Pediatric Ophthalmology

Question 1

Concerning examination findings for children with strabismus include […] corneal light reflections and deviation on cover test.

Answer 1

Concerning examination findings for children with strabismus include asymmetric corneal light reflections and deviation on cover test.

Question 2

How often should vision assessment be assessed in children?

Answer 2

At every well-child visit

infants are evaluated by observing fixation and tracking; cover-uncover tests assess for strabismus in older infants and children; visual acuity can be tested after age 3

Question 3

Is allergic conjunctivitis typically unilateral or bilateral?

Answer 3

Always bilateral

Question 4

Retinoblastoma is an eye cancer associated with a […] reflex, rather than the normal red reflex.

Answer 4

Retinoblastoma is an eye cancer associated with a white reflex, rather than the normal red reflex.

known as leukoria; this finding should prompt referral to an ophthalmologist for further evaluation

Question 5

Treatment of strabismus includes patching or blurring of the […] eye.

Answer 5

Treatment of strabismus includes patching or blurring of the normal eye.

allows for strengthening of the deviated eye

Question 6

What is the likely diagnosis in a child staying in a refugee camp that presents with inflammation and thickening of the tarsal conjunctivae bilaterally?

Answer 6

Trachoma

repeated or chronic infection causes inversion of eyelashes and scarring of the cornea

Question 7

What is the likely diagnosis in a child that presents with pain with eye movements as well as fever, periorbital edema, ophthalmoplegia, and proptosis?

Answer 7

Orbital cellulitis

Question 8

What is the likely diagnosis in a child with a history of asthma that presents with bilateral itchy, red eyes with watery discharge for the past several weeks?

Answer 8

Allergic conjunctivitis

IgE-mediated response to allergens; treatment involves avoidance of the triggering agent and topical agents (e.g. antihistamines, mast cell stabilizers)

Question 9

What is the likely diagnosis in a child with a history of neurofibromatosis type 1 that presents with unilateral vision loss, proptosis, and optic disk pallor?

Answer 9

Optic pathway glioma

arises in ~15% of children < 6 years old with NF1

Question 10

What is the most common predisposing factor for orbital cellulitis?

Answer 10

Bacterial sinusitis

due to proximity of the sinuses to the orbital space and the valveless orbital venous system

Question 11

What is the next step in management for a 2-month-old infant that presents with intermittent strabismus?

Answer 11

Reassurance

intermittent strabismus is normal during the first 4 months of life

Question 12

What is the recommended pharmacotherapy for trachoma?

Answer 12

Oral azithromycin

effective against Chlamydia trachomatis

Question 13

What is the recommended treatment for Chlamydial conjunctivitis?

Answer 13

Oral macrolide

topical macrolides have a high failure rate

Question 14

What is the recommended treatment for dacryostenosis?

Answer 14

Nasolacrimal sac massage

Question 15

What is the recommended treatment for Gonococcal conjunctivitis?

Answer 15

Single dose of intramuscular 3rd generation cephalosporin (e.g. ceftriaxone)

Question 16

What microorganism is involved in the pathogenesis of trachoma?

Answer 16

Chlamydia trachomatis (serotypes A, B, C)

Chlamydial infections can manifest in the eye, in the forms of inclusion conjunctivitis and trachoma, although each involves a different subtype of the bacteria. Inclusion conjunctivitis typically occurs in developed countries; in contrast, trachoma is primarily restricted to impoverished regions. While involving different serotypes, both diseases are caused by the same species of Chlamydia, illustrating the indiscriminate impact of C. trachomatis.

Question 17

[…] is caused by obstruction of the nasolacrimal duct and results in crusting of the eye lashes and tearing.

Answer 17

Dacryostenosis is caused by obstruction of the nasolacrimal duct and results in crusting of the eye lashes and tearing.

Question 18

[…] refers to intermittent or constant ocular misalignment.

Answer 18

Strabismus refers to intermittent or constant ocular misalignment.

may have nasal deviation (esotropia) or, less commonly, temporal deviation (exotropia)

Question 19

Chlamydial conjunctivitis typically presents […] - […] days after birth with mild eyelid edema and […] discharge.

Answer 19

Chlamydial conjunctivitis typically presents 5 - 14 days after birth with mild eyelid edema and watery discharge.

Question 20

[…] conjunctivitis typically presents 5 - 14 days after birth with mild eyelid edema and watery discharge.

Answer 20

Chlamydial conjunctivitis typically presents 5 - 14 days after birth with mild eyelid edema and watery discharge.

Question 21

Gonococcal conjunctivitis can be prevented with prophylactic topical […] ointment soon after birth.

Answer 21

Gonococcal conjunctivitis can be prevented with prophylactic topical erythromycin ointment soon after birth.

mandatory in most parts of the United States; this will not prevent Chlamydia conjunctivitis

Question 22

[…] conjunctivitis can be prevented with prophylactic topical erythromycin ointment soon after birth.

Answer 22

Gonococcal conjunctivitis can be prevented with prophylactic topical erythromycin ointment soon after birth.

mandatory in most parts of the United States; this will not prevent Chlamydia conjunctivitis

Question 23

Gonococcal conjunctivitis typically presents […] - […] days after birth with marked eyelid edema and […] discharge.

Answer 23

Gonococcal conjunctivitis typically presents 2 - 5 days after birth with marked eyelid edema and purulent discharge.

Question 24

[…] conjunctivitis typically presents 2 - 5 days after birth with marked eyelid edema and purulent discharge.

Answer 24

Gonococcal conjunctivitis typically presents 2 - 5 days after birth with marked eyelid edema and purulent discharge.