OCULAR DISEASE IN

PEADIATRIC

PREPARED BY:ANIS SUZANNA BINTI MOHAMAD

OPTOMETRIST AND CONTACT LENS CONSULTANT

B.SC (HONS) OPTOMETRY UKM

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

OBJECTIVE EXAMINATION

SUBJECTIVE EXAMINATION

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

DIFFRENTIAL DIAGNOSIS

Congenital nasolacrimal duct obstruction Chronic dacryocystitis Acute dacryocystitis

(Staphylococcus, Streptococcus, Haemophilus Influenza)

Amniocele Medial canthus encephalocele

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

TREATMENT-CHRONIC DACRYOCYCTITIS

Lac sac massage Broad spectrum ab for 2 wks Probing

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

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

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.

PTOSIS

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

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.

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

CYST OF MOLL

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

CHALAZION

Chronic inflammation of the meibomian gland causes slogged ductus

Initiate pressure to the cornea and causes irregular astigmatism.

T(x): Incision, steroid injections

CONJUNCTIVITIS: BACTERIA, VIRAL, CHLAMYDIAL, ALLERGIC

Bacteria –purulent discharge Gonoccocal, Staphylococcus pneumoniae, Can cause corneal ulcer, opacification, perforation,

cellulitis T(x); Gentamycin, erythomycin, bacitracin

VIRAL CONJUNCTIVITIS

Watery discharge Unilateral Periorbital pain Herpes simplex

conjunctivitis – vesicles & discharge, mucous, can cause dendritic keratitis

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

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

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

CATARACT

POST CATARACT TREATMENT

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

CONGENITAL GLAUCOMA

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

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)

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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