
  • mast cell stabilizers and H1 blocker combo (pasta day, bepreve, zaditor)
  • vasoconstriction (opcon A, similar to visine)
  • NSAIDs (Acular)
  • remove allergens
46
Q

Mast cell stabilizers and H1 blocker combo that can be used in 2 year olds

A

Bepreve
Lastacraft
Pazeo
Alomide

47
Q

Steroids in kids with allergies

A

FML, lotemax or Alex, pred)
Dosing
-should be based on the severity of the signs and symptoms
-Q2hrs, QID x 1 week, then taper to BID x 1 week
-can switch to antihistamine.mast cell stabilizers combo when stable
-severe cases get topical steroids
-the initial dose has to be frequent enough to quick reflief and remission
-follow up is very important

48
Q

Durezol

A
  • stronger
  • less dosing
  • proper follow ups
49
Q

Pred forte

A
  • tell patien to shake it well

- more dosing than durezol

50
Q

Lotemax

A
  • more chronic inflamamtory conditions

- less side effects

51
Q

Alrex

A

Allergies

Good for horners trantas dots

52
Q

Steroids are contraindicated in

A

Epithelial herpetic disease

-you can use it stromal

53
Q

Antivirals

A

HSV keratitis

  • Zirgan better than viroptic for kids
  • zirgan less dosing, ointment form, decrease toxicity

Skin disease

  • oral antivirals
  • 7-10 days
  • acycloviris a good choice in kids
54
Q

Acquired brain injury

A
  • sudden neurological damage due to TBI and/or stroke
  • TBI sudden neurological damage due to shearing forces within the brain that lead to injury and death of axons
  • CVAs can cause neurological damage due to ischemia
  • teenage boys and young chidlren are at greatest risk
55
Q

Symptoms of ABI

A

Diplopia, photophobia, asthenopia, blurred vision, skipping words, HA, etc

56
Q

Clinical findgins or ABI

A
  • CI-40%-most common BV dysfunction
  • oculomotor dysfunction (40-85%)
  • accommodative dysfunction (10-41%)-test both amplitude and faciltiy
  • CN 5 palsy-most common non-comitant deviation after trauam
  • cyclovertical heterphoria-double Maddox rod should be used to quantify
  • visual perception deficits-visual spatial and motor reduces visual perception
  • bilateral visual field loss (14%)-homonymous hemianopsia is the most common VF defect

3F: Peds Final (11 decks)

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