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Paediatrics > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Conjunctivitis in the neonate

A
  • <48 hours (discharge and conjunctivitis) Gonococcus
  • 1-2 weeks (discharge, conjunctivitis, pneumonia) Chlamydia trachomatis
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2
Q

Investigations for conjunctivitis?

A
  • Bacterial - Swab MC&S
  • Viral - Rapid adenovirus immunoassay

Neonate
- Gonoccocal - gram stain, culture
- Chlamydia - immunofluorescent staining

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3
Q

Conjunctivitis management?

A

Most self limiting

Neonate:
- Gonococcus IV ceftriaxone
- Chlamydia oral erythromycin (2 weeks)

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4
Q

Hypermetropia

A

Long-sighted
- Refraction beyond the retina
- Common in early childhood as accommodation reflex matures
- Corrected with convex lense

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5
Q

Myopia

A

Short-sighted
- Rays converge in front of the retina
- Uncommon in childhood, more common in teenagers
- Childhood = pre-term refractive errors
- Concave lense

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6
Q

Risk factors for retinopathy of prematurity?

A
  • LBW <1500g
  • Prematurity <32 weeks
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7
Q

Management ROP?

A

Laser photocoagulation or cryotherapy

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8
Q

Prognosis ROP?

A

Severe bilateral impairment in 1% (usually <28 weeks)

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9
Q

Two types of strabismus?

A
  • Non-paralytic (refractive error in more than one eye)
  • Paralytic (squinting eye could be caused by motor nerve paralysis)
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10
Q

When is strabismus normal?

A

Before 6 months

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11
Q

What age is strabismus usually diagnosed?

A

1-4 years old

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12
Q

What is the management of strabismus?

A

(Before 8y/o, brain connections can be rewired)

  1. Eyeglasses
  2. Eye patching
  3. Eye drops
  4. Eye muscle surgery
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13
Q

Allergic conjunctivitis presentation

A
  • Bilateral
  • Watery, ropy, mucoid discharge
  • Itching predominant symptom
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14
Q

Watery discharge

A

Viral conjunctivitis

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15
Q

Purulent discharge

A

Bacterial conjunctivitis

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16
Q

Tender, pre-auricular lymphadenopathy

A

Viral conjunctivitis

17
Q

Spreading from one eye to the other

A

Viral conjunctivitis

18
Q

Concurrent infections with bacterial conjunctivitis

A
  • Bacterial otitis media
  • Sinusitis
  • Pharyngitis
19
Q

Spread via camps, swimming pools

A

Viral

20
Q

Order of investigations for conjunctivitis?

A
  1. Rapid adenovirus immunoassay (10 minutes)
  2. Can consider MC&S

Otherwise clinical

21
Q

Viral conjunctivitis resolving

A

Within 2 weeks

22
Q

Viral conjunctivitis symptom relief

A
  • Clean with saline/ booled and cooled water
  • Cool compress
  • Artificial tears/ lubriciating drops
  • Can be contagious for 24 hours

AVOID ABx

23
Q

Bacterial conjunctivitis management

A

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

24
Q

Sx chalmydia conjunctivitis

A

Purulent discharge + eyelid swelling

25
Q

When is urgent opthalmology assessment required?

A

Corneal involvement

26
Q

Screening for retinopathy of prematurity?

A

<32 weeks AND/OR <1.5kg

27
Q

Prevention for retinopathy of prematurity?

A

Reduced concentration O2 when ventilating

28
Q

Hypermetropia

A

Convex lenses (+ lens perscription)

29
Q

Myopia

A

Concave (- lens prescription)

30
Q

What is used to screen for retinopathy of prematurity?

A

Binocular indirect opthalmoscopy and wide field digital retinal imaging

31
Q

What are the red flags for referring strabismus?

A
  • Limited abduction
  • Double vision
  • Headaches
  • Nystagmus

Refer to paediatric or orthotpist with opthalmology

32
Q

Key diagnostic features of strabismus?

A
  • Diplopia
  • Eye misalignment
  • Amblyopia (active process of the CNS where visual input of one eye is ignored)
33
Q

Risk factors for strabismus

A
  • Family hx
  • Prematurity
  • LBW
  • Maternal smoking
34
Q

Investigations for strabismus

A
  1. Cover test (cover one eye and follow object)
35
Q

Mx Strabismus

A
  1. Correction of refractive error - corrective glasses
  2. 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)
  3. Eye exercises
  4. Extra-ocular surgery
  5. Botox (causes extraocular paralysis for 3 months)
36
Q

Periorbital vs orbital cellulitis presentation

A

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

37
Q

Risk factors peri-orbital and orbital cellulitis

A
  • Male children
  • Previous sinus infection
  • Lack of HiB vaccine
  • Recent eyelid trauma
38
Q

Investigations peri-orbital and orbital cellulitis

A
  1. Clinical examination
  2. WBC (doesn’t differentiate between peri-orbital and orbital)
  3. CT sinus and orbits with contrast medium urgent (gold standard diagnostic)
39
Q

Orbital/ peri-orbital cellulitis management

A
  1. IV empirical antibiotics (Peri-orbital 2-5 days)
  2. Targeted abx

If there is sub-periosteal abscess (50% OC) incision and drainage

Paediatrics (16 decks)

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