Ophthalmology Flashcards
Tx of anterior uveitis?
Atropine + phenylephrine
Consequences of ROP?
Retinal detachment
Retinal vascular angiogenesis
Hallmark of congenital glaucoma?
Watering eye with photophobia
Cornea becomes hydrated and oedematous w/the elevation of intraocular presssure. It will also be cloudy
Mgmt of childhood squint?
1st line is conservative: patch the good eye and correction of refractive error
Surgical correction if conservative mgmt fails
Note: often runs in families
What is Duane syndrome?
A rare type of congenital strabismus (failure of abduction)
Characteristic feature is the eyeball with retract into the socket on adduction
Characteristic features of Moebius’ syndrome?
Facial paralysis and inability to move eyes form side to side. This is as cranial nerves VI and VII are under developed
Other features: clubbed feet, missing digits and chest wall abnormalities
How does brown syndrome present clinically?
Inability to look up particularly on adduction
Note: congenital or post infectious; defect in the superior oblique tendon sheath
In acute infective conjunctivitis most children will get better without antibiotic therapy in how many days?
7-14 days
Mgmt of orbital cellulitis?
CT of sinuses + orbit (if intracranial abscess suspected)
Broad spectrum IV abx +/- surgery (if evidence of orbital infection)
Ref to ophtho + ENT
Features of orbital cellulitis?
Fever, headache and systemic malaise
Proptosis
Pain + blurred vision (painful ophthalmoplegia)
Evidence of optic neuropathy (optic disc edema)
With relation to squints what if the difference between a phoria and a tropia?
Tropia is present at rest (AKA manifest)
Phoria is not present at rest (AKA latent)
Note: exo = lateral/external deviation
eso = medial/internal deviation
Newborn with altered red reflex, main differential diagnosis?
Congenital cataract
Note: retinoblastoma more commonly presents later, median of 2 year and before 5 yrs
What infants require screening for retinopathy of prematurity?
Born before 32 weeks gestation
Birth weight less than 1501g
When should infants get screening for retinopathy of prematurity?
If born before 27 weeks : 30 - 31 weeks corrected for screen
If born 27 1/7 - 32 weeks: 4-5 weeks post natal age
At what age should a child with a squint be referred to ophthalmology?
8 weeks
Most squints are divergent or convergent?
Convergent (when one eye turns in)
They are also usually concomitant (non-paralytic)
Head tilt to right, trouble walking down stairs and vertical diplopia in left eye. What pathology?
Left trochlear nerve palsy (4th CN)
Controls superior oblique only
Alagille syndrome is associated with what eye abnormality?
Posterior embryotoxon - thin grey white arcuate ridge on the inner surface of the cornea, adjacent to the limbus. Can be seen on slit lamp exam
Features of optic glioma on physical exam?
RAPD on the side of the lesion - due to slowing of signal conduction through the optic nerve
Visual loss
Optic disc will be swollen early but it is usually atrophied by the time of diagnosis
Both a corneal abrasion and ulcer will light up under fluorescein T/F
T
Note: w/o fluorescein abrasion will be transparent and ulcer will be opaque
Management of corneal abrasion is topical anaesthetic and antibiotics ointment several times a day T/F
F - can apply topical anaesthetic in office for examination but do not send home with it as it can be toxic.
Note: cycloplegia drops are also no longer recommended as they have not been shown to be beneficial
Common locations of a branchial cleft cyst?
Most often: lower 1/2 anterior margin of the sternocleidomastoid muscle
Less commonly pre auricular or angle of mandibular
Any child < 12 with nasal polyps needs to be evaluated for CF T/F
T - even in the absence of other features concerning for CF
What is the initial management for bilateral choanal atresia?
Place an oral airway
What is the most common kind of strabismus?
Esotropia (eye deviated inwards)
Potential complication and treatment of hyphema?
Complication- glaucoma (it is caused by RBCs clogging the trabecular meshwork and causing increased intraocular pressure)
Tx: topical steroids and cycloplegic drops. Also ondansetron and analgesia to alleviate emesis/pain which can further increase intraoccular pressure
Non painful, nodular mass of eyelid chalazion or hordeolum?
Chalazion - this is a chronic granulomatous inflammatory lesion of meibomian gland. Usually not tx indicated
Note: hordeolum is purulent painful mass. May need antibiotics to treat
