Eye Disease

Question 1

What are the causes of conjunctivitis?

Answer 1

• In children = Bacterial or Allergic
• In adults = Viral or Allergic

Question 2

What are the signs and symptoms of bacterial/viral conjunctivitis?

Answer 2

• Painful red eyes
• Lacrimation ± purulent discharge
• “Gritty eyes”
• No visual change

Question 3

What are the signs and symptoms of allergic conjunctivitis?

Answer 3

• Bilateral
• Pruritic

Question 4

What are the signs and symptoms of conjunctivitis in a neonate?

Answer 4

• <48hrs of life = discharge ± conjunctivitis, swelling eyelids
  
  • Gonococcus
• 1-2w of life = discharge ± conjunctivitis, swelling eyelids ± pneumonia
  
  • Chlamydia trachomatis
• Be aware that it is sight-threatening

Question 5

What are the appropriate investigations for suspected conjunctivitis?

Answer 5

• Bacterial → swab MC&S - staphylococcal or streptococcal
• Viral → rapid adenovirus immunoassay
• Neonate gonococcal infection → gram stain, culture
• Neonate chlamydia infection → immunofluorescent staining

Question 6

What is the management of conjunctivitis?

Answer 6

• Most viral/bacterial infections are self-limiting
• Neonate gonococcal infection → immediate empirical treatment 3rd gen cephalosporin (i.e. ceftriaxone)
• Neonate chlamydia infection → oral erythromycin for 2 weeks

Question 7

What is hypermetropia an myopia?

Answer 7

• Hypermetropia = long sight → see long distance; rays focus behind retina
  
  • Mild hypermetropia common in early childhood
• Myopia = short sight → see short distance; rays focus in front of retina
  
  • Uncommon in childhood, more common in teenagers
    
    • Childhood conditions = pre-term refractive errors

Question 8

What is the management of hypermetropia an myopia?

Answer 8

• Hypermetropia = glasses → convex lens - make the eye look bigger
• Myopia = glasses → concave lens

Question 9

What is retinopathy of prematurity?

Answer 9

Affects developing blood vessels at the junction of the vascularised and non-vascularised retina

1. Vascular proliferation
2. Retinal detachment
3. Fibrosis
4. Blindness

Question 10

What are the signs and symptoms of retinopathy of prematurity?

Answer 10

• Unusual eye movements
• White pupils and vision loss

Question 11

What is the management of retinopathy of prematurity?

Answer 11

• Screening in - LBW <1500g, or prematurity <32w gestation
• Laser photocoagulation or Cryotherapy
• Prognosis → severe bilateral visual impairment in 1% of LBW infants
  
  • Mostly in infants <28w gestation

Question 12

Define Strabismus.

Answer 12

Abnormal alignment of the eyes.

Question 13

What are the types of strabismus?

Answer 13

• Non-paralytic - refractive error in one or more eye
• Paralytic - squinting eye could be caused by motor nerve paralysis or SOL → i.e. 3rd nerve palsy

Question 14

What are the signs and symptoms of strabismus?

Answer 14

• Eyes look in different directions and do not focus simultaneously on a single point
  
  • Diagnosed 1-4yo - normal in young infants before 6m

Question 15

What is the management of strabismus?

Answer 15

• 1^st line = Eyeglasses
• 2^nd line = Eye patching
• 3^rd line = Eye drops
• 4^th line = Eye muscle surgery
• Must be before 8yo → brain connections can be rewired at this age