Paediatric Tearing/Discharge Flashcards
What are the causes of Paediatric Tearing/Discharge?
Common
- Congenital nasolacrimal duct obstruction (C-NLDO)
- Allergic conjunctivitis
- Epiblepharon
Rare (but important)
- Congenital glaucoma
- Ophthalmia neonatorum
what is the pathophysiology behind congenital nasolacrimal duct obstruction?
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
what is the clinical features of congenital nasolacrimal duct obstruction?
- Epiphora (tearing)
- Eye discharge, mucus
- May be complicated by acute dacryocystitis (infection of the lacrimal sac)
- Elevated tear meniscus
- Delayed fluorescein dye disappearance test
what is the management of congenital nasolacrimal duct obstruction?
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
what is the clinical features of allergic conjunctivitis?
- 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
what is the pathophysiology of epiblepharon?
- 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
what is the treatment for epiblepharon?
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
what are the clinical features of infantile glaucoma?
Epiphora (tearing)
Photophobia
Blepharospasm
what are the signs of infantile glaucoma?
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
what is the treatment of glaucoma?
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
what is ophthalmia neonatorum?
Conjunctivitis in the first 28 days of life (neonatal period)
what are the causes of ophthalmia neonatorum?
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)
what are the systemic complications of ophthalmia neonatorum?
Pneumonia, meningitis, encephalitis, septicaemia
what is the management of ophthalmia neonatorum?
Systemic antibiotics or antivirals