Paediatric Tearing/Discharge Flashcards

1
Q

What are the causes of Paediatric Tearing/Discharge?

A

Common

  • Congenital nasolacrimal duct obstruction (C-NLDO)
  • Allergic conjunctivitis
  • Epiblepharon

Rare (but important)

  • Congenital glaucoma
  • Ophthalmia neonatorum
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2
Q

what is the pathophysiology behind congenital nasolacrimal duct obstruction?

A

Nasolacrimal duct develops as a solid cord-like structure that slowly canalises towards term 🡪 complete canalisation can take up to 12 months of life to occur 🡪 C-NLDO can occur as a result of:

Incomplete canalisation of the nasolacrimal duct

Membranous obstruction at the valve of Hasner

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3
Q

what is the clinical features of congenital nasolacrimal duct obstruction?

A
  • Epiphora (tearing)
  • Eye discharge, mucus
  • May be complicated by acute dacryocystitis (infection of the lacrimal sac)
  • Elevated tear meniscus
  • Delayed fluorescein dye disappearance test
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4
Q

what is the management of congenital nasolacrimal duct obstruction?

A

Observation and conservative

  • Crigler lacrimal duct massage: lacrimal duct massage to help open it
  • Broad spectrum antibiotics (BSA) eyedrops: when ocular surface infection/ conjunctivitis develops

Surgical (probing and syringing)

  • Indicated for persistent tearing > 1y age
  • Thin metal probe is inserted into lacrimal duct to widen it and overcome the blockage at valve of Hasner
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5
Q

what is the clinical features of allergic conjunctivitis?

A
  • Itch/pruritus (prominent symptom)
  • Eye redness, eyelid puffiness
  • Tearing, stringy mucoid discharge
  • Micro- and macro-papillae on lower and upper eyelid conjunctiva
  • Large protuberant papillae can erode cornea 🡪 shield ulcer
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6
Q

what is the pathophysiology of epiblepharon?

A
  • Lower eyelid orbicularis oculi muscle and skin override the lower eyelid margin to form an additional horizontal skin fold 🡪 causes lower lashes to be directed vertically upwards towards globe
  • Lash-cornea touch 🡪 corneal erosions, eye irritation, epiphora
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7
Q

what is the treatment for epiblepharon?

A

Ocular lubricants, while awaiting spontaneous resolution

Indications for corrective eyelid surgery

  • No resolution with age (e.g. no resolution by age 5-6) (normally, child grows older and loses baby fat around cheek + face elongates, so the lash alignment corrects itself)
  • Significant corneal compromise from lash-cornea touch
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8
Q

what are the clinical features of infantile glaucoma?

A

Epiphora (tearing)
Photophobia
Blepharospasm

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9
Q

what are the signs of infantile glaucoma?

A

Elevated IOP

Cloudy/hazy cornea

Enlarged corneal diameter

  • Globe distension in response to elevated IOP 🡪 corneal enlargement
  • Diameter > 12 mm in first year 🡪 highly suggestive of glaucoma
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10
Q

what is the treatment of glaucoma?

A

Medical: IOP lowering eyedrops (topical), oral medications (systemic)

Surgical (most cases of primary congenital glaucoma are treated surgically)

  • Opening drainage canals in the angle, OR
  • Creating bypass route for aqueous to drain out
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11
Q

what is ophthalmia neonatorum?

A

Conjunctivitis in the first 28 days of life (neonatal period)

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12
Q

what are the causes of ophthalmia neonatorum?

A

Non-infective
- Chemical, e.g. topical AgNO3 (silver nitrate) prophylaxis

Infective (bacterial and viral)

  • Gonococcal (intracellular Gram negative diplococci), if untreated, can progress rapidly 🡪 corneal ulceration, perforation 🡪 endophthalmitis
  • Chlamydial
  • Herpetic (HSV)
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13
Q

what are the systemic complications of ophthalmia neonatorum?

A

Pneumonia, meningitis, encephalitis, septicaemia

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14
Q

what is the management of ophthalmia neonatorum?

A

Systemic antibiotics or antivirals

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