Paediatric ophthalmology

Question 1

What is leukocorya?

Answer 1

Leukocoria is a white pupil reflex, caused by a dense opacity in the ocular media.

Question 2

name two causes of leukocorya?

Answer 2

1. Congenital cataract
2. retinoblastoma

Question 3

What is the management of congenital cataract?

Answer 3

early surgery to prevent amblyopia

Question 4

mutation in which gene causes retinoblastoma?

Answer 4

RB1

Question 5

What is the management of retinoblastoma?

Answer 5

Systemic Chemotherapy in conjunction with ocular treatments (laser, cryotherapy, and radiation). Often the eye is saved, but enucleation is needed in some cases

Question 6

What is amblyopia? What is the principle behind the development of amyopia?

Answer 6

Amblyopia is the irreversible permanent reduction in vision of one or both eyes, sometimes in the absence of apparent ocular disease. Amblyopia develops due to the SUPPRESSION OF vision of the eye in which there is pathology, preventing double vision

Question 7

What are the 3 categories of amblyopia? How are they defined?

Answer 7

1. Strabismic amblyopia = where the squinting eye becomes ambyopic
2. Ametropic amblyopia = where the eye(s) in which there is refractive error become ambyopic. The amount of amblyopia depends on the amount of refractive error, and is more pronounced in hypermetropia
3. Form deprivation amblyopia = where there is ocular disease e.g. Cataract, Retinoblastoma

Question 8

What is the treatment of amblyopia?

Answer 8

After the cause is treated or if there is no identifiable cause, the ‘good eye’ needs to be covered with a patch or atropine drops, this forces the child to use the ‘poor eye’ and prevents it from shutting down

Question 9

Strabismus can be manifest or latent, and can be classified into Paralytic (incomitant) and Non-paralytic (comitant) forms. The eyes may be Convergent (____), Divergent (_______), or Vertical (______)

Answer 9

1. esotropia
2. exotropia
3. hypertropia

Question 10

________ strabismus is more common in adults and can be due to CN palsy, infection, muscle disease, or compression. Adults = diplopia

___-_______strabismus is more common in children; all eye movements are full and equal, and the angle of strabismus is ______. This is due to reduced vision in the affected eye, causing a distorted retinal image that the brain tries to correct by adjusting the eye position. Children= Amblyopia

Answer 10

1. paralytic
2. non-paralytic
3. Constant

Question 11

name some methods used to reduce strabismus in children

Answer 11

Treatment = Prism glasses, Botox or Surgical alignment, and there should always be treatment of any concurrent amblyopia in children prior to treating the strabismus.

Question 12

What is ophthalmia neonatorum?

Answer 12

Ophthalmia neonatorum is any conjunctivitis within the 1st month of life; it requires prompt treatment to prevent sight threatening complications such as corneal ulceration and perforation.

Question 13

Time Likely Organism

Day 0 – 5 _______

Day 3 – 14 __________

Week 1 – 2 ________

Answer 13

1. gonorrhoeae – Gonorrhoea
2. Chlamydia – C. trachomatis
3. Herpes Simplex

Question 14

What is the management of ophthalmia neonatorum?

Answer 14

Treatment = Systemic or Topical ABx, the ABx used should reflect the causative organism – identified through culture of the conjunctiva

Question 15

if nasolacrimal duct obstruction does not improve within one year of birth then what can be attempted?

Answer 15

lacrimal probing which involves passing a metal rod into the nasolacrimal duct to open the valve under GA

Question 16

What causes retinopathy of prematurity?

Answer 16

ROP is caused by abnormal retinal vasculature development; normally the retinal vessels will grow from the Optic Nerve out to the peripheral retina. This process continues after birth, and issues with it are associated with O2 Therapy

Question 17

What is the management and rationale of retinopathy of prematurity?

Answer 17

Treatment = Laser Photocoagulation of the peripheral avascular retina, decreasing O2 demand