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YR5 Paediatrics > Eye Disease in a Child > Flashcards

Eye Disease in a Child Flashcards

1
Q

Define conjunctivitis.

A

Purulent discharge from the eye.

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2
Q

Define hypermetropia.

A

: Long-sightedness. Light focusses at a point behind the retina.

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3
Q

Define myopia.

A

Short-sightedness. Light focuses on a point in front of the retina.

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4
Q

Define strabismus.

A

Abnormal alignment of both eyes. As a result, the eyes look in different directions and do not focus simultaneously on a single point.

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5
Q

Define retinopathy of prematurity.

A

Vaso-proliferative disorder of the retina affecting premature infants.

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6
Q

Define retinoblastoma.

A

Primary tumor of the immature cells of the retina. Autosomal dominant.

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7
Q

Explain the aetiology/risk factors for conjunctivitis.

A

Infection:

  • Staph aureus, strep pneumoniae, strep viridans
  • Chlamydia trachomatis: Vertical transmission most common (serovars A-C)
  • Neisseria gonorrhoeae: Opthalmia neonatorum
  • Viral: adenovirus; exclude HSV.

Allergy: Vernal keratoconjunctivitis; chronic allergy, history of atopy

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8
Q

Explain the aetiology/risk factors of hypermetropia.

A

Genetic factors

Age

Structural: Abnormal shape of cornea, weak ciliary muscle, low converging power of eye lens.

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9
Q

Explain the aetiology/risk factors for myopia.

A

Genetic factors

Structural factors: Long eyeball diameter, thick cornea.

Endocrine: Acromegaly

Environmental factors (not yet established): Too little time outdoors, excessive close work.

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10
Q

Explain the aetiology/risk factors for strabismus.

A

Non-paralytic: refractive error in one or both eyes.

Paralytic: Squinting eye could be caused by motor nerve paralysis or SOL.

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11
Q

Explain the aetiology of retinopathy of prematurity.

A

During intrauterine development of the retina, retinal vessels should grow out from the optic disc as a wave of mesenchymal spindle cells. The growth of the blood vessels is related to the level of oxygen. In pre-term infants there is earlier exposure to oxygen. In hyperoxic extrauterine situations normal retinal vessel maturation stops causing atrophy of the vessels and leads to ischamia. This in turn causes angiogenic factors to be released leading to angiogenesis in the retina. The new vessels formed are more tortuous and fragile increasing the likelihood of haemorrhage.

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12
Q

What are the risk factors for retinopathy of prematurity?

A

Low birth-weight

Low gestational age at delivery

Prolonged exposure to high oxygen levels

Acidosis

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13
Q

Explain the aetiology/risk factors for retinoblastoma.

A

Genetic defect in chromosome 13q14. Alters RB1 gene (tumour suppressor) or MYCN gene.

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14
Q

Summarise the epidemiology of conjunctivitis.

A

1% live births.

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15
Q

Summarise the epidemiology of myopia.

A

One in 5 teenagers.

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16
Q

Summarise the epidemiology of hypermetropia.

A

10%

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17
Q

Summarise the epidemiology of strabismus.

A

4% of children

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18
Q

Summarise the epidemiology of retinopathy of prematurity.

A

Up to 70% of infants who weigh below 1.25 kg develop ROP.

19
Q

Summarise the epidemiology of retinoblastoma.

A

Rare. 1 case per 30,000.

20
Q

What are the signs and symptoms of conjuncitivits?

A

Newborn: Mild purulent discharge which may be present from the first week of life.

Infections:

  • Lid oedema, chemosis (swelling of the conjunctiva) and discharge.
  • Gonococcal: Rhinitis, stomatitis, arthritis or meningitis.
  • Chlamydial: Pneumonitis, pharyngitis, otitis media.
  • Viral: Usually presents with red watery eye.
  • VKC: Stingy white discharge, very itchy. Giant papillae are seen in the upper tarsal conjunctiva.
21
Q

What are the signs and symptoms of visual impairments?

A

Baby to Toddler: Lack of eye contact with parents, no responsive smiling and impaired social bonding, visual inattention, other developmental delays.

22
Q

What are the signs and symptoms of myopia?

A

Needing to sit near the front of the class, tv. Headaches or tired eyes. Regularly rubbing eyes.

23
Q

What are signs and symptoms of hypermetropia?

A

Need to squint to see clearly, have tired or strained eyes after activities that involve focusing on nearby objects (i.e. computers, books or writing). Headaches.

24
Q

What are signs and symptoms of strabismus?

A

Squint appearance, may have difficulty reading or writing. Headaches.

25
Q

What are signs and symptoms of retinopathy of prematurity?

A

 Prematurity (less than 32 weeks) and low birthweight (less than 1.5kg)

26
Q

What are the signs and symptoms of retinoblastoma?

A

White pupillary reflex, strabismus.

13q syndrome: Mental growth retardation, hand and foot anomalies, cranial-facial dysmorphisms.

27
Q

What are investigations for conjunctivitis?

A

Not usually needed. Swab for infection (chlamydial culture, PCR for viruses), skin prick test for VKC and intraocular pressure.

28
Q

What examinations can be performed for visual impairment?

A

Snellen’s acuity chart- Will reveal if it either short or long-sightedness.

Corneal light reflection test: Reflection of the light simultaneously off both corneas does not appear in the same place.

Cover test: Squinting eye moves to take up fixation when normal eye is covered.

Neuro and fundoscopy should be unremarkable.

29
Q

What investigations should be performed for visual impairment?

A

: Slit lamp test. IOP pressure and retinal imaging if suspicion of other eye conditions. Can perform CT and MRI if there is gross abnormality or suspicion of SOL.

30
Q

What investigations should be performed for retinopathy of prematurity?

A

Indirect ophthalmoscope with indentor to examine the retina after dilation drops. Imaging of the retina may also be useful.

31
Q

What investigations should be performed for retinoblastoma?

A

Fundoscopy, genetic testing. MRI may be needed.

32
Q

What is the management for conjunctivitis?

A

Clean with saline.

Bacterial causes

  • Mild to moderate: Azithromycin ophthalmic 1%
  • Severe or immunocompromised: Ciprofloxacin ophthalmic 0.3%
  • Hyperacute bacterial conjunctivitis (Neisseria): Doxycycline and Ciprofloxacin ophthalmic 0.3%
  • Chlamydia: Azithromycin and Azithromycin ophthalmic 1%.

Viral:

  • Topical antihistamines.
  • Consider adding steroids and ganciclovir.

Allergic: Sodium cromoglicate ophthalmic 4% and anti-histamine.

33
Q

What is the management for visual impairment?

A

Correct refractive errors with glasses or contact lenses (only in older children).

Advise parents on reducing screen time. May need special educational input.

Laser eye surgery when older, only offered above 21 and when the glasses or contact lens prescription has not changed significantly.

34
Q

What is the management for strabismus?

A

Glasses, eye exercises, surgeries and injections into the eye muscle.

35
Q

What is the management for retinopathy of prematurity?

A

Prevention by using reduced concentrations of oxygen when ventilating.

Ablative therapy of new vessels.

Cryotherapy can be considered but laser therapy is now preferred.

36
Q

What is the management for retinoblastoma?

A

Chemotherapy, radiotherapy. Enucleation if the anterior chamber is intact.

37
Q

What complications are associated with conjunctivitis?

A

Corneal ulceration, inversion of eyelids. Bacterial causes can lead to blindness.

38
Q

What complications are associated with visual impairment?

A

May not meet educational standards if not detected early, social stigma and amblyopia in strabismus. There are also complications in paralytic strabismus which are associated with its cause.

39
Q

What complications are associated with retinopathy of prematurity?

A

Severe visual impairment, myopia, amblyopia, strabismus and complications of treatment (conjunctival haemorrhages, laceration or cataracts).

40
Q

What complications are associated with retinoblastoma?

A

Secondary malignancy, carboplatin optic nerve atrophy.

41
Q

What is the prognosis of conjunctivitis?

A

Good with prompt treatment.

42
Q

What is the prognosis of visual impairment?

A

: Lifelong condition that is extremely manageable with corrective lenses. Can be treated definitively with laser eye therapy.

43
Q

What is the prognosis of retinopathy of prematurity?

A

: Require yearly follow-up due to complications, lower survival rate due to prematurity itself.

44
Q

What is the prognosis of retinoblastoma?

A

Varies according to optic nerve involvement. Poor with optic nerve involvement.

YR5 Paediatrics (116 decks)

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