Paediatric ophthalmology

Question 1

what visual milestones should neonates have 1

Answer 1

fixing and following
-eye popping

Question 2

what visual milestones should a baby have

Answer 2

preferential looking

Question 3

what visual milestones should a 2 year old have

Answer 3

identify or matching pictures

Question 4

what visual milestones should a 3 year old have

Answer 4

be able to match on a letter chart

Question 5

define amblyopia

Answer 5

poor vision in a structurally normal eye

Question 6

basic pathophys of ambylopia

Answer 6

happens during first 7 years of life
-if image received in brain from one eye is poorer than the other then the brain favours the better eye
-this causes one eye to turn off-> abylopia

Question 7

causes of ambylopia 3

Answer 7

reduced view thorguh eye
-eg ptosis or cataract

unequal focus
-one eye is more long or short sighted-> anisometropia

misalignment of eyes-> squint

Question 8

treatment for ambylopia

Answer 8

occulsion patch or atropine over the better eye
-forces the poorer eye to be used to see

-patch is always worn under glasses if prescribed

Question 9

regarding squints
-what are eye(s) turned inwards called
-what are eye(s) turned outwards called

Answer 9

inward- esotropia or convergent squint

outward- exotropia or divergent squint

Question 10

how to assess symmetry of eyes

Answer 10

look at the corneal light reflex

check eye movements
-must be assured to be full in both versions
-and separately also

Question 11

treatment of squints 3

Answer 11

many are cured by glasses to correct existing longsightedness (hypermetropia)
if completely cured-> fully accommodative squint

if partial cure (some squint remains)-> partially accommodative squint

otherwise
-conserative management
-surgery

Question 12

when is the red reflex checked in a baby

*- note it is red in caucasains and more yellow coloured in other races

Answer 12

at birth

and at 6 week check

Question 13

causes of loss of red reflex (often becomes white-> Leukocoria) 5

Answer 13

cataract- most common
-operated on in first few weeks of life

retinoblastoma
-rare but potentially fatal tumour of the retina
-can be treated successfully if present early

retinal detachment

toxoplasmosis

uveitis

Question 14

what eye involvement is seen in neurofibromatosis type 1 (NF1)
-when is it helpful

Answer 14

Lisch nodules
-used if genetic testing has been declined

Question 15

what eye involvement is seen in Albinism

Answer 15

iris transillumination
-used in diagnosis
-child may benefit from tinted lenses

Question 16

what eye involvement is seen in Marfans syndrome

Answer 16

dislocated lens
-part of marfans screening
-may require treatment and/or management

Question 17

what eye involvement is seen in juvenile idiopathic arthritis

Answer 17

anterior uveitis
-screen for JIA if seen

Question 18

define nasolacrimal duct obstruction (NLDO)

Answer 18

incomplete canalisation of nasolacrimal duct

-v common presentation with anxious parents in new borns

Question 19

how does nasolacrimal duct obstruction (NLDO) present 1
-managemnt 1

Answer 19

sticky watery eye with no conjuncititis

-most resolve spontaneously by age 1

Question 20

define conjunctivitis

Answer 20

inflammation of the conjunctiva

Question 21

define the conjunctiva

Answer 21

think layer of tissue that covers the inside of the eyelids and the sclera of the eye

Question 22

types of conjunctivitis 3

Answer 22

bacterial

viral

allergic

Question 23

presenation of conjunctivitis 5

Answer 23

unilateral or bilateral

red eye

blood shot

itchy or gritty sensation

discharge from eye

Question 24

what symptoms are not caused by conjunctivitis and should prompt a different diagnosis 3

Answer 24

pain

photophobia

reduced visual acuity
(although vision may be blured by discharge should clear when discharge is removed)

Question 25

how does bacterial conjunctivitis present diffirenetly 4

Answer 25

purulent discharge and inflamed conjunctiva worse in morning usually starts one eye and can spread highly contagious

Question 26

how does conjunctivitis (viral) present differently 4

Answer 26

usually with clear discharge often associated w syx of viral infection ie dry cough, sore throat and blocked nose may find tender preauricular lymph nodes contagious

Question 27

how can causes of red eye be split

Answer 27

painless and painful *generaly the more serious causes are painful and also have reduced visual acuity

Question 28

causes of painless red eye 3

Answer 28

conjunctivitis episcleritis subconjunctival haemorrhage

Question 29

causes of painful red eye 7

Answer 29

glaucoma anterior uveitis scleritis corneal abraision or ulceration keratitis foreign body traumatic or chemical injury

Question 30

prinicples of management of conjunctivitis 5

Answer 30

usually resolves without treatment after 1-2 weeks advise good hygiene to avoid spreading: -avoid sharing towels -avoid rubbing eyes -regularly wash hands avoid use of contact lenses clean eyes w cooled boiled water and cotton wool to help clear discharge

Question 31

treatment for bacterial conjunctivitis 2

Answer 31

antibiotic eye drops can be considered *-note often get better without treatment chloramphenicol eye drops or fusidic acid eye drops

Question 32

how is management of conjunctivitis in patients under 1 year old different 1 -why 2

Answer 32

need urgent ophthalmology review -neonatal conjunctivitis can be associated with gonococcal infection -can cause loss of sight and more severe complications like pneumonia

Question 33

cause of allergic conjunctivitis

Answer 33

caused by contact with allergens

Question 34

presenation of allergic conjunctivitis

Answer 34

swelling of conjunctival sac and eye lid with significant watery discharge and itch

Question 35

treatment for allergic conjunctivitis 1 -patients with chronic seasonal syx treatment 1

Answer 35

antihistamines (oral or topical) can be used to reduce symptoms (topical- antazoline) -chronic seaonsal symptoms -use topical mast-cell stabilisers (nedocromil) -work by preventing mast cells releasing histamine require several weeks before showing any benefit

Question 36

inheritance pattern of retinoblastoma

Answer 36

autosomal dominant -around 10% of cases are hereditary

Question 37

basic pathophys of retinoblastoma

Answer 37

loss of function of retinoblastoma tumour suppressor gene on chromosome 13

Question 38

ffeatures of retinoblastoma 3

Answer 38

loss of red reflex - get white pupil (leukocoria) instead strabismus visual problems

Question 39

managemtn of retinoblastoma

Answer 39

enucleation (remove eye) if not so advanced: -external beam radiation therapy -chemo -photocoagulation

Question 40

mangement of congenital cataracts

Answer 40

surgery

Question 41

mangement of congenital cataracts

Answer 41

surgery

Question 42

investigations for retinoblastoma and congenital cataracts

Answer 42

complete eye exam by specialist ophthalmologist