wk10: BVP - Paeds OCULAR CONDITIONS Flashcards
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
Hyperopia: > +3.50D Myopia: > -3.00D Astigmatism: >1.50D at 90/180 >1.00D at oblique axis Anisometropia: >1.50D
What is the main guideline for managing refractive error in children 1-4yo?
If >+3.50, prescribe 1D less
What is the main guideline for managing refractive error in children 4-5yo?
If >+2.50, prescribe 1D less
What is the main guideline for managing refractive error in children 5+yo? (3)
If >+1.50, prescribe full If any myopia, prescribe full If myopia with eso, prescribe full and near add
What is the main guideline for managing anisometropia in children 3.5+?
If >1.00 anisometropia, prescribe full
What is the main guideline for managing astigmatism in children 4+?
If >1.50D astigmatism, prescribe full
What condition is this? Describe. How long will it present like this for? Is it common or rare? How serious is it?
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
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?
Cataract
Limited or no red reflex
Poor sight
May look like leukocoria
What is this? Define it. What condition is this associated with?
Ectopia lentis - connective tissue defect often associated with Marfan syndrome
What is this? Define. How is vision? Explain. Unilateral or bilateral? What comorbidities is it associated with? (2)
Aniridia - no iris. Poor vision because there is no aperture to control for light. Bilateral. Associated with nystagmus and (often) cataract)
What is this? Describe characteristics (3).
Microphthalmos: one eye underdeveloped and way too small.
Small globe
Marked hypermetropia
Macular hypoplasia
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?
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)
In ON hypoplasia, is there a correlation between the size of the optic nerve and vision loss?
No
What is this? Define. Describe it’s characteristics/what happens to the eye (4)
ROP (retinopathy of prematurity) - incomoplete retinal vessel growth which leads to vascular changes
Features:
Retinal detachment
Vessel tortuosity
Neovascularisation
Haemorrhages
What is “Plus disease”? How many stages are there
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
What are the risk factors for ROP (retinopathy of prematurity)? (3)
Premature birth (<30wks)
Low birth weight (<1500g)
Supplemental O2 at birth (triggers adverse reaction in retina)
What’s this? Unilateral or bilateral? Describe characteristics (2) What does it cause? (3)
Papilledema
Bilateral
Vascular tortuosity
Swelling of the disc
Causes: Brain tumour, hydrocephalus (water on brain), ADEM (acute disseminated encephalomycleitis)
What’s this? Describe (2). Unilateral or Bilateral? What is the percentage incidence in kids? What causes this? (1)
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
What’s this? Is it self limiting? What does it most commonly lead to?
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)
What is inactive toxoplasmosis (static lesion) characterised by? (3)
Chorioretinitis, with a large, round atrophic scar (pigmented margins, but white centrally) at the posterior pole and macula
What is active toxoplasmosis (progressive lesion) characterised by? (5, but you could just name the first 2 honestly)
Active inflammation with a “foggy headlights” appearance. You have retinal opacification and associated retinal vascular sheathing. Pigmented lesion is present
What’s this? What does it typically lead to? What causes it?
Toxocariasis, typically causes a posterior uveitis, caused by a worm like parasite infection from dog faeces living in the retina
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?
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.
What condition is this? Describe clinical features (3). Any symptoms? (2) Is it unilateral or bilateral? How common? Which gender most affected?
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
List 8 factors that may place an infant, toddler or child at significatn risk for visual impairment or reduced visual functioning
- Prematurity, etc.
- Fx history retinoblastoma, congenital cataract, metabolic or genetic disease
- Infected pregarnt mother (e.g. rubella, toxoplasmosis, AIDS, or cytomegalovania ;) )
- Difficult/assisted labour
- High Rx
- STRAB
- Anisometropia
- Known/suspected CNS dysfunction, developmental delay, palsy, seizures, hydrocephalus
List 5 special needs conditions children might have
Down syndrome
Cerebral palsy
Autism (ASD)
Juvenile idiopathic arthritis (JIA)
Learning/developmental conditions (dyslexia, learning disability, intellectual disability, motor delay, language delay)
List 6 ocular manifestations of down syndrome
STRAB, Amblyopia, High Rx, Medication sensitivity (e.g. tropicamide, cyclopentolate), Reduced accommodative function, Vision impairment/cataract
List 4 ocular manifestations of cerebral palsy
Visual impairment (ocular/cortical)
High Rx
STRAB
Cataract
When is the risk of cerebral palsy development greater? (1)
In low birht weight babies
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)
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
What percentage of children with cerebral palsy also manifest cortical/cerebral visual impairment (CVI)?
60-70%
List 5 ocular manifestations of autism
- Avoid eye contact, excessive blinking
- Higher risk of STRAB, amblyipia, anisometropia
- Visual motor + sequencing problems common
- Accommodation dysfunction, astigmatism common
- Visual processing (non motor) usually very well developed (i.e. is fine/ok)
How does Juvenile Idiopathic Arthritis manifest ocularly? (2). What ocular complications may occur? (4)
8% higher incidence of uveitis (20% in children who are ANA +)
Asymptomatic, bilateral, non-granulomatous iridocyclitis
Complications: Cataract, glaucoma, band keratopathy, phtisis bulbi
Do patients with Juvenile Idiopathic Arthritis present with eye pain?
No. It’s incidious
When must children with JIA have an eye examination?
Children with JIA under 12 years of age are at risk of ocular complications and must have an eye exam
What facet/component of vision is affected the most by learning disabilities?
Visual efficiency
Is excessive blinking associated with ocular/systemic disorder?
Not neccessarily, but must examine thoroughly to ensure any possible ocular cause is uncovered and managed by way of exclusion.
What is Psychogenic Vision Loss/Streff syndrome? When does it occur? Provide an example, lol
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
In 4 points, explain the unexplained vision loss that can occur in Streff Syndrome? (4)
- Bilateral (near and or distance)
- Psychogenic origin - not typically deliberate
- Able to pass some psycho-physical tests that should
- No evidence of any pathology, refractive or amblyogenic causes (try VEP testing?)
Describe the typical presentation of somebody with Streff syndrome? (3)
Child 7-12 years
Female < male sensitive
Co-existing external emotional disturbance (learning issues, self esteem, family crisis)
(Like nunally amirite?. Jibun wooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo)
What should you rule out in a patient with possible Streff syndrome? (1)
Rule out stargardts disease
