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Block 3 CM Ophtho 1: Pediatric Eye Disorders
Terms in this set (67)
All children are screened for visual problems at the youngest possible age. Which of these kids are at higher risk for visual problems?
Children with a family history of eye disorders, developmental delay, Down syndrome, or are preterm infants.
Down syndrome is a risk factor for what eye and vision problems?
Refractive error, strabismus, cataract.
Being born preterm puts the child at risk for what eye and vision problems?
Retinopathy of prematurity, strabismus, refractive error.
When is color vision fully developed?
At around 4 months.
What is visual acuity at birth?
When is visual fixation present?
When is visual fixation well developed?
At 6 - 9 weeks of age.
What are the milestones for visual tracking?
Follows to midline: 1 month.
Follows past midline: 2 months.
Follows 180°: 3 months (or earlier).
When is the milestone for accommodation?
When is the milestone for stereopsis?
What are the types of refractive errors?
Myopia (nearsightedness), hyperopia (farsightedness), astigmatism.
How are refractive errors treated?
With glasses or contact lenses (glasses for kids).
What is the deformity of the eye that leads to myopia?
The eyeball is too long or the cornea has too much curvature.
What is the deformity of the eye that leads to hyperopia?
The eyeball is too short or the cornea has too little curvature.
What is astigmatism? How does it present?
Irregular shape of the cornea or curvature of the lens, causing vision to blur at any distance.
What is a strabismus?
When can strabismus be diagnosed?
After the child is at least 6 weeks old.
How is strabismus corrected?
With corrective lenses or surgery (extraocular muscle resection).
(Incidentally, the muscle resection is why I have a nystagmus.)
What is esophoria?
Intermittent inward deviation.
What is exophoria?
Intermittent outward deviation.
What is esotropia?
Constant inward deviation.
What is exotropia?
Constant outward deviation.
What is pseudostrabismus?
The appearance of eye misalignment without them actually being aligned, usually due to a broad nasal bridge.
What are the tests used to assess for strabismus or pseudostrabismus?
Cover test and corneal light reflex test.
What is the most common cause of vision loss in children?
What causes amblyopia?
Altered visual development within the central visual pathways.
What is strabismic amblyopia?
Misalignment of an eye with suppression to avoid diplopia.
What is anisometropic amblyopia?
One eye is a different length than the other, resulting in a different focusing ability.
What is deprivational amblyopia?
The result of not using an eye.
What is the favored screening method for amblyopia?
Visual acuity testing.
While checking the red reflex, you notice one eye is white. What is this condition, and what does it indicate?
Leukokoria, indicating a cataract or retinoblastoma.
While checking the red reflex, you notice one eye's reflex is more prominent than the other, but they are both red. What does this indicate?
Refractive error in one or both eyes.
What are the visual acuity tests for ages up to 3 years old?
Allen test (cartoon pictures), LH test (readily identifiable shapes).
What are the visual acuity tests for ages up to 5 years old?
HOTV test (choose which of four letter shapes is presented), tumbling E test (which way the E is pointing).
What is the visual acuity test for ages 5 years old and older?
Which test differentiates between strabismus and pseudostrabismus?
The corneal light reflex test.
Which test differentiates between a tropia or a phoria (strabismus)?
The cover test.
What is dacrostenosis?
Obstruction of the nasolacrimal duct (due to clogging, stenosis, or a congenital membrane).
What are the signs of nasolacrimal duct obstruction?
Excessive tearing, watery or cloudy liquid draining from the eyes, crusty eyelashes on waking, constant rubbing of the eyes.
How is a nasolacrimal duct obstruction treated?
With OMM at first, antibiotics or ointments if infection is present. If ineffective, corrective surgery.
What is dacryocystitis?
Infection of the lacrimal sac, typically secondary to nasolacrimal duct stenosis.
What are the typical pathogens of dacryocystitis?
S. aureus and S. pneumoniae.
What are the exam findings of dacryocystitis?
Pain, swelling and redness of the medial lower eyelid.
What are the possible complications of dacryocystitis?
How is dacryocystitis treated?
With oral antibiotics, warm compress and treatment of nasolacrimal duct obstruction (if present).
How is colorblindness diagnosed?
Using Ishihara test cards.
What is a coloboma?
Failure of fusion of the embryonic fissure of the optic cup, resulting in a keyhole-shaped pupil.
How does coloboma affect vision?
If it only affects the iris, at most there will be some sensitivity to bright lights. If the retina is affected, vision will be significantly disrupted.
With what syndromes is coloboma associated?
CHARGE, cat eye syndrome, Rieger syndrome.
What is aniridia?
Failure of the mesoderm to grow from the iris root, leaving only rudimentary iris structures.
With what tumor is aniridia associated?
What are the potential complications of aniridia?
Photophobia, nystagmus, glaucoma, hypoplasia of the macula, decreased visual acuity.
What defects of the eye are associated with aniridia?
Corneal opacity, lens dislocation, cataracts.
What is the finding on red reflex exam that suggests a cataract?
With what syndromes is congenital glaucoma associated?
Sturge-Weber syndrome, Lowe syndrome, neurofibromatosis, Rubinstein-Taybi syndrome, congenital rubella syndrome.
What are the signs and symptoms of congenital glaucoma in an infant?
Blinking, photophobia, squinting, tearing, pain, decreased visual acuity, cornea edema (appears cloudy), increased anterior chamber size.
What are the findings on physical examination that support a diagnosis of congenital glaucoma?
Dull red reflex, irregular corneal light reflex, enlargement of the optic cup on funduscopic exam.
What is the first line treatment for congenital glaucoma?
Eye drops to reduce IOP.
When is retinoblastoma typically diagnosed in children?
At ages 12 - 18 months.
What is the gross appearance of retinoblastoma?
Elevated, round, white or yellow mass.
What are the most common presenting signs of retinoblastoma?
Leukokoria, then strabismus.
What is retinopathy of prematurity?
An abnormal growth of fibrous tissue and increased number of blood vessels in the retina, associated with preterm birth. This extra tissue acts like scar tissue, leading to poor macular development or retinal detachment.
What are the risk factors for retinopathy of prematurity?
, very low birth weight
, high-oxygen environment
*, intrauterine growth retardation, necrotizing enterocolitis, male gender, sepsis, dexamethasone, transfusions.
Leukokoria may be associated with retinopathy of prematurity, but it cannot be used to diagnose it. What must you do to diagnose retinopathy of prematurity?
Funduscopic evaluation of the damage.
How is retinopathy of prematurity treated?
Cryotherapy or laser photocoagulation, indicated for advanced disease.
What is retinitis pigmentosa?
A rare hereditary diseases that causes the rods in the retina to degenerate over time.
What are the signs and symptoms of retinitis pigmentosa?
Poor night vision, eye fatigue, loss of contrast sensitivity. May progress to complete night blindness, loss of peripheral vision, tunnel vision, and sometimes total blindness.
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