Download Word version of this scenario

Last updated on 14 Feb 2013 at 2:36 PM (Oph12)
Infant with an altered light reflex
A 6 week old NZ European baby boy, having his 6 week GP check-up has absence of
the red reflex in the right eye. On examination the child is alert and has no objection
to occlusion of the right eye, but he has objection to occlusion of his left eye. He has a
full range of extraocular motility.
Applied Science for Medicine
Ocular anatomy relevant to possible site of the opacity: cornea, lens, vitreous, retina
Pathogenesis of congenital cataract, congenital corneal opacity, retinopathy of
prematurity
Pathogenesis of retinoblastoma
Describe the genetic basis of cancer; oncogenes, tumour suppressor genes, genes that
control cell death, DNA repair genes
Clinical and Communication Skills
Obtain an appropriate history; consider duration, history of prematurity, birth weight,
ocular injury, evidence of maternal infection, other systemic conditions, family
history of eye problem/operations
Examination including visual acuity, pupil response; assess for strabismus and
nystagmus; dilate pupil and assess for lens opacities; compare ocular status of eyes
Differential diagnosis of strabismus.pdf' target='_blank' title='Click to go to:
Ophthalmology'>strabismus.pdf' target='_blank' title='Click to go to:
Ophthalmology'>leukocoria
Additional investigations that may be required: slit lamp examination (portable),
ultrasound if the media is opaque and Retcam (fundus camera), neuroimaging for
retinoblastoma, general paediatric assessment (for systemic causes), genetic/other
laboratory investigations
Outline the management of congenital cataract
Long-term visual prognosis and rehabilitation following congenital cataract surgery;
resources for children with visual impairment
Communicate with parents/family/whĕnau to establish relationship that will assist
in adherence to management plan (postoperative correction of residual refractive
error)
Management of amblyopia (patching or atropine); consider effect on school
performance of visual disability/hospital attendance
Personal and Professional Skills
Empathetic communication with family/whĕnau and sensitivity to parental anxiety
which ensues when the possibility of an abnormality is raised
Hauora MÄ•ori
Appropriate engagement and consultation with whĕnau
Population Health
Epidemiology of congenital cataract
Conditions to be considered relating to this scenario
congenital cataract, retinoblastoma, retinopathy of
Common
prematurity and its stages, persistent hyperplastic
primary vitreous, vitreous hemorrhage, toxocariasis,
Coats disease
chorioretinal colobomas, other tumours e.g. choroidal
Uncommon
haemangioma