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Binocular Vision > Paediatric Ocular Pathology- Retina - Alistair > Flashcards

Paediatric Ocular Pathology- Retina - Alistair Flashcards

1
Q

What is the most common cause of visual blindness in children?

A

Cerebral visual impairment

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2
Q

What is the most important electrophysiology test?

A

ERG

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3
Q

What is the minimum age an EOG can be performed on and why?

A

7 years old because requires a lot of patient co operation

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4
Q

What are three ophthalmic tests that can be done to assess the retina?

A
  • OCT
  • Electrophysiology
  • Ultrasound
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5
Q

What test should be the last thing you do at the end of your paeds examination?

A

Ophthalmoscopy

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6
Q

How do you assess the retina and optic nerve in detail? And why do we do this?

A

Using OCT and electrophysiology (ERG, EOG, VEP) because retinal signs and optic nerve disorders can be very subtle but also co-occur

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7
Q

What is used to conduct an ERG?

A

Skin or conjunctival electrode

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8
Q

What are the two frequencies an ERG is done at ?

A

2 & 30 Hz

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9
Q

What is presented with a VEP?

A

A flash or a pattern which tells you the intactness of the visual pathway - limited

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10
Q

What eye condition is normally associated with an absence of septum pellucidum (the middle of the brain that splits the two hemispheres)?

A

Optic nerve hypoplasia

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11
Q

Why are two frequencies used in an ERG?

A

2 Hz are for rods assessment
30 Hz are cone assessment

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12
Q

What do the patients of the two right ERGS have wrong with them and how do you know that ?

A

They have no cones, at 30 Hz there was no response

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13
Q

What classifies whether a baby is premature and how many people get affected by this?

A

Born before 37 weeks, affects 5-8%

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14
Q

Does vision start to develop from the preterm date (that is if the baby is premature) or the due date?

A

Due date

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15
Q

What are some signs of a preterm baby’s retina?

A

Not fully vascularised and thin vessels

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16
Q

What week of gestation do blood vessels come out the optic disc?

A

12-13 weeks

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17
Q

At what point of gestation is the retina fully vascularised?

A

Full term time

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18
Q

With pre term babies, as their retinas are not fully vascularised, where do their retinas get blood supply from?

A

Choroid

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19
Q

What are the two phases of retinopathy of prematurity (ROP)?

A

Acute phase and sequelae

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20
Q

How long does the acute phase last?

A

Only occurs until a few weeks until after birth
*we dont need to know details about what this is

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21
Q

What can severe ROP cause?

A

Blindness but can be prevented with timely screening

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22
Q

Can mild ROP resolve without major sequelae?

A

Yes :) just like anisha and hardeep

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23
Q

Where on the Retina does ROP develop?

A

At the junction between vascularised and non-vascularised retina

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24
Q

How many stages are there of ROP?

A

5

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25
Q

Which stages are classified into mild ROP?

A

Stage 1 and 2

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26
Q

What does stage 1 look like?

A

White line within the retina is formed

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27
Q

What is stage 2?

A

White line becomes a ridge

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28
Q

What is stage 3?

A

Ridge with extra retinal fibrovascular proliferation (similar to DM - has CWS and neovasc of bv coming out of the retina into the vitreous)

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29
Q

What stage is this?

A

3

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30
Q

What changes in regard to the BVs from mild ROP to stage 3 ROP?

A

Bv become thick and tortuous

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31
Q

If ROP is left untreated what might the child get?

A

An RD

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32
Q

What is stage 4 ROP?

A

Partial RD

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33
Q

What is stage 5?

A

Total RD

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34
Q

What is stage 5?

A

Total RD

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35
Q

Why is the risk for blindness greater in India than here?

A

They have a greater prevalence of pre term babies

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36
Q

Why is the screening programme for preterm babies tight?

A

There is a narrow window for treating babies with ROP (you have to catch the baby at exactly the right time)

37
Q

What is treatment for severe acute ROP?

A

Cryotherapy, laser and AntiVEGF

38
Q

What is cryotherapy?

A

Freezing the retina where the tear has occurred

39
Q

What are patients who were born premature likely to have who have had NO or mild ROP?

A

Slightly reduced va and contrast

40
Q

What acuity is a patient who has severe ROP likely to have?

A

Ranges from normal to blind

41
Q

What acuity is a patient who has severe ROP likely to have?

A

Ranges from normal to blind

41
Q

What acuity is a patient who has severe ROP likely to have?

A

Ranges from normal to blind

42
Q

What % of preterm babies will have strabismus?

A

20% (it’s only 3% in full term babies!)

43
Q

If a baby had severe ROP what is the likelihood of having strabismus? (%)

A

> 60%

44
Q

What does prematurity do to the eye?

A

Cornea develops abnormally so they have a mild degree of keratoconous and myopia

45
Q

What is a px who has had severe ROP likely to have?

A

Very high myopia (16-20D)

46
Q

What is this ? + at what stages does it occur?

A

Dragged disc - this is temporal retina is pulling or dragging of the disc and vessels
Stage 3 or after

47
Q

What are causes of a dragged disc?

A
  • ROP
  • Exudative vitreoretinopathies
  • Norrie’s disease
  • Congenital fold
    *all of which are rare diseases
48
Q

What is this? And what is that white stuff?

A

End stage ROP, px likely to be blind, retrofibroplasia is the white stuff

49
Q

In baby what is the ONLY cause if a sub-conjunctival haemorrhage?

A

Trauma

50
Q

If you see a retinal haemorrhage like this, what are you thinking could have happened to the baby?

A

Shaken baby syndrome

51
Q

What is this disease?

A

Coat’s disease

52
Q

What are some features of Coat’s disease?

A
  • M>F
  • Unilateral
  • Retinal telangiectasia (massive exudates and RD)
  • Systemic association

In the lecture just says know these vascular diseases exists, so down worry if you do not know this

53
Q

What is this disease and some features of the disease?

A

Von Hippel Lindau syndrome
Bilateral, both sexes, tumours of the brain and retina

54
Q

What is this disease ?

A

Sickle cell retinopathy

55
Q

What people is sickle cell more prevalent in?

A

African or Mediterranean origin

56
Q

What are some signs of the Retina with sickle cell retinopathy?

A

Peripheral occlusion of BV, neovasc, could regress or cause RD

57
Q

What are five names of infections of the Retina?

A
  • Toxoplasmosis
  • Cytomegalovirus
  • TB
  • Rubella
  • Toxocara
58
Q

What does this px have?

A

Toxoplasmosis

59
Q

What type of infection is toxoplasmosis?

A

Protozoa

60
Q

How can you get toxoplasmosis?

A

Eating raw meat or eating food that has been contaminated by cat faeces

61
Q

What else might someone with toxoplasmosis have?

A

Lesions to the brain, cataract, uveitis

62
Q

What is toxocara?

A

Worm infection from a cat or dog

63
Q

What is similar to toxoplasmosis?

A

Toxocara however, toxocara only occurs in one eye

64
Q

What is this ?

A

Toxocara

65
Q

Is rubella rare in this country?

A

Yes because we have all be vaccinated

66
Q

What problems can someone who has rubella have?

A

Heart defects, deafness, mental retardation, small eyes, pigmented retinopathy

67
Q

What does this px have and describe the fundus?

A

Speckled pigment giving a mottled appearance
(rubella- salt and pepper appearance)

68
Q

What is someone with cmv likely to also have?

A

HIV

69
Q

What does CMV stand for ?

A

Cytomegalovirus

70
Q

What does this px have?

A

CMV

71
Q

What ophthalmic issues is a px with CMV likely to have?

A

Microphthalmos, cataract, keratitis, optic atrophy

72
Q

What are some stationary retinal dystrophies?

A
  • Congenital night-blindness
  • Achromatopsia
73
Q

What does someone with congenital night blindness have a disorder of?

A

Rods (associated with myopia)

74
Q

What are five signs of someone with achromatopsia will have?

A
  • Reduced vision
  • Photosensitivity
  • Nystagmus
  • High hyperopia
  • Absent flicker on an ERG
  • Normal looking retina
75
Q

What is a disease of a child with a progressive rod-cone retinal dystrophy?
(There are three)

A
  • Leber’s congenital amaurosis
  • Retinitis pigmentosa
  • Choroideremia
76
Q

What signs would a child with Leber’s congenital amaurosis have?

A

Reduced vas
Nystagmus
High hyperopia
Normal Retina ( can later become pigmentary)
Flat ERG

77
Q

If a child comes in with high hyperopia, nystagmus, reduced vas and sensitive to light, what two conditions should you be thinking of ?

A

Achromtopsia and Leber’s congenital amaurosis

78
Q

What are four inherited macular dystrophies?

A
  • Stargardt’s disease
  • X-linked retinoschisis
    -Best’s disease
  • Pattern dystrophy
79
Q

As the signs are very subtle, what are the patients often labelled as?

A

Hysterical

80
Q

What does leucocoria mean?

A

White pupil

81
Q

Name some diseases with leucocoria

A
  • Retinoblastoma
  • Cataract
  • ROP
  • Developmental anomalies such as a Coloboma
  • Coat’s disease
82
Q

What is the most common malignant ocular tumour of childhood?

A

Retinoblastoma

83
Q

Is a retinoblastoma likely to be bilateral or unilateral?

A

Unilateral

84
Q

What are three presentations of someone with retinoblastoma?

A

Leucocoria, strab, glaucoma

85
Q

What is treatment of retinoblastoma (it is a tumour remember)?

A

Chemotherapy

86
Q

What does ROP mean?

A

Retinopathy Of Prematurity

87
Q

Which stages are considered severe ROP?

A

Stage 3-5; they require treatment

Binocular Vision (30 decks)

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