Peadiatric ophthalmology in 10 minutesDavid Kinshuck, Good Hope Hospital• Retinopathy of Prematurity• Leukocoria………• Examining neonates • Amblyopia• Squint=Strabismus• (not covered here in detail…links)

– Cataracts– Nystagmus– Anisocoria– Nasolacrimal Duct Obstruction– Ptosis– Cloudy Cornea/many other conditions– Infections: conjunctivitis, cellulitis, etc

Retinopathy of prematurity (1)

• in premature babies peripheral retina is not vascularised at birth• Under certain conditions instead of the vascularisation proceeding

normally, there is a growth of new vessels and scarring • 100% oxygen, crucial period 28-36weeks, especially low birth

weight

www.nyee.edu/images/ar038.jpg

Retinopathy of prematurity (2)

• vascularisation

www.nyee.edu/images/ar038.jpg

• Scarring

• Laser peripheral retina

• Without laser,retinal detachment/blindness; have to check (screen) all appropriate neonates

www.nei.nih.gov

Retinopathy of prematurity (3)

www.aafp.org/afp/990901ap/907.html

Leukocoria (1)=white pupil

Have to check red reflex of all neonates & children• Retinoblastoma• congenital cataract • PHPV (persistent hyperplasia of primary vitreous)• Retina detachment (trauma/ retinopathy of

prematurity)• Toxocariasis (nematode infection) from exposure

to puppies• Uveitis, infections, other conditions

www.occhioallaretina.it/Immagini/leucocoria.JPG

http://oftalmologo.bravepages.com/Leucocoria%201.jpg

Leukocoria (2)

Examination of neonates

• Gross abnormality• Red reflex (eg cataract)

• Discharge (gonococcal/chlamydial conjunctivitis)

• Large eye..buphthalmos

http://oftalmologo.bravepages.com/Leucocoria%201.jpg

www.kfunigraz.ac.at

Examination of neonates (2):ophthalmic neonatorum

Discharge in first week of life will be gonococcal or chlamydial conjunctivitis. Gonococcal infection can cause serious corneal damage www.kfunigraz.ac.at

Examination of neonates (3):ophthalmic neonatorum

arapaho.nsuok.edu/~fulk/ Images/Img0055.JPG

Examination of neonates (4) buphthalmos

Amblyopia (1)

• Early childhood is essential for visual maturation….visual cortex has to receive good quality images to develop

• Critical period 6 weeks…….(5y)• Early period most important• If no clear image is received, even if

the problem (eg cataract, squint) is corrected, eye will never see

Amblyopia (2)

• A structurally normal eye that cannot see as well as it should

• Common causes are– Squints– Refractive errors with/without a

squint– cataract

Squints (1)

• Esotropia

• Exotropia

• (vertical)

• Correct refractive error & patch good eye to treat amblyopia

• online (section 12, double vision and pupil, 3rd ‘?’ left)

• Folder similar

www.aafp.org/afp/990901ap/907.html

Exotropia: divergent

Esotropia: convergent

Squints (2)

• Exotropia

• See video if online http://www.mrcophth.com/vidoes.html

www.aafp.org/afp/990901ap/907.html

…briefly (not omitted here)……………….

• Cataracts (danger of amblyopia) online• Nystagmus online (section 12, double vision and pupil)

folder

• Anisocoria online (section 12, double vision and pupil) folder

• Nasolacrimal Duct Obstruction online • Ptosis online (section 12, double vision and pupil) folder

• Cloudy Cornea/many other conditions• Infections: conjunctivitis, cellulitis, etc