Flashcards in Pediatric Ophthalmology Deck (35)
When should the red-reflex be checked?
- within the first week of life
- at 2 weeks
- every eye exam following that: 1, 2, 3, 6... months
When should the corneal reflex be added to the eye exam?
At 1 month
When should the cover/uncover test be added to the eye exam?
When should visual acuity testing be done in children
starting at around 2-3 years
What can an abnormal red reflex be a sign of?
can indicate a pre-cancerous lesion on the retina
- can lead to retinoblastoma if not treated
What can the cover/uncover test tell you?
if there is a tropia = aka a manifested strabismus
covering the "good" eye will cause the "bad" eye to redirect itself
What is the difference between a tropia and a phoria?
tropia = manifested strabismus or misalignment of the eye
phoria = latent deviation of the eye that is manifested when the "good" eye is covered and binocular vision is broken
What are the main "types" of tropias and phorias?
either eso = inverted or exo = everted with regards to the midline vision
or hyper = up, and hypo = down with regards to horizontal plane of vision
Besides the cover/uncover test, what 3 tests can be used to identify strabismus?
Hirshberg = looking for the corneal light reflex
Bruckner = looking for asymmetry in the red reflex
Krimsky = essentially the Hirschberg test, but with prisms employed to quantitate deviation of ocular misalignment by determining how much prism is required to centre the reflex
What is normal for a child's vision at 1 month?
What is normal for a child's vision at 1-2 months?
- making eye contact
- following a slow target
What is normal for a child's vision at 3 months ?
demonstrates binocular coordination
What is normal for a child's vision at 6 months?
reaches accurately for toys
What is normal for a child's vision at 2 years?
Can match pictures
What is normal for a child's vision at 3 years?
Can match letters
What is normal for a child's vision at 5 years?
Determined by the Snellen chart
What are the 3 types of refractive errors?
myopia: "near sightedness"
Hyperopia = "far sightedness"
Astigmatism = uneven focussing of light on the retina
What are 2 ways to slow myopia progression in children?
- outdoor play
- atropine drops
What are the 4 types of esotrophic strabismus?
2. infantile esotrophia
What are the 3 types of exotrophic strabismus?
3. convergence insufficiency
What are 4 features of infantile esotropia? when does it present?
Presents before 6 months
- cross fixation
- larger deviation
- can alternate
What is the treatment for infantile esotropia?
When does accommodative esotropia present? What are 2 features?
Presents between 6 months to 7 years. average is 2.5 years
- intermittent at initial presentation
- have hyperopic refraction sometimes due to cycloplegia = paralysis of the ciliary muscle of the eye
What are 2 treatment options for accommodative esotropia?
2. surgery for residual deviation
When does intermittent exotropia present? Wheat are some features on history and exam?
Presents before 5 years old
- worse with fatigue, distance vision
- will close eyes in the sun
What are 3 treatment options of intermittent exotropia?
What are 4 possible causes of vertical strabismus ?
1. 4th nerve paresis
2. Monocular elevation deficiency
3. Brown syndrome
4. "Trapdoor" fracture in the floor of the orbit
What is the most common cause of monocular visual impairment from childhood to middle age?
Amblyopia = aka lazy eyes
What % of the population are affected by amblyopia?