PEDIATRIC EYE CONDITIONS

Posted by e-Medical PPT Friday, February 3, 2012
Differential diagnosis_RED EYE
Ophthalmia neonatorum
Conjunctivitis (bacterial, viral or allergic)
Traumatic injury (e.g., corneal abrasion)
Corneal infection/keratitis
Foreign body
Glaucoma
Uveitis (iritis)( anterior)
Preseptal and  orbital cellulitis

DANGER FEATURES- RED EYE
Severe pain (unilateral)
Photophobia
Reduced visual acuity/ persistent blurring
Reduced ocular movement
Ciliary flush
Irregular corneal light reflection
Pupil non-reactive to direct light
Corneal epithelial defect/opacity
Exophthalmos
Worsening symptoms after 2-3 days of Rx of a simple conjunctivitis
Compromised host - neonate, contact lens wearer, immuno-suppressed patient

OPHTHALMIA NEONATORUM

Moderate -Severe bacterial conjunctivitis in newborns <28 days of age
This condition must be differentiated from the more common mild conjunctivitis

Causes
- Generally acquired from the maternal genital tract
- Bacterial organisms include Chlamydia and Neisseria gonorrhea
- Chlamydial infection is the more common cause of neonatal conjunctivitis
- Less commonly, Hemophilus strains, Staphylococcus aureus, Streptococcus pneumoniae and other gram-negative organisms may be involved

NASOLACRIMAL DUCTOBSTRUCTION –DACRYOSTENOSIS
A congenital disorder of the lacrimal system characterized by blockage of the nasolacrimal duct
Results in excessive tearing and mucopurulent discharge from the affected eye
The condition occurs in approximately 2% to 6% of newborns
Onset is usually within the first few weeks of life

Cause
Persistence of a membrane at the lower end of the nasolacrimal duct results in incomplete canalization of the duct and its consequent obstruction

History And Physical Findings

- Tearing within the affected eye
- Pooling or puddling of tears
- Epiphora (frank overflow of tears)
- Accumulation of mucoid or mucopurulent discharge in the affected eye, which results in crusting (usually evident upon awakening)
- Erythema or maceration of the skin under the eye
- Expression of clear fluid or mucopurulent discharge which may be intermittent or continuous over several months
URTI may exacerbate the condition
- Usually unilateral but may be bilateral
- Conjunctival erythema and irritation minimal

STRABISMUS
An abnormality in the alignment of the eyes
The classification of strabismus is complex
On an etiologic basis, it may be paralytic or non-paralytic
 It can also be classified as congenital or acquired, intermittent or constant, or convergent or divergent

Pathogenesis
-When the eyes are positioned so that an image falls on the fovea (the area of best visual acuity) of one eye, but not the other, the second eye will deviate so that the image falls on it’s fovea as well

-This deviation may be up, down, in or out and results in strabismus.

CONGENITAL CATARACTS
Congenital cataracts present with leucocoria and are often noticed very early by the parents as they feed their child.
the cataract may be less than complete and not interfere significantly with visual development...

More common situation is a complete opacity of the lens
These must be operated on immediately to clear the visual axis and a contact lens or spectacle correction used to correct for the resultant high hyperopia.

Because of the rapid growth of the eye during the first two years of life, and the resultant change in refractive power of the eye, intraocular lenses are not currently recommended for infants.
Aggressive occlusion therapy is always necessary to force use of the involved eye, and patching is frequently continued to the age of eight years.
Even with early surgery and aggressive optical correction and patching therapy, the visual prognosis in an eye harbouring a uniocular congenital cataract is quite poor
Past the age of three months cataract surgery is not recommended at all because the visual prognosis is so grim from the resultant deprivational amblyopia.

CONGENITAL GLAUCOMA
Associated with other congenital syndromes such as Down’s Turner’s

S&S –
Decreased vision, photophobia
Increased tearing during daylight or in bright  light,
Corneas hazy/cloudy, decreased corneal reflex
Referral to Ophthalmology
Medications, surgeries
Good prognosis if picked up early, but is a lifelong condition

RETINOBLASTOMA
The average age of children with retinoblastoma is 18 months.
More than 75% of children are first noted to have a “white-pupil” leukocoria,
or strabismus
or a red and painful eye (usually due to glaucoma).
CAT scans, and ultrasound can diagnose intraocular retinoblastomas in over 95% of cases.

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