Paediatrics Flashcards
What are the traditional tests used to assess a child’s VA?
Snellen/Logmar
Jay’s
Cardiff cards (forced choice)
What VA is considered to be normal?
6/9.5
At what astigmatic power is considered to be normal for a child?
20% have ~1-2D
What is Amblyopia?
Disruption in the visual development
What key feature is found if a px presented with amblyopia?
> 2 lines difference b/w 2 eyes
What are the 3 main causes of amblyopia?
- Refractive
- Strabismic
- Structural
At what VA would an amblyopic be presenting with?
<6/12 AFTER refraction
When is it most appropriate to refer an amblyopia child?
<7yrs
>2 lines difference AFTER refraction
What are the possible management options for amblyopia?
Occlusion
Optical penalisation
Atropine
(Successful for <7yrs)
When do you NOT prescribe an rx to a child?
If Asxs and Vision better than 6/9.5
When is it indicted to prescribe an rx to a child?
Symptomatic
Vision
Strabismus
When is a cycloplegic refraction performed?
<6yrs
Reduced vision
Squint
What is a strabismus?
Misalignment of the 2 eyes
What features are present in an SOT?
Worse looking Near Hyperopic Loss of binocular function Cause Ambly Asxs
What features are present in XOT?
Worse at Far Mild myopia Normal binocular function Ambly RARE Sxs: HAs, blinking
When is it essential to refer for SOT and XOT?
SOT- Any variable or constant SOT, Patching/surgery maybe required
XOT- Constant, sxs, only sx surgery (most monitored)
Before a squint surgery takes place, what must be done before?
Vision sorted 1st!
Full spectacle adaption
Patching…. then surgery!
What is a nystagmus?
Wobbly eyes uncontrolled
What are the common causes of nystagmus?
IDIOPATHIC Albinism Achromatopsia Aniridia Lever cong amarausis Cone dystrophy Congenital/idiopathic
What 4 aspects could potentially cause nystagmus?
Meds- toxic, alcohol, thiamine
Neurological- MS, tumour CVA
Ocular- sensory, cataracts, trauma
Physiological
What features are assessed in nystagmus?
Amplitude Biggest Conjugate Direction AHP Frequency
Whats features are suspicious in nystagmus?
ACQUIRED Vz Disconjugate Oscillopsia Hearing loss Reversal of dev. Milestones Ataxia weakness
When is it necessary to refer urgently when presented with a nystagmus?
New
Oscillpsia
Vz
If none of these features present- routine referral
What would give rise to Red eyes?
Infection
FB
Allergy
What is blepharitis?
Staphylococcal skin flora interferes with oil at lid margin
When are the sxs for chronic blepharitis worse?
Worse in the AM
What signs maybe present in blepharitis in children?
Chalazion
Red eye
Crusty lid
Dry eye
How is blepharitis treated?
Makeup wipes
When is blepharitis referred to the HES?
Any corneal changes
What conditions are associated with allergy?
Asthma
Eczema
Ptosis
What are the signs and sxs of allergy?
Itchy
Lid papillae
Sticky AM
What advice would you give to reduce an allergy?
Cold compress and OTC antihistamines
What are the sxs if the px has a foreign body?
Photophobic
Painful
Watery
What is the difference in viral and bacterial infectious conjunctivitis signs?
Viral- watery, puffy
Bacterial- sticky
What are the 3 blinders found in children?
Cataracts
Uveaitis
HSK
What is the cause of cataracts in children?
Idiopathic- congenital
What other disease processes occur with cataracts in children?
Chromosomal
Infection
Metabolic
What is the 1st sign of reduced vision?
Uveitis
What key aspects do we look out for in uveitis?
Posterior synachiae
Keratitic precipitate
What else can uveitis cause?
Cataracts
What is uveitis commonly associated with?
JIA- Juvenile idiopathic atheritis
How is cataracts managed in children?
Infancy- 6-8/52 old
Sxs- surgery indicated
Asxs- no surgery indicated
What is the criteria for referral to the HES in young children with the blinders?
Causing amblyopia- urgent
How is HSK referred?
Urgently HES
What are the killer conditions that maybe found in children?
Retinoblastoma
Papilloedma
Optic disc drusen
What conditions maybe normal to see in children?
Bergmeister papilla
Mylinated nerve fibres
What is retinoblastoma and what are the potential signs?
Rare malignant tumour (fatal) Signs... Leukocoria Strabismus Poor vision
What is the referral route for a retinoblastoma?
Urgent referral to HES same day
What can papilloedema sometimes be confused with?
Drusen
What are options dusc drusen made up of?
Buried colloid bodies (lump under disc)
What features are included in optic disc drusen?
Disc vasc remains visible Elevation confined to OD No exudate Small cupless discs No venous congestion
What is myelinated nerve fibres?
Fatty content nerve to brain
What is ON Coloboma?
A defect in the retina and choroid
What aspects would be considered when referring for swollen discs?
Symptoms
Associated signs
Incidental findings
What are the associated signs for swollen discs?
6th NP
Color vision loss
Disc Haemmorage
What sxs would suggest a disc swelling?
HAs
Dip
Unwell- referred by GP
Appointment made by parents for specific reason
What should be included in the referral for swollen discs?
Dip CV Pupils NV Prev documentation HAs/sickness
What are the main causes for a child who can’t see?
Refractive error
Accom problem
Undiagnosed ambly
No specific cause
What is included in an eye exam for children?
Stereoacuity
Cyclo refraction
Recheck VA after cyclo
Tes t @ 3m not 6m
What cerebral VI problems would a child be experiencing?
Using vision for a long term Copying from board Problems c VF Problems finding way around placs Problems with visual search and noisy places
Who would need referring in relation to cerebral VI?
Brain injury
Probs using vision
No tx- solution strategies to help make seeing easier
