Paediatric Opthamology

Question 1

What may be a sign that a baby cannot see?

Answer 1

No response to smiles
Doesn’t reach for toys
Doesn’t notice mothers face

Question 2

What could be use to objectively assess an infant’s vision?

What tool is used?

Answer 2

Preferential looking- if given a choice the baby will look at the more interesting stimulus

Teller cards are used- baby will look at the stripes rather than the blank side. The finer the stripes the better the vision

Question 3

What is amblyopia?

Answer 3

Lazy eye- irreversible permanent reduction in the vision of one or both eyes

Question 4

What is strabismus?

Answer 4

Strabismus is a squint- where there is asymmetry between the eyes and they do not point in the same direction

Question 5

How does strabismus cause amblyopia?

Answer 5

Eyes do not converge properly and so this would cause double vision

Therefore the bad eye is suppressed and becomes lazy- leading to amblyopia

Question 6

What causes amblyopia?

Answer 6

Anything that reduces visual stimulus
Strabismic Amblyopia- squinting eye becomes lazy
Ametropic Amblyopia- refractive error in one or both of the eyes
Form deprivation- ocular disease such as congenital cataract

Question 7

What must be cone to correct ambylopia?

Answer 7

Correct any causes- e.g. congenital cataract, glasses
Patch the good eye forcing the child to use their bad eye
Atropine drops to blur vision are an alternative

Question 8

What types of quint are there?

Answer 8

Convergent- eye looks in
Divergent- eye looks out
Vertical- deviation up or down (less common)

Question 9

What are the treatment options for strabismus?

Answer 9

Corrective glasses
Patching over the good eye
Surgery

Question 10

What is leukocoria?

Answer 10

White pupil- refer urgently

Question 11

What is the most common cause of leukocoria?

Answer 11

Congenital cataract- refer urgently

Question 12

What ocular problems must be checked for in new born children?

Answer 12

Congenital cataracts

Question 13

Why must children with congenital cataracts be referred urgently?

Answer 13

Development issues- e.g. wont learn to smile if cant see it

Risk of developing ambylopia- form deprivation kind

Question 14

What is the most common ocular cancer in children?

Answer 14

Retinoblastoma- absent red reflex

Question 15

What is the treatment for retinoblastoma?

Answer 15

Systemic chemotherapy- highly responsive
Local Treatments- Laser, cryotherapy, radioactive plaque
Sometimes surgical removal

Question 16

What might indicate a bacterial conjunctivitis over a viral conjunctivitis?

Answer 16

Bacterial conjunctivitis is often a sticky discharge

Viral conjunctivitis is often a water discharge, also likely to have pre-auricular lymphadenopathy

Question 17

What associated illness is likely to be seen in a patient with viral conjunctivitis?

Answer 17

URTI

Often caused by adenovirus

Question 18

What kind of lymphadenopathy may be seen in viral conjunctivitis?

Answer 18

Pre-auricular

Question 19

How does allergic conjunctivitis present?

Answer 19

Bilateral red eyes
Stringy mucous
Itchy eyes
Associated with atopy- hay fever, eczema

Question 20

What is the treatment for allergic conjunctivitis?

Answer 20

Topical anti-histamines and mast cell stabilisers

Question 21

What is opthalmia neonatorum?

Answer 21

Any conjunctivitis within the first month of life

It’s is an emergency and can cause blindess

Question 22

What is a main cause of opthalmia neonatorum?

Answer 22

Gonorrhoea

Also chlamydia

Question 23

What is the management

Answer 23

Identify the organism- swabs for culture and NAAT

Systemic antibiotics depending on the cause

Question 24

How might naso-lacrimal duct obstruction present?

Answer 24

Sticky eye but not red (red indicates infection)

Question 25

What causes retinopathy of prematurity?

Answer 25

Retinal vasculature is not fully developed at birth- there is abnormal vasculature. Abnormal vessels are prone to bleeding, causing scar tissue to form which can lead to retinal detachment

It is associated with oxygen therapy

Question 26

What is the treatment for retinopathy of prematurity?

Answer 26

Laser to reduce ischaemic stimulus due to poorly formed blood vessels causing distal ischaemia