Peds Flashcards
The average axial length of the human eye in a newborn is __-__ mm. The majority of growth of the axial length occurs in the first year of life; it increases by __ mm in the first 6 months, and an additional 2 mm during the subsequent 6 months. Final axial length is reached between __ and __ years.
The average axial length of the human eye in a newborn is 14.5-15.5 mm. The majority of growth of the axial length occurs in the first year of life; it increases by 4 mm in the first 6 months, and an additional 2 mm during the subsequent 6 months. Final axial length is reached between 13 and 16 years.
Chalazia are caused by blockage of the meibomian glands. Hordeola arise form from blocked ___ or ___ glands.
Chalazia are caused by blockage of the meibomian glands. Hordeola arise form from blocked eccrine or apocrine glands.
Tenderness over the area of the ___ in the superonasal orbit may be seen in patients with acquired Brown syndrome, and symptoms are often worst when the globe is ___ and ___ on the affected side.
Tenderness over the area of the trochlea in the superonasal orbit may be seen in patients with acquired Brown syndrome, and symptoms are often worst when the globe is elevated and adducted on the affected side.
What imaging tests should be obtained in a patient with morning glory disc anomaly? (2) What conditions are you screening for? (3)
MRI/MRA brain to rule out basal encephalocele, midface anomalies, Moyamoya disease
What does PHACE stand for? What ocular condition is it associated with?
Posterior fossa abnormalities Hemangioma Arterial lesions Cardiac abnormalities Eye abnormalities
Morning glory disc anomaly
Most common cause of glaucoma-like optic nerve cupping in preterm infants?
Periventricular leukomalacia (associated with premature birth).
The optic nerve cupping is a result of transsynaptic degeneration from bilateral lesions in the optic radiations. It presents as a large cup within a normal-sized optic disc, described as an unusual form of optic nerve hypoplasia.
Exotropic Duane syndrome results from the abnormal development of the ___ nerve/nucleus. The result is anomalous innervation of the ___ rectus muscle by aberrant branches of ___ nuclei.
Exotropic Duane syndrome results from the abnormal development of the abducens nerve/nucleus. The result is anomalous innervation of the lateral rectus muscle by aberrant branches of oculomotor nuclei.
Much less common than esotropic (Type I) Duane syndrome
Surgical treatment options for exotropic Duane syndrome include ___ rectus muscle ___ in one or both eyes. However, ___ rectus muscle ___ should be avoided because this procedure often worsens globe retraction.
Surgical treatment options include lateral rectus muscle recession in one or both eyes. However, medial rectus muscle resection should be avoided because this procedure often worsens globe retraction.
The Congenital Esotropia Observational Study showed that when patients present with constant esotropia of at least __Δ after __ weeks of age, the deviations are unlikely to resolve spontaneously.
The Congenital Esotropia Observational Study showed that when patients present with constant esotropia of at least 40Δ after 10 weeks of age, the deviations are unlikely to resolve spontaneously.
Hyperopia or astigmatism greater than ___ diopters suggests a refractive strabismus.
Hyperopia or astigmatism greater than +2.50 diopters suggests a refractive strabismus.
An apparent abduction deficit may result from cross-fixation. The infant’s ability to abduct can be elicited by the ___ ___ ___ spinning the infant to stimulate the vestibulo-ocular reflex, or by ___ with either eye patched.
An apparent abduction deficit may result from cross-fixation. The infant’s ability to abduct can be elicited by the doll’s head maneuver, spinning the infant to stimulate the vestibulo-ocular reflex, or by observation with either eye patched.
Causes of ophthalmia neonatorum and time of onset (4)
Chemical - first 24 hours
Gonorrhea - first 3-4 days
Chlamydia - first week
HSV - second week
Genetic disorder most commonly associated with congenital iris ectropion
NF1
Fusional convergence eliminates ___ retinal disparity and controls an ___. Fusional divergence eliminates ___ retinal disparity and controls an ___.
Fusional convergence eliminates bitemporal retinal disparity and controls an exophoria. Fusional divergence eliminates binasal retinal disparity and controls an esophoria.
Vertical fusional vergences are used to correct a hyperphoria.
What is a useful clinical finding often seen with disc drusen versus true papilledema?
Anomalous branching of the large retinal vessels over the disc
For acquired esotropia, the maximal angle of strabismus and fusional potential can be assessed by what test?
Prism adaptation: patient fitted with prisms to induce orthophoria and reexamined every 1-2 weeks, and the prism correction is increased until a stable amount of prism to achieve orthophoria is found.
How can lymphatic malformations of the orbit present? When do exacerbations tend to occur? How are they managed?
Lymphatic malformations of the orbit may present with sudden proptosis caused by spontaneous intralesional hemorrhage. Exacerbations tend to occur during upper respiratory tract infections and can be managed with a short course of systemic corticosteroids. Surgical intervention is deferred unless vision is affected.
Interpupillary distance, if large, can result in ___.
Interpupillary distance, if large, can result in pseudoexotropia.
Most common retinal finding in patient with morning glory disc anomaly?
Retinal detachment (up to 30%!)
Neurofibromatosis (1 and 2) shows ___ ___ inheritance. However, about __% of patients do not have a family history of the disease, reflecting the high rate of new mutations in the responsible gene.
Neurofibromatosis (1 and 2) shows autosomal dominant inheritance. However, about 50% of patients do not have a family history of the disease, reflecting the high rate of new mutations in the responsible gene.
3 conditions with findings of intraocular cartilage
Patau syndrome (trisomy 13), medulloepitheliomas, PFV
Surgical approaches to DVD if small-moderate, large, and in association with IOOA (3)
Large superior rectus muscle recessions
If residual, inferior rectus muscle resection or plication
If also IOOA, inferior oblique muscle anterior transposition/anteriorization
Surgical treatment of IOOA without DVD
Inferior oblique myectomy
The nerves to the rectus muscles and the superior oblique muscle enter the muscles approximately ___ of the distance from the origin to the insertion (or trochlea). An instrument thrust more than __ mm posterior to a rectus muscle’s insertion may cause injury to the nerve.
The nerves to the rectus muscles and the superior oblique muscle enter the muscles approximately one-third of the distance from the origin to the insertion (or trochlea). An instrument thrust more than 25 mm posterior to a rectus muscle’s insertion may cause injury to the nerve.
Searching nystagmus suggests that the child has worse than ___ vision. Pendular nystagmus typically occurs in patients with visual acuity better than ___ in at least 1 eye. Jerk nystagmus often is associated with visual acuity between ___ and ___.
Searching nystagmus suggests that the child has worse than 20/200 vision. Pendular nystagmus typically occurs in patients with visual acuity better than 20/200 in at least 1 eye. Jerk nystagmus often is associated with visual acuity between 20/60 and 20/100.
What test can be used to determine potential for postoperative single binocular vision?
Amblyoscope
Tests fusional potential, retinal correspondence, detect suppression, measure primary/secondary deviations and suppression scotomas
What is the earliest sign of anterior segment ischemia following strabismus surgery?
AC cell and flare
Can also see corneal edema, irregular pupil
How does postoperative steroid treatment in pediatric cataract surgery patients with IOL placement compare to treatment in those without IOL placement?
Patients with an IOL require more aggressive steroid treatment postoperatively compared to patients without an IOL
How might leukemia present in advanced stages? (orbital manifestation)
Unilateral or bilateral proptosis
Chloroma (also known as granulocytic sarcoma or myeloid sarcoma) is a rare extramedullary variant of myelogenous leukemia that can develop as the sole manifestation of relapse after apparently successful treatment of AML
What are 3 causes of acquired Brown syndrome, and what work-up should be considered?
Local trauma to the region of the trochlea, systemic inflammatory conditions, sinusitis
CT scan should be considered
Positive angle kappa occurs when the fovea is usually slightly ___ to the pupillary axis, making the corneal light reflection slightly ___ to the center of the cornea.
Positive angle kappa occurs when the fovea is usually slightly temporal to the pupillary axis, making the corneal light reflection slightly nasal to the center of the cornea. This causes a pseudoexotropia, e.g. foveal dragging in ROP.
Congenital stationary night blindness is a group of hereditary conditions (___ most common form) causing ___ dysfunction.
Congenital stationary night blindness is a group of hereditary conditions (X-linked most common form) causing rod dysfunction, resulting in night blindness and electronegative dark-adapted ERG (large a-wave with reduced b-wave).
How do patients with CSNB typically present? How might those with the X-linked form differ?
Patients typically present in infancy with nystagmus and a normal appearing fundus. The X-linked form is the most common, and presents with myopic tilt and temporal pallor.
Compare and contrast iris stromal cysts from cysts of the iris pigment epithelium (pathogenesis and presentation)
Iris stromal cysts: enlarging congenital lesions caused by sequestration of epithelial tissues during embryogenesis. May cause visual obstruction, glaucoma, and corneal decompensation.
Cysts of the iris pigment epithelium: caused by separation of the 2 layers of the iris pigment epithelium, not by sequestration of tissue. They typically are stable and do not usually cause clinical complications.
What does CHARGE syndrome stand for, and what ocular finding is it associated with?
C – Coloboma of the eye (iris and CB colobomas), CNS anomalies
H – Heart defects
A – Atresia of the choanae
R – Retardation of growth and/or development
G – GU defects
E – Ear anomalies (bowl-shaped and concave ears, known as “lop ears”)
What are the steps of the 3-step test? What is this test used for?
(1) hypertropic eye with distance fixation
(2) misalignment worse in left or right gaze
(3) misalignment worse in left or right head tilt
Used to identify which paralytic muscle is causing cyclovertical strabismus
The 3-step test does not work with patients who have had ___ ___ surgery, have a ___ disease, or have ___ syndrome.
The 3-step test does not work with patients who have had previous strabismus surgery, have a restrictive disease (such as thyroid eye disease), or have Brown syndrome.
___ ___, disconjugate eye movements, and ___ ___ deviation of both eyes can be noted in healthy newborns but should not persist beyond __ months of age.
Skew deviation, disconjugate eye movements, and tonic downward deviation of both eyes (sunsetting) can be noted in healthy newborns but should not persist beyond 4 months of age.
Signs of poor visual development include ___ eye movements, lack of response to ___ ___, ___, and forceful rubbing or poking of the eyes.
Signs of poor visual development include searching eye movements, lack of response to familiar faces/objects, nystagmus, and forceful rubbing or poking of the eyes (oculodigital reflex).
What distinguishes type 1 Duane from 6th nerve palsy?
Limited adduction of affected eye
The ___ ___ is the primary anatomical site affected in the development of amblyopia.
The visual cortex is the primary anatomical site affected in the development of amblyopia.
___ ___ or ___ ___ would be associated with the sensation of a soft stop while probing.
Lacrimal tumor or canalicular obstruction would be associated with the sensation of a soft stop while probing.
Paradoxical pupils, a pupillary constriction in response to darkness, are most commonly associated with ___ ___, although they can occur with ___ ___.
Paradoxical pupils, a pupillary constriction in response to darkness, are most commonly associated with retinal dystrophies, although they can occur with optic neuropathies.
Delayed visual maturation is the condition wherein normal visual ___ and ___ do not develop in an infant within the first __ months of life.
Delayed visual maturation is the condition wherein normal visual fixation and tracking do not develop in an infant within the first 3 months of life.
