ophtha and ent Flashcards
Which vitamin can lower chances of cleft lip
Folate (Vitamin B9)
A neonate presents with respiratory distress with inability to pass NG through the anterior nasal vestibule
CT scan: bony narrowing of the anterior most aspect of the nasal airway
What’s the diagnosis?
Pyriform Apeture Stenosis
* Associated with single central megaincisor
* Dx: nasopharyngoscopy and CT scan
* Tx: widening of bone via sublabial approach, may need nasal stent after to prevent impact of edema
- Presents with nose smaller than average internal diameter
- Normal neonatal rhinits and mucosal edema causes airway obstruction
What’s the diagnosis?
Midvault stenosis
* Tx: nasal decongesant, steroid drops
* After several weeks- airway will grow
- It is the most common anatomic cause of nasal obstruction
- Results from incomplete rupture of buccopharyngeal membrane or abnormal palatal dev’t
- Pe: resp distress when quiet or feeding, resolves on crying, unable to pass NG
What’s the diagnosis?
Choanal atresia
* Dx: CT scan (aspirate secretions prior to procedure for optimal visualization)
* Associated with CHARGE- needs to be eval
* Tx: endoscopic visualization and removal of tissue vs removal of bony plate
- avoid damage to skull base
- Baby presents with respiratory distress and feeding difficulty
- PE: grey mass under the head of the inferior turbinate
What’s the diagnosis?
Nasolacrimal duct cyst
* Tx: endoscopic marsupialization
Congenital nasal mass that may have a connection to the CNS
What’s the differential diagnosis?
Dermoid cyst- most common nasal masses
*Buzz word: external pit on the nasal dorsum with pus
*may be connected to the CNS via fonticulus frontalis
Glioma- neural element, continue to grow after birth
Encephalocele
* Buzz: cyst that increases in size with crying or compression of the jugular veins (Fursternberg’s sign)
Dx: MRI
Tx: Consult ENT- resection if no connection with CNS otherwise ENT and neuro surg to include close of skull base
It is a mesenchymal tumor of the alveolar ridge (hard palate)
Epulis
Tx: excision
Its is mucocele of the sublignual or submandibular glands (floor of the mouth musculature)
Ranula
* Can cause anterior cervical compression
* Can cause airway obstruction
* STAT mgt: needle aspiration
* Definite mgt: surgical resection
Relationship of ROP and gestational age
Inverse
- 22-24 wks 90%
What is the relationship of severe ROP and long term neuro developmental outcome
Severe ROP is a predictor of functional disability (lower longitudinal IQ)
also includes: strabismus, myopia
Risk with laser therapy for ROP
- loss of peripheral vision
- myopia
- cataract
- pthisis bulbi (shruken nonfunctional eye)
What is timing of retinal vasculogenesis and angiogenesis
vasculogenesis- de novo synthesis of bld vessels
angiogenesis- formation of bld vessels from preexisting
- Vasculogenesis- 12-22 wks
- angiogenesis- 17- (36-40) wks GA
What is needed for retinal vasculogenesis
VEGF
Retinal vessels grow following hypoxia (inc VEGF) due to inc O2 demand by retinal vessels
What is pathogenesis of ROP
Phase 1- O2 sats 85-89% (most important)- until 31 wks
Phase 2 O2 sats 85-92% until 34 wks, > 94% at >34 wks
- Fluctuating O2 sat have increased risk for severe ROP
What increase phase I ROP (reduced physiologic retinal vascular dev’t)
Retinal hyperoxia
preterm birth leads to inc O2 tension
Leads of dec retinal VEGF, EPO, dec amt growth factors (IGF-1 and Omega 3 FA)
What factors increases risk for phase 2 ROP
- elevated VEGF
- increased levels of retinal EPO
Until when is
a. exotropia
b. esotropia
c. strabismus or abnormal eye movement
considered normal
a. 4 months
b. 2 months
c. 3 months
Conditions associated with eyelid coloboma
a. Goldenhar syndrome- upper eyelid
b. Treacher Collins- lower lid
Need close monitoring - can lead to corneal scarring and vision loss
Newborn presents with persistent tearing and intermittent mucoid discharge
Whats the dx?
Nasolacrimal duct obstruction
Mgt: observation and lacrimal sac massage
resolves spontaneously by 12 mos
Differential: congenital glaucoma, infection, corneal injury
Differential for conjunctivitis
classification of ROP: What are the Zone
- zone I optic disk initially
- zone II- complete on the nasal
- zone III reach the ora serrata as they complete crossing on the temporal side
Newborn presents with photophobia, tearing, blepharospasm
What’s the dx?
involuntary tight closure of the eyelids.
Congenital glaucoma
Complication: optic nerve damage, bupthalmos
Mgt: urgent ophtha referral (surgical intervention, lower intraoccular pressure)
Classification of ROP
What are the stages
- Stage 1: a distinct line (usually white or yellowish) demarcating the vascularized to avascular retina
- Stage 2: line develops thickness in height and width, it is called a ridge
- Stage 3: When vessels break through the retina into the vitreous space, they become extraretinal neovascularization
- Stage 4- retina begins to detach
- Stage 5- detachment becomes complete
Classification of ROP
Definition of plus disease, pre-plus disease, aggressive posterior ROP
- Plus: severe form of ROP followed by rapid progression to retinal detachment. Characterized- dilation and tortuosity of the retinal arterioles and venule
- Pre-plus: dilation and tortuosity of the retinal arterioles and venule that are insufficent plus disease
- Aggressive posterior ROP: more serious variant; subtle retinal finding, posterior location, rapid progression
Classification of ROP
Definition of threshold, prethreshold, Type I ROP
- Threshold: 5 contiguous clock hours or eight total clock hrs of stage 3 and plus disease in zone I or II
- Prethreshold: ROP less than threhold in zone I; S2 plus in zone II, S3 with plus in ZII but fewer clock hr
- Type I ROP
* Any stage ROP with plus disease in zone I
* Stage 3 ROP without plus disease in zone I
* Stage 2 or 3 ROP with plus disease in zone II
When to treat ROP
- Type I ROP
* Any stage ROP with plus disease in zone I
* Stage 3 ROP without plus disease in zone I
* Stage 2 or 3 ROP with plus disease in zone II
When is pupillary light response
31 weeks
When does optic myelination conclude
2 years
Treatment goals for retinoblastoma
- Overall survival remains the top priority over globe salvage
- Requires multidisciplinary team
- Treatment: enucleation, chemotherapy is globe saving therapy and also target metz
- Best treatment approach: consider individual disease characteristics, family’s needs from an economic and psychological standpoint
A baby was born via forceps assisted delivery. On exam, there was unilateral corneal clouding with vertical tears in Descemet membrane (posterior corneal layer).
a. What is the cause
b. Management
- A. Trauma
- B. 1. Reassure parents 2. Followed by ophtha
Resolves in a few months
can cause ambylopia & astigmatism- ophtha ref
Factoids on retinoblastoma
- Majority (60%) are nonheritable
- Involves the RB1 gene
- All Bilateral or unilateral but multifocal RB are heritable
- Heritable presents: younger, assoc nonmetastatic pineal tumors, nonoccular tumors, higher chance to pass to future generation (45%)
Screen for retinoblastoma
- screening at-risk patients from birth until 7 years of age.
- After 7 years, if there is no clinical evidence of Rb and does not have RB1 mutation, no further ophthalmologic follow-up is needed.
- If there is an existing RB1 mutation, ophthalmologic screening should be done every year and indefinitely.
