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Paediatrics cabinetchip > Paediatric ophthalmology > Flashcards

Paediatric ophthalmology Flashcards

1
Q

what visual milestones should neonates have 1

A

fixing and following
-eye popping

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2
Q

what visual milestones should a baby have

A

preferential looking

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3
Q

what visual milestones should a 2 year old have

A

identify or matching pictures

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4
Q

what visual milestones should a 3 year old have

A

be able to match on a letter chart

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5
Q

define amblyopia

A

poor vision in a structurally normal eye

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6
Q

basic pathophys of ambylopia

A

happens during first 7 years of life
-if image received in brain from one eye is poorer than the other then the brain favours the better eye
-this causes one eye to turn off-> abylopia

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7
Q

causes of ambylopia 3

A

reduced view thorguh eye
-eg ptosis or cataract

unequal focus
-one eye is more long or short sighted-> anisometropia

misalignment of eyes-> squint

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8
Q

treatment for ambylopia

A

occulsion patch or atropine over the better eye
-forces the poorer eye to be used to see

-patch is always worn under glasses if prescribed

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9
Q

regarding squints
-what are eye(s) turned inwards called
-what are eye(s) turned outwards called

A

inward- esotropia or convergent squint

outward- exotropia or divergent squint

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10
Q

how to assess symmetry of eyes

A

look at the corneal light reflex

check eye movements
-must be assured to be full in both versions
-and separately also

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11
Q

treatment of squints 3

A

many are cured by glasses to correct existing longsightedness (hypermetropia)
if completely cured-> fully accommodative squint

if partial cure (some squint remains)-> partially accommodative squint

otherwise
-conserative management
-surgery

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12
Q

when is the red reflex checked in a baby

*- note it is red in caucasains and more yellow coloured in other races

A

at birth

and at 6 week check

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13
Q

causes of loss of red reflex (often becomes white-> Leukocoria) 5

A

cataract- most common
-operated on in first few weeks of life

retinoblastoma
-rare but potentially fatal tumour of the retina
-can be treated successfully if present early

retinal detachment

toxoplasmosis

uveitis

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14
Q

what eye involvement is seen in neurofibromatosis type 1 (NF1)
-when is it helpful

A

Lisch nodules
-used if genetic testing has been declined

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15
Q

what eye involvement is seen in Albinism

A

iris transillumination
-used in diagnosis
-child may benefit from tinted lenses

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16
Q

what eye involvement is seen in Marfans syndrome

A

dislocated lens
-part of marfans screening
-may require treatment and/or management

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17
Q

what eye involvement is seen in juvenile idiopathic arthritis

A

anterior uveitis
-screen for JIA if seen

18
Q

define nasolacrimal duct obstruction (NLDO)

A

incomplete canalisation of nasolacrimal duct

-v common presentation with anxious parents in new borns

19
Q

how does nasolacrimal duct obstruction (NLDO) present 1
-managemnt 1

A

sticky watery eye with no conjuncititis

-most resolve spontaneously by age 1

20
Q

define conjunctivitis

A

inflammation of the conjunctiva

21
Q

define the conjunctiva

A

think layer of tissue that covers the inside of the eyelids and the sclera of the eye

22
Q

types of conjunctivitis 3

A

bacterial

viral

allergic

23
Q

presenation of conjunctivitis 5

A

unilateral or bilateral

red eye

blood shot

itchy or gritty sensation

discharge from eye

24
Q

what symptoms are not caused by conjunctivitis and should prompt a different diagnosis 3

A

pain

photophobia

reduced visual acuity
(although vision may be blured by discharge should clear when discharge is removed)

25
Q

how does bacterial conjunctivitis present diffirenetly 4

A

purulent discharge and inflamed conjunctiva

worse in morning

usually starts one eye and can spread

highly contagious

26
Q

how does conjunctivitis (viral) present differently 4

A

usually with clear discharge

often associated w syx of viral infection ie dry cough, sore throat and blocked nose

may find tender preauricular lymph nodes

contagious

27
Q

how can causes of red eye be split

A

painless and painful

*generaly the more serious causes are painful and also have reduced visual acuity

28
Q

causes of painless red eye 3

A

conjunctivitis

episcleritis

subconjunctival haemorrhage

29
Q

causes of painful red eye 7

A

glaucoma

anterior uveitis

scleritis

corneal abraision or ulceration

keratitis

foreign body

traumatic or chemical injury

30
Q

prinicples of management of conjunctivitis 5

A

usually resolves without treatment after 1-2 weeks

advise good hygiene to avoid spreading:
-avoid sharing towels
-avoid rubbing eyes
-regularly wash hands

avoid use of contact lenses

clean eyes w cooled boiled water and cotton wool to help clear discharge

31
Q

treatment for bacterial conjunctivitis 2

A

antibiotic eye drops can be considered
*-note often get better without treatment

chloramphenicol eye drops
or
fusidic acid eye drops

32
Q

how is management of conjunctivitis in patients under 1 year old different 1
-why 2

A

need urgent ophthalmology review

-neonatal conjunctivitis can be associated with gonococcal infection
-can cause loss of sight and more severe complications like pneumonia

33
Q

cause of allergic conjunctivitis

A

caused by contact with allergens

34
Q

presenation of allergic conjunctivitis

A

swelling of conjunctival sac and eye lid with significant watery discharge and itch

35
Q

treatment for allergic conjunctivitis 1

-patients with chronic seasonal syx treatment 1

A

antihistamines (oral or topical) can be used to reduce symptoms (topical- antazoline)

-chronic seaonsal symptoms
-use topical mast-cell stabilisers (nedocromil)
-work by preventing mast cells releasing histamine

require several weeks before showing any benefit

36
Q

inheritance pattern of retinoblastoma

A

autosomal dominant

-around 10% of cases are hereditary

37
Q

basic pathophys of retinoblastoma

A

loss of function of retinoblastoma tumour suppressor gene on chromosome 13

38
Q

ffeatures of retinoblastoma 3

A

loss of red reflex - get white pupil (leukocoria) instead

strabismus

visual problems

39
Q

managemtn of retinoblastoma

A

enucleation (remove eye)

if not so advanced:
-external beam radiation therapy
-chemo
-photocoagulation

40
Q

mangement of congenital cataracts

A

surgery

41
Q

mangement of congenital cataracts

A

surgery

42
Q

investigations for retinoblastoma and congenital cataracts

A

complete eye exam by specialist ophthalmologist

Paediatrics cabinetchip (80 decks)

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