Paediatric ophthalmology Flashcards
what visual milestones should neonates have 1
fixing and following
-eye popping
what visual milestones should a baby have
preferential looking
what visual milestones should a 2 year old have
identify or matching pictures
what visual milestones should a 3 year old have
be able to match on a letter chart
define amblyopia
poor vision in a structurally normal eye
basic pathophys of ambylopia
happens during first 7 years of life
-if image received in brain from one eye is poorer than the other then the brain favours the better eye
-this causes one eye to turn off-> abylopia
causes of ambylopia 3
reduced view thorguh eye
-eg ptosis or cataract
unequal focus
-one eye is more long or short sighted-> anisometropia
misalignment of eyes-> squint
treatment for ambylopia
occulsion patch or atropine over the better eye
-forces the poorer eye to be used to see
-patch is always worn under glasses if prescribed
regarding squints
-what are eye(s) turned inwards called
-what are eye(s) turned outwards called
inward- esotropia or convergent squint
outward- exotropia or divergent squint
how to assess symmetry of eyes
look at the corneal light reflex
check eye movements
-must be assured to be full in both versions
-and separately also
treatment of squints 3
many are cured by glasses to correct existing longsightedness (hypermetropia)
if completely cured-> fully accommodative squint
if partial cure (some squint remains)-> partially accommodative squint
otherwise
-conserative management
-surgery
when is the red reflex checked in a baby
*- note it is red in caucasains and more yellow coloured in other races
at birth
and at 6 week check
causes of loss of red reflex (often becomes white-> Leukocoria) 5
cataract- most common
-operated on in first few weeks of life
retinoblastoma
-rare but potentially fatal tumour of the retina
-can be treated successfully if present early
retinal detachment
toxoplasmosis
uveitis
what eye involvement is seen in neurofibromatosis type 1 (NF1)
-when is it helpful
Lisch nodules
-used if genetic testing has been declined
what eye involvement is seen in Albinism
iris transillumination
-used in diagnosis
-child may benefit from tinted lenses
what eye involvement is seen in Marfans syndrome
dislocated lens
-part of marfans screening
-may require treatment and/or management
what eye involvement is seen in juvenile idiopathic arthritis
anterior uveitis
-screen for JIA if seen
define nasolacrimal duct obstruction (NLDO)
incomplete canalisation of nasolacrimal duct
-v common presentation with anxious parents in new borns
how does nasolacrimal duct obstruction (NLDO) present 1
-managemnt 1
sticky watery eye with no conjuncititis
-most resolve spontaneously by age 1
define conjunctivitis
inflammation of the conjunctiva
define the conjunctiva
think layer of tissue that covers the inside of the eyelids and the sclera of the eye
types of conjunctivitis 3
bacterial
viral
allergic
presenation of conjunctivitis 5
unilateral or bilateral
red eye
blood shot
itchy or gritty sensation
discharge from eye
what symptoms are not caused by conjunctivitis and should prompt a different diagnosis 3
pain
photophobia
reduced visual acuity
(although vision may be blured by discharge should clear when discharge is removed)
how does bacterial conjunctivitis present diffirenetly 4
purulent discharge and inflamed conjunctiva
worse in morning
usually starts one eye and can spread
highly contagious
how does conjunctivitis (viral) present differently 4
usually with clear discharge
often associated w syx of viral infection ie dry cough, sore throat and blocked nose
may find tender preauricular lymph nodes
contagious
how can causes of red eye be split
painless and painful
*generaly the more serious causes are painful and also have reduced visual acuity
causes of painless red eye 3
conjunctivitis
episcleritis
subconjunctival haemorrhage
causes of painful red eye 7
glaucoma
anterior uveitis
scleritis
corneal abraision or ulceration
keratitis
foreign body
traumatic or chemical injury
prinicples of management of conjunctivitis 5
usually resolves without treatment after 1-2 weeks
advise good hygiene to avoid spreading:
-avoid sharing towels
-avoid rubbing eyes
-regularly wash hands
avoid use of contact lenses
clean eyes w cooled boiled water and cotton wool to help clear discharge
treatment for bacterial conjunctivitis 2
antibiotic eye drops can be considered
*-note often get better without treatment
chloramphenicol eye drops
or
fusidic acid eye drops
how is management of conjunctivitis in patients under 1 year old different 1
-why 2
need urgent ophthalmology review
-neonatal conjunctivitis can be associated with gonococcal infection
-can cause loss of sight and more severe complications like pneumonia
cause of allergic conjunctivitis
caused by contact with allergens
presenation of allergic conjunctivitis
swelling of conjunctival sac and eye lid with significant watery discharge and itch
treatment for allergic conjunctivitis 1
-patients with chronic seasonal syx treatment 1
antihistamines (oral or topical) can be used to reduce symptoms (topical- antazoline)
-chronic seaonsal symptoms
-use topical mast-cell stabilisers (nedocromil)
-work by preventing mast cells releasing histamine
require several weeks before showing any benefit
inheritance pattern of retinoblastoma
autosomal dominant
-around 10% of cases are hereditary
basic pathophys of retinoblastoma
loss of function of retinoblastoma tumour suppressor gene on chromosome 13
ffeatures of retinoblastoma 3
loss of red reflex - get white pupil (leukocoria) instead
strabismus
visual problems
managemtn of retinoblastoma
enucleation (remove eye)
if not so advanced:
-external beam radiation therapy
-chemo
-photocoagulation
mangement of congenital cataracts
surgery
mangement of congenital cataracts
surgery
investigations for retinoblastoma and congenital cataracts
complete eye exam by specialist ophthalmologist
