Pedi Ophtho

Question 1

Describe the visual development of an infant at 1 month

Answer 1

• may briefly focus on face
• prefer brightly colored objects within 3 feet
• interested in close objects
• eyes periodically cross/wander (constant needs evaluation)

Question 2

Describe the visual development at 2-4 mos

Answer 2

• eyes should stop crossing/wandering (if still wandering or not tracking objects - investigate)
• 2 mos: follow moving objects
• 3 mos: eyes work together to focus and track objects (“fix and follow”)

Question 3

Describe visual development at 5-8 mos

Answer 3

5 mos: depth perception (stereopsis) more developed
- better at reaching for objects
- good color vision
- central vision improved
- may recognize ppl across the room and smile
- can see out windows

8 mos: eye hand coordination improving with crawling

Question 4

Describe visual development at 9-12 mos

Answer 4

better judgement of distance with motor events of pulling selves up, walking

Question 5

Describe visual development by toddlerhood

Answer 5

• enhancements in hand-eye coordination, fine motor skills, depth perception
• can read most lines of an eye chart by 3-4 y/o
• 4/6 y/o developing reading skills

Question 6

When should a pediatric eye exam be done

Answer 6

• on newborns to look for congenital problems
• at all routine well child checks

Refer to ophtho: kids at risk for eye problems (premature, FH of conditions, developmental delay, neuro problems)

Refer to optometry: concerns about vision, school

Question 7

Describe what is done on a newborn/infant eye exam

Answer 7

• look for red reflex
• look for fix and follow
• inspect eyelids, lacrimal ducts, sclera, pupils, ambylopia

Question 8

Describe what is tested on an eye exam for 3-5 y/o

Answer 8

• look for red reflex
• look for fix and follow
• inspect eyelids, lacrimal ducts, sclera, pupils, ambylopia
• visual acuity
• cover/uncover test for ocular alignment

Question 9

Describe the common refractory errors in childhood

Answer 9

• hyperopia: farsightedness, close objects blurry but far objects clear
• myopia: nearsightedness, far objects blurry but close objects clear
• astigmatism: near and far vision may be blurry, abnormal shape of cornea/lens

Question 10

Describe the etiology of strabismus

Answer 10

misalignment of the eye

Question 11

Describe the clinical presentation of strabismus

Answer 11

Constant or intermittent double vision, closing/covering one eye when looking at something, tilting/turning head, HA, difficulty reading

Question 12

Describe the physical exam for strabismus

Answer 12

Asymmetrical corneal light reflex, EOMs may be abnormal in a certain direction

Question 13

What is a complication of strabismus

Answer 13

amblyopia

Question 14

Describe pseudostrabismus

Answer 14

eyes appear crossed d/t wide nasal bridge and/or prominent epicanthal skin folds covering medial portion of sclera, corneal light reflex is symmetrical

Question 15

Describe the etiology of amblyopia

Answer 15

Aka lazy eye

One or both eyes does not develop normal vision in childhood

MC cause strabismus, also refractive error, ptosis, cataracts

Brain ignores one eye to avoid diplopia

Question 16

Describe the diagnostic testing for amblyopia

Answer 16

visual acuity testing

Question 17

Describe the treatment for amblyopia

Answer 17

Treat underlying cause, mainstay is part time patching of good eye to increase stimulation of lazy eye

Can also fog the good eye with atropine drops

Question 18

Describe the etiology of retinoblastoma

Answer 18

MC intraocular malignancy in childhood

Common <3, retinal tumor heritable form (bilateral), can metastasize to other structures

Can lead to leukocoria + abnormal red reflex

Question 19

Describe the diagnostic testing for retinoblastoma

Answer 19

Abnormal red reflex (missing) - white appearing (leukocoria)

Question 20

Describe the treatment for retinoblastoma

Answer 20

Refer for surgery to remove tumor or whole eye & surrounding structures

+/- radiation, chemo

Question 21

Describe normal/abnormal red reflex testing

Answer 21