C&F: Congenital conditions & Common variation of normal ocular tissues

Question 1

briefly describe congenital abnormalities

Answer 1

condition that is recognised at birth / been present since birth

genetically/sporadically/environmentally caused

Question 2

explain epicanthal folds

Answer 2

congenital, benign condition of bilateral vertical folds of skin of the upper eyelid margins at the inner acanthi

cause of pseudostrabismus, common in oriental people (their fold structure), seen in babies before development of nose bridge

optometrist objective: rule out strabismus and px assurance + education

Question 3

compare & contrast distichiasis and trichiasis

Answer 3

distichiasis: extra row of lashes behind meibomian glands, may cause trichiasis, may be acquired (lashes grow from dysfunctional meibomian glands

optometrist objective: check corneal integrity to ensure eyelashes are not rubbing against cornea (corneal staining or secondary cornea infections)

mx: usually cryotherapy or laser/electrolysis as epilation is only short term and can be painful (full row to be plucked)
trichiasis: the inward growth of eyelashes that can poke the cornea, causing corneal staining or secondary corneal infection
mx: usually epilation (few lashes) or cryotherapy, laser/electrolysis

Question 4

describe Keratoconus

Answer 4

a form of corneal ectasia, onset usually in teens & stabilises in 30-40s, may not (+) FHx

systemic associations: Marfan syndrome, Down syndrome, ehlers-danlos syndrome

Question 5

explain subjective & objective aspects of Keratoconus

Answer 5

subjective: slow insidious refractive changes, frequent atopic association, painless, photophobia and occasional monocular diplopia
objective: changing rx with increasing myopia & irregular astigmatism, reduced best VA over months to years with specs, scissors reflex on retinoscopy