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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
Congenital glaucoma
Rare, male, isolated trabeculodysgenesis Other features: Tearing Buphthalmos (ox eye) Photophobia Optic disc cupping
25
Untreated congenital glaucoma results?
Increase IOP, that damage optic disc -> glaucomatous cupping -> optic atropy
26
5 other common problems encountered with children
1. Tearing 2. Discharge 3. Itchiness 4. Redness 5. Swelling
27
Tearing 4 Causes?
1. Nasolacrimal duct obstruction 2. Congenital glaucoma 3. Blephritis 4. Corneal abrasion
28
Nasolacrimial duct obstruction 1. Patho 2. Manifestation 3. Management
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
2 Causes of discharge in children?
1. Ophthalmic neonatorum due to niesseria gonorrhea | 2. Acute dacryocystitis
30
2 Causes of itchiness in children?
1. Giant papillae in VKC | 2. Shield ulcer in VKC
31
5 Causes of eye REDNESS in children?
1. Infection 2. Diffuse - conjunctival, corneal ulcer/abrasion 3. Inflammation - ciliary - uveitis 4. Tumour 5. Trauma - focal - foreign bodies
32
4 Causes of EYE SWELLING in children?
1. Chalazion 2. Preseptal cellulitis 3. Viral conjunctivitis 4. Orbital cellulitis
33
Orbital cellulitis 1. Signs 2. Management
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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