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paeds ophthal Flashcards

1
Q

snellen acuity at birth

A

6/300

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2
Q

snellen acuity at 12 months

A

6/24

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3
Q

snellen acuity at 36 months

A

6/9-6/6

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4
Q

what age can start using snellen chart (6m) to test VA

A

4 yo and above

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5
Q

visual assessment in preverbal children

A
  1. fixation preference
  2. forced preferential looking (teller cards)
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6
Q

visual assessment in older children

A
  1. allen pictures
  2. kay pictures
  3. sheridan gardner matching test
  4. snellen
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7
Q

amblyopia (lazy eye) definition

A

Unilateral (or rarely bilateral) BOV due to disruption in normal visual development, caused by abnormal visual stimulation during sensitive period of visual development

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8
Q

VA criteria for amblyopia

A
  • Unilateral amblyopia: difference in BCVA is 2 or more Snellen lines between 2 eyes
  • Bilateral amblyopia: BCVA of 6/12 or less
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9
Q

pathophysiology of amblyopia

A

*Development of lateral geniculate nucleus and primary visual cortex is incomplete at birth and persists into postnatal period
*During critical period when there’s plasticity within visual system esp visual cortex, external factors can modify its development

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10
Q

causes of amblyopia

A
  1. strabismus (commonest)
  2. stimulus deprivation
  3. refractive error (anisometropia (2 eyes diff RE), ammetropia (both eyes deg high), astigmatism)
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11
Q

criteria for anisometropia

A

any of:
hyperopia > 1.5D
myopia > -3-4D
astigmatism > 1.5D

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12
Q

criteria for ammetropia

A

hyperopia >5D
myopia <-8D

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13
Q

criteria for astigmatism

A

> 2.5D

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14
Q

screening for amblyopia

A
  1. measure VA
  2. Holler test - child upset when good eye covered
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15
Q

principles of management for amblyopia

A
  1. provide clear retinal image
  2. correct ocular dominance
  3. parental counselling
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16
Q

how to provide clear retinal image

A

*identify and correct RE
*fulltime spectacle wear for refractive amblyopia

17
Q

how to correct ocular dominance

A

*occlusion therapy (gold std): patch good eye to force fixation by amblyopic eye
*topical atropine cycloplegic eyedrops in good eye (paralyses accommodation causing blurring in good eye): use amblyopic eye, not useful in dense amblyopia or myopes (near vision preserved even on eyedrops)

18
Q

when is tx possible for amblyopia

A

critical period <7-8yo, best time to correct during infancy or early childhood (<4-5 yo)

19
Q

what is strabismus

A

ocular misalignment

20
Q

heterophoria vs heterotropia

A

heterophoria: latent strabismus, deviation not seen when pt focusing with both eyes
heterotropia: strabismus, deviation seen even when pt using both eyes

21
Q

assessment for strabismus

A
  1. visual acuity
  2. Hirschberg corneal light reflex
  3. cover test
  4. simultaneous red reflex (check ocular alignment)
  5. extraocular eye movements in all 9 positions of gaze
  6. stereoacuity (3D vision)
  7. full eye and neurological examination
22
Q

complications of strabismus

A
  1. amblyopia: squint eye becomes amblyopic (if child develops fixation preference)
  2. poor binocular vision
  3. abnormal head posture
23
Q

comitant vs incomitant strabismus

A

comitant: non paralytic
incomitant: paralytic (eye movement limited due to EOM paralysis)

24
Q

management of strabismus

A
  1. botulinum toxin injection
  2. corrective/prism glasses
  3. strabismus surgery
25
Q

leukocoria

A

white pupil or white reflex

urgent referral

26
Q

abnormal red reflexes

A

*Absent red reflex/ asymmetry (1 eye no red reflex, other eye RR present)
*White reflex (1 eye white, other eye RR present)

normal RR: both eyes RR present

27
Q

5 causes of leukocoria

A
  1. retinablastoma (most impt TRO)
  2. congenital cataract
  3. persistent fetal vasculature / persistent hyperplastic primary vitreous (PHPV) - small eye
  4. advanced retinopathy of prematurity (with tractional retinal detachment stage IV/V)
  5. coat’s disease/exudative retinal telangiectasis
28
Q

retinoblastoma age

A

before 3yo

29
Q

inx for retinoblastoma

A

CT and MRI (CT if only for dx)

30
Q

mx of retinoblastoma

A

*Local Tx (e.g. cryotherapy/laser) for small tumours
* Radiotherapy
* Chemotherapy
* Enucleation (eye removed) for very large tumours in eyes of no visual potential
*Intra-arterial chemotherapy
* Screen siblings, genetic counselling

31
Q

ophthalmia neonatorum time period

A

first 28 days of life

32
Q

organisms involved in ON

A

Neisseria gonorrhea
chlamydia trachomatis serovars D-K

*do conjunctival swab

33
Q

presentation on ON

A
  1. Purulent conjunctivitis
  2. profuse exudate/discharge
  3. eyelid swelling
34
Q

cx of ON

A

Infection can extend from superficial epithelial layers into subconjunctival connective tissue and cornea –> corneal ulceration, corneal scarring, blindness

35
Q

mx for ON

A
  1. Admit child for observation
  2. IM ceftriaxone + PO azithromycin for Neisseria, PO erythromycin for Chlamydia
  3. Treat mother, screen her sexual partners for sexually transmitted diseases and treat
36
Q

Disseminated disease by organisms causing ON

A

sepsis, septic arthritis, meningitis

eye (7 decks)

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