PEDIATRIC - HOMEOPATHY

1. CATARACT, ANISOCORIA AND OCCULAR INJURIES
BY
DR PULLA UMA MAHESWARI
DEPARTMENT OF PAEDIATRICS
PG PART - II
CATARACT,
ANISOCORIA AND
OCULAR INJURIES
BY
DR PULLA UMA MAHESWARI
DEPARTMENT OF PAEDIATRICS
PG PART - II

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OBJECTIVES
 DEFINE CATARACT
 CLASSIFY THE CATARACT
 EXPLAIN THE EACH TYPE OF CATARACT
 LIST THE CAUSES
 LIST THE RUBRICS OF CATARACT
 DEFINE OCULAR INJURIES
 LIST THE CAUSES
 CLASSIFY THE INJURIES
 DEFINE ANISOCORIA
 LIST THE RUBRICS OF ANISOCORIA

3. CATARACT

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• A cataract is any opacity of the lens
• The incidence of infantile cataracts is approximately 2-13/10,000 live births
• Approximately 60% of cataracts are an isolated defect, 22% are part of a
syndrome, and the remaining cases are associated with other unrelated major
birth defects.
• Cataracts are more common in low birthweight infants
INTRODUCTION

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ANTERIOR POLAR CATARACT
• Anterior polar cataracts are often hereditary, and
visually insignificant.
• The most common type of anterior polar cataract
presents as a tiny white dot in the center of the
anterior capsule
• They are usually 1 mm or less in diameter and
generally do not progress in size
• Corneal astigmatism may be present, however, and
can cause amblyopia

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ANTERIOR CAPSULAR CATARACT
• Anterior subcapsular cataracts are often
associated with trauma, radiation, or acquired
diseases such as uveitis, Alport syndrome
(cataracts associated with anterior lenticonus),
and atopic skin diseases (shield-like anterior
subcapsular cataracts are classic).
• Anterior subcapsular opacities may also be part of
a more widespread multilayer cataract

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ANTERIOR CAPSULAR PLAQUE
• These are axial opacities in the capsular
epithelium
• They occur either as multiple plaques
distributed throughout the anterior lens
epithelium or as a single large plaque, which
may be located centrally or eccentrically
• They are commonly associated with a
persistent pupillary membrane and/or
microcornea.

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ANTERIOR AND POSTERIOR CORTICAL CATARACT
• Isolated cortical cataract is less common in infants
and young children and posterior cortical cataract
is more common than anterior cortical cataract
• Cortical cataract is usually present as club-shaped
opacities in the peripheral zone of the lens cortex,
which does not interfere with vision
• The blue dot cataract is a type of cortical cataract.
• The classically described coronary cataract is a
type of deep cortical cataract

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MEMBRANOUS CATARACT
• Membranous cataract is an advanced form of cortical
cataract, in which the entire lens substance is absorbed,
leaving a thin gray-white capsular membrane that
replaces the cortex
• It is frequently bilateral and visual prognosis is poor
• Most cases are sporadic and a familial or dominant
transmission is rare.
• It is often associated with aniridia and in congenital
rubella, it occurs as a sequence of intrauterine iridocyclitis
that remains active after birth, leading to microphthalmos

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ISOLATED NUCLEAR CATARACT
• This has been classically described as a central
pulverulent cataract
• The opacity involves the embryonic nucleus.
• It is caused by an insult occurring during the first 3
months of development.
• It is always bilateral and nonprogressive.
• The white, discrete dots appear as a granular disc
in the center of the lens and sometimes the dot-like
opacities may extend into the overlying cortex

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RUBELLA CATARACT
• This cataract accounts for 4–5% of all
congenital cataracts in developing countries
• The infection is contracted by the mother
during the first 3 months of pregnancy
• Rubella is bilateral, progressive, and may be
associated with microphthalmos
• It may present as dense nuclear cataract or
as total cataract soon after birth

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LAMELLAR CATARACT
• It is usually acquired rather than congenital.
• They involve a layer (lamellae) of cortex surrounding the fetal
nucleus, peripheral to the Y sutures.
• They are almost always bilateral, but are commonly asymmetric.
• The visual prognosis is usually better with lamellar cataracts
(even when surgery is delayed) than with cataract types that are
densely opaque at birth such as fetal nuclear opacities
• In sporadic cases of the congenital form, cataract can be
attributed to a parathyroid deficiency resulting in hypocalcemia
and avitaminosis-D in the mother during the last trimester of
pregnancy or in the fetus

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SUTURAL CATARACT
• It is a Y-shaped opacity affecting one or both
the sutures of the fetal nucleus
• The opacity is either around the suture or
involves the sutures, more posterior than
anterior
• Opacification of both anterior and posterior
sutures is called stellate cataract
PUNCTATE CATARACT
• The floriform and coralliform cataracts are types
of nuclear cataract which follow an autosomal
dominant inheritance pattern.
• In floriform cataract, clusters of opacities are
present around the fetal sutures
• Coralliform cataract has large crystals
accumulated in the center of the lens without
reference to the sutures.

18. POSTERIOR POLAR
CATARACT
These are usually
sporadic cortical
opacities with a
propensity for
spontaneous posterior
capsule rupture.
can be unilateral or
bilateral, mild or severe
POSTERIOR
SUBCAPSULAR
CATARACT
This form of cataract is seen
as vacuolar or plaque-like
opacities close to the posterior
capsule. Typically it is seen in
older children following
trauma, uveitis secondary to
rheumatoid arthritis, or after
prolonged use of steroids for
spring catarrh and radiation.
POSTERIOR
LENTICONUS
mostly unilateral and is not
associated with microphthalmia.
Most forms are sporadic, but
occasionally an autosomal-
dominant inherited bilateral form
The bulge in the posterior
capsule is usually not present at
birth, but becomes more
exaggerated as intra lenticular
pressure increases with age

19. POSTERIOR POLAR
CATARACT
POSTERIOR SUBCAPSULAR
CATARACT

20. TOTAL CATARACT
• It presents as a general opacity of all the lens fibers
• This occurs due to an insult acting throughout the period
of development or a severe insult late in fetal life
• They are frequently bilateral.
• Total cataract is frequently reported with congenital
rubella syndrome, Down’s syndrome, acute metabolic or
even sporadic cataracts
• Aggressive surgical management is mandatory for good
visual prognosis.

21. MANAGEMENT OF CATARACT
• Surgery is the primary mode of therapy
• Pediatric cataract needs a special surgical strategy as these eyes
have greater elasticity of the capsule, lower scleral rigidity, higher
incidence of inflammation and posterior capsule opacification
(PCO), a thick vitreous gel, and a small growing eye.

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RUBRICS – CATARACT

23. OCULAR
INJURIES

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OCULAR INJURIES
 Ocular trauma is a major cause of ocular morbidity in
children and is one of the important causes of non
congenital unilateral blindness in pediatric population.
 Pediatric eye trauma is a particular concern as the injured
eye of the child is prone to develop vision deprivation
amblyopia.
 The spectrum of injuries ranges from trivial to potentially
blinding

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ETIOLOGY
BIRTH TRAUMA
• occurs during
forceps-assisted
vaginal delivery
can cause
trauma to the
cornea leading
to corneal scar.
DOMESTIC INJURIES
Accidental fall, blunt
trauma with toys or
household appliances,
penetrating eye injuries
with sharp objects are the
frequent causes of ocular
injuries in toddlers
FIRE CRACKER
INJURIES
encountered during
festivals like Diwali, Holi
and can lead to variable
damage to ocular
structures like lid tear,
corneal tear, traumatic
cataract, retained
intraocular foreign body
CHEMICAL INJURIES
accidental entry of color into
the eye almost any chemical
can cause ocular irritation,
serious damage generally
results from either strongly
basic (alkaline) compounds or
acidic compounds
Exposure to lime powder or
paste is one of the commonly
encountered chemical injuries

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CLASSIFICATION
 Ocular injury occurs in three forms:
OPEN GLOBE
CLOSED GLOBE
ADNEXAL INJURIES

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CLOSE GLOBE
Closed globe injury or nonpenetrating trauma :
The eye globe is intact, but tears may occur in seven rings of the eye namely
• central iris: sphincter tear;
• peripheral iris: iridodialysis;
• anterior ciliary body: angle recession;
• separation of ciliary body from the scleral spur: cyclodialysis;
• trabecular meshwork: trabecular meshwork tear;
• zonules/lens: zonular tears with possible lens subluxation;
• separation of the retina from the ora serrata: retinal dialyses have been classically
described as affected by blunt trauma.

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OPEN GLOBE
• Penetrating trauma: The globe integrity is disrupted by a full thickness entry wound
and may be associated with prolapse of internal contents of the eye
• Perforating trauma: A severe injury where globe integrity is disrupted in two places
due to an entrance and exit wound (through and through injury).
OPEN GLOBE INJURIES ARE ONE OF THE MOST COMMON EMERGENCIES IN
OPHTHALMOLOGIC CLINICS AND REQUIRE IMMEDIATE OPERATION

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ADNEXAL INJURIES
• Blowout fracture of the orbit is caused by blunt trauma, classically
described for fist or ball injury, leading to fracture of floor or medial wall of
orbit due to sudden increased pressure on orbital contents.
• Fracture of orbital bones can lead to muscular entrapment limiting gaze in
one direction

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CLINICAL MANIFESTATIONS
 Orbit and Eyelid injuries
 Conjunctival injuries
 Corneal injuries
 Scleral injuries
 Lens injuries
 Anterior chamber injuries
 Posterior segment injuries

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ORBIT AND EYELID INJURIES
1. LID LACERATIONS :
• Lid lacerations may be partial or full
thickness and may involve the complex
lacrimal drainage system.
2. BLOW OUT FRACTURES :
• The medial and inferior walls are most
susceptible areas, with entrapment of orbital
contents in adjacent sinuses.
• The main features include enophthalmos with
limited ocular motility in affected region.

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CONJUNCTIVAL INJURY CORNEAL ABRASION

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PROGNOSIS OF OCULAR INJURIES
• Children are not aware of the consequences of eye injury and often report the injury after
substantial damage has already occurred.
• This leads to delayed medical and surgical intervention and ultimately poor visual
outcome.
• The major prognostic factors include extent of primary injury; time interval between injury
and seeking medical advice; superadded infection; coexistent glaucoma; and posterior
segment complications like post-traumatic endophthalmitis, traumatic optic neuropathy,
severe Berlins oedema and optic nerve avulsion.
• The prognosis for posterior segment complications like post-traumatic endophthalmitis,
traumatic optic neuropathy and optic nerve avulsion remain poor inspite of aggressive
treatment.

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RUBRICS – EYE INJURY

37. ANISOCORIA
(aniso-” meaning unequal, “kore” meaning pupil)
• Anisocoria occurs when the pupils are of different size
• This may be a result of local or neurologic disorders
• As a rule, if the inequality is more pronounced in the presence of bright focal
illumination or on near gaze, there is a defect in pupillary constriction and the
larger pupil is abnormal.
• If the anisocoria is worse in reduced illumination, a defect in dilation exists and
the smaller pupil is abnormal
• Horner syndrome is an important cause of anisocoria 37

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RUBRICS - ANISOCORIA