lecture 5 Flashcards by Christie Wong

marfans syndrome

• Most common systemic disease
associated with lens dislocation
• Ocular, Cardiovascular and musculoskeletal abnormities

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subluxated dislocated lenses

marfans

homocystinuria

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Rare, autosomal recessive
Usually between 3-10 yrs old
Lens subluxation usually symmetrical

homocystinuria

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Result of incomplete closure of the embryonic fissure
Usually inferior nasal, forming a “keyhole” pupil
May be associated with coloboma of other parts of the eye (e.g. lid, optic nerve)

iris coloboma

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Aniridia (see photos)
Albinism
Uveitis
– Traumatic anterior uveitis is most likely to cause photophobia

uvea

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Keratitis

Corneal foreign body Corneal abrasion Corneal scarring Corneal dystrophies

cornea

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– Aniridia
– Anterior Chamber Cleavage Syndrome
– Sturge-Weber
– Neurofibromatosis

associated congential conditions of glaucoma

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treatment for congenital glaucoma

– Primarily Surgical

– REFER TO PEDIATRIC GLAUCOMA SPECIALIST!

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– Optic neuritis
– Vitritis/endophthalmitis
– Congenital cone dystrophies (associated poor vision and nystagmus)

posterior segment

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other causes of photophobia

posterior segment
Intermittent XT
Migraine
Fair skinned individuals

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Nasolacrimal duct obstruction – most common in

causes of epiphora

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Tearing that occurs only when the patient salivates
Lesion of the 7th cranial nerve, causing facial paralysis and profuse lacrimation during eating
AssociatedwithDuane’ssyndrome

crocodile tears syndrome

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Similar to capillary hemangioma, but lymphoid in nature
Usually involves the orbit, can affect lid and conjunctiva
No spontaneous regression
Surgery needed if vision threatened due to optic nerve compression, corneal exposure or amblyopia

lymphangioma

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Usually before 20 yrs old, 75%

optic nerve glioma

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Arise from adrenal medulla
Most common solid tumor of childhood, accounting for 10- 15% of pediatric cancer
Frequent orbital metastases
90%

neuroblastoma

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Can effect any part of eye:
Orbital infiltration of bone or soft tissue
Conjunctiva, iris infiltration Cataracts after treatment Subchoroidal mass, RD
Retinal & Vitreous • Hyperviscousity
• Retinal hemorrhages • Roth spots

leukemia

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other causes of bulging

Capillary Hemangioma Orbital Cellulitis Dermoid Cyst Rhabdomyosarcoma
• Mostfrequentorbitalmalignancy in children

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Corneal diameter > 11.5-12 mm in infant or > 13 mm in fully grown eye
Three patterns:
• Simplemegalocornea: unassociated with other ocular anomalies, autosomal dominant
• X-linked megalocornea (Anterior Megalophthalmos): recessive, associated with iris and angle abnormalities, lens subluxation and early cataract
• Buphthalmos: infantile glaucoma

megalocornea

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Micropthalmos
– Associations • PHPV
• Congenital cataracts • Toxoplasmosis
• Rubella
• Coloboma
• High hyperopia Anophthalmos
• Primary optic vesicle fail to grow out from the cerebral vesicle
Megalophthalmos

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orbital size abnormalities

The most common corneal degeneration in early adolescent
Bilateral, non-inflammatory
10% patients have FHx
Association with other diseases:
– Down’s syndrome
– Floppy eyelid syndrome
– Leber’s congenital amaurosis
– Retinitis pigmentosa
– Atopic disease: rubbing eye excessively

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keratoconus

Inherited disorder of copper metabolism, copper deposit in liver, brainstem and eye
Copper deposits on corneal Descemet’s membrane
Kayser-Fleischer ring Most prominent inferiorly
and superiorly
Rarely, sunflower cataracts – yellowish, star-like, anterior subcapsular discoloration

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wilsons disease

Severe Vitamin A deficiency, causing severe dry eye
One of most common causes of blindness in the world – Corneal scarring
– More common in undernourished populations
Night blindness is earliest symptom

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xerophthalmia

Bilateral chronic follicular conjunctivitis
Leading cause of blindness in the developing country Conjunctival and corneal scaring
“SAFE” strategy promoted by WHO
– Surgery to correct advanced stages of the disease;
– Antibiotics to treat active infection, using Zithromax (azithromycin) donated by Pfizer Inc;
– Facial cleanliness to reduce disease transmission;
– Environmental change to increase access to clean water and improved sanitation.

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trachoma

Dermoid
Vernal keratoconjunctivitis Trauma/chemical burn Keratitis
Foreign body
Congenital glaucoma

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other causes of corneal opacities

Most commonly due to dysplasia of levator palpebrae Unilateral or bilateral Reduced tarsal fold Often associated with lid lag on down gaze and superior rectus weakness. Risk of deprivation amblyopia if visual axis is blocked

congenital ptosis

A unique type of congenital ptosis Aberrant innervation of the levator muscle with nerves normally directed to the muscle of mastication. Ptotic eye elevates with contralateral jaw movement

marcus gun jaw winking phenomenon

BPES: Blepharophimosis Ptosis Epicanthus Inversus Syndrome Ptosis associated with horizontal narrowing of palpebral fissure, telecanthus and epicanthus inversus  Autosomal-dominant Flattened nasal bridge Can result in deprivation amblyopia or abnormal head posture May need cosmetic surgery

blepharophimosis

Aponeurotic defects due to trauma or edema Third nerve palsy Horner’s syndrome Mechanical ptosis Myogenic ptosis  Pseudoptosis • Hypotropia

other causes of ptosis

horners syndrome

``` ptosis anyhydrosis miosis enophthalmos loss of ciliospinary reflex ```

```  Acute infection of oil glands  90-95% caused by Staphylococcus aureus  External v.s. internal – Glands of Zeis or Moll – Meibomian glands  Localized, painful, erythematous and edematous ```

hordeolum

Chronic, granulomatous inflammation of meibomian gland Localized, painless, slow growing If large, may press on eye, inducing astigmatism

chalazion

Staphylococcus aureus, Haemophilus influenza or Streptococcus pneumoniae Unilateral painful lid edema with systemic symptoms – Preseptal: affects tissue anterior to the orbital septum (more common) – Orbital: affects deeper orbital tissues (behind septum) Orbital cellulitis needs immediate treatment – Vision loss results if optic nerve is affected – Life-threatening if infection spreads into the cavernous sinus

cellulitis

Usually chronic, indolent form Sometimes acute - pain, redness and swelling around lacrimal sac Often associated with nasolacrimal duct obstruction Fever or systemic symptoms may occur H. influenza or S. pneumoniae

dacryocystitis

Newborn baby, Bluish, distended cyst of lacrimal sac Both nasolacrimal duct and the common internal punctum are closed in utero Often become infected in the first few days of life if untreated Usually need probing

dacryocystocele

The most common eyelid and orbital tumor in the infant Vascular tumors with rapid onset near birth, continue to enlarge till 18 months of age Most hemangioma regress spontaneous by age of 7 Amblyopia due to – Form Deprivation – Induced astigmatism Treated with steroid injections

capillary hemangioma

Congenital tumor, benign Firm, smooth, painless May cause proptosis, ptosis, restriction of ocular motility May induce astigmatism Some associated with Goldenhar’s syndrome: epibulbar dermoids, preauricular appendages, and vertebral anormalies

dermoid

Orbital cysts Molluscum Contagiosum • poxvirus Juvenile Xanthogranuloma (benign red or yellow papules or nodules on scalp and face, can infiltrate the uvea leading to hyphema)

other causes of bumps on lid

– Neonatal conjunctivitis – Bacterial, viral, allergic conjunctivitis – Systemic causes (Kawasaki’s, Stevens-Johnson) – Uveitis, episcleritis/scleritis – Foreign body – Keratitis

acute causes of red eye

– Allergic conjunctivitis – Nasolacrimal duct obstruction – Lid/lash abnormalities causing corneal/ocular irritation – Blepharitis – Dry eye

chronic causes of red eye

– Purulent conjunctivitis – hyperacute – Usually bilateral – 2-5 days after birth

neisseria gonorrhoeae

– Neonatal inclusion conjunctivitis – Discharge ranges from watery to purulent – Incubation period 5-14 days

chlamydia trachomatis

– Associated with generalized HSV, 80% has vesicular lesions | – Usually 6- 14 days after birth

HSV

• Adenovirus – most common – PCF: pharyngoconjunctival fever – EKC: epidemic keratoconjunctivitis • Other: HSV, Epstein-Barr virus etc.

acute viral conjunctivitis

Symptoms for what? – Extreme photophobia – Eye rubbing – Epiphora

congenital glaucoma

``` signs for what? – Megalocornea – Corneal clouding – Haab’s stria – Glaucomatous cupping – Increased IOP ```

congenital glaucoma

– Aniridia – Anterior Chamber Cleavage Syndrome – Sturge-Weber – Neurofibromatosis

associated congenital conditions of congenital glaucoma

treatment for congenital glaucoma

Primarily Surgical | – REFER TO PEDIATRIC GLAUCOMA SPECIALIST!

lecture 5 Flashcards

(47 cards)