Ocular disease in peadiatric

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Ocular disease in peadiatric

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Ocular disease in peadiatric

  1. 1. OCULAR DISEASE IN PEADIATRIC PREPARED BY: ANIS SUZANNA BINTI MOHAMAD OPTOMETRIST AND CONTACT LENS CONSULTANT B.SC (HONS) OPTOMETRY UKM
  2. 2. 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
  3. 3. OBJECTIVE EXAMINATION
  4. 4. SUBJECTIVE EXAMINATION
  5. 5. 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
  6. 6. DIFFRENTIAL DIAGNOSIS  Congenital nasolacrimal duct obstruction  Chronic dacryocystitis  Acute dacryocystitis  (Staphylococcus, Streptococcus, Haemophilus Influenza)  Amniocele  Medial canthus encephalocele
  7. 7. 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
  8. 8. TREATMENT- CHRONIC DACRYOCYCTITIS  Lac sac massage  Broad spectrum ab for 2 wks  Probing
  9. 9. 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
  10. 10. 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
  11. 11. PSEDOSTRABISMUS Epicanthus  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.
  12. 12. PTOSIS
  13. 13. 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
  14. 14. 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.
  15. 15. 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
  16. 16. CYST OF MOLL
  17. 17. 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
  18. 18. CHALAZION  Chronic inflammation of the meibomian gland causes slogged ductus  Initiate pressure to the cornea and causes irregular astigmatism.  T(x): Incision, steroid injections
  19. 19. CONJUNCTIVITIS: BACTERIA, VIRAL, CHLAMYDIAL, ALLERGIC  Bacteria –purulent discharge  Gonoccocal, Staphylococcus pneumoniae,  Can cause corneal ulcer, opacification, perforation, cellulitis  T(x); Gentamycin, erythomycin, bacitracin
  20. 20. VIRAL CONJUNCTIVITIS  Watery discharge  Unilateral  Periorbital pain  Herpes simplex conjunctivitis – vesicles & discharge, mucous, can cause dendritic keratitis
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. CATARACT
  25. 25. POST CATARACT TREATMENT
  26. 26. 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
  27. 27. CONGENITAL GLAUCOMA
  28. 28. 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
  29. 29. 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)
  30. 30. 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
  31. 31. THANK YOU

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