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89 Cards in this Set
- Front
- Back
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what are the 4 components of the eye exam
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I-ARM
Inspection Acuity Assessment Red Reflex Motility assessment |
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what is assessed in the inspection part of the eye exam
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pupil symmetry
eyelid symmetry face/head tilt conjunctival redness squinting |
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how is acuity assessed in the infant/neonate
in the child? |
infant - eval of eye fixation and pupillary response
child - use of eye charts or cards |
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what does the pupil response tell you and how early can it be seen
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it is a marker that the visual sensory system is working
can be seen in the NICU - respond to light at 32 wks |
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what is the visual acuity at birth estimated to be? when does it reach 20/20?
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20/100 - 20/200
??? |
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what is the impact of stimulation on eye/acuity development
what is the most critical period? |
highly dependent on stimulation
if the eye isn't functioning well early in life or if there is a structural problem, the visual acuity will not develop correctly most critical devel period 3-4mo (high susept. 0-10yo) |
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at what age do they:
have pupils which respond to light fix their eyes on a target follow a target have 20/50 vision have 20/40 vision |
32 wks - respond to light
6wks - fixes on target 12 wks - follows a target 20/50 @ 3yo 20/40 by 4 yo |
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what is indicated if the red reflex is dark or dull
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cataract - dark, dull or white
vitreous hemorrhage - dark or dull glaucoma - dull |
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what is indicated if the red reflex is white
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cataract - dark, dull or white
retinoblastoma - white or yellow |
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what is indicated if the red reflex is yellow
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retinoblastoma - white or yellow
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what is indicated if the red reflex is brighter in a deviated eye (corneal light reflex uncentered)
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strabismus
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what is necessary for normal visual development (in addition to normal CNS development and connectivity)
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1. proper eye alignment
2. equal visual stim of each retina |
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what is stereopsis and what can lead to abnormality
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normal depth perception
- improper eye alignement - any unilateral blur of the retinal image, ie congenital cataract |
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what are the 4 types of REFRACTIVE ERROR
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1. hypermetropia - far sighted
2. myopia - near sighted 3. astigmatism - 2 curvatures, can't see well near or far 4. leucocoria - structural that creates an opacity at/behind the pupil-> white light reflex |
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what is the etiology of leucocoria
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retinoblastoma
cataract opacity w/in vitreous |
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what is the management of leucocoria
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URGENT
depends on etiology |
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what is the management of hypermetropia (far-sightdness)
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most kids don't need treatment, won't need glasses
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when is myopia (near sightedness) diagnosed and who is at higher risk (ethnic groups)
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high school
AA & Asian populations w/ higher prevalence (1/3rd pop myopic by 18yo) |
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what is the management of refractive error
what about lasix or other laser treatments? |
glasses/lenses
reassurance that it's normal there is NO cure laser trt NOT approved for <18yo, but there are a few case studies of success |
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epiphora
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tearing
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what needs to be ruled out urgently if the eye is cloudy
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GLAUCOMA
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what is glaucoma and how does it differ from adult glaucoma
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increased intraoccular pressure
glaucoma in kids is generally congenital & occurs at or soon after birth in juvenile glaucoma the eye stretches and expands w the pressure. both damage the optic nerve. |
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what is the clinical presentation of glaucoma
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tearing (epiphora)
enlarged cornea (often cannot see the cornea) corneal clouding dull red reflex often bilateral - 70% of cases |
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what are the potential complications of glaucoma in kids
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corneal edema
corneal clouding amblyopia blindness - if undetected/untreated |
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what is the etiology of glaucoma
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blockage of the outflow of aqueous humor
ofent maldevelopment issue - generally inherited dis'd can also be from: infection, occular abnormalities, or genetic syndromes |
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what genetic syndromes are a/w glaucoma
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Sturge-Weber
neurofibromatosis marfans |
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wha are the possible causes of lens opacities
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sporadic
familial metabolic (ie G6PD) |
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when lens opacities are MONOcular, what is the etiology
what if they're binocular? |
monocular - sporadic, usually a defect of development
binocular - can be sporadic, metabolic dis'd, or familial |
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what labs are done to work up unilateral cataracts?
what about bilateral cataracts? |
unilateral - TORCH testing only
bilateral: - urine for reducing substances, amino acids - blood for calcium & phosphorous - TORCH testing - VDRL testing - RBC galactokinase level |
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what is the recommendation re: eye exams for kids with diabetes?
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endocrinologists rec annual exam (AAP does not)
kids can get retinopathy after puberty |
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define retinoblastoma and the etiology
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malignant tumor of the sensory retina
caused by a mutation - can be genetic or sporadic |
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what is the common age and clinical presentation of retinoblastoma
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13-18 mo (avg)
more than 90% <5yo LEUKOCORIA STRABISMUS may also have: glaucoma vitreous hemmg retinal detachment hyphema |
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what is inconsequentia pigmenta
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congenital dis'd not compatible w life
only females survive till birth |
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what is hypoplasia
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the optic nerve never developed - little to no vision in the eye
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what is amblyopia
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poor vision - usually <20/40
caused by abnormal stimulation resulting in abnormal visual development |
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how prevalent is amblyopia
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2-4% population
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what are the causes of amblyopia
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lazy eye - eye turns out so it doesn't develop as well
OR assymetrical defocus (more farsighted in one eye) & anything else that causes blurred image |
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what is the presentation of amblyopia
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often NO external clues
mostly UNI-lateral fail acuity test |
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what is the management of amblyopia and what determines if it will be successful?
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EARLY INTERVENTION - easiest young, success through age 8
***always offer at any age*** Management: - GLASSES - patching - surgical correction of lens opacities/barriers - (cycloplegic drops to blur good eye) |
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3 types of strabismus
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ESOtropia
EXOtropia HYPERtropia |
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esotropia
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eye turns in toward nose
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Exotropia
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eye turns out laterally
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Hypertropia
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vertical turnout of the eye
(aka vertical strabismus) |
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pseudostrabismus
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eyes are CORRECTLY ALIGNED
BUT appear off b/c of the epicanthal folds |
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what is the etiology of strabismus
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generally unknown
possible causes: brain tumor farsightedness paresthesia of EOM |
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how is strabismus diagnosed
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cover - uncover test
light reflex testing |
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what is the onset of
esotropia |
esotropia - early onset, congenital or infantile OR acquired
exotropia - onset in preschool & worsens w/ time |
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what is the effect of strabismus on visual develpment if it occurs
(a) before 5-7yo (b) after 5-7yo |
(a) <5-7yo - AMBLYOPIA from suppressing image in the deviated eye
(b) >5-6yo - DIPLOPIA - cannot suppress that image |
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what features of strabismus are RED FLAGS fro underlying cause
(dangerous - ie tumor or neuro process) |
ACQUIRED strabismus
decreased eye Movement ptosis decreased vision abnormal red reflex |
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what is the management of strabismus
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depends on the underlying cause
- correct refractive error - correct amblyopia - surgery for larger angles that do not respond |
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what is the refractive error a/w exotropia
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MYopia
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what is the refractive error a/w ESOtropia
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HYPERmetropia
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per AAP guidelines, when do you start :
(1) checking red reflex (2) assessing alignment (3) measure visual acuity |
check red reflex - birth
assess alignment - 6 mo measure vision - 3-4yo (really??) - school age is mandated |
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what type of conjunctivitis is indicated by this finding:
vessicles |
herpes simplex
herpes zoster |
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what type of conjunctivitis is indicated by this finding:
purulent discharge |
bacterial
(can be nasolacrimal obstruction as well, canbe other) |
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what type of conjunctivitis is indicated by this finding:
preauricular node |
viral
chlamydial hsv |
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what type of conjunctivitis is indicated by this finding:
mucoid discharge |
allergic
(can be other) |
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what type of conjunctivitis is indicated by this finding:
watery eyes |
viral
can also be iritis, foreign body, nasolacrimal obstruction |
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what is the clinical presentation of allergic conjunctivitis
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symmetric, bilateral usually
NO adenopathy MINimal discharge + tearing itching and burning may have mucoid discharge |
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what is the treatment for allergic conjunctivitis
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topical antihistamines
mast cell stabilizing drops - CROMYLN systemic antihistamines |
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what is the clinical pres of VIRAL CONJUNCTIVITIS
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can present as epidemic keratoconjunctivitis OR pharyngeal conjunctival fever (with pharyngitis, etc)
- hyperemic conjunctiva - conjunctival follicles - little bumps - corneal opacities - preauricular lymphadenopathy - severe watery discharge - often FB sensation |
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what is the etiology of viral conjunctivitis
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adenovirus
herpes simplex herpes zoster |
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management of viral conjunctivitis
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cool compresses
decongestants antihistamines avoid steroids (but makes it feel better) anti-inflamm drops sunglasses restrict contact lenses |
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what is the clin presentation of bacterial conjunctivitis
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hyperemic
purulent discharge conjunctival erythema lid swelling maybe a/w OM |
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what is the mgt of bacterial conjunctivitis
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If no systemic disease - use topicals:
- erythromycin ointment - polymyxin-bacitracin + trimethopride (polytrim) - sulfacetamide - tobramycin - fluorquinolones - gentamycin if systemic OR chlamydial / gonorrheal / N. meningitidis: systemic therapy |
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when to refer bacterial conjunctivitis
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severe eye involvement
a/w contact lenses suspected corneal ulcer lack of improvement with topical abx |
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what are the common causes of bacterial conjunctivitis
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H. influenza
Strep pneumoniae M. catarrhalis Staph aureus |
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what to do if the kid wears contacts AND has conjunctivitis
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ALWAYS treat
consider referral |
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what conjunctivitis types have itching
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all, but in allergic it's severe
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what types of conjunctivitis have tearing
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all, but in viral it's most profuse
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what are the potential other systemic s/s a/w conjunctivitis of the various types
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VIRAL - rash, sore throat, fever
BACTERIAL - occasional fever, sore throat CHLAMYDIAL -pneumonia in neonates ALLERGIC - variable, allergic |
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what is the clinical presentation of nasolacrimal duct obstruction
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SWELLING
eye itself is NOT inflammed UNIlateral inflammation watery eye matted lashes mucous in medial canthal area bilateral involvement (1/3rd) eye is NOT red (but starts with looking red |
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what is the mgt of nasolacrimal duct obstruction
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massage
antibiotics probing (after 1yo) supportive |
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what is the prognosis w/ NLD obstruction
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generally resolves in 6mo
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what is the leading cause of blindness in N. America
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retinopathy of prematurity
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what is retinopathy of prematurity
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proliferation of vessels in the eye
a/w exposure to O2 in premature infants & low BW & other factors |
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what are late complications of ROP
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myopia
astigmatism amblyopia strabismus blindness |
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what is the management of Retinopathy of prematurity
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Opthalmologic exams Q1-2 WEEKS
IF severe: more invasive procedures |
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what is the prevention of retinopathy of prematurity
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* early detection *
minimize O2 dilated opth. exam @ 4-6wks of age for infants born </= 28wks OR BW <1500 |
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what are the differentials for presentation of EYE REDNESS
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FB
infection allergy systemic infx noxious irritant subconjunctival hemmg tumor |
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what are the etiologies of subconjunctival hemmg
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traumatic
spontaneous disease related (hematopoetic, vascular, inflammatory processes) |
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what are the differentials for presentation of TEARING
- infants -children |
INFANTS:
nasolacrimal obstruction congenital glaucoma (a/w photophobia, blepharospasm) CHILD: inflammation allergy viral disease conjunctival Irritant corneal irritation |
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what are the differentials for presentation of WATERY DISCHARGE
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viral infection
iritis FB nasolacrimal obstruction |
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what are the differentials for presentation of PURULENT DISCHARGE
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nasolacrimal obstruction
bacterial conjunctivitis |
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what are the differentials for presentation of MUCOID DISCHARGE
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allergic conjunctivitis
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what are the differentials for presentation of pain/FB sensation
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corneal abrasion
FB laceration infection of the globe/adnexa irritis closed angle glaucoma trichiasis contact lens |
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what is trichiasis
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in turned lashes
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what are the differentials for presentation of photophobia in an infant
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glaucoma
aniridia retinal dystrophies (acromatopsia) |
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what are the differentials for presentation of photophobia at any age
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s/p surgery or dilation
intermittent extropia if a/w squinting migraines meningitis retrobulbar optic neuritis |
