Opthalmology Flashcards
Conjunctivitis in the neonate
- <48 hours (discharge and conjunctivitis) Gonococcus
- 1-2 weeks (discharge, conjunctivitis, pneumonia) Chlamydia trachomatis
Investigations for conjunctivitis?
- Bacterial - Swab MC&S
- Viral - Rapid adenovirus immunoassay
Neonate
- Gonoccocal - gram stain, culture
- Chlamydia - immunofluorescent staining
Conjunctivitis management?
Most self limiting
Neonate:
- Gonococcus IV ceftriaxone
- Chlamydia oral erythromycin (2 weeks)
Hypermetropia
Long-sighted
- Refraction beyond the retina
- Common in early childhood as accommodation reflex matures
- Corrected with convex lense
Myopia
Short-sighted
- Rays converge in front of the retina
- Uncommon in childhood, more common in teenagers
- Childhood = pre-term refractive errors
- Concave lense
Risk factors for retinopathy of prematurity?
- LBW <1500g
- Prematurity <32 weeks
Management ROP?
Laser photocoagulation or cryotherapy
Prognosis ROP?
Severe bilateral impairment in 1% (usually <28 weeks)
Two types of strabismus?
- Non-paralytic (refractive error in more than one eye)
- Paralytic (squinting eye could be caused by motor nerve paralysis)
When is strabismus normal?
Before 6 months
What age is strabismus usually diagnosed?
1-4 years old
What is the management of strabismus?
(Before 8y/o, brain connections can be rewired)
- Eyeglasses
- Eye patching
- Eye drops
- Eye muscle surgery
Allergic conjunctivitis presentation
- Bilateral
- Watery, ropy, mucoid discharge
- Itching predominant symptom
Watery discharge
Viral conjunctivitis
Purulent discharge
Bacterial conjunctivitis
Tender, pre-auricular lymphadenopathy
Viral conjunctivitis
Spreading from one eye to the other
Viral conjunctivitis
Concurrent infections with bacterial conjunctivitis
- Bacterial otitis media
- Sinusitis
- Pharyngitis
Spread via camps, swimming pools
Viral
Order of investigations for conjunctivitis?
- Rapid adenovirus immunoassay (10 minutes)
- Can consider MC&S
Otherwise clinical
Viral conjunctivitis resolving
Within 2 weeks
Viral conjunctivitis symptom relief
- Clean with saline/ booled and cooled water
- Cool compress
- Artificial tears/ lubriciating drops
- Can be contagious for 24 hours
AVOID ABx
Bacterial conjunctivitis management
Self limiting 5-7 days
- Topical abx if symptoms not resolved in 3 days
- Staph/ strep chloramphenicol or neomycin
- Gonococcal IV 3rd generation cephalosporin
- Chlamydia oral erythromycin 2 weeks
No school exclusion
Sx chalmydia conjunctivitis
Purulent discharge + eyelid swelling
When is urgent opthalmology assessment required?
Corneal involvement
Screening for retinopathy of prematurity?
<32 weeks AND/OR <1.5kg
Prevention for retinopathy of prematurity?
Reduced concentration O2 when ventilating
Hypermetropia
Convex lenses (+ lens perscription)
Myopia
Concave (- lens prescription)
What is used to screen for retinopathy of prematurity?
Binocular indirect opthalmoscopy and wide field digital retinal imaging
What are the red flags for referring strabismus?
- Limited abduction
- Double vision
- Headaches
- Nystagmus
Refer to paediatric or orthotpist with opthalmology
Key diagnostic features of strabismus?
- Diplopia
- Eye misalignment
- Amblyopia (active process of the CNS where visual input of one eye is ignored)
Risk factors for strabismus
- Family hx
- Prematurity
- LBW
- Maternal smoking
Investigations for strabismus
- Cover test (cover one eye and follow object)
Mx Strabismus
- Correction of refractive error - corrective glasses
- Correction of amblyopia - occlusion of normal eye with patch (no. hrs per day), penalization deliberately blurring vision in normal eye using atropine drops (used when problematic compliance to occlusion)
- Eye exercises
- Extra-ocular surgery
- Botox (causes extraocular paralysis for 3 months)
Periorbital vs orbital cellulitis presentation
Periorbital: Inflammation of the superficial eyelid
Orbital: orbital soft tissue infection (usually due to bacterial sinusitis), severe redness around a swollen eyelid with ptosis, visual disturbance/ rapidly declining vision
Pain for both
Risk factors peri-orbital and orbital cellulitis
- Male children
- Previous sinus infection
- Lack of HiB vaccine
- Recent eyelid trauma
Investigations peri-orbital and orbital cellulitis
- Clinical examination
- WBC (doesn’t differentiate between peri-orbital and orbital)
- CT sinus and orbits with contrast medium urgent (gold standard diagnostic)
Orbital/ peri-orbital cellulitis management
- IV empirical antibiotics (Peri-orbital 2-5 days)
- Targeted abx
If there is sub-periosteal abscess (50% OC) incision and drainage
