ocular disease in peadiatric
DESCRIPTION
Ocular disease in peadiatricTRANSCRIPT
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OCULAR DISEASE IN
PEADIATRIC
PREPARED BY:ANIS SUZANNA BINTI MOHAMAD
OPTOMETRIST AND CONTACT LENS CONSULTANT
B.SC (HONS) OPTOMETRY UKM
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PEDIATRIC EYE EXAMINATION
Overall examination – indirectly during communication
Appearance of the external eye– lid abnormality, eye lashes, eyeglobe, cornea and conjunctiva
Compare both eyes Pupil reaction – direct and indirect Internal examination – if needed
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OBJECTIVE EXAMINATION
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SUBJECTIVE EXAMINATION
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NASOLACRIMAL DUCT OBSTRUCTION
30% infants at birth Relative narrowing of the distal nasolacrimal
system Resulting in decreased tear outflow Causes: congenital dacryostenosis.
Secondary to trauma, orbital tumours, various dev anomalies ie craniofacial clefts
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DIFFRENTIAL DIAGNOSIS
Congenital nasolacrimal duct obstruction Chronic dacryocystitis Acute dacryocystitis
(Staphylococcus, Streptococcus, Haemophilus Influenza)
Amniocele Medial canthus encephalocele
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TREATMENT – CONG DACRYOSTENOSIS-
spontaneously open by 1 year of age. Lacrimal sac massage Instillation of broadspectrum ab drops or
ointment. Over 1 year old; probing and irrigation of the
nasolac system Fail to probe – silicone tubing
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TREATMENT-CHRONIC DACRYOCYCTITIS
Lac sac massage Broad spectrum ab for 2 wks Probing
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TREATMENT ACUTE DACRYOCYSTITIS
purulent material - gently compress Obtain a Gram stain and culture and ab
sensitivity testing Pain control Warm compression Neonates and infants – IV ab
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EPIPHORA 5% obstruction to the nasolac duct. Diff Diag:- glaucoma, corneal abrasion,
conjunctivitis, keratitis, allergy and foreign body. T(x) – massage, after 1 year old - probing
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PSEDOSTRABISMUSEpicanthus
Common sign in babies Extra folds at the upper and the lower medial
canthus. Esotropic appearance, Hirscberg’s Test to
confirm. Typical in Down Syndrom Children.
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PTOSIS
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PTOSIS
Drooping of the upper eyelid Dystrophy of the levator muscles Cong ptosis - unilat. or bilat. Mild – cover more than 2 mm of the cornea Moderate - 3 mm Severe - 4 mm or more Effect on the vision and cosmesis value
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BLEPHARITIS
inflammation at the lid margin. red, swollen, with debris. 2 types; Squamos & Ulcerative Staphylococcal blepharitis; common irritation, red, warm & photophobic secondary infection ie conjunctivitis, stye
and chalazion.
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STYE (EXTERNAL HORDEOLUM)
Acute Bacterial infection at the eyelash follicle.
Sometimes it involves the Moll and Zeiss gland.
Causes; hygiene and chronic blepharitis. T(x): Hot compress, a/biotik topikal/sistemik,
excision
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CYST OF MOLL
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INTERNAL HORDEOLUM
Acute staphyloccal infection at the meibomian gland.
Advancement from meibomianitis & chronic blepharitis
Redness, swollen at the tarsal plate. T(x): same as stye
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CHALAZION
Chronic inflammation of the meibomian gland causes slogged ductus
Initiate pressure to the cornea and causes irregular astigmatism.
T(x): Incision, steroid injections
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CONJUNCTIVITIS: BACTERIA, VIRAL, CHLAMYDIAL, ALLERGIC
Bacteria –purulent discharge Gonoccocal, Staphylococcus pneumoniae, Can cause corneal ulcer, opacification, perforation,
cellulitis T(x); Gentamycin, erythomycin, bacitracin
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VIRAL CONJUNCTIVITIS
Watery discharge Unilateral Periorbital pain Herpes simplex
conjunctivitis – vesicles & discharge, mucous, can cause dendritic keratitis
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ALLERGIC CONJUNCTIVITIS
Epiphora, itchiness, redness, photophobic, chemosis.
Allergy to pollen, animals and food. Children with hay fever, eczema or asthmatic T(x) topical antihistamine & allergen disinfectant
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INFECTIOUS CONJUNCTIVITIS
< 28 days from birth– Ophthalmia neonatarum
Caused by gonorrhoea, staphylococcus, streptococcus, haemophilus, pneumococcus, chlamydia, herpes simplex
Can penetrate the cornea and cause blindness
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CONGENITAL CATARAT
Matured catarct > 3mm at central, need to be reffered
If bilateral, surgery need to be done within 2 weeks of birth
Small opacity– monitor Traumatic cataract ( 8 – 10 yrs) need urgent
surgery
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CATARACT
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POST CATARACT TREATMENT
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CONGENITAL GLAUCOMA
Present at birth Manifest differently compared to adults Children’s eye more elastic, so it will
stretch with pressure. Signs-Buphthalmos,corneal edema,
lacrimation, photophobia, diameter cornea 12- 13mm, endothelial breaks, usually unilateral, elevated IOP, cupping
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CONGENITAL GLAUCOMA
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CONGENITAL GLAUCOMA
M(x) surgeri; goniotomy or trabeculotomy, medical T(x), lens extraction
VA less then 6/15 due to damage optic nerve and corneal opacification.
Secondary Glaucoma– hyphema(trauma), Retinopathy of prematurity, retinoblastoma, post cataract surgery, rubella syndrome
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RETINOBLASTOMA Retinal cancer – detected at early birth,
heriditary (need to do the Genetic Test) Need early diagnosis, can be fatal. Nystagmus dan leucocoria (white pupil) T(x) – enucleation, chemotheraphy (93%
success)
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RETINOPATHY OF PREMATURITY (ROP)
Depends on the immaturity level or birth weight
If >2000g ROP infrequent <1500g ROP <1250g @ <28 wks – vulnerable Ophthalmology assessment for <1500g Severe ROP – complications; changes at
peripheral and posterior retina, Stretching of the vitroretinal causing detachment and, retinal folds
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THANK YOU