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Pediatrics > BRS Ophthalmology > Flashcards

BRS Ophthalmology Flashcards

0
Q

visual acuity rapidly improves in the first _____

A

3-4 months

this is when visual development is most critical and if impaired most likely will result in amblyopia

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1
Q

visual acuity is poor at birth

A

T

in the range of 20/200

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2
Q

_____ is poor vision caused by abnormal visual stimulus that resultsi n abnormal visual development
2 main categories of things that cause this

A

amblyopia
eye misalignment like strabismus
any pathologic condition that causes a blurred visual image

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3
Q

significant difference in refractive errors between the eyes

A

anisometropia

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4
Q

best screening tests to prevent amblyopia

A

infants: bilateral red reflex test

older kids: formal acuity testing

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5
Q

neonatal conjunctivitis occurs during ______

A

first month of life

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6
Q

common causes of neonatal conjunctivitis (4)

A

chemical irritation
neisseria gonorrhea infection
chlamydia trachomatis infection
HSV infection

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7
Q

chemical conjunctivitis during neonatal period usually due to _____
timeline and presentation of this
tx

A
  • 1% silver nitrate > 1% tetracycline and 0.5% erythromycin for gonorrhea ppx
  • watery discharge within 24 hours of birth
  • no tx needed
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8
Q

purulent eye discharge within 2-4 days of birth
-eyelid swelling
-can lead to corneal ulcer
what is this, conjunctival studies, tx

A

N gonorrhea infection
gram (-) intracellular diplococci, positive gonococcal culture
IV cefotaxime and topical erythromycin

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9
Q

serous or purulent eye discharge with variable lid swelling within 4-10 days of life
what is this, conjunctival studies, tx

A

chlamydia trachomatis infection
cytoplasmic inclusion bodies, positive culture
oral erythromycin

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10
Q

unilateral serous discharge within 6 days-2weeks of life

what is this, conjunctival studies, tx

A

HSV infection
multinucleated giant cells on gram stain, positive HSV culture
IV acyclovir and topical trifluorothymidine

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11
Q

clear tears, enlarged cornea, corneal edema in a newborn

A

congenital glaucoma

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12
Q

infection of the nasolacrimal sac

A

dacryocycstitis

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13
Q

infection within the eye itself

A

endophthalmitis

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14
Q

conjunctivitis assoc with contact use can be 2/2:

A

allergy to solution
corneal abrasion
bacterial corneal ulcer

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15
Q

causes of unilateral conjunctivitis (3)

A

foreign body
corneal ulcer
HSV keratitis

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16
Q

causes of bacterial conjunctivitis

A

nontypeable H flu, strep pneumo, moraxella, staph aureus

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17
Q

purulent eye discharge with minimal itching
no preauricular LAD
often bilateral involvement and sometimes assoc with otitis media

A

bacterial conjunctivitis

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18
Q

how to tx bacterial conjunctivitis

A

tx empirically- only get cx and gram stain for severe cases

topical abx: sulfacetamide, polymyxin B, trimethoprim sulfate, gentamicin, tobramycin, erythromycin

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19
Q

URI, pharyngitis, fever, bilateral conjunctivitis

what is it and what is it caused by

A

pharyngoconjunctival fever- a type of viral conjunctivitis caused by adenovirus types 3 and 7

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20
Q

severe watery conjunctival discharge, hyperemic conjunctiva, preauricular LAD, foreign body sensation
what is and how to tx it?

A

pharyngoconjunctival fever- a type of viral conjunctivitis
this is highly contagious
tx is supportive- cool compresses, NSAID drops

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21
Q

epidemic keratoconjunctivitis is clinically similar to ________ but sxs are confined to the eyes
which viruses cause this?

A

pharyngoconjunctival fever

adenovirus types 8, 19, and 37

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22
Q

petechial conjunctival hemorrhage, preauricular LAD, pseudomembrane along the conjunctiva, photophobia from corneal inflammation may be present
lack of fever or pharyngitis
highly contagious
what is it and how to tx?

A

epidemic keratoconjunctivitis

supportive tx with cool compresses and NSAID drops

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23
Q 
skin eruption with multiple vesicular lesions
corneal ulcer (rare)

what is it and how to dx and how to tx

A

primary ocular HSV

  • initial exposure to HSV-1
  • dx with H&P and positive viral cx or antibody staining
  • tx with systemic or topical acyclovir to speed up recovery if administered in first 1-2 days
  • topical abx for the skin may prevent secondary bacterial infection
24
Q

severe or mucoid eye discharge with severe itching

what is it, what’s the pathophys, how to tx?

A

allergic conjunctivitis
type 1 hypersensitivity reaction
tx: removal of allergens, topical mast cell stabilizing drops (cromolyn), topical antihistamine

25
Q

what is hemorrhagic conjunctivitis

what are some causes

A

conjunctivitis + subconjunctival hemorrhage

H flu, adenovirus, picornavirus

26
Q

____ is eyelid inflammation usually caused by _____ infection

A

blepharitis

staph aureus

27
Q

burning, crusting, scales at the eyelid bases, h/o awakening with eyes stuck together
what is it and how to tx

A

bepharitis

tx with eyelid hygiene (scrub eyelids with baby shampoo), topical erythromycin

28
Q

watery eye with increased tear lake, matted eyelashes, mucus in the medial canthal area, may be bilateral

A

nasolacrimal duct obstruction- failure of complete canalization of the lacrimal system that results in obstruction to tear outflow

29
Q

how to manage nasolacrimal duct obstruction

A

many resolve by 6 months
nasolacrimal massage
NLD probing if still present at 6-12 months

30
Q

NLD obstruction often occurs at _____

A

Hasner’s valve

31
Q

what is amniotocele/dacryocele

A

swelling of the nasolacrimal sac 2/2 accumulation of fluid as a result of NLD obstruction
-presents with bluish swelling the medial canthal area

32
Q

how to manage dacryocele/amniotocele

A

local massage

if infected, IV abx and urgent NLD probing

33
Q

retinal hemorrhages are highly suggestive of ______

A

child abuse

you would see hemorrhagic dots and blots on dilated funduscopic exam

34
Q

corneal abrasions heal in ______

ophtho consult is needed for ______

A

24-48 hours

corneal abrasions that are due to contact lens use b/c there is higher risk for corneal ulcer

35
Q

what is hyphema

what is the most common cause

A

blood in the anterior chamber

MCC is blunt trauma… others due to iris neovascularization and iris tumors

36
Q

with hyphema, you may see this on PE

what are some complications

A
  • blood aqueous fluid level

- rebleeding, glaucoma, staining of the cornea with blood, optic nerve damage in kids with SS disease

37
Q

how to tx hyphema

A

ophtho consult

bed rest for at least 5 days

38
Q

blow out fx

what are some clinical features

A

orbital floor fx
-orbital fat and inferior rectus muscle can be trapped –> diplopia, strabismus, enophthalmos (backward displacement of the globe)

39
Q

numbness of cheek and upper teeth may occur after ______ 2/2 infraorbital nerve injury

A

orbital floor fx/blow out fx

40
Q

how to tx orbital floor fx

A

empiric oral abx

surgical repair if diplopia persists 2-4 weeks or enophthalmos is bad

41
Q

intraocular pressure > 30 mmHg at or soon after birth

A

congenital glaucoma

42
Q

congenital glaucoma not only results in optic nerve injury but also ________

A

increased eye size b/c eye wall is much more elastic in infancy

43
Q

what causes congenital glaucoma

A

mostly AD inheritance

reduced outflow of aqueous humor 2/2 issues with trabecular meshwork

44
Q

tearing, photophobia, enlarged cornea, corneal clouding, dull red reflex

A

congenital glaucoma

45
Q

how to manage congenital glaucoma

A

surgery to open outflow channels is almost always required

topical or systemic meds: beta adrenergic and CA inhibitors –> may lower IOP

46
Q

retinopathy of prematurity (ROP)

A

proliferation of vessels seen in premature infants exposed to O2

47
Q

management of ROP

A

early detection is essential! for little and premies, do a screening funduscopic exam!!
ophtho exam every 1-2 weeks to monitor for progression
minimize amount of O2 delivered
tx hyaline membrane disease

if severe, then do laser therapy

48
Q

causes of congenital cataracts

A
  • majority are idiopathic
  • genetic syndromes: down, noonan, marfan, alport
  • nonsyndromic inheritance
  • galactosemia, DM
  • intrauterine infections (CMV, rubella)
49
Q

how to manage congenital cataract

A

early surgery within first weeks of life –> great prognosis

50
Q

retinoblastoma is a malignant tumor of the sensory retina

  • age of presentation
  • what’s the etiology/pathophys
  • what’s the inheritance
A
  • 13-18 months
  • mutation or deletion of a growth suppressor gene on both alleles on the long arm of chromosome 13
  • mutations may be sporadic or AR inherited
51
Q

leukocoria, strabismus, and calcification in the eye should make you think of ______

A

retinoblastoma

52
Q

how to dx retinoblastoma

A

ophthalmoscope exam

ocular US or CT to further evaluate the tumor

53
Q

how to tx retinoblastoma

A
  • large tumors involving the macula –> removal of entire eye
  • smaller tumors –> external beam radiation
  • very small peripheral tumors –> cryotherapy or laser photocoagulation
54
Q

cure rate of retinoblastoma

A

90%

prognosis is good but you have to catch it!

55
Q

_______ eye turned nasally

_______ eye turned laterally

A

esotropia

exotropia

56
Q

pseudostrabismus

A

prominence of the epicanthal folds that result in the false appearance of strabismus

57
Q

what happens if you have strabismus before age 5-7 vs. after age 5-7

A

before age 5-7 years: amblyopia

after age 5-7 years: diplopia

58
Q

how to tx amblyopia

A

ocular patching
glasses
surgery if those 2 don’t work

Pediatrics (14 decks)

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