Ophthamology: pediatric ocular disorders

Question 1

Two biggest culprits in bacterial neonatal conjuncivits.

Answer 1

1. Neisseria g.

2. Chlamydia t.

Question 2

What is palpebral conjunctiva vs. bulbar conjunctiva?

Answer 2

Palpebral - inner lining of the eyelids and around the eye

Bulbar - layer on top of the sclera and cornea

Question 3

How can you diagnose and treat chlamydial conjunctivitis?

Answer 3

Geimsa stain of conjunctival scrapings that will show basophilic inclusion bodies within cells.

Treat with Erythromycin drops and sulfa drugs (for systemic coverage b/c chlamydia can spread to multiple sites in the body)

Question 4

What is a major concern with Neisseria conjuctivits that is not a big concern with Chlamydial conjunctivitis?

Answer 4

Neisseria secretions can melt the cornea and cause endophthalmitis or other inner eye infections.

Question 5

Describe the two types of orbital cellulitis.

Answer 5

Pre-Septal Cellulitis: infection or inflammation confined to eyelids and periorbital structures anterior to the orbital septum.
(white sclera)

Orbital Cellulitis: active infection or inflammation of the orbital soft tissues posterior to the orbital septum.
(red sclera)

Question 6

What are some clinical findings with orbital cellulitis and which two are more severe findings?

Answer 6

-fever, proptosis, decreased ocular motility, pain with eye movement, chemosis (conjunctival swelling)

Really bad signs:

1. Decreased vision
2. Pupil abnormality

Question 7

What are the two major culprits of orbital cellulitis?

Answer 7

Staph and Strep

Question 8

What is the cause of congenital ptosis and the two most common clinical presentations?

Answer 8

Caused by fibrous tissue replacing muscle in development.

Kids present with amblyopia and upward head tilt.

Question 9

Describe dacryostenosis.

Answer 9

Blockage of the nasolacrimal system leading to an inability to drain tears. Can lead to infection.

Question 10

What is epiphoria?

Answer 10

Excessive tearing, characteristic of dacryostenosis.

Question 11

What is the treatment for dacryostenosis?

Answer 11

Antibiotics to control infection

Creiger Maneuver: massage the nasolacrimal sac

Probe and irrigate the nasolacrimal system

Question 12

Name two conditions associated with most nystagmus pathology but not necessarily associated with congenital nystagmus.

Answer 12

1. Optic nerve hypoplasia

2. Albinism

Question 13

What is one neurologic difference between congenital nystagmus and acquired nystagmus?

Answer 13

Pts. with aquired nystagmus feel like the “world is spinning” but pts. with congenital nystagmus don’t perceive this.

Question 14

What is a treatment for congenital nystagmus.

Answer 14

Pts. will often have a head tilt to improve the nystagmus, so muscle surgical correction of the extra-ocular muscles will fix this.

Question 15

What is the best treatment for retinoblastoma?

Answer 15

Rb is often fatal at the time of diagnosis. To treat: complete removal of the eye and as much of the optic nerve as possible.

Question 16

What is the leading cause of childhood blindness?

Answer 16

Infantile Cataract

-need to remove as soon as it is diagnosed to prevent amblyopia or blindness

Question 17

What is a danger of infantile glaucoma that is not a concern in adults?

Answer 17

In children the sclera is not rigid and can expand with increased IOP. The cornea cannot however, and the expansion of the sclera often tears the cornea.