Why worry about strabismus? [1,8] Vitreous Hemorrhage (dark reflex) Hypopyon (layering of WBCs in...
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Transcript of Why worry about strabismus? [1,8] Vitreous Hemorrhage (dark reflex) Hypopyon (layering of WBCs in...
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Why worry about strabismus?
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[1,8]
Vitreous Hemorrhage (dark reflex)
Hypopyon (layering of WBCs in anterior chamber)
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Initial Presentation
• Most (75%) PARENTS detect abnormality
http://shainazhope.com/
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Retinoblastoma
• Autosomal dominant (RB1) with incomplete penetrance• Increased risk other cancers
– Only 5-10% of cases have family history
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Retinoblastoma
• Age– 90% younger than 5 years at diagnosis– Average of 18 months– Rare cases in adults [1]
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Morbidity/ Mortality
• 5 year survival 93%• If untreated: Metastatic spread within 6
months– 50% 1yr survival
• With early detection, among most curable childhood cancer
• Leukocoria is actually a late finding– Ocular survival 9% at 5 years
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Red Reflex
http://www.daisyseyecancerfund.org
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[9]
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Red Reflex
• Screens all aspects of optical pathway– Tear film, cornea, aqueous and vitreous humor,
iris, lens, retina.– Over 30 Diseases:
• Cataracts, glaucoma, retinoblastoma, systemic disease [3].
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White Reflex “White Pupil”
tapetum lucidum"bright tapestry"
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White Reflex
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• PCP first noted presenting signs in only 5%• Delayed PCP referral 21% (3.75 months)
– PCP reassured parents of normalcy or made wrong diagnosis– False reassurance with normal red reflex
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[11]
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AAP Policy (Dec 2008)
• Document Red Reflex:– In newborn nursery– ALL routine health supervision visits
• Previous Recs: within 2months; 6 months; 1,3,5,10yrs
• Refer to ophtho:– All high risk patients
• Fam Hx: RB, infantile cataracts, retinal dysplasia, glaucoma
– Based on parental observation alone– Abnormal red reflex (urgent)– Contact ophthalmologist directly– Document confirmation of proper followup [3]
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What’s your Dx
Retinoblastoma
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Pseudostrabismus
Strabismus
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www.kidsretina.blogspot.comPediatric retina blog
Persistent Fetal Vasculature
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Congenital Cataracts
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Congenital Glaucoma
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Normal Retina
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Take Home Points
• Screen in the nursery and at every checkup!• Take parental concerns seriously and refer!• Do not trust a normal red reflex if concerns
are present.• Call ophthalmologist directly, especially if
abnormal exam.• Close followup of high risk patients.