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Flashcards in Peds Deck (161)
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0
Q

Embryology - 22 days

A

Optic primordium appears in neural folds

1
Q

3 types of XT

A
  • convergence insufficiency
  • divergence excess
  • primary/idiopathic
2
Q

Embryology - 25 days

A

Optic Vesicle evaginates. Neural crest cells migrate to surround vesicle.

3
Q

Embryology - 28 days

A

Vesicle induces lens placode

4
Q

Embryology - 2nd Month

A

Invagination of optic and lens vesicles
Hyaloid artery fills embryonic fissure
Pigment granules appear in RPE
lateral rectus and superior oblique muscles grow anteriorly
Eyelid folds appear
Retinal differentiation begins
Migration of retinal cells begins
Neural Crest cells of corneal endothelium migrate centrally (corneal stroma follows)
cavity of lens vesicle is obliterated
Secondary vitreous surrounds hyaloid system
Choroidal vasculature develops
Axons from ganglion cells migrate to optic nerve
Glial Lamini cribrosa forms
Bruch’s membrane appears

5
Q

Embryology 3rd Month

A

Precursors of rods and cones differentiate
Anterior rim of optic vesicle grows forward and CB starts to develop.
Sclera condenses
Vortex veins pierce sclera
Eyelid folds meet and fuse

7
Q

Embryology -4th month

A
retinal vessels grow into RNFL at optic disc
Folds of ciliary processes appear
Iris sphincter develops
Descemets membrane forms
Schlemms canal appears
Hyaloid system starts to regress
Glands and Cilia develop
8
Q

Embryology 5th Month

A

Photoreceptor inner segments develop
Choroidal vessels form
Iris stroma is vascularized
Eyelids begin to separate

9
Q

Embryology - 6th Month

A

Ganglion cells thicken in the macula
Recurrent Atrerial brances joing the choroidal vessels
Dilator muscle forms

10
Q

Embryology - 7th Month

A
Outer segments of photoreceptors differentiate
Central fovea starts to thin
Fibrous lamina cribrosa forms
Choroidal melanocytes produce pigment
Circular muscle forms in CB
11
Q

Embryology - 8th Month

A

Chamber angle completes formation

Hyaloid system disappears

12
Q

Embryology - 9th Month

A

Retinal vessels reach periphery
Myelination of nerve fibers are complete to the lamina
pupillary membrane dissapears

13
Q

What is the name for the celluar area of retinal proliferation at the leading edge of the vasculature in the ember

A

Vascular Anlage

14
Q

Types of abnormal small eyes

A

Microphthalmos with cyst. - clinically when you open the lids the cyst tends to be infront as a retina

15
Q

Embryonic Fissure

A

Closure at 6 weeks - closes inferonasally (This is where we get colobomas

16
Q

Ocular features of Trisomy 13

A

Microphthalmia, lens is catatractous, persistant hyaloid primary vasculature with cartilage behind lens, dyspalastic retina.
Die by 6 months.
Part of ddx of intra-ocular cartilege, and retained lens nuclei

17
Q

Synophthalmia

A

Associated with Holoprosencephaly and the

18
Q

Acardi Syndrome

A

rare genetic malformation syndrome characterized by the partial or complete absence of a key structure in the brain called the corpus callosum, the presence of retinal abnormalities (peripapillary retinal colobomas), and seizures in the form of infantile spasms. Aicardi syndrome is theorized to be caused by a defect on the X chromosome as it has thus far only been observed in girls or in boys with Klinefelter syndrome.

19
Q

Peters Anomaly

A

Type 1 – posterior defect - leukoma plus iridocorneal adhesions
Type 2 – leukoma + iridocorneal adhesions + lenticulocorneal adhesions
Peters Plus – above + renal, cardiac, genitourinary, cleft palate.

Pathology - Look for abscence of DM.
RECALL: DM is PAS +’ve and so is the lens capsule, look for both of them.
AD - PAX6

Long term sequelae includes posterior keratoconnus

20
Q

Tuberous Sclerosis

A

Astrocytic hamartoma

21
Q

Pilomatrixoma

A

Occur in children - tend to be in brow

22
Q

Limbal Dermoid

A

Think about Goldenhaar syndrome

23
Q

Meesman’s Juvinille

A

Kids with tearing and RCE

24
Q

PPMD

A

endothelium behaving like epithelium, snail tracks.

25
Q

CHED

A

Type 1 - no nystagmus but tearing, photophobia, AD, presents later
Type 2 -

26
Q

Rubella Keratitis

A

congenital corneal opacifcation

27
Q

Cystinosis

A

crystaline keratopathy

28
Q

Marfan Syndrome

A
AD - FBN1 gene CHromosome 15, Encodes forfibrillin 1. 25% are sporadic. 
Ocular findings, abnormal ciliary processes and absent or disorganized zonules (tend to sublix superotemporally. 
Risk of: bilateral ectopic lentis
RD
Lattice
early vitreous liquéfaction
Choroidal and scleral thinning, 
flat cornea
KC
Glaucoma, strab
29
Q

diagnostic criteria for Marfans

A

Aortic root z score >than 2 SD above the norm + ectopic lentis or + FBN1 gene or + systemic signs (learn a list of 6 or 7)

30
Q

Ectopia Lentis

A

Trauma
Homocystinuria - AR - methionine - (develop seizures, osteoporosis, MR, prone to thromboembolism)
Hyperlysinemia
Weiil Marchesani syndrome
Sulfite oxidase
Others - ectopia lentis et pupillae (eccentric pupils, AR)

31
Q

Dacaryoadenitis

A

Infectious - Virus (EBV, CMV,HSV, Mumps), bacterial (S. Aureus,
Inflammatory - Sjogrens, Sarcoid, Wegners, thyroid
Infiltrative - pleomorphic adenoma, lymphoma, adenoid cystic ca.

32
Q

How do you differentiate between a Browns and Inferior Oblique palsy

A

In Brown’s syndrome you see a V pattern - (Recall the OBliques are working so they will Abbduct on up gaze . Whereas, in an inferior oblique palsy the abductors are not working so on upgaze when you are in upgaze they will adduct seeing an A pattern

33
Q

Ddx of congenitally reduced vision with normal exam

A

Retina:

  • LCA
  • rod or cone dystrophy
  • achromatopsia
  • blue cone monochromatism
  • CSNB
  • albinism

ON

  • subtle hypoplasia
  • optic atrophy

Occipital

  • infarcts
  • hypoplasia
  • congenital TORCH
  • delayed visual maturation
34
Q

Leukocoria

A

Pink Roses Can Calm The Night

PHPV
RB, RD, ROP
Coats, Coloboma, Cataract
Toxocara
Norrie's
35
Q

High myopia in children

A
Idiopathic
Congenital glaucoma
ROP
Down's
CSNB
spherophakia
Marfan's, Stickler's
36
Q

Pseudostrabismus ddx

A
Dragged macula (ROP, toxocara, incontinentia pigmenti)
Wide-nasal bridge
Positive or negative angle kappa
Epicanthus
Hypertelorism
37
Q

Abnormal head posture

A

Strabismus (horizontal, vertical, torsional)
Nystagmus
Infantile VF defect
Ptosis

Neck problems
Glasses

38
Q

Conditions with torsion

A
SO palsy / overaction
IO palsy / overaction
IO myokymia
Torsional nystagmus
Restriction
39
Q

Child with left hypotropia. DDx?

A

Left eye hypo:

  • left superior orbital mass
  • left SR weakness
  • left IO weakness
  • left IR tethering
  • left orbital floor #

Right eye hyper:

  • right SO palsy
  • right IR palsy
  • right IO overaction
  • right inferior orbital mass
  • right SR tethering
40
Q

Overelevation in adduction

A

ipsi IO overaction
ipsi SO palsy
DVD

41
Q

Features of congenital nystagmus

A

CONGENITAL

  • better with Convergence
  • no Opsoclonus
  • there is a Null point
  • no change with Gaze position
  • Equal OU
  • Near va better than distance (because it dampens with convergence)
  • Inversion of OKN
  • head Turn is present (for null point)
  • Absent during sleep
  • there is Latent nystagmus
42
Q

Ddx of congenital nystagmus

A
  • Congenital motor nystagmus
  • Brain lesion causing nystagmus
  • Sensory deprivation (lens, vitreous, retina, fovea, ON)
43
Q

Type of JRA most likely to get anterior uveitis

A

RF -
ANA +
pauciarticular (

44
Q

Ddx of congenital ptosis

A
Levator dehiscence (trauma)
Levator dysgenesis (idiopathic/familial)
Neurogenic (CN 3 palsy, Horner's)
NMJ (Myaesthenia)
Mechanical (lid tumors, chalazia, neurofibroma, etc)
45
Q

Eye syndromes with deafness

A
Usher
Syphillis
Polyarteritis nodosa
Goldenhaar
Cogan 
Alport
Wardenberg
46
Q

What is Herman Bieloschowsky and what do you worry about

A

Monocular nystagmus of childhood

Worry about ON/chiasm lesion - image

47
Q

Secondary tumors in RB

A

Melanoma
Osteogenic sarcoma
Breast
Lymphoma, leukemia

48
Q

Paradoxical pupil response in (3)

A

CSNB
Achromatopsia
ON hypoplasia

49
Q

Orbital cellulitis in child, indications for surgery

A
  • > 9 yo
  • gas on CT (shows its anaerobic)
  • any signs of optic nerve compromise
  • dental source
  • chronic sinusitis
  • frontal extension (frontal sinusitis, brain involvement)
  • recurrent orbital infxn
50
Q

Capillary hemangiomas - 3 things to worry about

A

Kassabach Meritt - consumptive coagulopathy (plt’s)
Left sided heart failure
May have other hemangiomas - e.g. subglottic - always get ENT consult pre-op

51
Q

Benign orbital masses in kids (big categories)

A

Vascular (hemangiomas, varix, lymphangiomas)
Neural tissue (glioma, neurofibroma, Schwannoma)
Choristomas (dermoid, lipo-dermoid, epidermoid)
Other (fibrous dysplasia, IOI, mucocele, thyroid)

52
Q

Malignant orbital masses in kids

A

Primary or secondary
Primary: RB!!!, glioma, meningioma, histiocytosis
Mets: neuroblastoma, Ewing sarcoma
Secondary extension: Burkitt’s lymphoma from maxillary sinus

53
Q

Telecanthus ddx

A

FAS
Blepharophimosis
Wardenburg

54
Q

Lacrimal fistula - symptoms, how to investigate and treat

A

Tearing at MEDIAL canthus (epiphora is always lateral)

May have recurrent dacryocystitis
Mucous on skin near nose

Look for the fistula
Check puncta
Dye disappearance test

Treat:

  • probing may resolve it
  • cautery has poor outcomes
  • you can excise it (excise completely including the whole tract) +/- stenting if needed
  • DCR if needed
55
Q

Nevus of ota - risks to eye

A

Glaucoma

Uveal/orbital melanoma

56
Q

Chlamydia - complicaitons and rx

A

Gastritis, pneumonitis, otitis, nasopharyngitis
Rx with topical erythro, oral erythro
Treat mother and sexual partners with doxy or azithro

57
Q

Gonorrhea - rx

A

IV ceftriaxone, topical vigamox

Treat for chalamydia at the same time

58
Q

VKC features

A

GLHT SRK

  • male>female
  • warm months
  • GPC
  • Limbal follicles
  • Horner Trantas dots
  • Shield ulcer
  • Ropy mucous
  • Filamentary keratitis
59
Q

Ligneous features

A
Girls > boys
Bilateral or unilateral
Pseudomembranous conjunctivitis
Woody plaque
May bleed if excised - highly vascular
Same process affects all mucous membranes (mouth, vagina, etc) --> get an ENT consult to ensure no throat involvement before removing; if it bleeds a lot they may need GA with intubation
60
Q

axial length at birth

A

16 - 17 mm

61
Q

lens dimensions at birth

A

6.5 x 3.5 mm

62
Q

corneal diam in infancy

A

10, 11, 12 mm @ birth, 1, and 2 years (respectively)

63
Q

Why do all infantile pupils seem big

A

Constrictor pupillae is immature at birth

64
Q

Congenital lid colobomas - upper or lower

A

upper

65
Q

Congenital ectropion/entropion - upper or lower

A

lower

66
Q

Blepharophimosis features

A

Epicanthus inversus
Ptosis
Telecanthus
Lid phimosis

67
Q

Are most prego’s suspectible or immune to toxoplasmosis

A

70% seronegative

68
Q

What is the most common cause of posterior uveitis in kids

A

Toxoplasmosis

69
Q

Rubella - ocular manifestations

A

Cataract or glaucoma - don’t get both together because they occur at different points in gestation
Salt and pepper retinopathy

70
Q

Do rubella ever get glaucoma and cataracts together?

A

No - only one or the other, depending on when in gestation the infection happens

71
Q

Be careful of rubella cataract sx because…

A

Live virus can persist in the cataract for 3 years

  • tons of inflammation after surgery
  • make sure everyone in the room during surgery is vaccinated
72
Q

Most common congenital infection

A

CMV

73
Q

Hutchinson’s triad of congenital syphillis

A

Interstitial keratitis
Peg shaped teeth
Hearing loss (CN 8)

74
Q

EKC - type of adenovirus

A

Type 8

75
Q

Pre-septal cellulitis organism

A

Staph aureus (from skin trauma)

76
Q

Orbital cellulitis organism in kids

A

H flu

77
Q

Which muscle is hardest to find if it slips and why

A

MR - has no fasical attachments

78
Q

IO surgery - what 4 anatomical things do you need to identify

A
  • IO
  • IR
  • LR
  • infero-temporal vortex vein
79
Q

IR/SR act purely vertical in what eye position

A

23 degrees ABducted

80
Q

IO/SO - act purely vertical in what eye position

A

51 degrees ADDucted

81
Q

What type of amblyopia is least affected by neutral density filters

A

Strabismic

double check this

82
Q

What type of ambylopia is most affected by crowding

A

Strabismic

83
Q

What levels of ametropia do you need to start getting amblyopia (hyperopia, myopia, or astigmatism)

A

Hyperopia > +5
Myopia > -8
Astigmatism > 2.5D

84
Q

What levels of anisometropia do you need to start getting amblyopia

A

Hyperopia > 1
Myopia > 3
Astigmatism > 1.5

85
Q

What are the 3 causes of amblyopia (broad categories)

A

Strabismic
Deprivational
Refractive

86
Q

Eye findings in Kawasaki (and systemic)

A

Conjunctivitis

Fever x 5d
Conjunctivitis
Strawberry tongue
Injected pharynx
Palmar erythema
Desquamating rash
Lymphadenopathy
87
Q

Treatment of kawasaki

A

ASA

88
Q

Risk of kawasaki

A

Coronary artery vasculitis –> MI

89
Q

Cannaliculi - measurements

A

2-8-10 mm

90
Q

Where will a mass of the lacrimal sac present

A

Under the medial canthus

91
Q

Where is the obstruction in a dacryocystocele

A

Double obstruction - valve of Hasner (inferior opening) and Valve of Rosenmuller - entry to sac)

92
Q

What is your ddx of a dacryocystocele

A

Mucocele
Meningocele, encephalocele (present higher)
Vascular malformation
Other orbital tumor

93
Q

What is your investigation of a dacryocystocele

A

Can ultrasound if you’re unsure of the dx
CT/MRI

Usually no investigations are needed as it’s a clinical dx

94
Q

What is your management of a dacryocystocele

A

Get ENT consult to see if its obstructing the airway - esp if breathing or feeding difficulties, FTT, etc

ENT can marsupialise if needed

You can probe/irrigate if not resolving
Otherwise just massage, topical abx if infected

Risks - breathing difficulties or disseminated infxn from dacryocystitis

95
Q

Marfan’s - ocular and systemic manifestations

A
Ocular: 
Lens subluxation (up and out)
Myopia, high astigmatism
KC
amblyopia
Systemic:
connective tissue problems
joint problems, arthritis
aortic anneurysms
mitral valve prolapse, aortic insufficiency
96
Q

Homocystinuria - ocular and systemic complications

A

Ocular:
- lens subluxation (down and in)

Systemic:

  • thrombotic vascular events
  • MR
97
Q

Optic nerve hypoplasia - risk factors

A

Materal DM

Ingestion of LD, other substances

98
Q

Optic nerve hypoplasia - investigations

A

MRI brain for de Morsier’s syndrome

Send to endocrine to rule out pituitary problems

99
Q

Optic nerve hypoplasia - management

A

Send to endocrine to rule out pituitary problems

For the eye - think about amblyopia and treat

100
Q

How does leukemia present in the retina

A

CWS

Roth spots, hemorrhages

101
Q

What does Lowe’s syndrome give you (ocular)

A

Cataract and glaucoma

102
Q

Ocular albinism - findings

A
  • pale iris
  • iris TID (even in carriers)
  • pale retina
  • foveal hypoplasia
  • nystagmus
  • photophobia
  • high myopia
  • strabismus
103
Q

Aicardi - inheritance and findings

A

X-linked. Lethal in males

Lacunar chorioretinal degeneration
Agenesis of corpus callosum
MR

104
Q

Fibrous dysplasia vs ossifying fibroma

A

Fibrous dysplasia:

  • stabilises after skeletal maturity
  • precocious puberty
  • pigmented skin macules

Both can have ON compression
Difference is histological

105
Q

Schwannoma - type of spread

A

Perineural

106
Q

Neurofibroma of upper eyelid. Risks?

A

Glaucoma

Amblyopia (ptosis or astigmatism)

107
Q

Neuroblastoma - where is the primary most often

A

Abdomen (adrenal gland)
2nd = retroperitoneal

mets @ presentation in 1/3 of cases

108
Q

What part of the brain controls pursuit

A

Parietal (that’s why abnormal OKN towards the side of the lesion)

109
Q

What part of the brain controls saccades

A

Frontal (FEF)

110
Q

What is cogan’s dictum

A

Homonymous hemianopia

  • with abnormal OKN = parietal
  • with symmetric OKN = occipital
111
Q

What do you rule out in spasmus nutans

A

Can look like monocular nystagmus of childhood so rule out nerve or chiasmal tumor (image)

112
Q

Ocular findings in axenfeld reiger’s

A
Posterior embryotoxin (anteriorly displaced Schwalbe's line)
Iris hypoplasia with holes
113
Q

What is Allagile’s

A

Axenfeld Reiger + pigmentary retinopathy + systemic findings

114
Q

What is Peter’s syndrome

A

Opacified cornea

115
Q

Name 5 iris nodules

A
  • Brushfield spots - in Down’s - stromal hyperplasia surrounded by hypoplasia
  • Lisch nodules - NF1 - hamartomas
  • Iris nevi in ICE - heaped up iris stroma due to the endothelial membrane on top that contracts and tents up the stroma
  • Iris cysts - often from phospholine iodide use
  • JXG: yellow-orange spots. Touton on path. Bleed spontaneously.
116
Q

How do you treat a medulloepithelioma

A

Watch
Excise
Enucleate

117
Q

What do you find in Alport’s syndrome

A

Cataract

Hearing loss

118
Q

Microspherophakia - ddx and management

A
Weill-Marchesani
Alport
Lowe's
Hyperlysinemia
Rubella
Peter's

Use cycloplegics to flatten the lens and pull it back to relieve ACG

119
Q

Cataracts - work up for bilateral

A

Hearing tests: Alport, Rubella
Urine tests: reducing sugars (galactosemia) and amino acids (Lowe’s)
Genetics: Trisomy 13, 18, 21
Blood tests: blood sugar (DM), calcium, TORCH titres, RBC galactokinase (galactosemia)

Alport & Lowe’s are x-linked so only w/u boys

120
Q

Cataracts - work up for unilateral

A

TORCH titres
family history
do a good eye exam (both eyes)

121
Q

Cataracts, bilateral - when do you intervene

A

Visually sig is >3 mm usually

Operate on BETTER eye first. Aim for 6-8 weeks old, then second eye 1 week later

122
Q

Ddx of cataract + glaucoma

A

Lowe’s
Hallerman-Streiff
Rubella (very rare)

123
Q

ROP - screening criteria (canada)

A

birth weight

124
Q

ROP - when do you do their first exam

A

Either 4 weeks after birth, or 31 weeks GA, whichever is LATER

125
Q

ROP - what is threshold dz

A

Zone I or II
Stage 3
With plus
5 continuous or 8 cumulative clock hours

126
Q

ROP - what do you do for threshold dz and when

A

3 options:

  • cryo
  • laser
  • anti-VEGF

Treat within 72 hours. Treat whole avascular retina

127
Q

ROP - what is pre-threshold dz

A

Think of it as anything that doesn’t quite meet threshold:

  • Zone I, any stage with plus
  • Zone I, stage 3 no plus
  • Zone 2, stage 2 with plus
128
Q

What did we learn from CRYO-ROP

A

Defined threshold dz

And said cryo worked

129
Q

What did we learn from ETROP

A
Said treating pre-threshold dz is also probably a good idea
Used laser (?)
130
Q

How often do you follow ROP kids and when do you stop

A

Every 1 or 2 weeks depending on the severity (it’s kind of complicated….)
Stop when zone 3 is vascularized
Or if all good at 45 weeks

131
Q

How can you make an ROP exam easier on the newborn

A
Cooperative nursing staff
Swaddle
Soothers
Use sugar
Topical anaesthesia
Stop if the HR drops
132
Q

What are treatment options for RB

A

Chemo or enucleation are mainstays of treatment

RT/plaque are second line

133
Q

If you enucleate RB, how much ON do you want to remove

A

> 10 mm

134
Q

What imaging do you want to get in RB

A

Look at pineal gland

135
Q

What is your initial metastatic w/u in RB

A

Bone scan, LP

136
Q

How do you investigate an RB

A
Anterior chamber LDH: plasma LDH >1.0
Check both eyes carefully
B-scan = calcium, high internal reflectivity
FA = early hyper, late leakage
Orbital CT looking for calcium
Brain MRI for pineal tumor
Metastatic workup (bone scan, LP)
137
Q

What are the second malignancies in RB

A

Melanoma
Osteogenic sarcoma
Breast ca
Lymphoma, leukemia

138
Q

What are poor prognostic factors in RB

A

Optic nerve invasion
Uveal invastion
Extra-scleral extension
Multifocal tumors

Any metastatic dz at presentaiton
Unilateral = bilateral prognosis

139
Q

What’s more common in kids, leukemia or lymphoma?

A

Leukemia

140
Q

What is the inheritance pattern of phakomatoses? What are the exceptions?

A

All AD with incomplete penetrance except the Weird ones: sturge Webber and Wyburn mason are AR

  • other exception: ataxia telangiectasia is sporadic
141
Q

Dx criteria for NF1 (7)

A
  • 1st degree relative with NF1
  • > 2 lisch nodules
  • > 6 cafe au lait spots (>5 mm pre-pubertal, >15 mm post-pubertal)
  • 1 plexiform or 2 neurofibromas
  • osseous dysplasia (e.g. sphenoid wing)
  • intertiginous freckling
  • optic nerve glioma
142
Q

Dx criteria for NF2

A

Either

  • 2 acoustic neuromas
  • 1st degree relative with NF2 and either 1 acoustic neuroma or 2 of: meningioma, schwannoma, neurofibroma, glioma, PSCC
143
Q

SWS - what do you need to rule out

A

Leptomeningeal vascular malformations

144
Q

SWS - what is the mechanism of glaucoma

A

Combined:

  • increased EVP from the conj lesions
  • angle abnormalities from the hemangiomas growing over/in the angle
  • neovascular
145
Q

VHL - list all the findings (systemic + ocular)

A

Chromosome 3

Ocular:

  • retinal angiomas
  • may leak
  • treat only if causing a serous RD

Systemic:

  • cerebellar angiomas
  • cysts and tumors of kidney, pancreas, liver, adrenal glands
  • renal cell carcinoma
  • pheochromocytoma
146
Q

Tuberous sclerosis - retinal finding

A

Retinal astrocytoma

147
Q

Tuberous sclerosis - triad

A

Adenoma sebaceum, mental retardation, and seizures

148
Q

Tuberous sclerosis - skin findings

A
Ash leaf spots
Shagreen patches
Adenoma sebaceum
Peri-ungal fibromas
\+/- cafe au lait spot
149
Q

Ataxia telangiectasia - ocular findings

A

Telangiectactic conj vessels
Impaired convergence
Nystagmus
Ocular motor apraxia

150
Q

Ataxia telangiectasia - systemic concerns

A

Defective T cell function and IgA deficiency can cause recurrent infections or malignancies (leukemia/lymphoma)

Also get ataxia and MR

151
Q

Retinal cavernous hemangioma - systemic association

A

None!

Unlike retinal capillary hemangiomas (VHL) or choroidal hemangiomas (SWS)

152
Q

Brown’s features vs IO palsy

Brown’s Rx

A

Can’t adduct in upgaze
May have palpable click or audible click
May be associated with systemic inflammatory dz
No associated SO overaction

Brown’s will give you a V-pattern (eye can’t adduct in upgaze so it’s out) while IO palsy will give you an A pattern

Rx Brown’s with SO tenectomy, tenotomy, or silicone spacer

153
Q

Epinephrine dose for anaphylaxis

A

IM: 0.3 - 0.5 mL of 1:1000

always remember ABC, call code, stop offending agent, etc

154
Q

FAS features

A

Think of it mostly as lids:

  • ptosis
  • telecanthus
  • short palpebral fissures
  • microphthalmos
  • ET
  • refractive error
  • amblyopia
  • on hypoplasia
  • ant seg dysgenesis
155
Q

Crouzon features

A

This is a craniosynostosis:

Inferior scleral show
Proptosis, globes can luxate forward
Exposure keratitis
V-pattern XT
Therefore amblyopia
Refractive error

High pressure in the head from suture closure can give you papilledema
And always look for ON pallor from the optic canal becoming narrowed

156
Q

What is Apert

A

Craniosynostosis. It’s Crouzon + syndactycly

157
Q

Goldenhaar - ocular and systemic features

A

Remember the whole thing is one side of the face is dysplastic. That side of body can have issues too.

Ocular:

  • limbal dermoid
  • lower lid coloboma

Ear:

  • pre-auricular skin tag
  • poor hearing

Systemic:

  • cleft lip/palate
  • vertebral anomalies
  • can have dysplastia of the organs on that side of body - heart, lung, kidneys
158
Q

Treacher Collins

A

Mandibular dysplasia

159
Q

Pierre Robin - ocular association

A

Sticklers

think “Pierre Robin & Stickler are all friends” :)

160
Q

Infantile vision at birth and 6 months

A

20/200-20/400 at birth

20/20 at 6 months (by VEP)

161
Q

How do you measure infantile vision

A

VEP
or preferrential looking

Preferrential looking doesn’t give you 20/20 until a couple years old (may involve more than just vision i.e. processing, motor capabilities, etc)
VEP is 20/20 by 6 months