Paediatric acute ophthalmology. Harry Bradshaw

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1 Paediatric acute ophthalmology Harry Bradshaw

2 Approach Red eye Leukocoria Neurological Trauma Visual loss

3 Red eye Orbital Eyelid Conjunctiva Cornea Uvea

4 Orbital Orbit fixed volume Contiguous with sinuses, brain Swollen inflamed lids Proptosis Limitation eye movements Optic nerve compromise Systemically unwell

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7 Lids Layered composition Skin Orbicularis Fat Septum / tarsal plate Conjunctiva

8 Preseptal cellulitis Lid oedema Lid erythema Upper or lower lid Infective focus on skin Conjunctiva white No proptosis Eye movements full

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10 Dacryoadenitis Inflammation of the lacrimal gland Post septal structure Localised lid swelling Variable conjunctival reaction S sign Focal tenderness Limitation of abduction

11 Conjunctiva Most exposed mucous membrane Tarsal Forniceal Bulbar

12 Sub conjunctival haemorrhage Common Seldom history Frequency

13 Conjunctivitis Age of infant Timecourse Erythema Injection Oedema Discharge Follicular / Papillae Lymphatic response

14 Acute neonatal conjunctivitis Discuss with ophthalmology Swab Viral Bacterial Chlamyidial Gonorrhoea Urgent conjunctival gram stain Low threshold for Ceftriaxone

15 Allergic conjunctivitis Seasonal allergic Horner-Tantras dots Papillary reaction Acute atopic History of exposure Vernal keratoconjunctivitis Moorens ulceration Pannus

16 Infective Conjunctivitis Bacterial Staphylococcal Streptococcal Neisseria Chlamydia Viral Herpes virus Adenoviral Molluscum contagiosum Coxsackie Enterovirus Pediculosis

17 Congenital nasolacrimal duct obstruction Very common 5% newborns Constant watering Mucous on lids in morning Elevated meniscus Failure to respond to drops Expression of mucous on compression

18 Cornea Infection Microbial Viral Fungal Protozoan Inflammation

19 Iritis Inflammation of uveal tissue Migration of white cells Anterior most common Posterior can be involved Asymptomatic Associated with systemic disease

20 Leukocoria White pupil Causes Retinoblastoma Cataract PHPV Retinal scarring Detachment

21 Retinoblastoma Tumour of retina Neonate / toddler Leukocoria Strabismus White grey lesion Superficial vessels Can be bilateral Urgent referral

22 Squint Strabismus Deviation of eyes Esotropic Exotropic Vertical Can be acute

23 Esodeviation Eye turned inwards Fixates with dominant eye Causes Congenital Sixth nerve palsy Sensory deprivation Accomodative Convergence spasm Duanes

24 Exodeviation Third nerve palsy Sensory deprivation Intermittent exotropia Duanes syndrome Orbital lesions

25 Nystagmus Oscillatory movements of eyes Horizontal Congenital Vestibular Associated Vertical Upbeat Downbeat

26 Pupil anomalies Reaction Direct consensual Size Larger Third nerve palsy Pharmacological Smaller Horner s syndrome

27 Trauma Orbital fracture Lid lacerations Blunt globe injury Hyphaema Iridodialysis Retinal detachment Globe lacerations

28 Orbital Fracture Signs; Haematoma, eyelid oedema Ecchymosis Restricted eye movement Subcutaneous or conjunctival emphysema Hyperaesthesia infraorbital nerve Palpable step orbital rim Enophthalmos

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30 Trauma Lid lacerations Lid margin Lid skin Canaliculi Underlying structures

31 Trauma Hyphaema Blunt injury to globe Damage to iris vessels Pressure rise Associated trauma Late risk of glaucoma

32 Hyphaema Management Admission Bed rest 30 degrees Topical steroids Dilating drops Close review

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35 Trauma Corneal lacerations Hyphaema Haemorrhage Peaked pupil Seidel test

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37 Globe lacerations Minimal manipulation Clear shield Rest Urgent admission Keep fasting Imaging

38 Visual loss Uncommon Strabismus Shutting eye Vocalising loss

39 Functional visual loss Common in school age children Often unilateral Inconsistency in performance Aim to catch out Stereoacuity Fogging with glasses Coordination tasks Visual field testing

40 Try to establish cause / mechanism of injury Check vision Fluorescein useful Exclude sinister pathology Ophthalmology input Harry Bradshaw 2eyez2c@gmail.com