Sepideh Tara Rousta, MD FAAO Robert Wood Johnson University Hospital Saint Peter s University Hospital Wills Eye Hospital

Transcription

1 Sepideh Tara Rousta, MD FAAO Robert Wood Johnson University Hospital Saint Peter s University Hospital Wills Eye Hospital

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3 14 mo old w R eye cross (parents)

4 9 mo old R eye crossing getting worse for past 6 months

5 What type of strabismus reponds to glasses? Without specs With full strength specs

6 Why should torticollis be a concern? Right head tilt Left head tilt

7 3 y old girl w abnl reflex in photos

8 Leukocoria: an ocular emergency

9 Name ocular abnormalities:

10 Can you examine pupils from a distance?

11 Name 2 ocular abnormalities here:

12 Name 3 ocular abnormalities here:

13 What birthmarks are concerning?

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15 6 mo old with excess tearing/discharge since birth

16 Which eye is abnormal?

17 Name 3 abnormalities here:

18 6 mo old with growing lump

19 13 y old with growing lump

20 Orbital Dermoid Cyst

21 3 y old with eye swelling, fever, uri for 2 days

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24 refer to ophthalmologist same day treated with bed rest, cycloplegics, topical steroids risk of re bleed within 5 days short and long term risk of glaucoma

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26 copious irrigation in general, alkali burns much more serious refer

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28 history and abnormal pupil severe subconjunctival hemorrhage hyphema place shield on eye, refer immediately

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33 sensitivity to light pupil may be miotic Rx: steroids and cycloplegic

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36 tetracaine and flourescein antibiotic ointment, patch if central never patch if contact lens wearer

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39 Persistent Red Eye? Foreign body Eversion of the eyelid is essential when there is suspicion of a foreign body.

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41 if cannot be removed from cornea easily, probably metallic evert lid especially if presence of a vertical corneal abrasion

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44 inferior floor most common, followed by medial wall restriction of movement on up gaze in children, should be repaired within 7 to 14 days

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46 involving canaliculis involving lid margin refer to ophthalmologist

47 Traumatic optic neuropathy Epidemiology any age, most are young men 4 5 cases/100,000/year MVA and bicycle accidents blows to brow and cheek most common

48 Mechanism of injury deceleration of the head Shearing forces of the nerve fixed to the dura in the canal Bone impact energy transferred to the canal, causing contusion Optic nerve in optic canal

49 Traumatic optic neuropathy afferent pupillary defect decreased acuity decreased color vision normal fundus appearance contusion of brow or cheek area

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52 hordeolum

53 eyelid infections anterior anatomy blepharitis hordeulum posterior anatomy chalazion meibomitis

54 treatment warm compresses (tea bags) qid antibiotic ointment (+/ ) if associated with blepharitis, then eyelid scrubs bid with cotton tipper applicator or wash cloth (use mild soap)

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57 orbital cellulitis symptoms: pain on eye movement painful red eye double vision signs: eyelid edema conjunctival injection proptosis decreased ocular motility

58 orbital cellulitis etiology direct extension from a sinus infection organisms staphylococcus streptococcus haemophilus influenzae

59 orbital cellulitis treatment hospitalize CAT scan intravenous antibiotics decongestants (nasal and systemic) if abscess, may need surgical drainage

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62 Infectious Pink Eye Acute presentation Discharge is common URI is common Bacterial vs viral PCP vs Ophthalmologist

63 Viral Conjunctivitis pink eye Usually adenovirus Usually unilateral, then affects fellow eye May be associated with pharyngitis, URI Associated with preauricular lymphadenopathy Highly contagious

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65 Adenoviral Conjunctivitis Treatment supportive Cold compresses, tears Patient education (highly contagious) Possible steroids for severe cases Lasts up to 2 weeks

66 vernal limbal conjunctivitis Horner Trantas dots large conjunctival papillae treat same as allergic responds well to Patanol

67 Viral conjunctivitis

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69 Viral conjunctivitis Etiology Mostly adenovirus Treatment Highly contagious Child must be out of school until eye is no longer red Family should wash sheets every day, etc. Cold compresses, refrigerated artificial tears Patanol if eyes very itchy Topical steroids if corneal infiltrates or membrane formation (by ophthalmologist)

70 bacterial conjunctivitis clinical signs purulent discharge no pre auricular node responds rapidly to topical antibiotics treatment topical antibiotics (Polytrim, Vigamox, Tobramycin, etc.)

71 Herpes Simplex primary vesicles of the eyelid follicular conjunctivitis no corneal involvement treatment antiviral (Viroptic or Zirgan) antibiotic ointment for vesicles

72 Herpes Simplex secondary dendritc keratitis scarring of the cornea stromal iritis, severe corneal changes treatment Viroptic 7x per day Zirgan BID QID

73 Uveitis JRA most common etiology in peds **asymptomatic HLA B27 Sarcoidosis, TB Complications: cataracts, glaucoma

74 Evaluation of the Red Eye History Recent trauma Assoc. illness Other family members with same Contact lens use Unilateral or bilateral Signs and symptoms tearing Discharge Itching Photophobia pain

75 Signs Preauricular nodes + pharyngitis viral 2 weeks to resolve Mucopurulent discharge, no nodes bacterial Otitis media H. influenzae Antibiotic drops, improve 2 3 days Bilateral, no nodes, +itching allergic Antihistamine drops (better than systemic)