Ocular disease in peadiatric

1. OCULAR DISEASE IN
PEADIATRIC
PREPARED BY:
ANIS SUZANNA BINTI MOHAMAD
OPTOMETRIST AND CONTACT LENS
CONSULTANT
B.SC (HONS) OPTOMETRY UKM

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. OBJECTIVE EXAMINATION

4. SUBJECTIVE EXAMINATION

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. DIFFRENTIAL DIAGNOSIS
 Congenital nasolacrimal duct obstruction
 Chronic dacryocystitis
 Acute dacryocystitis
 (Staphylococcus, Streptococcus, Haemophilus
Influenza)
 Amniocele
 Medial canthus encephalocele

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. TREATMENT-
CHRONIC DACRYOCYCTITIS
 Lac sac massage
 Broad spectrum ab for 2 wks
 Probing

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. 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. 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. PTOSIS

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. 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. 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. CYST OF MOLL

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. 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. CONJUNCTIVITIS: BACTERIA, VIRAL,
CHLAMYDIAL, ALLERGIC
 Bacteria –purulent discharge
 Gonoccocal, Staphylococcus pneumoniae,
 Can cause corneal ulcer, opacification, perforation,
cellulitis
 T(x); Gentamycin, erythomycin, bacitracin

20. VIRAL CONJUNCTIVITIS
 Watery discharge
 Unilateral
 Periorbital pain
 Herpes simplex
conjunctivitis –
vesicles & discharge,
mucous, can cause
dendritic keratitis

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. 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. 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. CATARACT

25. POST CATARACT TREATMENT

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. CONGENITAL GLAUCOMA

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. 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. 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. THANK YOU