This document summarizes several common pediatric eye conditions seen by Dr. Mona Hussein. It discusses conditions such as conjunctivitis (bacterial, viral, allergic), refractive errors, amblyopia, strabismus, and others. For each condition, it provides details on symptoms, signs, investigations, and treatment approaches. The document is intended to inform specialists about evaluating and managing these common eye issues in children.

1. Common pediatric eye
conditions
Dr. Mona Hussein
Specialist ophthalmologist- Al Bahia clinic

2. Topics
 Conjunctivitis – (neonatal conjunctivitis – Bacterial - viral - Allergic).
 Refractive errors.
 Amblyopia.
 Strabismus; Pseudoesotropia, pseudoexotropia
 Congenital Nasolacrimal duct obstruction
 Chalazion.
 corneal abrasion.
 Congenital cataract.
 Congenital glaucoma.
 Leuckocoria.
 Retinopathy of prematurity.
 Eye Screening for children.

3. Bacterial Conjunctivitis
 Symptoms: redness, grittiness, and discharge , Bilateral , one eye before the other,
On waking, the eyelids are frequently stuck together and may be difficult to open.
 Signs Eyelid oedema and erythema, Conjunctival injection , mucopurulent eye
discharge .
 Investigations are not performed routinely but may be indicated In severe cases,
binocular conjunctival swabs and scrapings should be taken for urgent Gram staining, to
exclude gonococcal and meningococcal infection.
 Treatment: according to severity of condition
 Topical antibiotics
 Ciprofloxacin, ofloxacin, Tobramycin, or moxifloxacin eye drops QID, fusidic acid ointment
at bedtime
 Gonococcal and meningococcal conjunctivitis should be treated with a quinolone, like
moxifloxacine (Vigamox eye drops) 1–2 hourly as well as oral antibiotics.
 Risk of transmission should be reduced by face and hand-washing and the avoidance of
towel sharing.

4. Neonatal conjunctivitis (ophthalmia neonatorum)
 Conjunctival inflammation that occur within the first month of life.
 It is identified as a specific entity distinct from conjunctivitis in older infants because of its potentially serious
nature, has (both ocular and systemic complications) and because it is often the result of infection transmitted from
mother to infant during delivery.
 Causes:
 Organisms acquired during vaginal delivery: C. trachomatis, N. gonorrhoeae and herpes simplex virus
 Staphylococci are usually responsible for mild conjunctivitis.
 Other bacterial : streptococci, H. influenzae.
 Topical preparations used as prophylaxis against infection may themselves cause conjunctival irritation (chemical
conjunctivitis).
 Congenital nasolacrimal obstruction. mildly watery eye with recurrent mild bacterial conjunctivitis may be
secondary to a blocked tear duct.

5.  Signs
 Discharge, lids edema, Eyelid and periocular vesicles may occur in HSV infection
 Corneal examination (fluorescine stain) is mandatory and is particularly important if gonococcal infection is
suspected, as ulceration with rapid progression is common.
 Investigations
 Conjunctival scrapings are taken for (PCR), particularly for Chlamydia and HSV.
 Separate conjunctival scrapings are applied to a glass slide for Gram and Giemsa staining. Multinucleated giant cells
may be present on Gram stain in HSV infection.
 Conjunctival swabs are taken with a sterile cotton-tipped applicator, for standard bacterial culture and chocolate
agar or Thayer–Martin media (for N. gonorrhoe).

6. Treatment
 Prophylaxis :A single instillation of povidone-iodine 2.5% solution is effective against common pathogens.
 Mild conjunctivitis: topical antibiotic like erythromycin or fusidic acid ointment is sufficient in most cases
 Moderate–severe:
 empirical oral erythromycin If the diagnosis is uncertain and chlamydial infection is a suspected.
 broad-spectrum topical antibiotic (e.g erythromycin for Gram-positive organisms, ofloxacin for Gram-negatives)
should be used until sensitivities are available.
 Severe conjunctivitis or when systemic illness is suspected, it requires hospital admission.
 Systemic treatment such as parenteral ceftriaxone. (with pediatrcian consultation)
 Topical Erythromycin
 Chlamydial infection is treated with oral erythromycin for 2 weeks And Erythromycin ointment.
 Gonococcal conjunctivitis is treated systemically with a third generation cephalosporin and topical erythromycin
ointment.
 Herpes simplex infection should always be considered as a systemic condition and is treated with high-dose
intravenous aciclovir under paediatric specialist care.
 Early diagnosis and treatment of encephalitis (PCR of cerebrospinal fluid (CSF) which is positive in 95% of cases) may
be life-saving and prevent serious neurological complications. Topical aciclovir should be used in addition.
 Paediatric specialist involvement is mandatory when systemic Disease is present.

7. VIRAL CONJUNCTIVITIS
 Most commonly caused by adenovirus, It is highly contagious infection, and is facilitated by the ability of viral particles to
survive on dry surfaces for weeks.
Presentation:
 Unilateral watering, redness, irritation and/or itching and mild photophobia.
 the other eye get affected 1–2 days later.
 systemic symptoms, such as a sore throat or common cold.
Signs
 Eyelid oedema, tender preauricular LND, Conjunctival hyperaemia and follicles.
 Severe inflammation may be associated with conjunctival Haemorrhages, chemosis, and pseudomembranes.
Keratitis (adenoviral):
 Punctate epithelial keratitis (staining)
 Focal white subepithelial/anterior stromal infiltrates.

8. Treatment
 Spontaneous resolution occurs within 2–3 weeks.
 Reduction of transmission risk by meticulous hand/face hygiene, avoiding eye rubbing and towel sharing.
 Preservative-free –unit dose Artificial tears four times daily .
 Cold compresses for symptomatic relief.
 Removal of symptomatic pseudomembranes.
 Topical antibiotics if secondary bacterial infection is suspected.
 Povidone-iodine is very effective against free adenovirus and has been proposed as a means of decreasing
infectivity.
 Topical steroids such as prednisolone 0.5% four times daily for severe membranous or pseudomembranous
adenoviral conjunctivitis.
 Symptomatic keratitis may require weak topical steroids Flurometholone, or Loteprednol.

9. Acute allergic conjunctivitis
Symptoms. acute or subacute attacks of redness,
watering and itching, associated with sneezing and nasal
discharge.
Signs: Conjunctival hyperaemia with mild papillary reaction, variable
chemosis and lid oedema.
Treatment:
Cold compresses:
Mast cell stabilizers (e.g. sodium cromoglicate)
Topical Antihistamines (e.g. emedastine)
Topical Dual action antihistamine and mast cell stabilizers (e.g.
ketotifen, olopatadine)
• Topical steroids may be used Flurometholone and Loteprednol.
• Oral antihistamines

10. Vernal keratoconjunctivitis VKC
 recurrent bilateral keratoconjunctivitis in which both IgE- and cell-mediated immune mechanisms play important roles.
 Palpebral VKC it involves the upper tarsal conjunctiva
 Limbal disease
 Mixed VKC has features of both palpebral and limbal disease
Symptoms consist of intense itching, lacrimation, photophobia, a foreign body sensation, and thick mucoid discharge.
Increased blinking.
Signs:
 conjunctival hyperaemia and diffuse papillary hypertrophy.
 Macropapillae (<1 mm) , giant papillae (>1 mm)
 Gelatinous limbal conjunctival papillae
 Keratoconus and other forms of corneal ectasia are more common in VKC and are thought to be at least partly due to
persistent eye rubbing.

11. Treatment of VKC
 Allergen avoidance
 Cool compresses
 Mast cell stabilizers (e.g. sodium cromoglicate)
 Topical antihistamines (e.g. emedastine)
 Combined action antihistamine/mast cell stabilizers (e.g.ketotifen, olopatadine)
 Non-steroidal anti-inflammatory preparations (e.g. ketorolac, diclofenac) may improve comfort by blocking non-histamine mediators.
 Topical steroids (e.g. fluorometholone 0.1%, prednisolone 0.5%, loteprednol 0.2% )
 Oral antihistamines
 Supratarsal steroid injection
 Topical Ciclosporin (0.05–2% between two and six times daily)may be indicated if steroids are ineffective, inadequate or poorly
tolerated, or as a steroid-sparing agent in patients with severe disease.
 Immunosuppressive agents (e.g. steroids, ciclosporin, tacrolimus, azathioprine) may be effective .

12. chalazion
 Signs: swelling, tenderness, redness, eyelid edema
 Treatment:
 Oral antibiotics : eyelid cellulitis
 Topical: erythromycin ointment, Tobramycin + dexamethasome ointment
 Hot compress
 Expression / massage
 Treat underlying blepharitis +/- refractive errors, uncontrolled DM.
 Conservative treatment first, if not resolved: Surgical incision and curettage.

13. Refractive errors:
 Myopia:
Myopia is a common optical aberration in which
parallel light rays from a distant image are focused
on a point anterior to the retina.
 Hypermetropia:
is also a common aberration and in which distant
light rays converge incompletely before striking the
retina.
 Astigmatism:
occur when incident light rays do not converge at a
single focal point. astigmatism can be divided into
corneal (or keratometric) astigmatism, lenticular
astigmatism, and retinal astigmatism.

14. Symptoms of refractive errors:
 If the child can't see well, they can have trouble learning. They might
lose their place while reading or avoid doing it. Their grades might
fall. Signs of an eye problem aren't always obvious in children.
So the child may be
 Asymptomatic specially in anisometropia, screening is important.
 Frowning (simulate pinhole effect)
 Headache
 Squint or blinks much of the time.
 Intolerance to near work
 Rub their eyes a lot.
 Holds books / things close to their face, come close to TV or screen.
 Blurring of vision (older children)

18. Refractive amblyogenic risk factors

19. Prescribing glasses In children:
symptoms, AUVA, age of child
 UAVA:
 3-4 years: 20/50 or worse , or 2 lines difference between the 2 eyes.
 5 years: 20/40 or worse or 2 lines difference between the 2 eyes.
 > 5 years: 20/30 or worse , or or 2 lines difference between the 2 eyes.
 Myopia:
Full cycloplegic refraction. Undercorrection of myopia was found to increase progression of myopia.
 Hypermetropia:
Undercorrection of the hyperopia improves eyeglass wear (tolerability of the glasses), especially in older children. A
manifest noncycloplegic refraction may be required to optimize visual acuity and binocular alignment in older children
because correction of the full cycloplegic refractive error may blur their distance vision.
 Accomudative Esortopia:
 prescription is given to correct the full refractive error as determined after cycloplegia.
 Give Cycloplegic ED can be used temporarily to facilitate compliance of eyeglass wear.
 In older children, gradual reduction of the hyperopic correction can be attempted if the deviation is controlled.
 Have to make sure that binocular alignment is optimized while maintaining best-corrected visual acuity.

20. Intermittent alternating exotropia.
 corrective lenses should be prescribed for any clinically significant refractive error that causes reduced vision in one
or both eyes.
 Improved retinal-image clarity often improves the control of the exotropia.
 In one study, myopia was found in more than 90% of exotropic patients by 20 years of age.
 Correcting even mild amounts of myopia may be beneficial. (highest minus)
 Correction of mild to moderate amounts of hyperopia is not generally recommended for patients with intermittent
exotropia because reducing accommodative convergence can worsen the control or size of the exodeviation.
 If hyperopic correction is necessary, the amount prescribed is the least amount needed to promote good vision while
still promoting accommodative convergence to control the exodeviation.

21. Cycloplegic refraction:
 For children younger than 6 months, an eye drop combination of
cyclopentolate 0.5% and phenylephrine 2.5% is often needed.
 infants over 6 months old : Cyclopentolate 1% solution is typically used.
 The use of topical anesthetic prior to the cycloplegic reduces the stinging of
subsequent eyedrops and promotes its penetration.
© 2017 by the American Academy of Ophthalmology
Published by Elsevier Inc.

24. Authors' conclusions: The most likely effective treatment to slow myopia progression
thus far is anti-muscarinic topical medication (Atropin 0.05% / cyclopentolate eye drops).
However, side effects of these medications include light sensitivity and near blur. Also, they
are not yet commercially available, so their use is limited.
Main results: this article included 23 studies (4696 total
participants) in this review.

25. Amblyopia:
 Strabismic amblyopia results from abnormal binocular interaction
where there is continued monocular suppression
of the deviating eye.
 Anisometropic amblyopia is caused by a difference in refractive
error between the eyes and may result from a difference of as little as 1 dioptre.
 Stimulus deprivation typically caused by opacities in the media (e.g. cataract) or ptosis that covers the
pupil.
 Bilateral ametropic amblyopia results from high symmetrical refractive errors, usually hypermetropia.
 Meridional results from image blur in one meridian. It can be unilateral or bilateral and is caused by uncorrected
 astigmatism (usually >1 D).
Amblyopia is the unilateral, or bilateral, decrease in best corrected visual acuity (VA) caused by vision deprivation and/or
abnormal binocular interaction, for which there is no identifiable pathology of the eye or visual pathway.

26. Diagnosis
 In the absence of an organic lesion, a difference in best corrected VA of two Snellen lines or more is indicative of amblyopia.
Prevention
Vision screening is important to identify factors that predispose to amblyopia. The earlier that clinically significant refractive error and
strabismus are detected and treated, the greater the likelihood of preventing amblyopia.
Treatment
 examine the fundus to diagnose and exclude any visible organic disease.
 The sensitive period during which acuity of an amblyopic eye can be improved is usually up to 7–8 years in strabismic amblyopia, and may be longer
(teens) for anisometropic amblyopia where good binocular function is present.
 Success rates of amblyopia treatment decline with increasing age. However, an attempt at treatment should be offered to children regardless of age,
including older children and teenagers.
 Several strategies are used to improve visual acuity in amblyopia.
 The first is to correct the causes of visual deprivation ( cataract- strabismus – ptosis).
 The second is to correct refractive errors.
 The third is to promote use of the amblyopic eye by occluding or blurring the fellow eye.

27. Patching/occlusion
 Occlusion :of the normal eye, to encourage use of the amblyopic eye, is the most effective treatment.
 The regimen, fulltime or part-time, depends on the age of the patient and the density of amblyopia. 2-6 hours
 The younger the patient, the more rapid the likely improvement but the greater the risk of inducing amblyopia in the
normal eye. It is therefore very important to monitor VA In both eyes
 Poor compliance is the single greatest barrier to improvement and must be monitored.

28.  Penalization, in which vision in the normal eye is blurred with atropine, is an alternative method.
 It may work best in the treatment of mild–moderate amblyopia (6/24 or better), especially when due to
anisometropic hypermetropia.

29. Esotropia

30. Early onset infantile esotropia
 Up to the age of 4 months, infrequent episodes of convergence are normal but after that ocular misalignment is abnormal.
 is an idiopathic esotropia developing within the first 6 months of life in an, no significant refractive error and no limitation of
ocular movements.
Signs:
 Large stable angle > 30 PD
 alternate fixation in the primary position.
 cross-fixating in side gaze so that the child uses the left eye in right gaze and the right eye on left gaze. Such cross-fixation
may give a false impression of bilateral abduction deficits, as in bilateral sixth nerve palsy.
 Abduction can usually be demonstrated, either by the doll’s head manoeuvre or by rotating the child.
 Latent nystagmus (LN) is seen only when one eye is covered and the fast phase beats towards the side of the fixing eye.
 Manifest latent nystagmus (MLN) is the same except that nystagmus is present with both eyes open, but the amplitude
increases when one is covered.
 The refractive error is usually normal for the age of the child (about +1 to +2 D).
 Inferior oblique overaction may be present initially or develop later.
 Dissociated vertical deviation (DVD) develops in 80% of children.

31. Initial treatment
 Amblyopia and any significant refractive error should be corrected.
 Early ocular alignment gives the best chance of the development of some degree of binocular function.
 Ideally, the eyes should be surgically aligned by the age of 12 months and at the very latest by the age of 2
years.
 Procedure: Bilateral MR recession, or unilateral medial rectus muscle recession with lateral rectus muscle
resection.
 Botulin toxin injection to MR.
 An acceptable goal is alignment of the eyes to within 10 PD
Subsequent treatment
 • Under-correction may require further recession of the medial recti, resection of one or both lateral recti or
surgery to the other eye, depending on the initial procedure.
 • Inferior oblique overaction may develop subsequently, most commonly at age 2 years. The parents should
therefore be warned that further surgery may be necessary. Inferior oblique weakening procedures include
disinsertion, recession and myectomy.


32. Accomudative esotropia
 Refractive accommodative esotropia
 In this type of accommodative esotropia, the AC/A ratio is normal and esotropia is a physiological response to
excessive hypermetropia, usually between +2.00 and +7.00 D.
 Fully accommodative:The deviation is eliminated and BSV is present at all distances following optical correction of
hypermetropia,
 Partially accommodative esotropia is reduced but not eliminated by full correction of hypermetropia. (Residual
agnle).
 Surgery should aim to correct only the residual angle present with glasses.
 Non-refractive accommodative esotropia:
In this type of accommodative esotropia the AC/A ratio is high, treated by bifocal glasses.

33. Pseudoesotropia
 prominent Epicanthal folds, narrow IPD, flat/broad nasal bridge, negative angle Kappa (high myopia)
 Cover/uncover, ulternate cover test: normal

34. EXOTROPIA
 infantile (early onset) exotropia
 Intermittent exotropia
 Convergence insufficiency
 Sensory exotropia
 Consecutive exotropia
 Pseudoexotropia

35. Intermittent alternating exotropia

Presentation
present around age of 2 years with exophoria, which breaks down to exotropia under
conditions of visual inattention, day dreaming, bright light (resulting in reflex closure of
the affected eye), fatigue, or illness.
Signs
 The eyes are straight with BSV at times and manifest exotropia with suppression at
other times
 Control of the squint varies with the distance of fixation and other factors such as
concentration.
 Children with intermittent exotropia tend to close an eye when exposed to bright light.

36. Treatment
 Correction of Refractive Errors
 in myopic patients may, in some cases, control the deviation by stimulating accommodation and with it,
convergence. In some cases over-minus prescription is useful.
 Correction of mild to moderate amounts of hyperopia is not generally recommended for patients with intermittent
exotropia because reducing accommodative convergence can worsen the control or size of the exodeviation.
 If hyperopic correction is necessary, the amount prescribed is the least amount needed to
promote good vision while still promoting accommodative convergence to control the exodeviation.
 Surgery
 Patients with effective and stable control of their intermittent exotropia are often just observed.
 Surgery is indicated if control is poor or is progressively deteriorating.
 Procedure: Unilateral lateral rectus recession and medial rectus resection or
bilateral lateral rectus recessions.

37. Congenital CNLDO
 Failure of canalization of the lower end of the nasolacrimal duct, in the region of the valve of Hasner.
 Spontaneous resolution occurs in approximately 90% within the first year.
 Signs:
Epiphora: constant or intermittent and may be particularly noticeable when the child has an upper respiratory tract
infection (nasal congestion)
Gentle pressure over the lacrimal sac may cause mucopurulent reflux.
The fluorescein disappearance test is highly specific in this setting. Only a fine line of dye, should remain
at 5–10 minutes under inspection with a blue light in a darkened room.

38. treatment
 Conservative TTT
 Lacrimal massage (pressure over lacrimal sac) + topical AB until age of 12
months
 Probing +/- silicon tube insertion: Earlier in severe symptoms

39. Treatment:
 Massage of the lacrimal sac: Massage is performed by applying pressure to the lacrimal sac, at the medial canthus, a few
times per day. This is the only location where application of external pressure on the lacrimal sac can be effective.
 Passing the finger along the nares, which is often recommended, is not effective because the NLD is covered by bone at this
site.
 Topical antibiotic: fucidic acid ointment.
 Sodium chloride 0.9% nasal drops: to clear mucous from the nose.
 Probing +/- silicon tube insertion.
 If symptoms are mild–moderate,probing may be delayed until the age of 12–18 months and is carried out under general
anaesthesia.
 For more marked symptoms: early probing may be appropriate. (9-12 months)

40. Corneal abrasion
 Symptoms:
 History of trauma.
 Redness, watery discharge, photophobia.
 Treatment
 Antibiotic ointment four times daily and cyclopentolate 1% twice daily.
 Pressure patching.
 In severe cases a bandage contact lens alleviates pain but may not improve healing. Specially in large abrasion.
 Topical diclofenac 0.1% reduces pain.
 Topical anaesthetic dramatically relieves pain but should not be dispensed for patient use.
 Hypertonic sodium chloride 5% drops four times daily and ointment at bedtime may improve epithelial adhesion.
 Following resolution, some authorities advise using a prophylactic topical lubricant such as carbomer gel three
 or four times daily for several months.

41. Congenital cataract
 Aetiology: Autosomal dominant (AD) inheritance is the most common aetiological
factor. metabolic disorders and intrauterine infections. Unilateral cataracts are usually
sporadic.
 Associated metabolic disorders: Galactosaemia, Lowe syndrome and Fabry disease.
 Associated intrauterine infections: Congenital rubella, congenital toxoplasmosis,
cytomegalovirus (CMV) infection and Varicella.
 Other systemic associations: Down syndrome (trisomy 21) and Edwards syndrome
(trisomy 18)

42. Treatment
 Bilateral dense cataracts require surgery between 4–10 weeks of age
 Bilateral partial cataracts may not require surgery until later, or indeed at any stage. Need careful monitoring.
 Unilateral dense cataract merits more urgent surgery. between4 and 6 weeks.
 Partial unilateral cataract can usually be observed or treated non-surgically with pupillary dilatation and possibly
part-time contralateral occlusion.
 Surgery involves anterior capsulorhexis, aspiration of lens matter, capsulorhexis of the posterior capsule, limited
anterior vitrectomy and IOL implantation, if appropriate. It is important to correct associated refractive errors.
Visual rehabilitation
 Spectacles for older children with bilateral aphakia
 Contact lenses provide a superior optical solution for unilateral or bilateral aphakia.
 IOL implantation is increasingly being performed in younger children and appears to be effective and safe in
selected cases.
 After cataract surgery in a child, measures need to be taken to prevent amblyopia.

43. Congenital glaucoma
 Primary congenital glaucoma (PCG) is rare, with an incidence of 1: 10 000 in many
populations. Boys are more commonly affected than girls.
 impaired aqueous outflow due to maldevelopment of the anterior chamber angle
(trabeculodysgenesis).
 Diagnosis
 Presentation usually occurs when an abnormality such as corneal haze, large or
asymmetrical eyes, watering, photophobia or blepharospasm.
 Corneal haze is due to diffuse oedema secondary to raised IOP, or localized oedema due
to breaks in Descemet membrane.
 Buphthalmos is a large eye as a result of stretching due to elevated IOP prior to the age
of 3 years.
 Haab striae
 Corneal scarring and vascularization
 Optic disc cupping in infants may regress once IOP is normalized.

44. Evaluation:
 Evaluation under general anaesthesia is generally required
 IOP measurement should be performed first,
 Anterior chamber examination
 Optic disc examination; asymmetry or a cup/disc ratio of >0.3 is suspicious.
 Corneal diameter measurement; >12 mm prior to the age of 1 year is highly suspicious.
 Gonioscopy using a direct goniolens may be normal or reveal trabeculodysgenesis,

45. Treatment
 Primary congenital glaucoma is always treated surgically as soon as the diagnosis has been confirmed.
 Goniotomy.
 Trabeculotomy
 A modification of trabeculotomy is used in some centres. An illuminated canaloplasty device is threaded into the
Schlemm canal followed by a 6-0 Proline suture, which is then pulled into the anterior chamber thus opening 360% of
the trabecular meshwork (Fig. 11.65). The postoperative IOP using this technique is approximately 5 mmHg lower at 2
years than that obtained with the traditional approach.
 trabeculectomy,
 tube shunt implantation and ciliary body ablative procedures.
 Monitoring of IOP
, corneal diameter and other parameters is required long term.
 Amblyopia and refractive error should be managed aggressively.

46. Retinopathy of prematurity
 Pathogenesis:
 Proliferative retinopathy affecting premature infants of very low birth weight who have often been exposed to high O2
concentration.
 Retinal bl.V. reach the nasal retina at 8th months gestation, and reach temporal retina 1 month after delivery.
 The avascular retina produces VEGF which in utero is the stimulus for vessels migration in the developing retina.
 In the early phase of ROP development vessel growth is retarded by hyperoxia, but subsequently retinal hypoxia promotes
anomalous vascularization.
 Active disease
 Location Concentric zones centred on the optic disc are described
 Zone I:is bounded by an imaginary circle, the radius of which is twice the distance from the disc to the centre of
the macula.
 Zone II: extends concentrically from the edge of zone I to the nasal ora serrata.
 Zone III consists of a residual temporal crescent anterior to zone II.

47. Staging
 Stage 1 (demarcation line)
 Stage 2 (ridge) arises in the region of the demarcation line
 Stage 3 (extraretinal fibrovascular proliferation) extends from the ridge into the
vitreous.
 Stage 4 (partial retinal detachment) is divided into extrafoveal (stage 4A ) and
foveal (stage 4B).
 Stage 5 refers to total retinal detachment.
 ‘Plus’ disease signifies a tendency to progression and is characterized by
dilatation and tortuosity of blood vessels involving at least two quadrants of the
posterior fundus.
 Aggressive posterior (‘rush’ disease) It is characterized by its posterior
location, prominence of plus disease and ill-defined nature of the retinopathy.

48. Type
 Treatment guidelines at most centres have been revised based on the Early Treatment of Retinopathy of
Prematurity (ETROP)clinical trial.
 Type 1. Treatment is now recommended within 72 hours for type 1 disease.
 Any ROP stage in zone I when accompanied by plus disease.
 Stage 3 to any extent within zone I.
 Stage 2 or 3 in zone II, together with plus disease.
 • Type 2 disease requires observation.
 Stage 1 or 2 in zone I without plus disease.
 Stage 3 ROP within zone II without plus disease.
Screening
 Babies born before 32 weeks gestational age or weighing less than 1500 g should be screened for
retinopathy of prematurity.
 Use: indirect ophthalmoscopy with a 28 D lens or a wide-field retinal camera.
 Screening should begin 4–7 weeks postnatally. Subsequent review is at 1–3-week intervals, depending on
the severity of the disease, continuing until retinal vascularization reaches zone III.
 The pupils is dilated with 0.5% cyclopentolate and 2.5% phenylephrine. Topical anaesthetic is instilled and
a neonatal eyelid speculum used.
Treatment:
 Laser ablation of avascular peripheral retina has largely replaced cryotherapy because visual and
anatomical outcomes are superior.
 Intravitreal anti-VEGF agents: (Bevacizumab Eliminates the Angiogenic Threat of Retinopathy of
Prematurity)
 Pars plana vitrectomy for tractional retinal detachment not involving the macula.

49. Cicatricial disease
 Straightening of vascular arcades
 with ‘dragging’ of the macula and disc.
 falciform retinal fold formation.
 retrolental fibrovascular tissue and partial retinal detachment
 Total retinal detachment

50. Leuckocoria
DD
 Retinoplastoma
 Coats disease
 Toxocariasis
 Persistent hyperplastic primary vitreous (PHPV)
 Cong. Cataract
 ROP
 Retinal astrocytoma
 Retinochodoidal coloboma, RD, cong. retinoschisis,
 myelinated nerve fibers.

51. leuckocoria
 a 9 month old infant.
 refered from pediatrician, was brought by parents for
vaccination, and she noted a yellow RR.
 Put cycloplegic eye drops.
 We discovered he has RD
 Was not sure: retinoplastoma or coats disease: no US
available.
 Was seen by several VR doctors.
 Child was examined under GA:
Cong. Retinoschesis was Confirmed

52. Online learning

54. Common children eye
conditions Thank you