Paediatric Ophthal

Question 1

Visual milestones

Answer 1

6 weeks - fix and follow light source.
3 months - fix and follow slow target.
6 months - reaches for toys.
2 years - picture matching (kay pictures).
3 years - letter matching (Sheridan-Gardiner chart).
5 years - snellen/Logmar

Question 2

Describe features of Amblyopia

Answer 2

Halting of visual development due to reduced visual input. Leaves kids monocular.
Develops up to age 8 years old and becomes fixed at age 8.

Treatment - Referral to Ophthalmology for glasses/penalising non-amblyopic eye (patche/atropine) or surgery.

Question 3

What are the causes of opthalmia neonatorum?

Answer 3

Usually non infective but want to rule out bacteria.
Most common cause is S.aureus but usually self-limiting/chloramphenicol drops
Gonococcal - Typically present on day 1-3. Presents with copious pus and requires systemic abx (life threatening).
Chlamydia - Typically presents age 4-28 and can cause pneumonitis. Treat with oral erythromycin.
HSV - systemic upset and encephalitis. Give systemic antivirals (life threatening)

Worry if: purulent discharge, red eye (conjunctivitis doesn’t normally cause red eye in neonate), systemic upset!!

Question 4

Describe features of nasolacrimal duct obstruction

Answer 4

There is an imperforate distal valve, most will open by 12 months.
Often presents with bit of sticky eye when have colds, sometimes in between colds.
Medical canthal massage can help chance of opening. If not open by 12 months then can perform surgery.

Question 5

Orbital cellulitis in paeds

Answer 5

Don’t CT scan immediately. Give IV abx for 24 hours then reassess. Look for abscesses.
Low threshold for admitting patients with periorbital cellulits because more of spectrum with orbital

Question 6

What is strabismus

Answer 6

Squint! Rule out CN palsies and refer to ophthlamology

Question 7

Describe features of retinopathy of prematurity

Answer 7

Defined screening programme.
Occurs because blood supply to retina develops in 3rd trimester.
Treatment often not required but can give intravitreal anti-VEGF

Question 8

What is leukocoria?

Answer 8

Babies screened at birth and 6 weeks.
Leukocoria - white pupil. Must refer all cases urgently!
Most are not pathological however can be caused by congenital cataracts and retinoblastoma

Question 9

Non accidental images in ophthal?

Answer 9

Retinal haemorrhages

Question 10

How can you screen for paediatric squints?

Answer 10

Corneal light reflection test