DISORDERS OF THE EYE PART 2 (NELSONS)

Question 1

What is congenital esotropia and when does it develop?

Answer 1

Congenital esotropia, also known as infantile esotropia, is a convergent strabismus that develops during the first 6 months of life.

Question 2

What is the prevalence of congenital esotropia?

Answer 2

It represents 8.1% of all esodeviations and has been reported in 1 of 403 live births.

Question 3

What are the characteristics of infantile esotropia?

Answer 3

Infantile esotropia is characterized by a constant large-angle esotropia, usually around 40 prism diopters.

Question 4

How does cross-fixation manifest in congenital esotropia?

Answer 4

Cross-fixation occurs when the infant looks at objects on the left side with the right eye and uses the left eye for objects on the right.

Question 5

What percentage of infants with congenital esotropia develop amblyopia?

Answer 5

Amblyopia is present in 20% to 70% of infants with congenital esotropia.

Question 6

What systemic conditions are associated with congenital esotropia?

Answer 6

Conditions include Down syndrome, albinism, cerebral palsy, and neurologic or developmental issues.

Question 7

What is the primary management for congenital esotropia?

Answer 7

Strabismus surgery, typically bilateral medial rectus recessions, is the definitive management.

Question 8

At what age is surgery recommended for congenital esotropia?

Answer 8

Surgery is recommended between 6 months and 18 months of age.

Question 9

What is congenital nasolacrimal duct (NLD) obstruction?

Answer 9

It is an obstruction of the nasolacrimal duct present at birth, affecting 5% of term babies.

Question 10

What are the signs of congenital NLD obstruction?

Answer 10

Signs include epiphora, increased tear lake, and mucous discharge.

Question 11

How is congenital NLD obstruction confirmed?

Answer 11

The dye disappearance test is used, where fluorescein dye retention after 5 minutes indicates obstruction.

Question 12

What is the conservative treatment for NLD obstruction?

Answer 12

Conservative treatment includes Crigler massage and topical antibiotics for conjunctivitis.

Question 13

What is the success rate of probing for NLD obstruction?

Answer 13

Probing is effective and has a higher success rate when done promptly at 12 months of age.

Question 14

What is amblyopia?

Answer 14

Amblyopia is a reversible loss of vision in one or both eyes not improved by glasses and without pathology of the fundus.

Question 15

What are the critical ages for amblyopia susceptibility?

Answer 15

Children are susceptible from birth to 7 or 8 years of age.

Question 16

What are the types of amblyopia based on causative factors?

Answer 16

Types include deprivational, strabismic, anisometropic, and ammetropic amblyopia.

Question 17

What is the prevalence of amblyopia in developed countries?

Answer 17

The prevalence ranges from 1% to 5%.

Question 18

How is amblyopia diagnosed clinically?

Answer 18

It is diagnosed by poor vision not improving with glasses and no organic pathology in the retina or optic nerve.

Question 19

What is occlusion therapy for amblyopia?

Answer 19

Occlusion therapy involves patching the better eye to force use of the amblyopic eye.

Question 20

How does atropine penalization work for amblyopia?

Answer 20

Atropine blurs the better eye to make it visually inferior, encouraging use of the amblyopic eye.

Question 21

What is strabismus?

Answer 21

Strabismus is any misalignment of the eyes from the visual axis. It can be horizontal (esotropia or exotropia) or vertical (hypertropia or hypotropia).

Question 22

What is esotropia?

Answer 22

Esotropia is the inward deviation of the eye.

Question 23

What is exotropia?

Answer 23

Exotropia is the outward deviation of the eye.

Question 24

What is hypertropia?

Answer 24

Hypertropia is the upward deviation of the eye.

Question 25

What is hypotropia?

Answer 25

Hypotropia is the downward deviation of the eye.

Question 26

What is the pathophysiology of strabismus due to thyroid eye disease?

Answer 26

Mechanical restriction of one or more extraocular muscles causes the eyes to drift towards the restricted muscles.

Question 27

Which conditions are associated with a high incidence of strabismus?

Answer 27

Cerebral palsy and Down syndrome.

Question 28

Which type of strabismus is more common in Caucasians?

Answer 28

Esotropia is more common than exotropia.

Question 29

Which type of strabismus is more common in Asians?

Answer 29

Exotropia is 2.5 times more common than esotropia.

Question 30

What is comitant esotropia?

Answer 30

It is esotropia where the degree of crossing remains the same in all gaze directions.

Question 31

What are examples of comitant esotropia?

Answer 31

Congenital esotropia and accommodative esotropia.

Question 32

What is accommodative esotropia?

Answer 32

It is a convergent strabismus that occurs in children aged 2–3 years, caused by the synkinetic reflex of accommodation and convergence.

Question 33

What is the treatment for persistent crossing in accommodative esotropia?

Answer 33

Eyeglasses correction, atropine penalization, and possibly surgery.

Question 34

What is pseudoesotropia?

Answer 34

Pseudoesotropia is a false appearance of esotropia caused by prominent epicanthal folds, especially in Asian children.

Question 35

What is the cause of incommitant esotropia?

Answer 35

It is caused by weak lateral rectus muscles or medial rectus restriction and may present with diplopia.

Question 36

What are key features of CN VI palsy?

Answer 36

Weakness of the lateral rectus muscle, esotropia on the affected side, and abduction deficit.

Question 37

What is Duane's syndrome?

Answer 37

A congenital absence of CN VI with aberrant regeneration of CN III, often presenting with lid fissure narrowing on adduction and face turn.

Question 38

What is Möebius syndrome?

Answer 38

It is bilateral facial nerve paralysis with horizontal gaze palsy, presenting with esotropia and no facial expression.

Question 39

What is intermittent exotropia?

Answer 39

It is a divergent strabismus with both phoric and trophic phases, initially seen in distance vision and progressing to constant deviation.

Question 40

What is the treatment for intermittent exotropia?

Answer 40

Early surgery to prevent loss of depth perception; non-surgical options include over-minus lenses and orthoptic exercises.

Question 41

What is convergence insufficiency?

Answer 41

It is the inability to maintain convergence on near objects, with symptoms of reading difficulty, blurred vision, and diplopia.

Question 42

What causes sensory strabismus?

Answer 42

Loss of vision due to optic or retinal pathology, amblyopia, or uncorrected refractive errors.

Question 43

What is retinoblastoma?

Answer 43

The most common primary intraocular tumor in children in the Philippines, caused by mutations in retinal cells.

Question 44

What is the inheritance pattern of heritable retinoblastoma?

Answer 44

It is passed in an autosomal dominant pattern with complete penetrance.

Question 45

What is the most common presentation of retinoblastoma?

Answer 45

Leukocoria (white pupil or cat's eye reflex).

Question 46

What are key imaging findings in retinoblastoma?

Answer 46

Presence of intraocular calcium deposits on B-scan ultrasound, CT, or MRI.

Question 47

What is the treatment for small retinoblastoma tumors?

Answer 47

Cryotherapy and laser photoablation.

Question 48

What is the treatment for retinoblastoma occupying more than 50% of the eye?

Answer 48

Enucleation of the affected eye.

Question 49

What is brachytherapy used for in retinoblastoma?

Answer 49

To treat small to medium-sized tumors, though it may cause radiation optic neuropathy.

Question 50

What are the stages of retinoblastoma?

Answer 50

Stage 1: Intraocular; Stage 2: Intraocular far advanced; Stage 3: Intraorbital/metastatic spread.

Question 51

How should retinoblastoma patients' families be counseled?

Answer 51

Genetic counseling is essential, particularly for heritable retinoblastoma cases.

Question 52

What is the typical duration of acute bacterial conjunctivitis?

Answer 52

Less than 3 weeks.

Question 53

What are the most common etiologic organisms in acute bacterial conjunctivitis?

Answer 53

S. pneumoniae, Haemophilus sp., and Moraxella spp.

Question 54

What are the key symptoms of acute bacterial conjunctivitis?

Answer 54

Unilateral or bilateral conjunctival hyperemia, mucopurulent discharge, morning lid sealing, and foreign body sensation.

Question 55

What is the recommended treatment for acute bacterial conjunctivitis?

Answer 55

Topical antibacterial drops.

Question 56

What is the duration of symptoms for hyperacute and chronic bacterial conjunctivitis?

Answer 56

Hyperacute: 24 hours to a few days; Chronic: More than 4 weeks.

Question 57

What are the possible pathogens for hyperacute bacterial conjunctivitis?

Answer 57

N. gonorrhea, N. meningitidis, Streptococcus, and Staphylococcus.

Question 58

What is the treatment for hyperacute bacterial conjunctivitis without corneal perforation?

Answer 58

1 g IM ceftriaxone.

Question 59

What is the treatment for hyperacute bacterial conjunctivitis with corneal perforation?

Answer 59

1 g IV ceftriaxone every 12 hours for 3 days.

Question 60

What syndrome is associated with blepharokeratoconjunctivitis?

Answer 60

Anterior or posterior lid margin blepharitis, conjunctivitis, and keratopathy.

Question 61

What are the symptoms of blepharokeratoconjunctivitis?

Answer 61

Recurrent episodes of chronic red eye, tearing, photophobia, blepharitis, and keratitis.

Question 62

What are the treatment options for blepharokeratoconjunctivitis?

Answer 62

Lid hygiene, topical antibacterials, steroids, and macrolides like erythromycin.

Question 63

What characterizes allergic conjunctivitis?

Answer 63

Type 1 hypersensitivity reaction with acute, bilateral pale conjunctival edema, tearing, photophobia, and marked itchiness.

Question 64

What conditions are associated with allergic conjunctivitis?

Answer 64

Asthma, atopic dermatitis, and allergic rhinitis.

Question 65

What are the subtypes of allergic conjunctivitis?

Answer 65

Seasonal keratoconjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis.

Question 66

What is the hallmark feature of vernal keratoconjunctivitis?

Answer 66

Intense itching with palpebral and bulbar conjunctival involvement.

Question 67

What is the recommended treatment for atopic keratoconjunctivitis?

Answer 67

Topical antihistamines, mast cell stabilizers, NSAIDs, and steroid-containing eye drops.

Question 68

What is the typical presentation of viral conjunctivitis?

Answer 68

Minimal conjunctival hyperemia and watery discharge lasting a few days.

Question 69

What is the cause of epidemic keratoconjunctivitis (EKC)?

Answer 69

Adenovirus 18, 19, and 37.

Question 70

What are the symptoms of pharyngoconjunctival fever (PCF)?

Answer 70

Conjunctival hyperemia, subconjunctival hemorrhage, edema, tearing, lid swelling, sore throat, fever, and preauricular lymphadenopathy.

Question 71

What is the diagnostic stain for herpes simplex virus conjunctivitis?

Answer 71

Fluorescein or Rose Bengal stain.

Question 72

What is the treatment for herpes simplex virus conjunctivitis?

Answer 72

Topical antivirals like trifluridine or vidarabine and oral acyclovir for recurrent cases.

Question 73

What pathogens cause bacterial keratitis in children?

Answer 73

P. aeruginosa, S. aureus, and Streptococcus pneumoniae.

Question 74

What differentiates preseptal cellulitis from orbital cellulitis?

Answer 74

Preseptal cellulitis has no proptosis or globe inflammation, and ocular motility is full.

Question 75

What are the common causes of preseptal cellulitis in children?

Answer 75

S. aureus and S. pyogenes.

Question 76

What is the treatment for preseptal cellulitis in children under 1 year old?

Answer 76

IV antibiotics.

Question 77

What are the diagnostic methods for orbital cellulitis?

Answer 77

Cranial and orbital CT scans.

Question 78

What is emmetropia?

Answer 78

A naturally focused eye for distance vision.

Question 79

What is the correction for hyperopia?

Answer 79

Biconvex or plus lenses.

Question 80

What is the correction for myopia?

Answer 80

Biconcave lenses.

Question 81

What type of lens corrects astigmatism?

Answer 81

Cylindrical lenses.

Question 82

What are the two broad classifications of causes for anterior uveitis in children?

Answer 82

"Infectious (e.g., herpes simplex, mumps) and noninfectious (e.g., juvenile idiopathic arthritis)."

Question 83

What systemic condition is most strongly associated with noninfectious anterior uveitis in children?

Answer 83

"Juvenile idiopathic arthritis (JIA)."

Question 84

What are common complications of JIA-associated uveitis?

Answer 84

"Band keratopathy, cataract, and glaucoma."

Question 85

What percentage of all cases of uveitis occur in children?

Answer 85

"Approximately 6%."

Question 86

What is the most frequent cause of chronic intraocular inflammation among children?

Answer 86

"JIA-associated uveitis."

Question 87

Which serologic tests may help evaluate the risk of uveitis in JIA patients?

Answer 87

"Antinuclear antibody, rheumatoid factor, and HLA-B27."

Question 88

What is the initial treatment for uveitis in children?

Answer 88

"Topical steroids and mydriatics."

Question 89

What percentage of eye injuries occur at home in the United States?

Answer 89

"40%."

Question 90

What is the most common cause of enucleation in children over 3 years of age?

Answer 90

"Trauma."

Question 91

What temporary protective measure can be used for eye injuries if an eye shield is unavailable?

Answer 91

"A disposable styrofoam coffee cup cut 2.5 cm from its base."

Question 92

What type of eye injury is strongly associated with shaken baby syndrome?

Answer 92

"Retinal hemorrhages."

Question 93

What are common mechanisms of injury for corneal foreign bodies?

Answer 93

"Inert or organic materials."

Question 94

What is the treatment for corneal abrasion?

Answer 94

"Look for occult foreign body, topical antibiotics, and eye patch."

Question 95

What clinical findings are associated with traumatic hyphema?

Answer 95

"Pain and blurring of vision."

Question 96

What are common signs of orbital blowout fractures?

Answer 96

"Diplopia, limitation of upward gaze, enophthalmos, lid ecchymosis, epistaxis, and hypesthesia of ipsilateral cheek."

Question 97

What condition is the hallmark finding in shaken baby syndrome?

Answer 97

"Retinal hemorrhages."

Question 98

What should always be considered in a child under 3 years with retinal hemorrhages?

Answer 98

"Non-accidental trauma or child abuse."

Question 99

What are the main treatment steps for lid lacerations caused by sharp objects?

Answer 99

"Evaluate for globe injury and perform primary edge-to-edge closure."

Question 100

Which study showed only 1 out of 56 visually impaired children had uveitis in the Philippines?

Answer 100

"National Survey of Blindness in the Philippines (2002)."

Question 101

How can public education campaigns impact eye injuries?

Answer 101

"By reducing the incidence through appropriate safety equipment like protective eyewear."