Week 8- Paediatricts

Question 1

What are the 3 aims of paediatric eye services?

Answer 1

• Primary prevention prevent visual handicap, e.g. ROP screening
- Red reflex check in the newborn!
• Secondary prevention limit impact eye condition, e.g. cataräct operation
• Tertiary prevention maximise visual function, e.g. low vision aids, rehabilitation

Question 2

Why is paediatric opthalmology important?

Answer 2

• Impairment of visual development will have consequences for general development
• Impairment of general development may have consequences for visual development
• paediatric ophthalmic problems should be seen against the general background of physical, emotional and social ealth and development.
• Treatment must be seen as an investment in a lifetime of vision

Question 3

What may parents/carers be important for?

Answer 3

Parents/carers are invaluable in:
• diagnosis (“the parents are always right”)
• decision making
• treatment

Children are NOT small adults

Question 4

What is important to note in paediatrics during history taking?

Answer 4

• Pregnancy
• Relevant medical history
• Medication
• (Drug) allergies
• Family history
- Consanguinity
• Social history

Question 5

What is normal visual development characterised by in children?

Answer 5

• Opening eyes, looking around/searching movements
• Eye contact, response to facial expression
• Fix and follow
• Interest in objects, images, screens

Question 6

What are some examples of abnormal visual development?

Answer 6

• “Eye poking” or eye rubbing
•Staring at lights
• Not fixing/following
• Keeping objects very close (<10 cm)
• Photophobia
•Weeping
• Upset in darkness
•Tripping
•Nystagmus/”roving eye movements”

Question 7

What are 5 common conditions to see in children?

Answer 7

• Amblyopia
• Refractive error
• Strabismus
• Nasolacrimal duct obstruction
• Red eyes

Question 8

What needs to be looked at with the eyelids?

Answer 8

• Position, symmetry
• Skin
• Colour
• Swelling
• Lesions

Question 9

What is infantile capillary haemangioma?

Answer 9

•Congenital
• Rapid growth first year of life
• Regression in long term (ca.78% by
7yrs)
• M:F=2:3
• Amblyogenic (occlusion, astigmatism)
• Refraction!

• Often responds to systemic or topic beta-blockers

Question 10

What is cellulitis?

Answer 10

• Preseptal or orbital?
Can be differentiated by looking at:
• visual acuity
• pupils
• white
• proptosis
• eye movements
• disc swelling

Question 11

What eyelid conditions related to lashes are there?

Answer 11

• Look at cilia, direction and rows

• Epiblepharon
• Trichiasis
• Distichiasis

Question 12

What conditions may affect the conjunctiva?

Answer 12

• Exudate
- Watery
- allergy, virus
• Purulent
- bacterial
•Mucous
- allergy

Question 13

How do optoms and orthoptists work together when doing a paediatric refraction?

Answer 13

• New referrals are dealt with by Orthoptists and optometrists
• Cyclo refraction - prescribe full with discussion with orthoptist

Question 14

Tips on refracting young children:

Answer 14

• Be friendly and introduce yourself
• Get down to their level - knees
• Explain what ur going to do in simple terms
• For babies - sing!
• Avoid trial frames, demonstrate on parents, older children is boring so show pictures/cartoons + stickers!

Question 15

Speed of ret on children?

Answer 15

• Quickly sweep streak over eyes - try work quickly
- small cyl missed is fine, can get exact next time

Question 16

Strabismus with ret?

Answer 16

• Get child to cover other eye if old enough

Question 17

Ophthalmoscopy in children?

Answer 17

• If child non-compliant, at least look at red reflexes, try look at discs/macula at least

Question 18

Follow up for children?

Answer 18

• 1 year usually for refraction
• Discharged by community optom when full prescription

Question 19

Managing Aphakic children?

Answer 19

• Babies with significant congenital cataracts operated first 2months leaving then aphakic
• Due to high Rx, cls visual correction - daily
- i.e +33.00Ds

Question 20

Pros in Cls over spectacles for Aphakic babies?

Answer 20

• Image mag is 8% - easier to tolerate in unilateral aphakia
• CLS increase visual field
• Cosmetically more acceptable, much better unilateral cases
• CLs more difficult for infant to remove

Question 21

Cons in Cls over spectacles for Aphakic babies?

Answer 21

• CLs have to be removed by parents every night and inserted every morning
• Increased risk of CL related microbial infections, esp in older days of extended wear CLs
• Parents often have to travel a greater distance for CLs appts as not available in every eye Dept

Question 22

Why is near correction initially important for a child?

Answer 22

• Babies/young children mainly use near vision
• aphakic infants +2.00 to +3.00Ds over corrected.
• As child grows CL power reduces and OD + BC needs to be altered

Question 23

What happens with aphakic Px when 4yrs+?

Answer 23

• can use distance vision muck more, school etc so understand how to use a bifocal for near

Question 24

When does the refraction journey end for aphakic children?

Answer 24

• IOL implants!
• More accurate measurements and better result the longer the child waits
• CLs have played their part in providing good acuity