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DIAGNOSIS AND MANAGEMENT
OF CHILD WITHOPHTHALMOLOGY DISORDER
Dr. Sunerti, SpM
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ANATOMI
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Equipment for OphthalmologicExamination
Flash light
Loupe
Ophthalmoscopy (Direct, Indirect) Slit lamp
Tonometry (Schiotz Tonometry)
Snellen chart
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Eye Examination
Anterior Segment
Eyelid, Eye brow
Conjunctiva
Sclera
Cornea
Anterior Chamber
Pupil
Posterior Segment
Lens
Vitreus Body
Retina
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Vision Examination
Any ocular examination must includeassessment of vision
Measurement of visual acuity is subjective
recuire respon from the patient Examines with Snellen chart, children can
be tested at about age 3 years
Normal visual Acuity 6/6 (20/20)
Poor vision 3/60, HM, LP
Totally blind NLP
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ILLiterate eye chart
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Slit Lamp Examination
The patient is seated, the head is stabilized byan adjustable chinrest and Fore head strap
We can be visualized the anterior segment
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Direct Ophthalmoscopy
Is a standard partof theophthalmologicexamination
Need dark room toallow evaluation ofthe central fundus
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Normal Fundus
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It is practical device, who might use it to screen patientfor glaucoma.
Patient is placed supine and topical anasthetic is instilledinto each eye
Normal intra ocular pressure 15 20 mmHg
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Congenital Ptosis
Is commonly due todytrophy of thelevator muscle of the
upper lid Other causes are
congenital thirdnerve palsy
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Congenital Palpebra Coloboma
Is a cleft ofussually the upperlid due to
incomplete fusionof fetal maxilaryprocesses
Large defects
require early repairto avoid cornealulceration
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MEGALOCORNEA
Is an enlargedcornea with normalclarity and function
It must bedifferentiated fromcongenital glaucoma
In new born thecorneal diameter is
9.5 to 10.5 mm
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CONGENITAL GLAUCOMA
Early sign : CornealHase/opacity,Increased cornealdiamter, increased
intra ocular pressure
The most strikingsymptom is extremephotophobia
Early Recognation isessential to preventpermanent blindness
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COLOBOMA OF THE IRIS
Indicatesincomplete closureof fetal ocular cleft
Usually occursinferiorly andnasally
It may beassociated withcoloboma of thelens, choroid andoptic nerve
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ANIRIDIA
Absence of the iris
Frequentlyassociated with
secondaryglaucoma andwilms tumor
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STRABISMUS
Any deviation fromperfect ocularalignment
Misalignment my beany direction inward,outward up or down
Treatment should be
started as soon as adiagnosis is made
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CONGENITAL CATARACT
A Cataract is anyopacity in the lens
Congenital cataractare common and often
visually insignificant If cataract are dense,
central and larger than2 mm in diameter,require surgical
management with inthe first 2 months oflife
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RETINOBLASTOMA
Malignant tumor ofchildhood
90 % of cases thediagnosis is madebefore the end of thethird year
Infants and childrenwith presentingsymptom of Strabismusshould be examined
carefully to role outRetinoblastoma
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Gonococcal Conjuntivitis
Inflamation of theconjunctiva cause byNeisseria gonorrhoeal,present between the
second and fifth daysafter birth
Marked by a profusepurulent exsudat
Profusely exsudativedemands immediatelaboratore andimmediate treatment
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