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Common Eye disorder in Children :baby::skin-tone-2: (:Five: Pediatric…
Common Eye disorder in Children
:baby::skin-tone-2:
Types of Eye problems in children
:one: Vision- or Life-threatening conditions :sheep:
:two: Routine, non-vision-threatening เจอได้บ่อย :sunflower:
tbc
:three: Systemic ds with the ocular findings :boat:
:sheep:
Vision- or Life-threatening eye conditions
Anything causing Leukocoria (Asymmetric red reflex)
Strabismus
Conditions that occlude one eye
Nystagmus
Glaucoma
Orbital cellulitis
Trauma
Amblyopia
tbc :white_flower:
Important concept
:sparkles:
Infants hv only
few ways
to tell us what's wrong with their vision!
Nystagmus
Squinting
Strabismus
Head tilt (Torticolis)
may indicate Strabismus or Refractive error
tends to show up later
Need to consider ocular & non-ocular causes
:star:
Bruckner test
:one:
Retinopathy of prematurity
(ROP)
Def: Proliferation of abnormal vss in immature retina
:arrow_up: incidence as Improved perinatal care
Primary care provider needs to help
confirm that F/U appointments are kept
Criteria for consult: GA≤ 32wk, BW 1,500gm, or Unstable clinical
Whom to screen?
to consult
BW < 1,500 g
or
GA < 30 wk
GA ≥ 30 wks + BW 1,500-2,000 with unstable clinical course
When to screen?
1st screen
at
4-6 wks after birth
but have to 31 wks up
Stop when
Until full retinal vascularization to Ora serrata
Treatment
CRYO Therapy (ไม่ค่อยทำ)
:star:
Laser BIO
Complication
Cataract
2nd glaucoma
Myopia
Astigmatism
Strabismus
:star:
Anti-VEGF
Drugs
Avastin (Bevacizumab)
Lucentis (Ranibizumab)
Complication
Trauma to lens (cataract)
Vit heg
Retinal tear
Infection
Unknown long term complication
:two:
Retinoblastoma
CC
may present as Leukocoria (จุดขาวๆบนตา)
Strabismus
Photophobia
:!: Early Dx & Therapy usu saves life
Treatment
:star:
Proton beam irradiation
(helpful บาง cases)
Intraarterial chemotherapy
by intervention to :arrow_down: ก้อน size
:!: late present + ก้อนโตมากๆ ➭ metas ตาม optic n. ➭ เข้า brain ได้
:three:
Orbital cellulitis
Only
orbital cellulitis causes
Proptosis
Globe displacement
Limitation of EOM
Double vision
Vision loss (indicates orbital apex involvement)
:!: still 1-2% mortality
Periorbital (preseptal) cellulitis
I/C for ATB
:star:
age
< 2 y/o
or
> 60 y/o
present with preseptal cellu (progress to orbital cellu
very quick
!!)
need close monitor ocular sign & v/s
:four:
Pediatric Glaucoma
Easy to Dx, Hard to Rx
Clinical presentation
:frame_with_picture:
Triads
Epiphora
Photophobia
Blepharospasm
Typically present with
Decrease vision
Induce myopia
Severe optic nerve damage
condition associated with glaucoma
no
corneal enlarge or Haab striae
after 2-3 yrs
(still has post. elongation of globe till 10y/o)
Obvious evidence of ocular stretching
Limited role of technology in Dx
usu. surgical
:Five:
Pediatric ocular trauma
Leading cause of vision loss in children
:star:
must differentiate Accidental vs Non-accidental (child abuse)
:star: Careful Hx taking (must fit physical findings) & common sense
:!: child may please adult ➭ provides incorrect answer
:star:
M/C cause
uni
lateral blindness in child
Aside fr
vision loss
&
psychological
problem
Risk factor
for
Accidental eye injury
Youth
0-5 y/o
greater risk > 5-18 y/o
Younger: Fall or Sharp object
Older: Sport injury
Sex
Boy, age > 6 y/o
Lack of parent supervision
Definitive & obvious RF
:warning:
Prognosis
was affected by
Severity
Psychological factors
Amblyopia
may limited recovery in children < 7 (9) y/o
caused by Amniocentesis & Birth injury
Amniocentesis 2nd trimester - very little risk for fetal loss :grapes:
Ocular anexal injury
after episio
rare
➭ upper/lower eyelid laceration
bruising, subconjunctival hemorrhage
Orbital injury
Forcep extraction ➭ Inferior rectus fibrosis
Vertical rupture of Descemet MB (DM), Contralateral occipital depression
Eye lid & Lacrimal system trauma
2 parts
hv to aware with special consideration
Injury to
Eye lid margin
Sharp or Blunt injury
Dog bite, Rat bite
Careful reapproximate eyelid margin to prevent notching
Injury to
Lacrimal drainage system
Medial eyelid margin injury
Require silastic intubation
:dog2:
dog bite
may effect eyelid margin & lacrimal drainage system or may involved to Inferior oblique
Subconjunctival hemorrhage
Spontaneously or Trauma
no significance
except
ถ้ามี abnormal tear distribution (bump near limbus) ➭ Delle formation ➭ Localized dry
If associated with trauma ➭ need thorough search for more serious injury, may m
ask penetrating injury
(sign: uvea laceration, distorted pupil, lower IOP)
Anterior segment trauma
Corneal abrasion
corneal epi. remove fr its BM (stained with fluorescein)
Blunt or Sharp injury,
Significant pain
Persistent abrasion ➭ Asymptomatic
:!: need F/U aware corneal ulcer
Ddx
HSV (dendritic appearance)
Corneal BM disease (recurrent abrasion with no Hx of trauma)
Treatment
Prophylaxis infection
Antibiotic ointment vs drop
Cycloplegic
drop reduce pain fr iridospasm
Strong potency: 1% Atropine ED
Moderate potency: 1% Cyclogyl ED
Patching?? debate but with pt subjectively it more comfortable than open
Corneal FB
If penetrated corneal epithelium ➭ small FB stick on cornea
Pain & FB body sensation
Beware uncertain Hx (children)
Examine carefully for Possibility penetrating injury
Mx as corneal abrasion
if corneal FB removed
:!:
Beware occult trauma
If trauma not witnessed ➭ assume the worst
Key complications
Penetration of globe
Canalicular laceration
Trauma to nerve
Primary MD = key role in prevention
Education
1M eye injuries/yr in US, 90% preventable
Leading causes: sports accidents, consumer fireworks, household chemicals, workshop, and yard debris
Advocacy
(support of eye protection legislation)
Face shield for baseball
Eye protection for most other sports
Regulation of BB guns
:six:
Self-inflicted injury
Young adult with
psychiatric ds
Burring, chemical or cutting
Autoenucleation in Schizophrenic
Keratoconjunctivitis artefacta
Thermal, chemical, mechanical
Demarcated lesion in
inferior or nasal of bulbar
conjunctiva and corneal and skin below
in
children
: psychopathic,
stress
caused by other
sexual or other abuse
Metabolic: Smith-Magenic syndrome, Lesch-Nyhan syndrome, Joubert syndrome and possible Gilles de la Tourette syndrome