Opthalmology

Question 1

Conjunctivitis in the neonate

Answer 1

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

Question 2

Investigations for conjunctivitis?

Answer 2

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

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

Question 3

Conjunctivitis management?

Answer 3

Most self limiting

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

Question 4

Hypermetropia

Answer 4

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

Question 5

Myopia

Answer 5

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

Question 6

Risk factors for retinopathy of prematurity?

Answer 6

• LBW <1500g
• Prematurity <32 weeks

Question 7

Management ROP?

Answer 7

Laser photocoagulation or cryotherapy

Question 8

Prognosis ROP?

Answer 8

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

Question 9

Two types of strabismus?

Answer 9

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

Question 10

When is strabismus normal?

Answer 10

Before 6 months

Question 11

What age is strabismus usually diagnosed?

Answer 11

1-4 years old

Question 12

What is the management of strabismus?

Answer 12

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

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

Question 13

Allergic conjunctivitis presentation

Answer 13

• Bilateral
• Watery, ropy, mucoid discharge
• Itching predominant symptom

Question 14

Watery discharge

Answer 14

Viral conjunctivitis

Question 15

Purulent discharge

Answer 15

Bacterial conjunctivitis

Question 16

Tender, pre-auricular lymphadenopathy

Answer 16

Viral conjunctivitis

Question 17

Spreading from one eye to the other

Answer 17

Viral conjunctivitis

Question 18

Concurrent infections with bacterial conjunctivitis

Answer 18

• Bacterial otitis media
• Sinusitis
• Pharyngitis

Question 19

Spread via camps, swimming pools

Answer 19

Viral

Question 20

Order of investigations for conjunctivitis?

Answer 20

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

Otherwise clinical

Question 21

Viral conjunctivitis resolving

Answer 21

Within 2 weeks

Question 22

Viral conjunctivitis symptom relief

Answer 22

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

AVOID ABx

Question 23

Bacterial conjunctivitis management

Answer 23

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

Question 24

Sx chalmydia conjunctivitis

Answer 24

Purulent discharge + eyelid swelling

Question 25

When is urgent opthalmology assessment required?

Answer 25

Corneal involvement

Question 26

Screening for retinopathy of prematurity?

Answer 26

<32 weeks AND/OR <1.5kg

Question 27

Prevention for retinopathy of prematurity?

Answer 27

Reduced concentration O2 when ventilating

Question 28

Hypermetropia

Answer 28

Convex lenses (+ lens perscription)

Question 29

Myopia

Answer 29

Concave (- lens prescription)

Question 30

What is used to screen for retinopathy of prematurity?

Answer 30

Binocular indirect opthalmoscopy and wide field digital retinal imaging

Question 31

What are the red flags for referring strabismus?

Answer 31

- Limited abduction - Double vision - Headaches - Nystagmus Refer to paediatric or orthotpist with opthalmology

Question 32

Key diagnostic features of strabismus?

Answer 32

- Diplopia - Eye misalignment - Amblyopia (active process of the CNS where visual input of one eye is ignored)

Question 33

Risk factors for strabismus

Answer 33

- Family hx - Prematurity - LBW - Maternal smoking

Question 34

Investigations for strabismus

Answer 34

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

Question 35

Mx Strabismus

Answer 35

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)

Question 36

Periorbital vs orbital cellulitis presentation

Answer 36

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

Question 37

Risk factors peri-orbital and orbital cellulitis

Answer 37

- Male children - Previous sinus infection - Lack of HiB vaccine - Recent eyelid trauma

Question 38

Investigations peri-orbital and orbital cellulitis

Answer 38

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

Question 39

Orbital/ peri-orbital cellulitis management

Answer 39

1. IV empirical antibiotics (Peri-orbital 2-5 days) 2. Targeted abx If there is sub-periosteal abscess (50% OC) incision and drainage