Packet Eye Diseases

Question 1

parinaud oculo-glandular syndrome

Answer 1

• cat scratch disease
• unilateral glanulamotous conjunctivitis
• prearicular and submandibular adenopathy
• self limiting
• oral antiviral may be used if more severe

Question 2

VKC

Answer 2

• mast cell lymphocyte mediated response
• males, under 20, usually in spring and fall
• 2 forms: palpebral or bulbar
• giant papillae, may have injection, photophobic, thick ropy milky discharge, extreme itch
• horner trantis dots and shield ulcer possible
• tx: antiallergy topical or steroids

Question 3

Kawasaki disease

Answer 3

• febrile illness affecting primarily kids under 5
• unexplainable fever for more than 5 days and at least 4 of the following: bilateral conjunctival injection, strawberry tongue, rash, cervical lympodenopathy, extremity changes such as redness of palm/soles, edema of hands/feet
• anterior uveitis during acute phase of disease common
• conjunctival scarring and bilateral retinal ischemia is possible
• tx: most sig. complication is coronary artery aneurysm

Question 4

nasolacrimal duct obstruction

Answer 4

• 5% of full term newborns
• thin mucosal membrane at lower end of nasolacrimal duct
• symptoms manifest by 1 month in 80-90% of cases
• severe cases resemble
  tx: digital massage and topical antibiotics over 1-2 weeks, should spontaneously resolve (consider surgery after 6months-year)

Question 5

Ehler Danlos syndrome

Answer 5

• collagen disease leading to hyper-extenable joints, easy bruising, and possible organ rupture
• can lead to keratoconus in dry eye and strabismus

Question 6

heterochromia iridis

Answer 6

-congenital, various causes, check pupils (if miotic pupil is ipsilateral to the hypo pigmented size, must be worked up for Horner’s syndrome)

Question 7

PPM (persistent pupillary membrane)

Answer 7

• most common developmental abnormality of the iris
• present in 95% of newborns, can remain present until adulthood
• if prominent, can adhere to anterior lens capsule and cause cataract

Question 8

Marfan’s syndrome

Answer 8

• abnormalities of cardiovascular, musculoskeletal, and ocular symptoms
• high mortality associated with cardiac condition, 80% have ocular manifestations, 75% have upward dislocation of the lens, intact zonules, small pupil that dilates poorly, possible transillumination defects, likely myopic with high risk of RD

Question 9

anterior uveitis is important because of

Answer 9

juvenille RA which is anterior uveitis that is recurring, normally asymptomatic (hard to see cells and flare)

• normally first sign of JRA
• if untreated, can get synechiae, band keratopathy, cataracts, glaucoma, vitritis, and mac. edema

Question 10

persistent fetal vasculature/ persistent hyperplastic primary vitreous

Answer 10

-usually unilateral and congenital, varies from prominent hyaloid vessel and mittendort dots to micro ophthalmic eyes and angle closure glaucoma

Question 11

retinopathy of prematurity

Answer 11

• abnormal development of retinal vasculature due to prematurity, highest risk at birth weight less than 1500 grams, risk increases as gestational age and birth weight decreases, supplemental oxygen increases the incidence
• stages 1-5

Question 12

Coat’s disease

Answer 12

• presence of abnormal retinal vessels and yellow sub retinal exudates usually in macular area, usually unilateral, thought to be caused by leaking telangetasic vessels, similar appearance to ROP, Leukocoria
• management aimed at stopping leakage, prognosis is poor once macula is involved

Question 13

tilted disc syndrome

Answer 13

• superior pole appears elevated, posterior displacement of nasal portion, could be horizontally tilted resulting in oval appearance of disc
• often accompanied by scleral crescent inferiorly, usually myopic astigmatism, tx: correct refractive error

Question 14

ON hypoplasia

Answer 14

• decreased number of optic nerve axons, unilateral or bilateral, many causes including insult in first trimester or maternal gestational diabetes, can be seen in many syndromes
• pale and small disc, yellow white ring around disc, tortuous vessels common
• visual acuity varies and VF defects common

Question 15

drusen (inner papillary)

Answer 15

• most common cause of pseudopapilladema in children, usually inherited
• elevated disc, does not obscure anterior blood vessels, often has irregular borders, no pallor, exudates, or hemorrhages, can be shiny if not buried
• can have VF defect that grows

Question 16

retinoblastoma

Answer 16

-malignant, moat common malignant ocular tumor, leukocoria, 25% present with strab, vitreous hemorrhaging, glaucoma, proptosis, hypopopian

Question 17

rhabdomyosarcoma

Answer 17

-malignant, most common orbital malignancy, normally 5-7 year old, if earlier, it is even more aggressive
-can be seen in conj, eyelid, or anterior uveal tract
80-100% present with proptosis, globe displacement, ptosis, conj and lid edema, palpebal mass and pain also possible

Question 18

Sterge-Weber

Answer 18

• port wine stain and ipsilateral vascular malformation
• can have neurological defects, not genetically transmitted but it is congenital
• when skin lesion involved the eyelids, glaucoma is likely
• retina may have deep red color, especially in posterior pole

Question 19

congenital glaucoma

Answer 19

• 1:10,000 births. results in blindness in 2-15% of cases
• usually bilateral, onset within the first year
• if it presents later, called primary juvenile glaucoma
• thought to be due to a membrane covering the trabecular meshwork
• classic triad: epiphora, photophobia, blepharospasm, other signs include corneal clouding and megalocornea, IOP ranges from 30-40mmHg
• immediate referral to OMD

Question 20

antibiotic drops that can be used at > 2 months

Answer 20

• polytrim

- tobrex

Question 21

antibiotic drops that can be used at > 4 months

Answer 21

-Moxeza