Common eye disorders in children 3 👁
2⃣Routine eye conditions 🌻
Nasolacrimal (tear duct) obstruction
Red eye
Infectious
Allergic
Inflammatory
Refractive error
🌻Nasolacrimal obstruction
Present in 5% of NB (usu. deve shortly after birth)
Presentation: Tearing & Discharge
Ddx
Glaucoma, Retinoblastoma
❗ Watch out for Lack of D/C, Large eye, Poor red reflex, Photophobia
Dx: Dye disapperance test
Treatment
ATB as needed
Massage-Crigler method
Goal: ⬆ pressure in sac
ทำโดย firm steady pressure with downward
Surgery around 1 y/o (or 18 mo. up)
Earlier if symptoms bad enough!
🌻 Red eye
Strategy
Painful/Sensitive to light?
Itchy?
Pre-auricular adenopathy with Watery d/c & Mild lid swelling?
Purulent d/c?
✅ ➭ Ciliary flush? Pupil smaller? Minimal D/C?
✅ ➭ Iritis - refer
❌ ➭ keep goin but don't eliminate iritis yet
✅ ➭ Allergic conjunctivitis
❌ ➭ keep goin
✅ ➭ Viral conjunctivitis
Given Hx of exposure
Highly contagious
✅ ➭ Bacterial conjunctivitis
Not contagious
Responsive to ATBs *unlike every other cause)
Allergic conjunctivitis
Onset
Acute
Chronic
Itch, with or without mild lid swelling
Chemosis (dramatic, clear conjunctival swelling)
Supportive treatment
Often responsive
Including
Remove new Ags from home
Apply cold compresses
Artificial tears if tolerated
If tears alone don't help ➭ try allergy drops
refer ❗
🌻 Refractive error
Myopia = nearsighted
Hyperopia = farsigthed
- Distance vision: blurred
- Near vision: fine
Little or No risk of Amblyopia
No imperative Dx in preschool years
⭐Incidence burden in Asian country ⭐⭐
Greater accommodation required at near
(Eye must generate focusing effort, accommodation to see clearly even at distance
cause either Permanent blur or Strabismus
Critical to Dx in preschool years
found in Caucasian > Asia
Astigmatism = Different refraction in 2 meridians
Rarely can cause Amblyopia
Causes
Multifactorial cause
Multistudy look
Outdoor act. may ⬇incidence of myopia
Prolonged near task night vision use ➭ may progress myopia
Genetic mayb main cause for refractive error
3⃣ Systemic ds with ocular findings⛵
Neurofibromatosis 1
Juvenile rheumatoid arthritis