Peds and Other Stuff Flashcards
strabismus
misalignment of the eyes
most common in infants and young kids under 3 (can go away for newborns)
some causes of strabismus
- congenital
- poor muscle control
- hyperopia
- stroke/trauma= if nerve gets knocked out
- down syndrome , cerebral palsy
strabismus is a_______-
what else to note
general category
esotropia
exotropia
hypotropia
hypertropia
note: descriptions—> unique one is alternating (one eye muscle gets tired and then the other takes over)
dx tests for strabismus
red light reflex
corneal light reflex
**cover uncover test
EOM
esotropia and etiology
1 or both turned inward
seen before 6 months of age and not present at birth
1) congenital
2) accommodative = secondary to hyperopia
3) 6th nerve palsy (trauma and stroke)
NOTE: b/w 2 and 3, w accommodative: diplopia is better w distance whereas 6th nerve is worse in the distance
tx of esotropia
infantile= surgical correction; BOTOX
accommodative= corrective lens; surgery is not corrected
6th nerve= prism correction (refracts light a certain way so diplopia goes away)–> surgery if it doesn’t leave by 6 months
exotropia
1 or both outward
1) congenital –> less common than eso so if its constant, rule out srs etiology
2) intermittent–> trying to focus but outward drift
3) 3rd nerve palsy (rare)–> can be congenital or acquired
which is more common ?
exotropia or esotropia
esotropia
tx for exotropia
same as eso
corrective lens
prism lens
botox surgical correction
what can mimick eso or exo tropia
if kids have extra skin for the epicanthic fold
we are concerned with ________________________________ with hypotropia
MASS PUSHING DOWN!!
amblyopia
lazy eye–> brain is too dumb to process the blurry image, so it picks the clear one and then ignores the other bad one
PERMENANT decrease in vision–> only in children
amblyopia only occurs in
children
causes of amblyopia most common
strabismic (the bad eye gets suppressed to prevent diplopia)
most severe cause of amblyopia
deprivation
–> excessive patching, corneal opacity, congenital cataract! –> MAKE SURE you aren’t missing a bigger pic bc you will see an ABSENCE of RED LIGHT REFLEX
most insidous cause of amblyopia
diff refractive states for each eye
can happen bilaterally if both eyes are out of focus
if a kid keeps running into walls and stuff….. could be_—-
amblyopia
ambylopia testing
basically everything we did for strabismus
+ UNIQUE: visual acuity (crowding phenomenon)–> harder to see crowded letters
also consider CT or MRI (tumor)
amblyopia treatment
correct structural issues (if cataract, fix by 2 months)
patching= cover good eye
glasses= if refractive issue
penalization= atropine drops to blur dominant eye
blepharitis ANDwhat organisms
bilateral inflammation of the eye LIDS
staph aureus= acute
seborrheic derm = chronic
anterior blepharitis
inflammation along eyelashes!
staph a: see scales and crusting
seborrheic= greasy scales
posterior blepharitis
most common
inflammation of the inner eyelid
( maybe seen w derm disease like rosacea or seb derm)
blepharitis sx
red swollen eyelids with flaking or scaling
crusty eyelashes
burning, tears, FB sensation
tx for blepharitis
- lid hygeine= baby shampoo , warm compress
if bacterial, bacitracin or erythromycin
if refractory:
- oral doxy
- tetra
- topical steroids short term
entropion
eyelid margins turned inward
potential causes of entropian
spasmotic entropion= spasm of eyelid
scar retraction on inside of eyelid (cicatrical entropion)
surgery= trichiasis= lashes rubbing on the eye irritating cornea and conjunctiva –> can lead to scarring
ectropion
1) what is it?
2) etiology
eyelid margins out
- senile ectropion- most common= age related
- cicatrical ectropion
- secondary to 7th nerve palsy (Bell’s)
tx for ectropion
surgery
hordeolum and s/s
staph infxn of eye glands
localized, red, swollen, tender abscess on eyelid margin
2 types= internal and external
internal hordeolum
staph infxn Meibomian gland
TOWARDS conjuctival surface
course for hordeolum
resolves by draining randomly
progress to lid cellulitis (down to maxilla)
become a chalazion (chronic inflammation)
external hordeolum
Zeis
smaller abcesses on external lid margin
points AWAY
which one has more of a FB sensation
external or internal hordeolum
internal
tx for hordeolum
warm compress (usually enough)
could add abx ointment= polymyxin-bacitracin or erythromycin
I&D if not resolved by 48 hours
dacryocystitis
acute or chronic (usually uni) inflammation of lacrimal sac —> caused by partial obstruction of nasolacrimal duct
-staph, strep, pneumococci, candida
common w infants and older than 40
dacryocystitis sx
red painful selling nearing medial canthus
reflex of pus from lactrimal puncta
workup for dacryocystitis
culture right by orbit and nose
consider imaging (make sure nothing deeper)
tx for dacro
augmentin
dacryocystorhinostomy
tx for dacrocystitis in ifants
delayed opening in the lower portion of the nasolacrimal duct or inferior meatus
watery eye
massage it several times a day
if chronic (past year) or get infxn–> dacryocystorhinistomy
pterygium
triangle white, pink /red fibrovascular conjuctival tissue
from medial canthus over the cornea and towards the pupil
point part of triangle towards the pupil
risk factors= frequent exposure to UV light, dust or wind
pterygium tx
topical lubricants
surgical excision if vision is obstructed (covering cornea)
pinguecula
yellowish triangle thickening
does NOT grow over cornea
apex away from pupil
pinguecula
no tx needed
doesn’t grow over cornea and obstruct vision
rhabdomyosarcoma
rare tumor or muscle/bone w unknown etiology
(other place:head neck, extremity)
most common malignant tumor of orbit in kids (1-10)
tx of rhabdomyosarcoma
get bx
1) chemo and radiation
2) enucleation
what does rhabdomyosarcoma look like
ptosis *
proptosis *
change in vision*
eye pain/ swelling
RAPID progression w metastasis to brain and lung
metastatic intraocular tumors are most common w
in adults
top 3 : breast lung kidney
TTK about metastatic intraocular tumors
most invade choroid
multiple solid creamy-white lesions with bad borders
can see mottled legion with pigment clumping on surface
can cause retinal detachment or impact vision
what is the most common intraocular tumor of childhood
retinoblastoma
retinoblastoma TTK
bilaterally 1/3 of time
present from birth and most dx by age 3
rare but life threatening
what are some signs for retinoblastoma
white pupil= aka leucocoria –> not seeing red reflex
messed up central vision–> strabismus
tx for retinoblastoma
enucleation bc posterior chamber is filled w tumor–> no useful vision
very curable unless there is spread of tumor or optic nerve involved
otherstuff is chemo and radiation
what dz can cause death from intracranial spread
retinoblastoma
what is the most primary intraocular tumor of adulthood
malignant melanoma
from pigmented cells in choroid(can be mets from skin melanoma)
what is special about malignant melanoma and tx
often not detected until retinal detachment happens
usually in middle age white
tx= enucleation before tumor spreads to orbit
iris nevus vs iris melanoma
nevus is little frechles
iris melanoma has lots of color change and assoc w malignant melanoma
glioma
rare optic nerve tumor
25-50% have neurofibromatosis
dx in kids w decreased VA, proptosis. papilledema, optic atrophy, strabismusm
well circumscribed lesion
tx for glioma
depends on size
surgery
chemo
radiation
neurofibromatosis found means you should
work up to make sure you are not missing a glioma
neurofibromatosis
genetic disorder where tumors for on nerve tissue
