This document discusses several common pediatric ophthalmic problems including congenital cataract, glaucoma, retinopathy of prematurity, squint, refractive error, allergic conjunctivitis, retinoblastoma, and ocular infections. It provides details on causes, presentations, investigations, and management of each condition. Congenital cataract surgery in children poses unique challenges due to the small eye and intense inflammation. Retinopathy of prematurity screening and timely laser treatment can help reduce vision loss in preterm infants.
Central retinal vein occlusion (CRVO) occurs when the central retinal vein that drains blood from the retina becomes blocked. This causes blood and fluid to spill into the retina, which can lead to swelling of the macula and loss of central vision. CRVO is classified as either ischemic or non-ischemic. Treatment aims to prevent further swelling and seal leaking blood vessels through medications, laser treatment, or injections into the eye. While some vision can be regained, CRVO often results in long-term vision loss or legal blindness without prompt treatment.
This document discusses different types of cataracts, including congenital and acquired cataracts. It describes various causes of congenital cataracts including genetic mutations, metabolic disorders, infections, and chromosomal abnormalities. Congenital cataracts affect approximately 0.03% of newborns and are a leading cause of childhood blindness. The document also discusses different types of cataracts including nuclear, lamellar, and cerulean cataracts. It provides information on diagnosing and treating pediatric cataracts through surgery and preventing amblyopia.
CASE PRESENTATION:Corneal stromal dystrophyNilay P
This case presentation discusses Avellino corneal dystrophy in a 45-year-old woman. Examination found multiple white dots in her cornea. Avellino corneal dystrophy is an autosomal dominant condition characterized by granular and lattice deposits in the cornea. Histopathology shows mixed hyaline and amyloid deposits. Initial management included lubricating drops and bandage contact lenses for recurrent erosions. The extensive stromal involvement made deep anterior lamellar keratoplasty difficult, so penetrating keratoplasty was the preferred surgical option.
Vitreous hemorrhage occurs when blood leaks into the vitreous humor of the eye. It can be nondispersed, allowing some retinal view, or dispersed throughout the vitreous. Common causes include diabetic retinopathy, retinal vein occlusion, trauma, and posterior vitreous detachment. Patients experience painless vision loss and floaters. Examination may show a red eye or obscured retina. Treatment focuses on the underlying cause through laser, surgery, or observation depending on severity and risk factors.
Iol power calculation in pediatric patientsAnisha Rathod
- Many factors affect intraocular lens (IOL) power calculation in pediatric patients including age at surgery, laterality, amblyopia, axial length, keratometry, and expected myopic shift due to ongoing eye growth.
- Normal eye development involves rapid growth of the axial length and changes in lens power in the first years of life.
- Target postoperative refraction must account for this myopic shift and generally involves undercorrecting more in younger patients.
- Accurate biometry using immersion ultrasound or optical techniques is important to minimize errors from corneal compression.
- Formulas, IOL type and position can further influence outcomes.
DISORDERS OF THE VITREOUS AND RETINAL DETACHMENTHossein Mirzaie
This document discusses disorders of the vitreous and retinal detachment. It provides details on the structure and aging of the vitreous, as well as causes of posterior vitreous detachment. It then covers retinal detachment, describing the three main types (rhegmatogenous, tractional, exudative), risk factors, symptoms, and treatment principles. Key complications of retinal detachment surgery are also summarized.
Gonioscopy refers to techniques for examining the anterior chamber angle of the eye to evaluate and classify normal and abnormal angle structures. It involves using specialized lenses and lights to view the iridocorneal angle. There are two main methods: direct gonioscopy uses large contact lenses requiring saline, while indirect uses smaller lenses with mirrors or prisms that utilize tear film. Gonioscopy is used to diagnose angle-closure glaucoma and other conditions by allowing visualization of the trabecular meshwork, scleral spur, and other angle structures. Indentation gonioscopy, where the lens is pressed against the cornea, can differentiate appositional from synechial angle closure. Proper technique and
This document provides information on pediatric cataracts, including:
- The types of pediatric cataracts including congenital, developmental, and traumatic cataracts.
- The morphology and classification of different types of pediatric cataracts such as punctate, zonular, nuclear, and anterior capsular cataracts.
- The management of pediatric cataracts including timing of surgery, surgical techniques, and options for aphakic correction including spectacles, contact lenses, and intraocular lenses. Management aims to prevent amblyopia and achieve good long-term vision outcomes.
Central retinal vein occlusion (CRVO) occurs when the central retinal vein that drains blood from the retina becomes blocked. This causes blood and fluid to spill into the retina, which can lead to swelling of the macula and loss of central vision. CRVO is classified as either ischemic or non-ischemic. Treatment aims to prevent further swelling and seal leaking blood vessels through medications, laser treatment, or injections into the eye. While some vision can be regained, CRVO often results in long-term vision loss or legal blindness without prompt treatment.
This document discusses different types of cataracts, including congenital and acquired cataracts. It describes various causes of congenital cataracts including genetic mutations, metabolic disorders, infections, and chromosomal abnormalities. Congenital cataracts affect approximately 0.03% of newborns and are a leading cause of childhood blindness. The document also discusses different types of cataracts including nuclear, lamellar, and cerulean cataracts. It provides information on diagnosing and treating pediatric cataracts through surgery and preventing amblyopia.
CASE PRESENTATION:Corneal stromal dystrophyNilay P
This case presentation discusses Avellino corneal dystrophy in a 45-year-old woman. Examination found multiple white dots in her cornea. Avellino corneal dystrophy is an autosomal dominant condition characterized by granular and lattice deposits in the cornea. Histopathology shows mixed hyaline and amyloid deposits. Initial management included lubricating drops and bandage contact lenses for recurrent erosions. The extensive stromal involvement made deep anterior lamellar keratoplasty difficult, so penetrating keratoplasty was the preferred surgical option.
Vitreous hemorrhage occurs when blood leaks into the vitreous humor of the eye. It can be nondispersed, allowing some retinal view, or dispersed throughout the vitreous. Common causes include diabetic retinopathy, retinal vein occlusion, trauma, and posterior vitreous detachment. Patients experience painless vision loss and floaters. Examination may show a red eye or obscured retina. Treatment focuses on the underlying cause through laser, surgery, or observation depending on severity and risk factors.
Iol power calculation in pediatric patientsAnisha Rathod
- Many factors affect intraocular lens (IOL) power calculation in pediatric patients including age at surgery, laterality, amblyopia, axial length, keratometry, and expected myopic shift due to ongoing eye growth.
- Normal eye development involves rapid growth of the axial length and changes in lens power in the first years of life.
- Target postoperative refraction must account for this myopic shift and generally involves undercorrecting more in younger patients.
- Accurate biometry using immersion ultrasound or optical techniques is important to minimize errors from corneal compression.
- Formulas, IOL type and position can further influence outcomes.
DISORDERS OF THE VITREOUS AND RETINAL DETACHMENTHossein Mirzaie
This document discusses disorders of the vitreous and retinal detachment. It provides details on the structure and aging of the vitreous, as well as causes of posterior vitreous detachment. It then covers retinal detachment, describing the three main types (rhegmatogenous, tractional, exudative), risk factors, symptoms, and treatment principles. Key complications of retinal detachment surgery are also summarized.
Gonioscopy refers to techniques for examining the anterior chamber angle of the eye to evaluate and classify normal and abnormal angle structures. It involves using specialized lenses and lights to view the iridocorneal angle. There are two main methods: direct gonioscopy uses large contact lenses requiring saline, while indirect uses smaller lenses with mirrors or prisms that utilize tear film. Gonioscopy is used to diagnose angle-closure glaucoma and other conditions by allowing visualization of the trabecular meshwork, scleral spur, and other angle structures. Indentation gonioscopy, where the lens is pressed against the cornea, can differentiate appositional from synechial angle closure. Proper technique and
This document provides information on pediatric cataracts, including:
- The types of pediatric cataracts including congenital, developmental, and traumatic cataracts.
- The morphology and classification of different types of pediatric cataracts such as punctate, zonular, nuclear, and anterior capsular cataracts.
- The management of pediatric cataracts including timing of surgery, surgical techniques, and options for aphakic correction including spectacles, contact lenses, and intraocular lenses. Management aims to prevent amblyopia and achieve good long-term vision outcomes.
The document discusses retinal vein occlusion (RVO), specifically central retinal vein occlusion (CRVO), including its demographics, pathogenesis, classification as either ischemic or non-ischemic CRVO, management through examination, investigation and treatment options, and guidelines on systemic evaluation and management. CRVO results from obstruction of venous outflow causing increased pressure and damage to retinal capillaries and is classified based on the location and extent of occlusion, with ischemic CRVO having a poorer visual prognosis without timely treatment.
A 22-year-old male presented with complaints of pain, redness, watering and diminishing vision in his right eye for 4 days. On examination, his right eye showed signs of acute non-granulomatous anterior uveitis including swollen lids, circumciliary congestion, fine keratic precipitates, a constricted pupil with posterior synechiae, aqueous flare and cells. Blood tests and further ocular exams were recommended to confirm the diagnosis and rule out other potential causes. The treatment plan included dark glasses, warm compresses, atropine drops to break synechiae and prevent new ones from forming, and a tapering dose of prednisolone acetate drops for anti-
This document provides information on rhegmatogenous retinal detachment including:
- The pathogenesis which involves vitreoretinal traction from liquefaction of the vitreous gel creating a hole that allows fluid into the subretinal space.
- Symptoms include photopsia, floaters, and visual field defects.
- Signs include Marcus Gunn pupil, low intraocular pressure, retinal breaks, and mild iritis.
- Treatment options depend on factors like location and size of retinal break, state of vitreous gel, and include laser photocoagulation, cryotherapy, scleral buckling, pneumatic retinopexy, and drainage of subretinal fluid in
The document discusses essential skills for pediatric eye care, including communication skills, physical exam techniques, common eye conditions in children like amblyopia and retinopathy of prematurity, and approaches to treating issues like cataracts and strabismus. It provides guidance on screening and examining children for vision, growth and development milestones, and identifying potential eye problems.
This document discusses aphakia, which is the absence of the crystalline lens from the eye. It covers the causes of aphakia, the optics and clinical features of the condition, and the various methods used to correct refractive errors in aphakic patients, including spectacles, contact lenses, and intraocular lenses. The advantages and disadvantages of each correction method are presented, as well as common problems experienced by newly corrected aphakic patients.
Keratoplasty involves replacing diseased cornea with donor tissue. The main types are penetrating keratoplasty (PK), which replaces the full corneal thickness, and lamellar keratoplasty, which replaces only diseased layers. PK indications include scarring, infections, dystrophies and injuries. It has risks of rejection, infection, and high astigmatism. Newer techniques like deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) replace only diseased layers, reducing risks. Careful donor screening, surgical technique and postoperative management including steroids can reduce complications of keratoplasty.
non paralytic and paralytic strabismus- 20.07.16ophthalmgmcri
Strabismus is a condition where the visual axes of the two eyes do not meet at the point of regard. It can be concomitant (non-paralytic) where the misaligned eyes maintain their relationship in all gazes, or incomitant (paralytic) where it is caused by paralysis of one or more extraocular muscles. Paralytic strabismus presents with diplopia, restricted eye movements, compensatory head posture, and different deviations in different gazes compared to concomitant strabismus which maintains a constant deviation. Investigation and management involves identifying the cause and affected muscle through history, examination and tests, with treatment targeting the underlying etiology.
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that can affect premature infants. It occurs when the retina develops abnormally due to premature birth and exposure to high levels of oxygen. Babies born before 30 weeks gestation or weighing less than 1500g are screened for ROP. Treatment includes laser photocoagulation or cryotherapy for severe cases to promote normal retinal development. With improved neonatal care and oxygen monitoring, the incidence of ROP and associated blindness can be reduced.
Robert, a 48-year-old man, came to his optometrist complaining of sudden vision loss in his left eye. He reported floaters, flashes of light, and light sensitivity. His left pupil was dilated and the eye was red around the cornea. The initial diagnosis would be retinal detachment, which was confirmed through retinal photos, a slit lamp exam, OCT scan, and verified vision loss. Retinal detachment occurs when the retina pulls away from the back of the eye, creating a fluid-filled space and compromising vision. Robert was referred to an ophthalmologist for possible surgery to repair the detachment using laser treatment, freezing, or vitrectomy.
This document discusses various types of secondary glaucoma caused by underlying ocular diseases and conditions. It describes the mechanisms of increased intraocular pressure, clinical features, and treatment approaches for different forms of secondary glaucoma including lens-induced glaucoma, inflammatory glaucoma, pigmentary glaucoma, neovascular glaucoma, and steroid-induced glaucoma among others. Management involves treating the underlying condition causing secondary glaucoma as well as lowering intraocular pressure through medical, laser, or surgical means.
Looking deep into retina : indirect ophthalmoscopy and fundus drawingPrachir Agarwal
Indirect ophthalmoscopy provides a panoramic view of the fundus and is essential for a complete examination. It works by forming an aerial image of the retina between the condensing lens and observer. The power of the condensing lens determines the working distance, magnification, and field of view. Indirect ophthalmoscopy has advantages over direct including an unaffected view by refractive error and better illumination, resolution, and peripheral visualization. Proper technique involves adjusting the device, positioning the patient, and using scleral depression for stereoscopic viewing. Fundus drawings document examination findings and utilize various colors and line styles to depict different retinal structures and pathologies.
This document discusses the history and clinical presentation of pathological myopia. It notes that myopia was first described by Galen using the Greek term "mŭopia". It then outlines several key figures throughout history who contributed to the understanding and definition of pathological myopia, including von Arlt who first connected staphyloma to high myopia and Curtin who proposed a classification scheme for staphyloma. The document defines pathological myopia and lists its prevalence worldwide. It describes the genetic and growth-related etiologies and various clinical signs seen on ophthalmic examination like tilted optic discs, lacquer cracks, and choroidal neovascularization. Treatment options including refractive surgery, lens replacement, and general measures are
This document discusses papilledema, which is swelling of the optic disc due to increased intracranial pressure. It defines papilledema and outlines its causes, signs, symptoms, grading, histopathology, investigations, differential diagnosis, and treatment. The main points are that papilledema is caused by increased intracranial pressure, it can be graded on a scale from 0-5 based on severity, and treatment involves addressing the underlying cause of pressure increase as well as surgical decompression in severe cases to prevent vision loss.
This document discusses macular edema in diabetic retinopathy and its treatment. It explains that macular edema is caused by chronic hyperactivity of the polyol pathway and increased vascular endothelial growth factor, which leads to increased vascular permeability. Laser photocoagulation and intravitreal anti-VEGF injections are effective treatments that work by reducing hypoxia and VEGF levels in the retina. Several studies found that treatments with drugs like ranibizumab and aflibercept were more effective at improving vision outcomes than laser alone in patients with diabetic macular edema.
1. The document describes the technique of direct ophthalmoscopy, providing details on its history, modern instrumentation, use, and what can be observed through examination of the retina.
2. Key aspects covered include how the examiner is able to view the retina by aligning their eye with the light source entering the patient's eye, and modern ophthalmoscopes using mirrors to reflect light at a 90 degree angle.
3. The summary also notes what can be seen through direct ophthalmoscopy like the optic disc, macula, blood vessels, and various pathological features.
Primary optic atrophy occurs due to direct damage to the optic nerve and results in chalky white disc color with well defined margins and normal cupping and vessels. Secondary optic atrophy follows conditions like papilledema that cause swelling first, resulting in a filled cup and dirty white color. Consecutive optic atrophy occurs after other retinal conditions and shows waxy pallor, normal cup and grossly thinned vessels.
Macular degeneration is a medical condition that usually affects older adults and results in loss of vision in the center of the visual field. It occurs in two forms: dry or geographic macular degeneration, which accounts for 90% of cases and results in atrophy of the retinal pigment epithelial layer; and wet or neovascular macular degeneration, which accounts for 10% of cases and involves abnormal blood vessel growth in the eye. Risk factors include age over 50, heredity, nutrition, smoking, hypertension, sunlight exposure, and cataracts. Treatment depends on the type, with no effective treatment for dry macular degeneration but options like anti-VEGF therapy, photodynamic therapy, and surgery
Ocular manifestations of systemic diseasesshovon2026
This document discusses the ocular manifestations of various systemic diseases. It begins by outlining the importance of eye exams in diagnosing multisystem disorders. Several sections then review the common ocular signs of different disease categories, including connective tissue diseases (such as rheumatoid arthritis and lupus), infectious diseases (like tuberculosis and syphilis), endocrine disorders (diabetes and thyroid disease), neurological conditions, hematological issues (leukemia), and more. For each condition, the document lists characteristic ocular findings that may indicate involvement of the eyes and assist in overall diagnosis and management of the systemic illness.
Dissociated vertical deviation (DVD) is a condition where one eye turns upward when the other eye fixes. It typically presents between ages 2-5 years and is often associated with infantile esotropia. DVD violates the rules of ocular motility as the deviating eye does not make a rapid movement to refixate. Measurement and tests like Bielschowsky's phenomenon and red glass testing help differentiate DVD from other vertical deviations. Treatment involves observation, encouraging bifixation, or surgery like superior rectus recession if the deviation is increasing. It is important to differentiate DVD from inferior oblique overaction.
This document discusses retinopathy of prematurity (ROP), a disorder in premature infants where abnormal blood vessel growth occurs in the retina. It begins with definitions and embryology of the retina and retinal vasculature. Key points include that the retina remains avascular until the 4th month of gestation, and develops its mature vascular pattern by 5 months after birth. The document then covers the historical perspectives of ROP, pathogenesis involving oxygen and growth factors, classification system involving zones/stages/plus disease, risk factors like low birth weight and oxygen therapy, and recent advances.
This document discusses the evaluation and management of uveitic glaucoma. It begins by defining uveitic glaucoma and noting that 10% of uveitis patients will develop elevated intraocular pressure (IOP) or open-angle glaucoma. The pathophysiology of secondary glaucoma from uveitis is described. Treatment principles aim to reduce inflammation, control IOP, and prevent permanent damage. Cycloplegics, corticosteroids, and sometimes immunosuppressants are used to control inflammation. Topical medications, laser treatments, and surgeries may be needed to control IOP depending on the mechanism and severity. Close monitoring is important with this patient population.
Retinopathy of prematurity (ROP) is a blinding eye disease that affects the developing retina of premature infants. It occurs in two phases - an initial delayed growth of retinal blood vessels after birth due to exposure to high oxygen levels, followed by abnormal neovascularization due to hypoxia. Babies born at less than 30 weeks gestation or weighing less than 1500g are screened, with treatment (laser photocoagulation or cryotherapy) for severe "threshold" or "pre-threshold" ROP. Surgical options like vitrectomy may be used if laser treatment fails, but long-term follow up is still needed to monitor for complications.
The document discusses retinal vein occlusion (RVO), specifically central retinal vein occlusion (CRVO), including its demographics, pathogenesis, classification as either ischemic or non-ischemic CRVO, management through examination, investigation and treatment options, and guidelines on systemic evaluation and management. CRVO results from obstruction of venous outflow causing increased pressure and damage to retinal capillaries and is classified based on the location and extent of occlusion, with ischemic CRVO having a poorer visual prognosis without timely treatment.
A 22-year-old male presented with complaints of pain, redness, watering and diminishing vision in his right eye for 4 days. On examination, his right eye showed signs of acute non-granulomatous anterior uveitis including swollen lids, circumciliary congestion, fine keratic precipitates, a constricted pupil with posterior synechiae, aqueous flare and cells. Blood tests and further ocular exams were recommended to confirm the diagnosis and rule out other potential causes. The treatment plan included dark glasses, warm compresses, atropine drops to break synechiae and prevent new ones from forming, and a tapering dose of prednisolone acetate drops for anti-
This document provides information on rhegmatogenous retinal detachment including:
- The pathogenesis which involves vitreoretinal traction from liquefaction of the vitreous gel creating a hole that allows fluid into the subretinal space.
- Symptoms include photopsia, floaters, and visual field defects.
- Signs include Marcus Gunn pupil, low intraocular pressure, retinal breaks, and mild iritis.
- Treatment options depend on factors like location and size of retinal break, state of vitreous gel, and include laser photocoagulation, cryotherapy, scleral buckling, pneumatic retinopexy, and drainage of subretinal fluid in
The document discusses essential skills for pediatric eye care, including communication skills, physical exam techniques, common eye conditions in children like amblyopia and retinopathy of prematurity, and approaches to treating issues like cataracts and strabismus. It provides guidance on screening and examining children for vision, growth and development milestones, and identifying potential eye problems.
This document discusses aphakia, which is the absence of the crystalline lens from the eye. It covers the causes of aphakia, the optics and clinical features of the condition, and the various methods used to correct refractive errors in aphakic patients, including spectacles, contact lenses, and intraocular lenses. The advantages and disadvantages of each correction method are presented, as well as common problems experienced by newly corrected aphakic patients.
Keratoplasty involves replacing diseased cornea with donor tissue. The main types are penetrating keratoplasty (PK), which replaces the full corneal thickness, and lamellar keratoplasty, which replaces only diseased layers. PK indications include scarring, infections, dystrophies and injuries. It has risks of rejection, infection, and high astigmatism. Newer techniques like deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) replace only diseased layers, reducing risks. Careful donor screening, surgical technique and postoperative management including steroids can reduce complications of keratoplasty.
non paralytic and paralytic strabismus- 20.07.16ophthalmgmcri
Strabismus is a condition where the visual axes of the two eyes do not meet at the point of regard. It can be concomitant (non-paralytic) where the misaligned eyes maintain their relationship in all gazes, or incomitant (paralytic) where it is caused by paralysis of one or more extraocular muscles. Paralytic strabismus presents with diplopia, restricted eye movements, compensatory head posture, and different deviations in different gazes compared to concomitant strabismus which maintains a constant deviation. Investigation and management involves identifying the cause and affected muscle through history, examination and tests, with treatment targeting the underlying etiology.
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that can affect premature infants. It occurs when the retina develops abnormally due to premature birth and exposure to high levels of oxygen. Babies born before 30 weeks gestation or weighing less than 1500g are screened for ROP. Treatment includes laser photocoagulation or cryotherapy for severe cases to promote normal retinal development. With improved neonatal care and oxygen monitoring, the incidence of ROP and associated blindness can be reduced.
Robert, a 48-year-old man, came to his optometrist complaining of sudden vision loss in his left eye. He reported floaters, flashes of light, and light sensitivity. His left pupil was dilated and the eye was red around the cornea. The initial diagnosis would be retinal detachment, which was confirmed through retinal photos, a slit lamp exam, OCT scan, and verified vision loss. Retinal detachment occurs when the retina pulls away from the back of the eye, creating a fluid-filled space and compromising vision. Robert was referred to an ophthalmologist for possible surgery to repair the detachment using laser treatment, freezing, or vitrectomy.
This document discusses various types of secondary glaucoma caused by underlying ocular diseases and conditions. It describes the mechanisms of increased intraocular pressure, clinical features, and treatment approaches for different forms of secondary glaucoma including lens-induced glaucoma, inflammatory glaucoma, pigmentary glaucoma, neovascular glaucoma, and steroid-induced glaucoma among others. Management involves treating the underlying condition causing secondary glaucoma as well as lowering intraocular pressure through medical, laser, or surgical means.
Looking deep into retina : indirect ophthalmoscopy and fundus drawingPrachir Agarwal
Indirect ophthalmoscopy provides a panoramic view of the fundus and is essential for a complete examination. It works by forming an aerial image of the retina between the condensing lens and observer. The power of the condensing lens determines the working distance, magnification, and field of view. Indirect ophthalmoscopy has advantages over direct including an unaffected view by refractive error and better illumination, resolution, and peripheral visualization. Proper technique involves adjusting the device, positioning the patient, and using scleral depression for stereoscopic viewing. Fundus drawings document examination findings and utilize various colors and line styles to depict different retinal structures and pathologies.
This document discusses the history and clinical presentation of pathological myopia. It notes that myopia was first described by Galen using the Greek term "mŭopia". It then outlines several key figures throughout history who contributed to the understanding and definition of pathological myopia, including von Arlt who first connected staphyloma to high myopia and Curtin who proposed a classification scheme for staphyloma. The document defines pathological myopia and lists its prevalence worldwide. It describes the genetic and growth-related etiologies and various clinical signs seen on ophthalmic examination like tilted optic discs, lacquer cracks, and choroidal neovascularization. Treatment options including refractive surgery, lens replacement, and general measures are
This document discusses papilledema, which is swelling of the optic disc due to increased intracranial pressure. It defines papilledema and outlines its causes, signs, symptoms, grading, histopathology, investigations, differential diagnosis, and treatment. The main points are that papilledema is caused by increased intracranial pressure, it can be graded on a scale from 0-5 based on severity, and treatment involves addressing the underlying cause of pressure increase as well as surgical decompression in severe cases to prevent vision loss.
This document discusses macular edema in diabetic retinopathy and its treatment. It explains that macular edema is caused by chronic hyperactivity of the polyol pathway and increased vascular endothelial growth factor, which leads to increased vascular permeability. Laser photocoagulation and intravitreal anti-VEGF injections are effective treatments that work by reducing hypoxia and VEGF levels in the retina. Several studies found that treatments with drugs like ranibizumab and aflibercept were more effective at improving vision outcomes than laser alone in patients with diabetic macular edema.
1. The document describes the technique of direct ophthalmoscopy, providing details on its history, modern instrumentation, use, and what can be observed through examination of the retina.
2. Key aspects covered include how the examiner is able to view the retina by aligning their eye with the light source entering the patient's eye, and modern ophthalmoscopes using mirrors to reflect light at a 90 degree angle.
3. The summary also notes what can be seen through direct ophthalmoscopy like the optic disc, macula, blood vessels, and various pathological features.
Primary optic atrophy occurs due to direct damage to the optic nerve and results in chalky white disc color with well defined margins and normal cupping and vessels. Secondary optic atrophy follows conditions like papilledema that cause swelling first, resulting in a filled cup and dirty white color. Consecutive optic atrophy occurs after other retinal conditions and shows waxy pallor, normal cup and grossly thinned vessels.
Macular degeneration is a medical condition that usually affects older adults and results in loss of vision in the center of the visual field. It occurs in two forms: dry or geographic macular degeneration, which accounts for 90% of cases and results in atrophy of the retinal pigment epithelial layer; and wet or neovascular macular degeneration, which accounts for 10% of cases and involves abnormal blood vessel growth in the eye. Risk factors include age over 50, heredity, nutrition, smoking, hypertension, sunlight exposure, and cataracts. Treatment depends on the type, with no effective treatment for dry macular degeneration but options like anti-VEGF therapy, photodynamic therapy, and surgery
Ocular manifestations of systemic diseasesshovon2026
This document discusses the ocular manifestations of various systemic diseases. It begins by outlining the importance of eye exams in diagnosing multisystem disorders. Several sections then review the common ocular signs of different disease categories, including connective tissue diseases (such as rheumatoid arthritis and lupus), infectious diseases (like tuberculosis and syphilis), endocrine disorders (diabetes and thyroid disease), neurological conditions, hematological issues (leukemia), and more. For each condition, the document lists characteristic ocular findings that may indicate involvement of the eyes and assist in overall diagnosis and management of the systemic illness.
Dissociated vertical deviation (DVD) is a condition where one eye turns upward when the other eye fixes. It typically presents between ages 2-5 years and is often associated with infantile esotropia. DVD violates the rules of ocular motility as the deviating eye does not make a rapid movement to refixate. Measurement and tests like Bielschowsky's phenomenon and red glass testing help differentiate DVD from other vertical deviations. Treatment involves observation, encouraging bifixation, or surgery like superior rectus recession if the deviation is increasing. It is important to differentiate DVD from inferior oblique overaction.
This document discusses retinopathy of prematurity (ROP), a disorder in premature infants where abnormal blood vessel growth occurs in the retina. It begins with definitions and embryology of the retina and retinal vasculature. Key points include that the retina remains avascular until the 4th month of gestation, and develops its mature vascular pattern by 5 months after birth. The document then covers the historical perspectives of ROP, pathogenesis involving oxygen and growth factors, classification system involving zones/stages/plus disease, risk factors like low birth weight and oxygen therapy, and recent advances.
This document discusses the evaluation and management of uveitic glaucoma. It begins by defining uveitic glaucoma and noting that 10% of uveitis patients will develop elevated intraocular pressure (IOP) or open-angle glaucoma. The pathophysiology of secondary glaucoma from uveitis is described. Treatment principles aim to reduce inflammation, control IOP, and prevent permanent damage. Cycloplegics, corticosteroids, and sometimes immunosuppressants are used to control inflammation. Topical medications, laser treatments, and surgeries may be needed to control IOP depending on the mechanism and severity. Close monitoring is important with this patient population.
Retinopathy of prematurity (ROP) is a blinding eye disease that affects the developing retina of premature infants. It occurs in two phases - an initial delayed growth of retinal blood vessels after birth due to exposure to high oxygen levels, followed by abnormal neovascularization due to hypoxia. Babies born at less than 30 weeks gestation or weighing less than 1500g are screened, with treatment (laser photocoagulation or cryotherapy) for severe "threshold" or "pre-threshold" ROP. Surgical options like vitrectomy may be used if laser treatment fails, but long-term follow up is still needed to monitor for complications.
Retinopathy of prematurity (ROP) is a disease of the developing retina that results from interrupted development of retinal blood vessels. It is a leading cause of blindness in children. ROP was initially described in the 1940s and is associated with supplemental oxygen use in premature infants. The retina develops from the optic cup and retinal blood vessel growth occurs after birth. ROP occurs when normal vessel growth is disrupted, leading to abnormal neovascularization. Staging of ROP involves evaluating location, severity, extent, and presence of plus disease. Laser treatment is the standard therapy to promote vessel growth and prevent retinal detachment. Screening high-risk infants and timely treatment can help prevent vision loss from ROP.
This document provides an overview of retinopathy of prematurity (ROP), including:
- ROP is a retinal vascular disease primarily affecting premature infants, with major risk factors being prematurity, low birth weight, and high oxygen exposure.
- The pathogenesis involves initial injury disrupting normal angiogenesis, followed by abnormal new vessel growth that can lead to retinal detachment.
- ROP is classified based on location, severity stage (1-5), extent, and presence of plus disease. The ETROP study showed benefit of early treatment for high-risk prethreshold ROP.
- Screening and treatment guidelines are based on gestational age and risk factors to detect treatable ROP as early as possible,
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that affects premature infants. It occurs when the retina of premature infants develops abnormally as a result of interrupted retinal vascularization. The disease ranges in severity from mild to severe, with the most severe cases resulting in retinal detachment and blindness. Screening for ROP involves examining the retina using indirect ophthalmoscopy starting between 20-30 days of life in infants born before 34-35 weeks gestation and/or weighing 1500g or less. Treatment options depend on the stage of ROP and may include laser therapy or anti-VEGF injections to prevent further progression. Affected infants require long-term follow-up to monitor vision and eye
Retinopathy of prematurity (ROP), initially described as retrolental fibroplasia one of the leading cause of blindness in children.
Despite advances in diagnosis and treatment, as medicine and technology advances and premature infants are surviving at earlier gestational ages, ROP continues to be a significant problem.
ROP results in disorganized growth of retinal blood vessels, which may lead to scarring and retinal detachment.
Retinopathy of prematurity by dr. tareq rahmantareq rahman
Retinopathy of prematurity (ROP) is a retinal vascular disorder that occurs primarily in preterm infants. It develops due to interrupted retinal vascularization and abnormal blood vessel growth caused by premature birth. Infants with very low birth weight (<1500g) or gestational age (<32 weeks) are most at risk. If left untreated, ROP can cause blindness or severe vision impairment. Screening, timely diagnosis, and treatment with laser photocoagulation or anti-VEGF injections can help prevent vision loss from ROP.
The document discusses the embryology, anatomy, growth and development of the human lens. It begins by describing how the lens forms from the surface ectoderm during early gestation. It notes the changes in lens size, weight and composition that occur from birth through adulthood. The majority of the document then focuses on pediatric cataracts, including definitions, etiologies, associated conditions, morphological classifications, evaluation, timing of surgery and considerations for intraocular lens implantation versus other management strategies. Key points include the various hereditary and metabolic causes of pediatric cataracts and challenges in predicting postoperative refractive outcomes in children.
This document discusses retinopathy of prematurity (ROP), including its causes, risk factors, screening recommendations, and treatment. ROP occurs when abnormal blood vessels grow in the retina of premature infants. Key points include: ROP screening is recommended for infants born before 34 weeks gestation or weighing less than 1750g; screening should begin between 3-4 weeks of life and continue until 44 weeks; laser photocoagulation or anti-VEGF treatment may be used depending on the severity and location of the ROP. Preventive measures include maintaining oxygen saturation between 88-92% and aggressive nutrition support for premature infants.
Retinopathy of prematurity (ROP) is a developmental vascular disorder of the retina that occurs in preterm infants. The retina is incompletely vascularized at birth for infants born before 30 weeks gestation. Premature birth interrupts normal retinal vascularization, exposing the retina to abnormal oxygen levels. This can cause vasoconstriction and arrest of blood vessel growth. Later, abnormal neovascularization may develop, potentially leading to retinal detachment and blindness if not treated. Screening guidelines recommend examinations starting at 4 weeks of age for infants born before 30 weeks, with treatment indicated for "threshold" or "pre-threshold" ROP. Laser photocoagulation is the primary treatment, which ablates the av
This document discusses retinopathy of prematurity (ROP), a disorder affecting the developing retina of premature infants. It begins by describing normal retinal development. ROP occurs when the retinal vasculature develops abnormally in preterm infants, and key risk factors include low birth weight, oxygen exposure, and infections. The pathogenesis involves initial vasoconstriction from excess oxygen, followed by abnormal neovascularization due to hypoxia. Classification systems and screening guidelines for ROP are provided. Treatment options discussed are laser photocoagulation, cryotherapy, and anti-VEGF therapy. Close monitoring is important to detect ROP and prevent vision loss in preterm infants.
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that increases in incidence with decreasing gestational age. It affects the developing retinal vasculature of premature infants. The main risk factors are low gestational age and low birth weight. ROP progresses through two stages - an initial vasoconstriction/arrest of vascular development stage, followed by a neovascularization stage where abnormal blood vessels grow into the retina. Treatment includes laser photocoagulation or cryotherapy to ablate the peripheral avascular retina and prevent retinal detachment.
This document discusses retinopathy of prematurity (ROP), including its definition, pathogenesis, classification, natural history, risk factors, prevention, and screening guidelines. ROP is a vasoproliferative retinal disorder that increases in incidence with decreasing gestational age and affects the developing retinal vasculature of premature infants. The classification system describes the location, severity, and extent of ROP. Screening guidelines recommend examining infants born under 1,750g or 34 weeks gestation between 3-4 weeks of life to detect ROP and determine if treatment is needed to prevent vision loss. Strict oxygen control, aggressive nutrition, and infection prevention are important for reducing ROP risk.
This document provides an overview of retinopathy of prematurity (ROP), including:
1) ROP is a proliferative retinopathy affecting premature infants that can cause lifelong visual impairment.
2) The development of the retinal vasculature is disrupted in premature infants due to their early exposure to a hyperoxic extra-uterine environment.
3) Laser photocoagulation treatment is recommended for high-risk pre-threshold and threshold ROP to ablate the peripheral avascular retina and prevent retinal detachment and blindness.
Retinopathy of Prematurity is a disease that affects the eyes of premature babies. It was previously known as Retrolental Fibroplasia. Studies have found the incidence of ROP to be between 22-40% in India, depending on the region and risk factors like low birth weight and oxygen therapy. Screening and treatment of ROP has advanced with the use of wide field retinal imaging and laser therapy replacing cryotherapy. Studies like CRYO-ROP and ETROP have shown that early treatment of high-risk prethreshold ROP improves visual outcomes.
Retinopathy of prematurity (ROP) is a retinal vascular disease that affects premature infants. It occurs when the retina of premature infants is exposed to high concentrations of oxygen, causing abnormal blood vessel growth. ROP is staged based on the severity and location of the disease, and may progress to retinal detachment if not treated. Treatment options include laser photocoagulation, cryotherapy, or anti-VEGF injections to promote normal blood vessel growth and prevent further progression. Regular screening is important for monitoring ROP and detecting complications in older children.
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that affects premature infants. It occurs when the retinal blood vessels in very premature infants grow abnormally and cause scarring at the back of the eye. If left untreated, ROP can cause retinal detachment and blindness. Screening examinations are recommended for high-risk preterm infants to detect ROP early when it is most treatable. Treatment options include laser photocoagulation, cryotherapy, or in severe cases, surgery to prevent blindness from ROP.
To understand ROP is very important so the newborns can be managed according to the stage efficiently and better visual rehabilitation can be offered to the patients and adequate knowledge can be given to the parents with counseling.
Evaluation of White Pupillary Reflex FINAL.pptxMahfuz Shohag
Leukocoria or white pupillary reflex can be caused by several conditions. The differential diagnosis can be narrowed through history, examination, and investigations. The main differentials discussed were congenital cataract, retinoblastoma, persistent hyperplastic primary vitreous, ocular toxocariasis, Coat's disease, retinopathy of prematurity, and coloboma. Early diagnosis is important as treatment can help save vision for many of these conditions causing leukocoria.
This document discusses cataracts in pediatric patients. It defines cataracts and classifies them as congenital or acquired. Congenital cataracts can be bilateral or unilateral and are often caused by genetic mutations, metabolic disorders, infections, or other ocular anomalies. Acquired cataracts have systemic or ocular disease causes, or result from drugs or trauma. Evaluation of pediatric cataracts involves examining for associated conditions and screening for underlying causes. Visually significant cataracts requiring surgery are defined. Surgery aims to prevent permanent vision loss, though postoperative care is important. A team approach is needed for congenital cataract management.
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Common problems in paediatric ophthalmology
1. Common Problems inCommon Problems in
PaediatricPaediatric
Dr. Lee Ming YuehDr. Lee Ming Yueh
Opthalmology DeptOpthalmology Dept
Penang HospitalPenang Hospital
6. History:History:
• Age of presentationAge of presentation
• Family history – consanguinityFamily history – consanguinity
• Birth history – trauma at birth?Birth history – trauma at birth?
• Maternal – DM? infection? eg. RubellaMaternal – DM? infection? eg. Rubella
• Drug exposure - steroid, chlorpromazineDrug exposure - steroid, chlorpromazine
• Radiation exposureRadiation exposure
10. InvestigationsInvestigations
• Full blood countFull blood count
• Renal function testRenal function test
• Serum calciumSerum calcium
• Serology for rubella, toxoplasmosisSerology for rubella, toxoplasmosis
• GPUT & galactokinase activity in RBCGPUT & galactokinase activity in RBC
• UrineUrine
- reducing sugar, amino acid,- reducing sugar, amino acid,
11. Cataract Surgery in PediatricCataract Surgery in Pediatric
• Timing of SurgeryTiming of Surgery
Bilateral severeBilateral severe – 2-3 months, operate fellow eye in 1 week– 2-3 months, operate fellow eye in 1 week
Unilateral severeUnilateral severe – before 8 weeks– before 8 weeks
Bilateral or unilateral mildBilateral or unilateral mild – wait till child is older– wait till child is older
• SurgerySurgery
Lens aspiration and primary posterior capsulotomyLens aspiration and primary posterior capsulotomy
Important issue: to implant IOL or not?Important issue: to implant IOL or not?
- No lens implantation if < 2 year-oldNo lens implantation if < 2 year-old
can consider IOL implantation > 6 monthscan consider IOL implantation > 6 months
- IOL power selection. Aim for emmetropic? Hyperopic?- IOL power selection. Aim for emmetropic? Hyperopic?
- If no IOL implant >Aphakic correction by glasses/contact lens- If no IOL implant >Aphakic correction by glasses/contact lens
12. Problems in Congenital Cataract SurgeryProblems in Congenital Cataract Surgery
• Intraoperative problemsIntraoperative problems
-- risk of GA due to prematurity or asso systemic dsrisk of GA due to prematurity or asso systemic ds
- small eye, anatomical difference- small eye, anatomical difference
- low scleral rigidity, solid vitreous- low scleral rigidity, solid vitreous
-- elastic anterior capsuleelastic anterior capsule
• Postoperative problemsPostoperative problems
-- intense inflammationintense inflammation
- posterior capsule opacification- posterior capsule opacification
- IOL decentralization- IOL decentralization
- Frequent refractive assessment- Frequent refractive assessment
15. Incidence & Health BurdenIncidence & Health Burden
• Baby less than 1250g > 65% have ROPBaby less than 1250g > 65% have ROP
• Baby less than 1000g > 80% have ROPBaby less than 1000g > 80% have ROP
• 6% needed treatment6% needed treatment
• Severe loss of visionSevere loss of vision
• Epidemic in developing countries includingEpidemic in developing countries including
Malaysia.Malaysia.
17. Normal Retinal AngiogenesisNormal Retinal Angiogenesis
• Starts at 16 weeksStarts at 16 weeks
• Reaches nasal ora at 36 weeksReaches nasal ora at 36 weeks
• Complete vascularization at 40 weeksComplete vascularization at 40 weeks
18. Clinical Practice Guideline (Malaysia)Clinical Practice Guideline (Malaysia)
• Birthweight < 1500gBirthweight < 1500g
• Gestation < 32 weeksGestation < 32 weeks
• Others -Others - as determined by neonatologistas determined by neonatologist
ie. Prolonged O2 therapy, very ill withie. Prolonged O2 therapy, very ill with
unstable clinical courseunstable clinical course
19. Active ROPActive ROP
• LocationLocation – zone I. II, III– zone I. II, III
• ExtentExtent – number of clock hours– number of clock hours
• StageStage
Stage 1 - 5Stage 1 - 5
• Plus diseasePlus disease
- dilatation & tortuosity of veins- dilatation & tortuosity of veins
- vitreous haze- vitreous haze
- engorged iris vessels- engorged iris vessels
- poor pupil dilation- poor pupil dilation
23. Clinical Practice Guideline (Malaysia)Clinical Practice Guideline (Malaysia)
• First screeningFirst screening – 4-6 weeks post gestation– 4-6 weeks post gestation
• Follow-upFollow-up
- stage 0 : 2 – 3 weeks- stage 0 : 2 – 3 weeks
- stage 1 : 2 weeks- stage 1 : 2 weeks
- stage 2 : 1 week- stage 2 : 1 week
- stage 3 : 1 week or less- stage 3 : 1 week or less
• When do you stop follow up?When do you stop follow up?
- ROP regression- ROP regression
- Fully vascularised retina- Fully vascularised retina
24. Threshold DiseaseThreshold Disease
• Zone I or IIZone I or II
• 55 contiguous clock hours orcontiguous clock hours or 88 noncontiguousnoncontiguous
clock hoursclock hours
• Stage 3Stage 3
• Plus diseasePlus disease
Threshold ROP is associated with 50% risk ofThreshold ROP is associated with 50% risk of
having VA 1/60 or worse without treatment.having VA 1/60 or worse without treatment.
25. Management of ROPManagement of ROP
• CryotherapyCryotherapy
- to ablate retina anterior to ridge- to ablate retina anterior to ridge
- ‘- ‘Multicentre Cryotherapy for ROP studyMulticentre Cryotherapy for ROP study’’ arch opht 1996arch opht 1996
>50% ↓ in poor VA>50% ↓ in poor VA
>50% ↓ in poor fundus status>50% ↓ in poor fundus status
• Indirect laser photocoagulationIndirect laser photocoagulation
- less traumatic, better visual outcome- less traumatic, better visual outcome
• Vitreo-retinal surgery (For stage 4 disease)Vitreo-retinal surgery (For stage 4 disease)
• Intravitreal triamcinolone & anti-VEGFIntravitreal triamcinolone & anti-VEGF
27. SquintSquint
• ““misalignment of the eyesmisalignment of the eyes””
- Esotropia, exotropia, hyper or hypotropia- Esotropia, exotropia, hyper or hypotropia
• Ocular alignment should stabilize by age of 2Ocular alignment should stabilize by age of 2
monthsmonths
• Any misalignment after age of 3 monthsAny misalignment after age of 3 months
- refer to ophthalmologist- refer to ophthalmologist
28. Hirschberg testHirschberg test
• Rough measure of deviationRough measure of deviation
• Note location of corneal light reflexNote location of corneal light reflex
• 1 mm = 71 mm = 7˚˚or 15or 15ΔΔ
Reflex at border of pupil=15˚ Reflex at limbus=45ْ
32. Refractive ErrorRefractive Error
• Image is focused eitherImage is focused either
- in front > Myopia (short-sighted)- in front > Myopia (short-sighted)
- behind retina > Hyperopia (long-sighted)- behind retina > Hyperopia (long-sighted)
• AstigmatismAstigmatism
• vision usually improves withvision usually improves with pinholepinhole
34. Refractive errorRefractive error
• Vision or refraction should be screened at leastVision or refraction should be screened at least
at age of 3 years and 6 yearsat age of 3 years and 6 years
• Can be treated by spectaclesCan be treated by spectacles
• Generally contact lens and refractive surgery areGenerally contact lens and refractive surgery are
not advisable in childrennot advisable in children
36. Allergic rhinoconjunctivitisAllergic rhinoconjunctivitis
• Hypersensitivity reactionHypersensitivity reaction
to specific airboneto specific airbone
antigensantigens
• Frequently associatedFrequently associated
with nasal symptomswith nasal symptoms
• May be seasonal orMay be seasonal or
perennialperennial
Transient conjunctival oedema
37. Vernal keratoconjunctivitisVernal keratoconjunctivitis
• Frequently associated withFrequently associated with
atopy- asthma, hayatopy- asthma, hay
fever,dermatitisfever,dermatitis
• Recurrent, bilateralRecurrent, bilateral
• Affecting children and youngAffecting children and young
adultsadults
• More common in males andMore common in males and
warm climateswarm climates
• Itching, mucoid dischargeItching, mucoid discharge
and lacrimationand lacrimation
• Treatment –topical mast cellTreatment –topical mast cell
stabiliser and topical steroidsstabiliser and topical steroids
38. Giant papillae
which give a
cobblestone
appearance
Trantas' dot are
whitish dots seen
at the limbus in
some people with
vernal
keratoconjunctivi
tis during active
phase of the
disease
40. Ocular TumoursOcular Tumours
• Can present as proptosis, squint or a whiteCan present as proptosis, squint or a white
reflex (absence of red reflex on fundoscopy)reflex (absence of red reflex on fundoscopy)
or poor visionor poor vision
• Primary intraocular tumour -retinoblastoma,Primary intraocular tumour -retinoblastoma,
optic nerve gliomaoptic nerve glioma
• Rhabdomyosarcoma - most common primaryRhabdomyosarcoma - most common primary
paediatric orbital malignancypaediatric orbital malignancy
• Metastases – neuroblastoma, leukemiaMetastases – neuroblastoma, leukemia
42. RetinoblastomaRetinoblastoma
• Most common primary intraocular malignancy ofMost common primary intraocular malignancy of
childhoodchildhood
• tumour of primitive photoreceptor cellstumour of primitive photoreceptor cells
• prevalence of 1 in 20,000prevalence of 1 in 20,000
• No sexual or racial predilectionNo sexual or racial predilection
• Presents before the age of 3 years (average 3 months)Presents before the age of 3 years (average 3 months)
• 40% hereditary, 60% non heritable40% hereditary, 60% non heritable
• Predisposing gene (RPE1) on 13q14Predisposing gene (RPE1) on 13q14
• cryotherapy & laser photocoagulation, enucleation,cryotherapy & laser photocoagulation, enucleation,
radiotherapy, chemotherapyradiotherapy, chemotherapy
46. BlepharitisBlepharitis
• Chronic irritation worse in morningsChronic irritation worse in mornings
Scales around base of lashes Hyperaemia and telangiectasia
of anterior lid margin
48. Ocular InfectionOcular Infection
Orbital cellulitisOrbital cellulitis
• lid and conjunctival swelling, proptosis,lid and conjunctival swelling, proptosis,
restricted eye movement and tendernessrestricted eye movement and tenderness
over sinuses, RAPD positiveover sinuses, RAPD positive
• patient usually ill & febrilepatient usually ill & febrile
50. Ocular traumaOcular trauma
• Toys can be a potential source of injuryToys can be a potential source of injury
• hammock, cloth hanger, pencil, metal ruler, wirehammock, cloth hanger, pencil, metal ruler, wire
and etc are all dangerous items in children’sand etc are all dangerous items in children’s
hand without supervisionhand without supervision
55. Congenital Nasolacrimal Duct ObstructionCongenital Nasolacrimal Duct Obstruction
• At birth, the lower end of the nasolacrimal ductAt birth, the lower end of the nasolacrimal duct
is frequently non-canalized n(valve of Hasner).is frequently non-canalized n(valve of Hasner).
• No clinical significance in most neonatesNo clinical significance in most neonates
because it canalizes spontaneously soon afterbecause it canalizes spontaneously soon after
birth.birth.
57. Clinical Features:Clinical Features:
• Epiphora and matting of the lashesEpiphora and matting of the lashes
• Reflux of purulent material from the punctumReflux of purulent material from the punctum
• Acute dacryocystitis is uncommon.Acute dacryocystitis is uncommon.
60. Management:Management:
• ConservativeConservative
- Massage of the nasolacrimal duct increases the- Massage of the nasolacrimal duct increases the
hydrostatic pressure and thereby rupture thehydrostatic pressure and thereby rupture the
membranous obstructionmembranous obstruction
- 10 mstokes 4x a day.- 10 mstokes 4x a day.
• SurgicalSurgical
- 95% spontaneous canalization- 95% spontaneous canalization
- Probing to overcome the obstructive membrane at- Probing to overcome the obstructive membrane at
Hasner’s valve.Hasner’s valve.
- Can be repeated 6 weeks after if no improvement.- Can be repeated 6 weeks after if no improvement.
- 90% cured by first probing and a further 6% by the- 90% cured by first probing and a further 6% by the
secondsecond