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Ophthalmology > Paediatric Ophthalmology > Flashcards

Paediatric Ophthalmology Flashcards

(60 cards)

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1
Q

Visual acuity testing in newborn - types and their general process

A

Fix and follow
Spinning baby test
Preferential looking
Visual evoked potentials

Pre-verbal so look at eye movements

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2
Q

Visual acuity testing in newborns - what is fix and follow test?

A

Use pen torch / silent toy
Move slowly from left to right (immature eye movements)
See if child fixes and follows target
Record as ‘fixes and follows’

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3
Q

Visual acuity in newborns - what causes child not to follow in fix and follow test?

A

Can’t see
Not interested
Drowsy

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4
Q

Visual acuity in newborns - what is spinning baby test?

A

Spin child and observe nystagmus
There will be nystagmus in opposite direction to rotation if child can see
There will be post rotational nystagmus after stopping spinning
If nystagmus persists - severely visually impaired

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5
Q

Visual acuity in newborns - what is preferential looking

A

Cards with different sized grating patterns on one side and plain on other side
Child will look at grating side of card if normal vision

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6
Q

Visual acuity in newborns - what is visual evoked potentials

A

Electrodes places on child’s head

Record signals when child sees pattern on screen

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7
Q

Visual acuity in infants (0-3) - what type of visual acuity test is used?

A

Cardiff Cards
Cards with line drawings of familiar objects, on upper or lower half of card and with different line thicknesses
Show cards quickly at 1m + observe vertical eye movements

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8
Q

Visual acuity in toddlers (1.5-4) - what type of visual acuity test is used?

A

Kay picture tests
Book of cards with line drawings
Child can name or match using matching cards
Single - one drawing on each card
Crowded - four drawings; better sensitivity

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9
Q

Visual acuity in children (4-5) - what type of visual acuity test is used?

A

Keeler crowded LogMAR test
Book with each page containing four letters
Child names letters or uses matching card

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10
Q

Strabismus - what is strabismus?

A

Malalignment of the two eyes

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11
Q

What is heterophoria

A

Latent strabismus
Malalignment only present on dissociation with cover-uncover test
Both eyes look straight but deviate on dissociation

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12
Q

What is heterotropia

A

Manifest strabismus
Malalignment constantly present
One eye not directed towards fixation point

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13
Q

What is concomitant strabismus

A

Deviation remains same in all directions of gaze

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14
Q

What is incomitant strabismus

A

Deviation changes with direction of gaze

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15
Q

What is amblyopia

A

‘Lazy eye’
Vision developmental disorder where one eye fails to achieve normal visual acuity
Due to insufficient use of eye during visual development so the brain suppresses image from the eye, disrupting visual development in that eye

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16
Q

What is pathophysiology of concomitant strabismus

A

Failure for binocular single vision to develop
Due to disruption in vision in one eye

Risk factors: hypermetropia, developmental abnormalities, family hx of trabismus or refractive error

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17
Q

What is binocular single vision

A

Use of both eyes together to achieve binocular depth perception

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18
Q

What are causes of concomitant strabisums

A

Reduced vision in one eye:
Retinoblastoma
Cataracts
Anisometropia (different refraction in two eyes)

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19
Q

What are causes of incomitant strabismus

A

Congenital: CN palsies
Acquired: secondary CN palsies, thyroid eye disease, orbital floor fracture

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20
Q

What is pathophysiology of incomitant strabismus

A

Angle of deviation changes with direction of gaze
Acquired incomitant strabismus causes diplopia
Child may have compensatory head tilt to minimise diplopia
Young child may suppress second image and develop amblyopia

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21
Q

What is the role of orthoptists in management of strabismus

A 
Assess visual acuity
Measure strabismus
Assess eye movements
Assess binocular vision (inc stereopsis)
Monitor amblyopia therapy with patching
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22
Q

What are the tests for strabismus

A

Cover-uncover test: detects presence of strabismus, cover fixating eye and see if other eye moves to take up fixation
Alternate cover test: detect latent strabismus, rapidly cover each eye and observe movement of eye to take up fixation

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23
Q

What is the management of strabismus in children

A

Correct refraction - glasses
Amblyopia therapy - patch
Surgery

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24
Q

How do you correct refractive error in strabismus

A

In esotropia with high hypermetropia

Glasses - correct strabismus and improve visual acuity, surgery may not be needed

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25
How do you treat amlyopia
Patch on good eye worn for several hours a day Encourages amblyopic eye to develop vision Unsuccessful after 7yo
26
What is surgical management of strabismus
In esotropia: recess medial rectus resect lateral rectus
27
How do you manage strabismus in adults
Treat underlying cause Prism incorprated into glasses - joins diplopia Strabismus surgery - if BSV not restored once EOM recover
28
Neonates - what is leukocoria
White pupillary reflex on opthalmoscopy | Indicates severe ocular pathology and is amblyogenic
29
What are the causes of leukocoria
``` Retinoblastoma Coloboma Congenital Retinopathy of prematurity Non-accidental injury ```
30
What is retinoblastoma
Malignant tumour of retina - most common intraocular tumour of childhood Most sinister cause of leukocoria
31
What are features of congenital cataracts
``` Leukocoria Concomitant Strabismus Amblyopia Nystagmus Can be bilateral - visually inattentive ```
32
What are causes of congenital cataracts
Idiopathic Familial autosomal dominant Galactosaemia Rubella infection
33
How do you manage congenital cataracts
Urgent referral Cataract surgery Amblyopia therapy
34
What is coloboma
Hole in any structure of the eye, due to failure for choroidal fissure to fuse during embryological development
35
What are features of coloboma
Choroido-retinal coloboma, optic disc coloboma: leukocoria, severe amblyopia Iris coloboma: misshaped pupils, posterior eye normal, normal visual acuity
36
What is retinopathy of prematurity (ROP)
Incomplete retinal vascularisation causes hypoxia and stimulates neovascularisation New vessels leak and cause scarring
37
Why do you get leukocoria in ROP
It occurs only in late disease due to tractional retinal detachment
38
What is the management for ROP
Ablation of avascular retina | Laser - reduce VEGF production
39
Sight threatening conditions of neonates - What is Ophthalmia neonatorum? What is the management?
Purulent conjunctivitis of newborn within few days of birth It is a notifiable disease Organisms: Neisseria gonorrhoea (acute), Chlamydia trachomatis (subacute) Systemic + topical antibiotic treatment Referral of parents to STD clinic
40
Sight threatening conditions in neonates - What is buphthalmos
Congential glaucoma | Can cause defective vision or blindness
41
What are features of buphthalmos
Large, watering photophobic eyes corneal clouding raised intraocular pressure
42
Sight threatening conditions in neonates - what is anopthalmos? what is micropthalmos?
Anopthalmos - absence of eye | Microphthalmos - small remnant of eye
43
What is the management for Anophthalmos/microphthalmos?
Promote growth of bony orbit Expand soft tissues of orbit Ocular prosthesis
44
Sight threatening conditions in neonates - what is a differential for buphthalmos?
Congenital Nasolacrimal duct obstruction - watery eyes in neonates but without large eye
45
What is congenital nasolacrimal duct obstruction
Common condition where there is a delay in opening of nasolacrimal duct at inferior meatus
46
What is the management for congenital NLDO
Reassurance - 90% resolves in 1 yr Massage over lacrimal sac at medial canthus If mucocoele at medial canthus - dacryocystorhinostomy Persistant after 1 yr - syringe and probing under GA
47
Common paediatric conditions - what are common eyelid lumps
Capillary haemangioma Stye Chalazion Molluscum contagiosum
48
What is capillary haemangioma
Benign swelling of capillaries at superonasal orbit or eyelid Occurs shortly after birth and grows in size for 6 months Can lead to mechanical ptosis and amblyopia if ptosis covers visual axis or weight causes astigmatism
49
What is molluscum contagiosum
Pearly umbilicated itchy nodules on hands, face, trunk and around eyes Caused by viral infection Leads to follicular conjunctivits if at lid margin
50
What is limbal dermoid
Benign congenital tumour at limbus | Associated with Goldenhar's syndrome
51
What is dermoid cyst
Smooth round non-tender immobile lump on orbital rim
52
What is dermolipoma
Benign congenital conjunctival fatty lesion | Lies close to lacrimal ductile openings - risk of dry eyes from ductile damage, caution in excision
53
What are the causes of ptosis in children
Congenital - levator muscle myopathy (often unilateral) Acquired - third nerve palsy Inflammatory - vernal keratoconjunctivitis
54
What is the management of ptosis in children
Surgery Poor levator function - frontalis suspension Good levator function - levator resection (anterior or posterior LR) Lid covers visual axis - urgent frontalis suspension Slight ptosis - wait surgery until >4yo
55
What are the types of cellulitis that can occur in the orbit
Preseptal cellulitis: limited and less severe | Orbital/post-septal cellulitis: medical emergency
56
What is preseptal cellulitis
Inflammation of eyelids only
57
What are features of preseptal cellulitis
Inflamed lids: swollen, red, tender, warm | White eye, No proptosis, normal eye movements, normal optic nerve function
58
How do you treat pre-septal cellulitis
IV antibiotics - in children similar to orbital cellulitis bc high risk of progression due to orbital septum not fully developed
59
What are features of orbital cellulitis
Inflamed lids Proptosis Reduced eye movements Optic nerve dysfunction: RAPD, VA, colour vision
60
What is the management for orbital cellulitis
Blood culture - Strep pneumoniae, Staph aureus, H influenzae CT - exclude sinusitis and subperiosteal abscess IV antibiotics

Ophthalmology (7 decks)

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