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Ophtalmology > Paediatric Ophthalmology > Flashcards

Paediatric Ophthalmology Flashcards

0
Q

Leucocoria

  1. Meaning?
  2. Definition?
  3. How to observe?
A
  1. White pupil
  2. White pupillary reflex
  3. obvious when dilated pupil seen in dim light
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1
Q

5 Common ophthalmic Problems

A
  1. Cataract
  2. Refractive error
  3. Amblyopia
  4. Strabismus
  5. Cloudy Cornea
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2
Q

5 Differential Diagnosis of leucocoria

A

R - Retinoblastoma

C - congenital Cataract

C - Coat’s Disease

P - Persistent Hyperplastic Primary Viterous (PHPV)

P - Retinopathy of Prematurity

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3
Q

Retinoblastoma

6 Presentations

A
  1. Leucocoria
  2. Strabismus
  3. Poor Vision
  4. Orbital Inflammation (redness, pain)
  5. Retinal detachment (exudative)
  6. Proptosis
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4
Q

Congenital Cataract

6 possible causes

A
  1. Idiopatic
  2. Trauma
  3. Ocular (aniridia, PHPV, ROP)
  4. Systemic
  5. Drugs related (steroid,Sulphonamide)
  6. Inherited (AD, AR, X linked)
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5
Q

4 Systemic disease causes congenital cataract

Hint:

Infective
Metabolic
Chromosomal
Other syndromic

A
  1. Infective - TORCHES
  2. Metabolic - Galactosaemia, Hypercalcaemia, Hyper/hypoglycaemia
  3. Chromosome - Down syndrome
  4. Other syndromic - Marfans, Alpert
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6
Q

3 types of congenital cataract

A
  1. Nuclear cataract
  2. Cortical cataract
  3. Lamellar cataract
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7
Q

Secondary causes congenital cataract

Hint:

Ocular
Systemic
Traumatic

A
  1. Ocular - Anterior Subcapsular (Atopic Dermatitis)
  2. Systemic - Oil droplet cataract (Galactossaemia)
  3. Traumatic Cataract (vossius ring)
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8
Q

5 presentations of childhood cataract

A
  1. Lack of visual interest
  2. Strabismus
  3. Nystagmus
  4. Developmental delay
  5. Associated with systemic/ ocular Abnormalities
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9
Q

Action prompt detection and dedicated screening.

Referal and why?

A

Monocular/binocular cataract in infant can result in significant visual deprivation. Early detection can prevent amblylopia

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10
Q

Coat’s disease

Patho?

Findings?

A
  1. Vascular exudation due to leaky telangietatic vessels

2. Finding - exudative RD with cholestrol crystals

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11
Q

Retinopathy of prematurity

Leucocoria occur in what stage?

A

Stage 5 (retinal detachment)

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12
Q

Refractive error

Definition?

A

Physiological condition whereby the refracting system of the eye does not focus object on the retina AND corrective lens has to be place in front of the eye to enable a sharp image to be seen

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13
Q

8 presentation of refractive error?

And 1 complication of untreated refractive error in child?

A

Presentation

  1. Squeezing eyes
  2. Squint
  3. Headache (ocular/frontal/diffuse)
  4. Tearing
  5. Complains of tired eyes
  6. Child slow at school
  7. Attentiveness problem
  8. Strong family hx

Complication -> AMBLYOPIA

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14
Q

Amblyopia

  1. Definition
  2. Causes
A
  1. Unilateral/bilateral decrease of best corrected visual acuity
  2. Caused by vision deprivation and/or abnormal binocular interaction
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15
Q

How amblyopia develop?

A
  1. Brain receives 2 stimuli
  2. Brain will select the better image and suppress the blur or conflicting image
  3. The abnormal eye will detrimental to visual development
16
Q

4 Causes of amblyopia?

A
  1. Ammetropia (bilateral high refractive error)
  2. Anisometropia (large/asymmetrical refractive error difference btwn eyes)
  3. Strabismus (squint) - dislocation of eye alignment
  4. Occulusional/form deprivation (media problem)
17
Q

Definition of Strabismus?

A

Deviation of eyes so that their visual axes are no longer parallel

18
Q

5 causes of squints?

Hint

Muscle
Error
Ocular
Special syndromes
Associated disease
A
  1. Muscle imbalance
  2. Refractive error
  3. Ocular abnormalities - cataract, macular scar, optic disc pathology
  4. Specual syndromes - Duanes, Brown
  5. Associated disease - hydrocephalus, cerebral palsy, meningitis
19
Q

Types of squints, definitions and causes?

A

Concomitant squint

D: angle of squint is the same in all direction of gaze
C: muscle imbalance, refractive error, occular abnormalities

Incomitant squint

D: due to lesion anywhere along neurological pathway and in orbit
C: cranial nerve lesion or orbital musculofacial syndrome (Duanes, Browns)

20
Q

2 Sign and 4 symptoms of strabismus?

A

4 Symptoms

  • none
  • noted by parent
  • poor vision
  • funny eye movement

3 sign

  • poor vision
  • abnormal head posture
21
Q

3 test for strabismus and the findings

A
  1. Torch test
    - corneal reflex is not symmetrical/central
  2. Cover test
  3. Extraocular movements
22
Q

Example of squints?

A
  1. Horizontal squints
    - esotropia (convergent squints)
    - Exotropia (divergent squints)
  2. Vertical
23
Q

6 Causes of cloudy cornea in children

And how to detect?

A
  1. CONGENITAL GLAUCOMA
  2. Mucopolysaccharidoses
  3. Corneal Dystrophy
  4. Birth trauma
  5. Chemical Injury
  6. Keratoconus - hydrops

How to detect

  1. External exam (+10 - 20 direct oph)
  2. Poor vision
  3. Reduce red reflex
24
Q

Congenital glaucoma

A

Rare, male, isolated trabeculodysgenesis

Other features:

Tearing
Buphthalmos (ox eye)
Photophobia
Optic disc cupping

25
Q

Untreated congenital glaucoma results?

A

Increase IOP, that damage optic disc -> glaucomatous cupping -> optic atropy

26
Q

5 other common problems encountered with children

A
  1. Tearing
  2. Discharge
  3. Itchiness
  4. Redness
  5. Swelling
27
Q

Tearing

4 Causes?

A
  1. Nasolacrimal duct obstruction
  2. Congenital glaucoma
  3. Blephritis
  4. Corneal abrasion
28
Q

Nasolacrimial duct obstruction

  1. Patho
  2. Manifestation
  3. Management
A
  1. Caused by late canalisation (usually spontaneous canalisation occur in 90% at 12-18 months) or blocked by debris
  2. Manifestation
    - tearing
    - sticky eye discharge
    - acute dacryocystitis
  3. Management
    - digital massage
    - probing
    - surgery
29
Q

2 Causes of discharge in children?

A
  1. Ophthalmic neonatorum due to niesseria gonorrhea

2. Acute dacryocystitis

30
Q

2 Causes of itchiness in children?

A
  1. Giant papillae in VKC

2. Shield ulcer in VKC

31
Q

5 Causes of eye REDNESS in children?

A
  1. Infection
  2. Diffuse - conjunctival, corneal ulcer/abrasion
  3. Inflammation
    - ciliary - uveitis
  4. Tumour
  5. Trauma
    - focal - foreign bodies
32
Q

4 Causes of EYE SWELLING in children?

A
  1. Chalazion
  2. Preseptal cellulitis
  3. Viral conjunctivitis
  4. Orbital cellulitis
33
Q

Orbital cellulitis

  1. Signs
  2. Management
A
  1. Sign
    - decrease vision
    - RAPD
    - impaired ocular motility
    - chemosis/injection
  2. Management
    - urgent referal and admission of IV antibiotic
    - may need surgical drainage

Ophtalmology (9 decks)

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