OPHTHALMOLOGY Flashcards
A 5-day-old infant with severe bilateral purulent
conjunctivitis and severe conjunctival chemosis.
What is the most likely organism?
Neisseria gonorrhoeae conjunctivitis
A 5-day-old newborn presents with severe bilateral purulent conjunctivitis, severe conjunctival chemosis. What is the best treatment?
IM or IV 3rd generation cephalosporin, topical
erythromycin, ophthalmology consultation
A 10-day-old infant with mild to moderate
purulent discharge also associated with a cough
and congestion. What is the most likely organism?
Chlamydia conjunctivitis
A 14-day-old infant presents with mucoid
discharge from both eyes and eyelid swelling.
What is the best treatment?
Oral erythromycin. Erythromycin ophthalmic
ointment 4 times a day for 1 week
Excessive tearing, photophobia, frequent spasms of the eyelid, corneal clouding and enlargement of the eye
Congenital glaucoma (immediate referral to
pediatric ophthalmology)
A newborn is being evaluated in the office for
leukocoria. The reflexes are absent in both eyes.
What is the next best step?
Immediate referral to ophthalmology—concern
for cataract or retinoblastoma
An 8-week-old male infant with right eye more
watery than the left. There is a golden-colored
crust on his eyelashes, more prevalent in the
morning. No redness
Nasolacrimal duct obstruction (topical antibiotic
if suspected bacterial infection)
What is the best initial treatment of nasolacrimal duct obstruction?
Lacrimal sac massage 2–3 times daily
Most of the cases of nasolacrimal duct obstruction spontaneously resolve at what age?
6 months to 1 year with no need for probing or
surgery
A 2-month-old baby boy presents with alternating deviations in both eyes, no other symptoms
Strabismus—if both eyes are alternating,
monitor till 3 months of age (refer if persists)
A 2-month-old infant presents with left eye
deviated inward with no other symptoms
Strabismus—if only one eye is deviating, refer
to ophthalmology to exclude underlying
pathology
The infant in the previous example continued to
have left eye deviation at 4 months well visit
Referral to a pediatric ophthalmologist
How long can a newborn be monitored for poor
tracking, lack of fixation, head tilt, nystagmus, or
squinting?
If persist beyond 3 months of age must be
referred to a pediatric ophthalmologist
A 9-month-old boy with crossed eyes. O/E:
corneal light reflex is centered in both pupils
equally; cover test shows no ocular deviation
Reassurance (pseudostrabismus)
A 9-month-old boy with crossed eyes. O/E:
corneal light reflex is asymmetric; the cover test
shows ocular deviation
Referral to a pediatric ophthalmologist
Red reflex is asymmetric, absent, dull, or opaque; dark spots in the red reflex; or leukocoria (white reflex). What is the next step?
Referral to ophthalmologist
What is the major consequence of delaying the
treatment of strabismus or cataract in pediatric
patients?
Amblyopia (lazy eye)
A 6-month-old infant presents with nystagmus,
head nodding, and torticollis. The nystagmus is
disconjugate, high frequency, small amplitude,
pendular, and intermittent
Spasmus nutans (often disappears after a few
years)—brain MRI on spasmus nutans patients
to rule out optic nerve glioma that can present
exactly like spasmus nutans
Child presents with swelling in the eyelid,
hyperemia, normal vision, no pain with eye
movement, no decrease in eye movement. What is the most likely diagnosis?
Periorbital cellulitis (may be treated with an oral
antibiotic as an outpatient)
Child with a fever, malaise, proptosis, decreased
vision, pain with eye movement, orbital pain and tenderness, decreased eye movement, dark red discoloration of the eyelids, chemosis, hyperemia of the conjunctiva. What is the most likely diagnosis?
Orbital cellulitis (admit for IV antibiotics and
ophthalmology consultation)
Child is presenting with a painful, warm, swollen, red lump on the eyelid. What is the best treatment?
Warm compresses and massages, topical
antibiotic if the lesion is draining
Child is presenting with a painless nodule on the left upper eyelid for 5 months not responding to conservative measures (warm compresses and lid hygiene). What is the next best step?
Referral to a pediatric ophthalmologist
A 5-year-old boy presents with eye pain, foreign
body sensation, and tearing after self-inflicted eye injury with a sharp pencil. What is the next best step?
Examine the eye with fluorescein stain (corneal
abrasion)
Management of corneal abrasion
Topical antibiotic, an oral analgesic, refer to an
ophthalmologist if no improvement in 24 h
Child is presenting with sudden onset of right eye discomfort and blurring of vision after exposure to flying debris of broken glass. What is the next best step?
Ophthalmology consult to rule out corneal
laceration and intraocular foreign bodies
A 7-year-old is noted to have blood in the anterior chamber of the eye after blunt trauma and pain with extra-ocular movements
Hyphema—emergent ophthalmology consult
Sickle cell screening if African-American
Management of hyphema
Ophthalmology consult, 45° bed elevation, bed
rest, eye shield, analgesia, sedation, topical
cycloplegic, and topical steroids
Child is complaining of significant pain, bruising,
and swelling in the periorbital area after eye
trauma; “sunken” appearance to the eye on the
affected side; decreased sensation to the cheek,
upper lip, and upper gingiva on the affected side; and limitation of upward gaze on the affected side
Orbital floor fractures (due to inferior rectus
muscle entrapment)
Adolescent girl with obesity is complaining of
pounding headache, double vision, nausea, and
vomiting; the headache is worse when she is
leaning forward. Her vital signs are normal, but
she is unable to abduct her right eye. What is the most likely finding in her eye exam?
Papilledema (untreated pseudotumor cerebri can result in permanent vision loss)
Child with pink eye, fever, cloudy rhinorrhea,
cough, headache, pharyngeal redness with scant exudates, a palpable right preauricular lymph node, profuse tearing, and edematous nasal mucosa. The right eye conjunctiva is hyperemic, and tiny follicles are present on the inner lower lid. What is the best treatment?
Reassurance (pharyngoconjunctival fever
commonly caused by adenovirus)
Treatment: cold compresses to the eyes,
analgesics, rest, and fluids
A 7-year-old girl is noted to have a large bloody
blotch under the conjunctiva, no history of trauma; she has a runny nose and congestion
Reassurance (viral subconjunctival hemorrhage
[enterovirus, or adenovirus infection])
A 7-year-old is noted to have a small area of
unilateral eye redness in the sclera. The redness
was noticed after a forceful sneeze
Reassurance (subconjunctival hemorrhage)
Child with watery, itchy eyes bilaterally, mild
eyelid edema, along with conjunctival erythema.
No mucoid or purulent discharge
Allergic conjunctivitis
Child is being treated for allergic conjunctivitis for 2 weeks with oral and topical antihistamine eye drops with no improvement. What is the next best step?
Referral to an ophthalmologist (topical
ophthalmic steroids require monitoring of eye
pressure)
A 3-year-old boy presents with different stage skin bruises; fundus examination shows bilateral multilayered flame shaped retinal hemorrhages. What is the most likely cause?
Child abuse
Night blindness, flashes of light, visual loss. O/E:
optic nerve waxy pallor, mid-peripheral retinal
hyperpigmentation, retinal arteriolar attenuation
Retinitis pigmentosa
Pigmentary retinopathy, polydactyly, truncal
obesity, kidney dysfunction, short stature
Bardet–Biedl syndrome
Syndromes associated with retinitis pigmentosa
and hearing loss
Alport syndrome, Waardenburg syndrome,
Refsum disease, Usher syndrome
A 9-year-old girl with a history of short stature,
vision 20/40, her eye exam is significant for optic nerve atrophy. What is the next best step?
Brain MRI (optic nerve atrophy can be
associated with a brain tumor)
Risk factors commonly associated with retinopathy of prematurity (ROP)
Birth before 30 weeks gestation, or low birth
weight < 1500 g
Do preterm infants at risk of ROP should be
followed by an ROP experienced ophthalmologist after discharge from the NICU
Yes. Within 4–6 months after discharge because
of risk of developing strabismus, amblyopia,
high refractive errors, cataracts, and glaucoma
Who should screen preterm infants at risk for
ROP?
Pediatric ophthalmologist with experience in
ROP
