Peadiatric ophthalmology in 10 minutes David Kinshuck, Good Hope Hospital Retinopathy of Prematurity Leukocoria……… Examining neonates Amblyopia Squint=Strabismus (not covered here in detail…links) –Cataracts –Nystagmus –Anisocoria –Nasolacrimal Duct Obstruction –Ptosis –Cloudy Cornea/many other conditions –Infections: conjunctivitis, cellulitis, etc

Retinopathy of prematurity (1) in premature babies peripheral retina is not vascularised at birth Under certain conditions instead of the vascularisation proceeding normally, there is a growth of new vessels and scarring 100% oxygen, crucial period 28-36weeks, especially low birth weight

Retinopathy of prematurity (2) vascularisation Scarring Laser peripheral retina Without laser,retinal detachment/blindness; have to check (screen) all appropriate neonates

Retinopathy of prematurity (3)

Leukocoria (1) = white pupil Have to check red reflex of all neonates & children Retinoblastoma congenital cataract PHPV (persistent hyperplasia of primary vitreous) Retina detachment (trauma/ retinopathy of prematurity) Toxocariasis (nematode infection) from exposure to puppies Uveitis, infections, other conditions

Leukocoria (2)

Examination of neonates Gross abnormality Red reflex (eg cataract) Discharge (gonococcal/chlamydial conjunctivitis) Large eye..buphthalmos

Examination of neonates (2): ophthalmic neonatorum Discharge in first week of life will be gonococcal or chlamydial conjunctivitis. Gonococcal infection can cause serious corneal damage

Examination of neonates (3): ophthalmic neonatorum

arapaho.nsuok.edu/~fulk/ Images/Img0055.JPG Examination of neonates (4) buphthalmos

Amblyopia (1) Early childhood is essential for visual maturation….visual cortex has to receive good quality images to develop Critical period 6 weeks…….(5y) Early period most important If no clear image is received, even if the problem (eg cataract, squint) is corrected, eye will never see

Amblyopia (2) A structurally normal eye that cannot see as well as it should Common causes are –Squints –Refractive errors with/without a squint –cataract

Squints (1) Esotropia Exotropia (vertical) Correct refractive error & patch good eye to treat amblyopia online (section 12, double vision and pupil, 3rd ‘?’ left)online (section 12, double vision and pupil, 3rd ‘?’ left) Folder similar Exotropia: divergent Esotropia: convergent

Squints (2) Exotropia See video if online

…briefly (not omitted here)………………. Cataracts (danger of amblyopia) onlineonline Nystagmus online (section 12, double vision and pupil) folder online (section 12, double vision and pupil)folder Anisocoria online (section 12, double vision and pupil) folder online (section 12, double vision and pupil)folder Nasolacrimal Duct Obstruction onlineonline Ptosis online (section 12, double vision and pupil) folder online (section 12, double vision and pupil)folder Cloudy Cornea/many other conditions Infections: conjunctivitis, cellulitis, etc