Paediatric opthalmology

Question 1

what is squint? (strabismus)

Answer 1

misalignment of visual axes.

divide into:
concomitant (common) and paralytic (rare).

Question 2

why should you correct squint?

Answer 2

could lead to amblyopia - brain fails to fully process inputs from 1 eye and over time favours the other.

Question 3

explain concomitant squint

Answer 3

due to imbalance in extraocular muscles

convergent more common than divergent

Question 4

explain paralytic squint

Answer 4

due to paralysis of extraocular muscles

Question 5

how to detect a squint?

Answer 5

corneal light reflection test : hold a light source 30cm from child’s face - see if light reflects symmetrically on pupils.

Question 6

what test is used to identify nature of squint?

Answer 6

ask child to focus on object

cover 1 eye

observe movement of uncovered eye

cover other eye and repeat

Question 7

how would you manage squint ? strabismus

Answer 7

refer to secondary care

eye patches may help prevent amblyopia.

Question 8

what is periorbital cellulitis? (preseptal)

Answer 8

infection of soft tissue anterior to orbital septum.

includes:
eyelids
skin
subcutaneous tissue of face

NOT contents of orbit.

Question 9

causative organisms of periorbital cellulitis?

how does it spread?

Answer 9

staph aureus
staph epidermidis
streptococci
anaerobic bacteria

spreads to structures surrounding orbit from nearby sites , MC from breaks in skin or local infections like sinusitis or RTI’S.

Question 10

symptoms of periorbital cellulitis

Answer 10

pt presents with red swollen painful eye of acute onset.

sx associated with fever.

Question 11

significant differentials of periorbital cellulitis

Answer 11

orbital cellulitis
allergic reaction

Question 12

signs of periorbital cellulitis

Answer 12

erythema and oedema of eyelids , can spread to surrounding skin

partial/complete ptosis of eye due to swelling

orbital signs must be absent!!

Question 13

what are orbital signs

Answer 13

pain on movement of eye
restriction of eye movement
proptosis - bulging eye
chemosis - swelling of tissue lining eyelid and surface of eye(conjunctiva)
RAPD
visual disturbance

Question 14

epidemiology of periorbital cellulitis

Answer 14

MC in kids - 80% under 10.

median presentation : 21 months.

winter more common - increased RTI prevalence.

Question 15

how would you investigate periorbital cellulitis?

Answer 15

bloods - raised inflammatory markers

swab of any discharge present

contrast CT of orbit - help diff between preseptal and orbital cellulitis.

Question 16

how to manage periorbital cellulitis?

Answer 16

oral abx - co-amoxiclav
secondary care
children admission possible

Question 17

complications for periorbital cellulitis

Answer 17

bacterial infection might spread into orbit and evolve into orbital cellulitis.