Paediatric Ophth

8/10/2019 Paediatric Ophth

1/41

PAEDIATRIC

OPHTHALMOLOGY

Dr Shuaibah Ab.GhaniPaediatric OphthalmologistHospital Queen Elizabeth

Kota Kinabalu

2ndeyecare-drssuha


2/41

INTRODUCTION

Children are the most precious resourceof families

Children represent the families future

and their hopeA blind child is a tragedy to the families

A child whose blindness could have

been prevented or cured is an EVEN agreater disaster

2ndeyecare-drssuha


3/41

EPIDEMIOLOGY

Definitions

Childindividual aged


4/41

Screening

2ndeyecare-drssuha


5/41

Pediatric Eye

Screening

History- Listen to what the mother says. They

are usually correct especially if they have

older children.- risk factors for eye and vision

abnormalities

- ex ; family history of Cong. Cataract

Cong. GlaucomaRetinoblastoma

2nd eyecare-drssuha


6/41

Snellen equivalent

AGE DEVELOPMENT

Birth 20/400

2 month

20/2004 month 20/200

6 month 20/150

1 year 20/50

5 year 20/20

2nd eyecare-drssuha


7/41

VISUAL ASSESSMENT

OF THE CHILDREN

Newborn to 3months

Inspection :

- structuralabnormality

- Size and clarity ofcornea

3 to 6 monthsable to follow an

object / light

2nd eyecare-drssuha


8/41

6 to 12 months

Inspection

Corneal light reflex

Fix and follow witheach eye

3 years and

abovedVisual acuity

(monocular)

2nd eyecare-drssuha


9/41

Guidelines for Screening

Preterm Perinatal /infantileperiod

Preschool Elementaryschool

Retinopathyofprematurity(ROP)

Cong.Cataract

Glaucoma

Anteriorsegmentdisorder

Strabismus

Refractive error

Anisometropia

Refractive error

2nd eyecare-drssuha


10/41

Retinopathy of

Prematurity (ROP)

Untreated will cause

blindness

Premature babies

< 32 weeks or

< 1500g

Needs screening byophthalmologists


11/41

Patho-physio

2nd eyecare-drssuha


12/412nd eyecare-drssuha

Normal fundus

Zone IZone III Zone II


13/41

Stage 1 Stage 2

Stage 3


14/41

Plus disease Rubeosis iridis

Stage 4


15/41

Laser therapy


16/41

Leukocoria

White red reflex

Leukocoria-white pupil

All must be referred to doctors as soonas possible

Possible diagnosis:

Retinoblastoma - eye cancer

Cataract

Infection

2nd eyecare-drssuha


17/41

Leukocoria - Cataract

Developmental at birthor in the first yr. of life

- usually harmless

Congenital

uni- or bi-lateral at birth

- symptoms

white pupilsquint

2nd eyecare-drssuha


18/41

Leukocoria -

retinoblastoma

2nd eyecare-drssuha


19/41

2nd eyecare-drssuha


20/41

SQUINT

synonym: cross-eye,strabismus

may be:convergentdivergentvertical

2nd eyecare-drssuha


21/41

Refractive error -

myopia Cannot focus on

distance object

Very common

Needs glasses /

contact lens correction

Needs regular visits to

the optometrist

2nd eyecare-drssuha


22/41

Refractive error -

hypermetropia

Cannot focus on nearobject

School children may

complain of headacheswhen doing close work

2nd eyecare-drssuha


23/41

Refractive error-

astigmatism

Common

Surface of the eye like rugby ball rather thana football

Usually mild but if significant will need glasses

2nd eyecare-drssuha


24/41

Common eye problems

Red eyes

Watering eyes

Other

2nd eyecare-drssuha


25/41

RED EYES

Conjunctivitis

gonococcal conjunctivitisophthalmia neonatorum

2nd eyecare-drssuha


26/41

RED EYES

Conjunctivitis

special type:

allergic conjunctivitis

dust, pollen oranimals

seasonal

Mx: avoidance ofallergenicsubstance

allergic to drug

2nd eyecare-drssuha


27/41

WATERING EYES

most commonamong babies

soon after birth

D/T incompletedev. of tearpassage

Settles during 1st

year


28/41

WATERING EYES

May becameinfected

Tx: See ophthalmologist

eyedrop &/orointment


29/41

OTHERS

Congenital ptosis

Unilateral or bilateral

May have other

neurological problems

May cause amblyopia

Cosmetically poor

2nd eyecare-drssuha


30/41

Glaucoma

i. Congenital ( at birth)

ii. Infantile ( 1-2 years)

iii. Juvenile ( 2-16 years)

Clinical triad

Epiphora +Blepharospasm +Photophobia

2nd eyecare-drssuha


31/41

Gross Congenital Abnormalities

Refer all gross abnormality to the

paediatrician / ophthalmologist

Some examples

2nd eyecare-drssuha


32/41

Sturge-Weber

Syndrome

2nd eyecare-drssuha


33/41

Facial cleft

2nd eyecare-drssuha


34/41

Down Syndrome

2nd eyecare-drssuha


35/41

Craniosynostosis

2nd eyecare-drssuha

Mi h l


36/41

Microcephaly-

small head

2nd eyecare-drssuha


37/41

Albinism

2nd eyecare-drssuha

Bl h hi i


38/41

Blepharophimosis-

small lids

2nd eyecare-drssuha

A hth l i


39/41

Anophthalmia-

no eye

2nd eyecare-drssuha


40/41

Massages!

Refer all gross abnormality to thepaediatricians.

Listen to what the mother says. Theyare usually correct especially if theyhave older children.

If the mother thinks that the child

cannot see, refer.

2nd eyecare-drssuha


41/41

Thank You

Documents

Paediatric Ophth