OCULAR DISEASE IN
ANIS SUZANNA BINTI MOHAMAD
OPTOMETRIST AND CONTACT LENS
B.SC (HONS) OPTOMETRY UKM
PEDIATRIC EYE EXAMINATION
Overall examination – indirectly during
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
30% infants at birth
Relative narrowing of the distal nasolacrimal
Resulting in decreased tear outflow
Causes: congenital dacryostenosis. Secondary to
trauma, orbital tumours, various dev anomalies
ie craniofacial clefts
spontaneously open by 1 year of age.
Lacrimal sac massage
Instillation of broadspectrum ab drops or
Over 1 year old; probing and irrigation of the
Fail to probe – silicone tubing
Lac sac massage
Broad spectrum ab for 2 wks
purulent material - gently compress
Obtain a Gram stain and culture and ab
Neonates and infants – IV ab
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
Common sign in babies
Extra folds at the upper and the lower medial
Esotropic appearance, Hirscberg’s Test to confirm.
Typical in Down Syndrom Children.
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
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
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,
Epiphora, itchiness, redness, photophobic, chemosis.
Allergy to pollen, animals and food.
Children with hay fever, eczema or asthmatic
T(x) topical antihistamine & allergen disinfectant
< 28 days from birth– Ophthalmia neonatarum
Caused by gonorrhoea, staphylococcus,
streptococcus, haemophilus, pneumococcus,
chlamydia, herpes simplex
Can penetrate the cornea and cause blindness
Matured catarct > 3mm at central, need to be
If bilateral, surgery need to be done within 2 weeks
Small opacity– monitor
Traumatic cataract ( 8 – 10 yrs) need urgent surgery
Present at birth
Manifest differently compared to adults
Children’s eye more elastic, so it will
stretch with pressure.
lacrimation, photophobia, diameter cornea
12- 13mm, endothelial breaks, usually
unilateral, elevated IOP, cupping
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
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
Depends on the immaturity level or birth
If >2000g ROP infrequent
<1250g @ <28 wks – vulnerable
Ophthalmology assessment for <1500g
Severe ROP – complications; changes at
peripheral and posterior retina, Stretching of
the vitroretinal causing detachment and,