Download Squint GP Refresher Course in Ophthalmology

Paediatric
Ophthalmology
MCH Services Conference – Feb 2008
James Elder
Assoc Prof & Director
Department of Ophthalmology,
RCH
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Topics to be covered
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Squint (= strabismus)
Red and sticky eyes
Infantile glaucoma
White pupil
Infant with poor vision
• Questions welcome at end of presentation
on any aspect of paediatric ophthalmology
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Squint
• Squint = misaligned
eyes
• Squint = strabismus
• Squint ≠ limited eye
movement
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Classification of squint simplified
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Causes of squint in children
• Loss of binocular control in the brain
• Refractive error
• Loss of vision in one eye
• Genetic tendency
• Commonly associated with conditions
that cause neurodeveopmental delay
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Rare causes of squint in
children
• Defect in innervation
• Muscle abnormality
• CNS tumour
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Consequences of squint - I
Children
Adults
• Amblyopia
• Diplopia
• Loss of binocular
depth perception
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Consequences of squint - II
• In both adults & children the head may
be turned to maximise binocular
function (abnormal or compensatory
head posture)
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Accommodative esotropia
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Detection of Squint
• Observation
• Cover test
• Eye movements
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Detection of Squint
• Observation
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Detection of Squint
• Observation
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Detection of Squint
• Observation
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Detection of Squint
• Cover test
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Cover test
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Cover test
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Detection of Squint
• Eye movements
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Additional examination
• Visual acuity
• Red reflex (children)
• General examination
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Red reflex
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Management of squint
• Confirm presence of squint
• Measure vision (including stereoacuity)
• Document diplopia
• Measure deviation
• Measure refractive error
• Examine for other disease (ocular &
non-ocular)
• Determine need for special
investigations
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Management of squint
• Prescribe glasses
• Treatment of amblyopia
• Surgery
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
When to refer
• Squint definitely present
• Squint cannot be excluded
• Large angle squint before 6 months of age
• Any squint after 6 months (even if
intermittent)
• Urgent referral if red reflex is abnormal
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Red +/- Sticky Eyes
• Blocked tear ducts
• Infections
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Nasolacrimal duct obstruction
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Infective Conjunctivitis
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Infection vs Nasolacrimal
obstruction
• NLD obstruction = white eye
• Infection = red eye
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Nasolacrimal duct obstruction
• Treat conservatively until 12 months
• Poly-Visc or Lacrilube ointment if skin
irritation
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Infantile glaucoma
• Big, watery and cloudy eye, often light
sensitive
• REFER IMMEDIATELY
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
White pupil (+leukocoria)
• Cataract or retinal abnormality
• REFER IMMEDIATELY
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)
Infant with poor vision
• Not fixing on a face by six weeks
• Not following by 10 weeks
• Nystagmus (= involuntary to and fro eye
movements)
• Bilateral white pupils
• REFER IMMEDIATELY
This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)