Pediatrics - Ophthalmology PDF

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Pediat rics

[OPHTHALM OLOGY]

Amblyopia This is essentially a cortical blindness and a defect of development that results when misalignment of the eyes (many causes including cataracts, tumor, strabismus, ocular motor dysfunction)  competing visual inputs  the brain will “turn off” inputs from the busted eye. One eye will be normal while the other eye will go blind. Fix the underlying problem.

This is a duplicate note-set from Surgery. The questions, the notes, and the video are identical for Peds-Ophtho and Surgery-Peds-Ophtho

Strabismus This is misalignment of the eyes that, if left untreated, can lead to amblyopia – or permanent “lazy eye”. Strabismus confirmed on physical exam when the reflection of light comes from separate locations on each eye. If present from birth, this needs to be surgically corrected to avoid amblyopia. However, if baby was NOT born with it, consider that this could simply be a refraction problem that can be fixed by glasses and then will resolve spontaneously. Retinoblastoma In the nursery, instead of a red light reflex a pure white retina can be seen in the back of the eye. Don’t confuse this with a cataract in front of the eye. Resect the tumor. Avoid radiation (↑ risk of “2nd knockout” in the good eye). Observe the patient for future osteosarcoma - especially in the distal femur. Cataracts Congenital cataracts have a milky white appearance in the front of the eye. You’ll see them just by looking. They are caused either by the TORCH infections if present at birth or galactokinase deficiency if acquired early in life. Fix it before amblyopia sets in with surgical removal of the cataract. Retinopathy of Prematurity Premature neonates requiring high-flow O2 can get these growths on the retina. Using laser ablation can improve vision in life. Look also for intraventricular hemorrhage, bronchopulmonary dysplasia, and necrotizing enterocolitis in a preemie in the ICU. Conjunctivitis in Newborns What we care about in newborns is being able to discern between a bacterial conjunctivitis that will cause baby to go blind and a chemical or viral conjunctivitis that will just get better on its own. We screen and treat all mothers for STIs. But sometimes a baby gets through without mom knowing or being treated. If that’s the case, we’re trying to protect baby from Gonorrhea and Chlamydia. We can use silver nitrate drops as prophylaxis. This stuff burns and can induce a chemical conjunctivitis (clear, non-purulent discharge on day 1). Use the timing and the laterality to help you decide which bacteria it is. Gonorrhea is first, appearing at 2-5 days and is a purulent bilateral discharge. It’s treated with topical erythromycin. Chlamydia occurs at day 7-14 and is mucopurulent unilateral discharge. It’s treated with topical PLUS oral erythromycin to prevent pneumonia.

Gonorrhea is gram negative diplococci Chlamydia shows nothing (bacteria is intracellular)

Type Chemical

Timing 24 hrs

Gonorrhea

Day 2-5

Purulent Nonpurulent Purulent

Problems Bilateral Bilateral, can turn into blindness

Chlamydia

Day 7-12

Mucopurulent

Unilateral Can turn into pneumonia

Treatment Caused by silver nitrate drops Topical erythromycin Or Silver Nitrate Prophylaxis Oral + Topical Erythromycin or PPX

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