Paediatric Opthalmology

Question 1

what is periorbital cellulitis?

Answer 1

infection of soft tissues anterior to orbital septum - including eyelids, skin and subcutaneous tissue of face but not orbit contents.

Question 2

how does the infection for periorbital cellulitis spread?

causative organisms

Answer 2

spreads to structures surrounding orbit from nearby sites - breaks in skin or local infections like sinusitis or other RTI.

staph aureus
staph epidermidis
streptococci
anaerobic bacteria

Question 3

who does periorbital cellulitis occur in most?

Answer 3

80% under 10 . median age : 21 months

winter more common

Question 4

symptoms and signs of periorbital cellulitis

Answer 4

signs:
- erythema and oedema of eyelids - spread to surrounding skin
-partial or complete ptosis of eye due to swelling
-orbital signs - (pain on movement of eye, restriction of eye movements, proptosis, visual disturbance, chemosis, RAPD) - ALL MUST BE APSENT IN PERIORBITAL - IF PRESENT ITS ORBITAL CELLULITIS

symptoms:
- red swollen painful eye of acute onset.
- sx associated with fever

Question 5

what investigations would you do for periorbital cellulitis?

Answer 5

bloods - raised inflammatory markers
swab of any discharge present
contrast ct of orbit - seperate periorbital and orbital .

Question 6

how would you manage periorbital cellulitis?

Answer 6

refer to secondary care

oral abx - co-amoxiclav

children - admission poss

Question 7

name a complication for periorbital cellulitis

Answer 7

bacterial infection spread to orbit and evolve into orbital cellulitis

Question 8

What is squint? (strabismus)

types

why should you detect quickly?

Answer 8

misalignment of visual axes.

concomitant (common) and paralytic (rare)

important to detect because uncorrected leads to amblyopia (brain cant fully process inputs from one eye and over time it favours one eye)

Question 9

difference between concomitant and paralytic squint

Answer 9

concomitant - due to imbalance in extraocular muscles.
convergent is more common than divergent

paralytic: paralysis of extraocular muscles

Question 10

3 tests to detect squint

examinations

Answer 10

corneal light reflection test - hold light source 30cm from childs face to see if light reflects symmetrically on pupils

hirschberg’s test: shine pen torch at pt 1m awayl. when they look observe reflection of light on their cornea. should be central and symmetrical. deviation will show squint.

cover test: identify nature of squint
- ask child to focus on object
-cover 1 eye
-observe movement of uncovered eye
-cover other eye and repeat test
if eye drift outwards its exotropia, if moves inwards esotropia.

generally inspect
eye movements
fundoscopy - rule out retinoblastoma, cataracts, retinal pathology
visual acuity.

Question 11

how would you manage squint?

Answer 11

secondary care refer

eye patches poss prevent ambylopia

alternate to pathc: atropine drops in good eye, cause vision in that eye to be blurred.

Question 12

definitions of the following

esotropia
exotropia
hypertropia
hypotropia

Answer 12

eso - inward positioned squint - affected eye towards the nose
exo - outward positioned squint - affected eye towards eye

hyper - upward moving affected eye
hypo - downward moving affected eye

Question 13

give some causes of squint

Answer 13

idiopathic normally

can be
hydrocephalus
cerebral palsy
space occupying lesions like retinoblastoma
trauma