wk10: BVP - Paeds OCULAR CONDITIONS

Question 1

What are the evidence based guidelines for screening for amblyogenic potential in the following refractive conditions in children from 0-3 yo? Hyperopia Myopia Astigmatism (including oblique axis, 2) Anisometropia

Answer 1

Hyperopia: > +3.50D Myopia: > -3.00D Astigmatism: >1.50D at 90/180 >1.00D at oblique axis Anisometropia: >1.50D

Question 2

What is the main guideline for managing refractive error in children 1-4yo?

Answer 2

If >+3.50, prescribe 1D less

Question 3

What is the main guideline for managing refractive error in children 4-5yo?

Answer 3

If >+2.50, prescribe 1D less

Question 4

What is the main guideline for managing refractive error in children 5+yo? (3)

Answer 4

If >+1.50, prescribe full If any myopia, prescribe full If myopia with eso, prescribe full and near add

Question 5

What is the main guideline for managing anisometropia in children 3.5+?

Answer 5

If >1.00 anisometropia, prescribe full

Question 6

What is the main guideline for managing astigmatism in children 4+?

Answer 6

If >1.50D astigmatism, prescribe full

Question 7

What condition is this? Describe. How long will it present like this for? Is it common or rare? How serious is it?

Answer 7

Retinoblastoma - malignant tumor of embryonic retinal cells
Presents with “leukocoria” (white milky pupil reflex) for first 2 years of life
Rare
Very serious, immediate referral

Question 8

What condition is this? What is it characterised by (as seen in image)? How good is the vision? What may this look like/be confused for?

Answer 8

Cataract
Limited or no red reflex
Poor sight
May look like leukocoria

Question 9

What is this? Define it. What condition is this associated with?

Answer 9

Ectopia lentis - connective tissue defect often associated with Marfan syndrome

Question 10

What is this? Define. How is vision? Explain. Unilateral or bilateral? What comorbidities is it associated with? (2)

Answer 10

Aniridia - no iris. Poor vision because there is no aperture to control for light. Bilateral. Associated with nystagmus and (often) cataract)

Question 11

What is this? Describe characteristics (3).

Answer 11

Microphthalmos: one eye underdeveloped and way too small.

Small globe
Marked hypermetropia
Macular hypoplasia

Question 12

What’s this? Describe appearance. How is vision affected? Is it easy or difficult to detect if mild? Unilateral or bilateral? How is this defined?

Answer 12

Optic Nerve hypoplasia
Small grey ON
Reduced/normal vision
Difficult to detect if mild
May be unilateral or bilateral
Defined by size of disc relative to distane from disc to macula (dist. from disc margin to mac >2DD)

Question 13

In ON hypoplasia, is there a correlation between the size of the optic nerve and vision loss?

Answer 13

No

Question 14

What is this? Define. Describe it’s characteristics/what happens to the eye (4)

Answer 14

ROP (retinopathy of prematurity) - incomoplete retinal vessel growth which leads to vascular changes
Features:
Retinal detachment
Vessel tortuosity
Neovascularisation
Haemorrhages

Question 15

What is “Plus disease”? How many stages are there

Answer 15

Collective term that refers to the vascular changes that occur as a result of ROP (retinopathy of prematurity). Categorised into 4 stages of severity, Stages I - IV

Question 16

What are the risk factors for ROP (retinopathy of prematurity)? (3)

Answer 16

Premature birth (<30wks)
Low birth weight (<1500g)
Supplemental O2 at birth (triggers adverse reaction in retina)

Question 17

What’s this? Unilateral or bilateral? Describe characteristics (2) What does it cause? (3)

Answer 17

Papilledema
Bilateral
Vascular tortuosity
Swelling of the disc
Causes: Brain tumour, hydrocephalus (water on brain), ADEM (acute disseminated encephalomycleitis)

Question 18

What’s this? Describe (2). Unilateral or Bilateral? What is the percentage incidence in kids? What causes this? (1)

Answer 18

ONH drusen: accellular calcified deposits (drusen) with a lumpy bumpy appearance that can be either unilateral or bilateral. Occurs in 0.4% of children. Cause unknown but possibly related to high hyperopia

Question 19

What’s this? Is it self limiting? What does it most commonly lead to?

Answer 19

Toxoplasmosis - infection carried from cat faeces. Usually self limiting in immunocompetent patients but can be severe in fetus or immunocompromised patients.
Commonly leads to posterior uveitis (inflammation of choroid)

Question 20

What is inactive toxoplasmosis (static lesion) characterised by? (3)

Answer 20

Chorioretinitis, with a large, round atrophic scar (pigmented margins, but white centrally) at the posterior pole and macula

Question 21

What is active toxoplasmosis (progressive lesion) characterised by? (5, but you could just name the first 2 honestly)

Answer 21

Active inflammation with a “foggy headlights” appearance. You have retinal opacification and associated retinal vascular sheathing. Pigmented lesion is present

Question 22

What’s this? What does it typically lead to? What causes it?

Answer 22

Toxocariasis, typically causes a posterior uveitis, caused by a worm like parasite infection from dog faeces living in the retina

Question 23

What’s this condition called? Describe it? How common is it in kids? How does it affect vision? Is it unilateral or bilateral? How is it genetically inheritied?

Answer 23

Stargardt’s disease - is the most common form of macula degeneration in kids (but still rare in general). It is bilateral and affects central vision, causing a loss in central vision by school age or first 20 years of life. It is autosomal recessive in inheritance.

Question 24

What condition is this? Describe clinical features (3). Any symptoms? (2) Is it unilateral or bilateral? How common? Which gender most affected?

Answer 24

Congential Glaucoma. Characterised by enlarged, swollen, hazy cornea in kids 0-3yo with blepharospasm and elevated IOP. Symptoms include: photophobia and excessive tearing. It’s bilateral, rare, and males>females

Question 25

List 8 factors that may place an infant, toddler or child at significatn risk for visual impairment or reduced visual functioning

Answer 25

1. Prematurity, etc.
2. Fx history retinoblastoma, congenital cataract, metabolic or genetic disease
3. Infected pregarnt mother (e.g. rubella, toxoplasmosis, AIDS, or cytomegalovania ;) )
4. Difficult/assisted labour
5. High Rx
6. STRAB
7. Anisometropia
8. Known/suspected CNS dysfunction, developmental delay, palsy, seizures, hydrocephalus

Question 26

List 5 special needs conditions children might have

Answer 26

Down syndrome
Cerebral palsy
Autism (ASD)
Juvenile idiopathic arthritis (JIA)
Learning/developmental conditions (dyslexia, learning disability, intellectual disability, motor delay, language delay)

Question 27

List 6 ocular manifestations of down syndrome

Answer 27

STRAB, Amblyopia, High Rx, Medication sensitivity (e.g. tropicamide, cyclopentolate), Reduced accommodative function, Vision impairment/cataract

Question 28

List 4 ocular manifestations of cerebral palsy

Answer 28

Visual impairment (ocular/cortical)
High Rx
STRAB
Cataract

Question 29

When is the risk of cerebral palsy development greater? (1)

Answer 29

In low birht weight babies

Question 30

Describe the pathology behind the cortical/cerebral visual impairment in cerebral palsy. Where does the problem occur? (important because it’s underlined in the lecture slide)

Answer 30

Damage/malfunction to retro-geniculate visual pathways posterior to the LGN (i.e. optic raditions, occipital cortex, visual associative areas) in the absence of any major ocular disease

Question 31

What percentage of children with cerebral palsy also manifest cortical/cerebral visual impairment (CVI)?

Answer 31

60-70%

Question 32

List 5 ocular manifestations of autism

Answer 32

1. Avoid eye contact, excessive blinking
2. Higher risk of STRAB, amblyipia, anisometropia
3. Visual motor + sequencing problems common
4. Accommodation dysfunction, astigmatism common
5. Visual processing (non motor) usually very well developed (i.e. is fine/ok)

Question 33

How does Juvenile Idiopathic Arthritis manifest ocularly? (2). What ocular complications may occur? (4)

Answer 33

8% higher incidence of uveitis (20% in children who are ANA +)
Asymptomatic, bilateral, non-granulomatous iridocyclitis
Complications: Cataract, glaucoma, band keratopathy, phtisis bulbi

Question 34

Do patients with Juvenile Idiopathic Arthritis present with eye pain?

Answer 34

No. It’s incidious

Question 35

When must children with JIA have an eye examination?

Answer 35

Children with JIA under 12 years of age are at risk of ocular complications and must have an eye exam

Question 36

What facet/component of vision is affected the most by learning disabilities?

Answer 36

Visual efficiency

Question 37

Is excessive blinking associated with ocular/systemic disorder?

Answer 37

Not neccessarily, but must examine thoroughly to ensure any possible ocular cause is uncovered and managed by way of exclusion.

Question 38

What is Psychogenic Vision Loss/Streff syndrome? When does it occur? Provide an example, lol

Answer 38

AKA functional vision loss or hysterical amblyopia. Characteristed by unexplained vision loss and is associated with kids in stressful situations

It’s kind of like Nunally from code geass, who went blind after seeing her mother get killed. It was the hysteria that made her blind. Ok that example is a tad extreme because I don’t think this causes blindness, but i’m not sure.

“Jibun Wo” https://www.youtube.com/watch?v=cZ7zQbMxm28

Question 39

In 4 points, explain the unexplained vision loss that can occur in Streff Syndrome? (4)

Answer 39

1. Bilateral (near and or distance)
2. Psychogenic origin - not typically deliberate
3. Able to pass some psycho-physical tests that should
4. No evidence of any pathology, refractive or amblyogenic causes (try VEP testing?)

Question 40

Describe the typical presentation of somebody with Streff syndrome? (3)

Answer 40

Child 7-12 years
Female < male sensitive
Co-existing external emotional disturbance (learning issues, self esteem, family crisis)

(Like nunally amirite?. Jibun wooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo)

Question 41

What should you rule out in a patient with possible Streff syndrome? (1)

Answer 41

Rule out stargardts disease