Pediatric Ocular Disorders

Question 1

most common infectious type of neonatal conjunctivitis?

Answer 1

• chlamydial conjunctivitis
• systemic implications due to multiple sites of inoculations i.e. the eyes are infected so it’s likely other areas of the body are too

Question 2

chlamydial conjunctivitis: clinical presentation, dx, tx

Answer 2

• onset 5-14d after birth or exposure
• acute purulent conjunctivitis
• dx: Geimsa stain = basophilic inclusion bodies
• tx: prophylaxis = topical erythromycin at birth
  infants = oral erythromycin or sulfa agent; topical erythromycin
  parents = oral tetracycline or erythromycin

Question 3

neisserial conjunctivitis

Answer 3

• onset 2-6d after birth; rapid progression
• copious purulent drainage, chemosis, lid edema
• could cause corneal perforation (b/c of pus created) w/ endophthalmitis (infection inside the eye)

Question 4

neisserial conjunctivitis: dx and tx

Answer 4

• gram stain = gram (-) diplococcic
• tx = ocular irrigation and fortified ophthalmic solutions (antibiotics)
• parents also need tx

Question 5

pre-septal v. orbital cellulitis

Answer 5

• pre-septal = confined to eyelids and periorbital structures; eye will not be affected i.e. will look normal
• orbital = eye affected; will look very red and irritated

Question 6

orbital cellulitis findings

Answer 6

fever, proptosis, chemosis (conjunctival swelling), restriction in EOM, pain w/ eye mvmt
- most serious complications = decreased vision and pupil abnormality (APD); suggest orbital apex involved = investigation and aggressive mngt ASAP

Question 7

what bugs can cause orbital cellulitis?

Answer 7

• staph and strep species
• anaerobes
• polymicrobial infections related to sinus infections
• H. influenza = more common in kids but decreased now b/c of vaccine

Question 8

congenital ptosis

Answer 8

• most common form of ptosis
• no laterality or sex predilection
• be aware of amblyopia and compensatory head tilt (tilt head back at about 6 months+)
• surgical tx: done early if amblyopia or head tilt present; otherwise can wait until school aged

Question 9

dacryostenosis

Answer 9

• nasolacrimal system blocked somewhere
• S&S = mucopurulent drainage, secondary plepharitis, epiphora (excessive tearing for no reason)
• spontaneous resolution in 85% of pts by 6 months old
• can tx w/ antibiotics (controls chronic dacryocystitis), Creiger manever (massage), probing/irrigation of nasolacrimal system

Question 10

retinoblastoma

Answer 10

• presents w/ leukocoria and strabismus usually
• tx = enucleation
• can spread by local invasion via optic n.

Question 11

infantile cataract

Answer 11

• leading cause of childhood blindness

- tx by extraction, optical correction of aphakia, occlusion therapy for amblyopia

Question 12

infantile glaucoma

Answer 12

• S&S = corneal clouding, buphthalmos (eye enlargement), epiphora (excessive tearing), photophobia
• tx = surgery; also need to tx refractive errors and amblyopia after surgery