Ophthalmology

Question 1

What does the CPS statement say about ophthalmia neonatorum?

Answer 1

• do not routinely recommend prophylaxis with erythromycin
• screen all pregnant women for G/C (at first prenatal visit and/or at delivery)
• if exposed to untreated mother: swab and treat immediately

CTX 50 mg/kg (max 125 mg) IM/IV
cefotaxime 100 mg/kg IV/IM once

Question 2

Which infants should be screened for ROP?

Answer 2

• All infants born ≤30+6 wks GA

* All infants with birth weight ≤ 1250 g

Question 3

When should infants have their first ROP exam? When should screening stop?

Answer 3

31 wks CGA or 4 weeks after birth, whichever is longer (ROP takes the longest to develop in more immature infants)

By CGA of 50 wks so long as ROP is improving

Question 4

What treatment is traditionally offered for children with signs of ROP?

Answer 4

• Photocoagulation (laser)

* Intravitreal injection of anti-VEGF

Question 5

What puts infants at greater risk for ROP?

Answer 5

• Hypotension
• Prolonged oxygenation and ventilation
• Slow postnatal growth
• Birth <28 wks GA
• BW of <1000 g

Question 6

What is the differential diagnosis of leucokoria?

Answer 6

• Retinoblastoma
• Cataracts
• Retinal detachment
• Coats disease
• Toxoplasmosis
• Incontinentia pigmenti

Question 7

At what age is eye colour established?

Answer 7

between 6-12 months

typically begins as blue-grey

Question 8

What is the expected visual acuity in a newborn?

Answer 8

20/400

Question 9

What measures should be taken in treating a child presenting with a hyphema?

Answer 9

• Position: elevate head of the bed to 30 degrees
• Prevention of secondary injury: eyeshield, steroids to decrease inflammation, antiemetics
• Cycloplegics to immobilize iris
• avoidance of NSAIDs