Ocular warning signs in GP practice: Paediatric Eye Pointers

Transcription

1 Ocular warning signs in GP practice: Paediatric Eye Pointers Dr Benjamin Chang MB, BCh, BAO, MMedSci, FRCS(Irel), FRCS(Edin), FRCOphth(Lond) Senior Consultant Ophthalmology and Visual Sciences Khoo Teck Puat Hospital

2 Case 1 2 year old Parents notice something odd in a recent family photo Medical hx: nil of note.

3 Case 1

4 Red Reflex Reddish-orange reflection of light from the retina Seen through a direct ophthalmoscope Very important part of eye exam

5 Red reflex Any opacity in the light pathway will affect it Cornea Anterior chamber Lens Vitreous Retina

6 Leukocoria (white pupil) Causes in children Cataract Retinoblastoma Infection (Toxocara) Vascular (Coats disease) Retinal detachment (retinopathy of prematurity) Retinal dysplasia (Norrie disease, incontinentia pigmenti)

7 Infantile cataract Leukocoria Early detection and surgery is crucial to prevent amblyopia Critical period much shorter than other causes of amblyopia (e.g. strabismus)

8 Infantile cataract Causes Leukocoria Familial TORCH infections Metabolic diseases (eg. Galactosemia) Genetic syndromes (eg. Downs) Trauma Medication Idiopathic

9 Retinoblastoma Leukocoria

10 Retinoblastoma Leukocoria Most common intraocular tumour in childhood Usually present under 5 years old

11 Presentation: Leukocoria Strabismus Glaucoma Orbital inflammation Pseudouveitis Routine examination Retinoblastoma

12 Leukocoria Neuroblastic tumour Often have calcification (seen on CT/ultrasound) If diagnosed early, survival rates are good Treatment: Enucleation Chemotherapy Laser/cryotherapy/radiotherapy

13 Other causes: Leukocoria Infection (Toxocara) Vascular (Coats disease) Congenital (PHPV) Retinal detachment (Retinopathy of Prematurity) Retinal dysplasia (Norrie disease, Incontinentia pigmenti) Others Normal (optic disc)

14 Case 2 1 year old Parents notice he is tearing in left eye. Appears to keep closing his eye to bright light. Also right eye appears smaller than the other. Medical hx: nil of note. Milestones normal.

15 Case 2 Examination:

16 Big, Watering Eye Congenital/infantile glaucoma Globe enlargement Sclera elastic in infants Myopic shift Buphthalmos ( ox eye ) Corneal changes Enlargement Cornea oedema Breaks in descemet s membrane

17 Congenital/infantile glaucoma Photophobia / tearing Can also present with a watering eye Reflex tearing from corneal oedema Optic disc cupping May be reversible High intraocular pressure May require sedation or GA for measurement

18 Congenital/infantile glaucoma Management Medication Topical Systemic Surgery

19 Epiphora Watering Eye Most common cause is blocked nasolacrimal duct About 5% of babies are born with this Watering eye, sticky discharge Eye is not red or inflamed No photophobia or discomfort

20 Watering Eye Majority resolve spontaneously within 1 year Massage lacrimal sac May require syringing and probing at 1 yo

21 Case 3 3 year old Parents says left upper lid swollen, red and tender for past 2 days Medical hx: sinus problem on and off. Nil else.

22 Case 3 Exam: Lid swollen, tender to touch T38.0 C Vision and pupils normal Ocular motility - mild limitation in LE movement

23 Periorbital Cellulitis Infection of tissues surrounding the eye 2 types Preseptal Orbital more serious Cause is infection spread from: Sinus Adjacent structures Trauma or surgery

24 Features: Periorbital Cellulitis Eyelid swelling, redness, tenderness Orbital cellulitis Proptosis Ocular movements affected Vision Conjunctival inflammation Pupils Systemic signs (e.g. fever)

25 Orbital Cellulitis In children, can worsen rapidly Complications Sight loss Abscess Intracranial spread Treatment Urgent intravenous antibiotics May need surgical drainage if abscess

26 Thank You