Ophthalmia Neonatorum and Congenital Glaucoma Overview

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Which of the following is a sign of Nasolacrimal Duct Obstruction in newborns?

Increased tear lake

What is the initial conservative measure for treating Nasolacrimal Duct Obstruction in newborns?

Lacrimal sac compression - massage

Which condition may require systemic antibiotics and acute surgical decompression of the sac?

Dacryocele

What is the most common risk factor associated with Nasolacrimal Duct Obstruction in newborns?

Down syndrome

Which procedure involves a portion of the levator muscle being removed and reattached to the tarsus?

Levator resection

When should lacrimal probing be performed in cases of persistent dacryocele?

No later than 1 month after birth

What is the normal axial length of a newborn eye?

15-16 mm

Which structure projects fibers through the optic nerve to the ipsilateral pretectal nucleus?

Ganglion cells of the retina

What is the normal developmental status of an infant's eye in terms of focusing on the retina?

Focusing on the retina without accommodation

What neutralizes the axial hypermetropia of 3-4 D in a newborn eye?

Physiological increase in axial length

Which structure provides the efferent pupillary motor output from the pretectal nucleus to the ciliary sphincter muscle of the iris?

Edinger Westphal

What is the significance of abnormal eye findings in a newborn?

They may indicate underlying pathology that needs clinical assessment

What happens when the ciliary body contracts in an infant's eye?

The zonules relax and the lens thickens

At what age does depth perception start to develop according to the text?

2-4 months

What is the critical period for development of visual acuity according to the text?

Birth to 3-5 years of age

What is the significance of the red reflex examination in newborns?

To detect lenticular opacities

What are subconjunctival hemorrhages often caused by in newborns?

Trauma during delivery

When are dysconjugate eye movements considered normal in infants?

In the first few months of life

What is the recommended prophylactic ocular medication for all newborns according to the USPSTF?

Erythromycin

What is the incidence rate of gonococcal ophthalmia neonatorum in newborns delivered to women with gonorrheal disease?

28%

What is the primary congenital glaucoma incidence rate per births as mentioned in the text?

1:10,000

What is the most common gender affected by primary congenital glaucoma?

Boys

What is the primary cause of an abnormal red reflex in a child according to the text?

Refractive error between the eyes

What should be done if a child presents with an abnormal red reflex?

Refer to a pediatric ophthalmologist

Which type of discharge is characteristic of Chlamydia Conjunctivitis in newborns?

Minimal to profuse

What is the immediate danger associated with Neisseria gonorrhoeae causing conjunctivitis in neonates?

Corneal ulceration or perforation

What is the most common infectious cause of conjunctivitis in newborns during their first week of life?

Chlamydia

What intervention is recommended for treatment of Herpes Simplex Conjunctivitis in neonates?

Acyclovir and trifluorothymidine

Which neonates have a 50% risk of developing Gonococcal Conjunctivitis?

Infants born to women with primary HSV

What is the characteristic feature of herpesvirus infection on the cornea in neonates?

Dendritic ulcer

What does a white pupil in one or both eyes may indicate?

Anisometropic amblyopia

What is the major cause of retinal hemorrhages in infants associated with bruises and fractures?

Child abuse

At what age do infants typically have a visual acuity of 20/400 and focus at 10 inches?

Birth

What developmental milestone is expected at 3 months of age?

Stable eye contact

What is the primary action indicated with the algorithm for evaluation of an infant who does not appear to see?

Refer immediately

Which condition may be detected by measuring the angle of deviation from the center of the light reflex using prisms?

Strabismus

What is the primary cause of congenital ptosis in newborns according to the text?

Compression of the facial nerve against sacral promontory

Which method is recommended for initial conservative treatment of Nasolacrimal Duct Obstruction in newborns?

Lacrimal sac compression massage

What is the most common risk factor associated with Nasolacrimal Duct Obstruction in newborns?

Craniosynostosis

In cases of persistent dacryocele, when should lacrimal probing be performed according to the text?

No later than 1 month after birth

What is the primary etiology of Ophthalmia Neonatorum according to the text?

Neisseria gonorrhoeae infection

What is the recommended investigation for evaluating Asymmetric Blink in newborns, as mentioned in the text?

Electrodiagnostic testing if no improvement in 7-10 days

What is the significance of the term 'Emmetropia' in the context of the visual system anatomy?

Emmetropia refers to normal vision without the need for glasses or contact lenses

Which structure provides the efferent pupillary motor output from the pretectal nucleus to the ciliary sphincter muscle of the iris?

Edinger Westphal nucleus

What is the primary cause of abnormalities like Ptosis and Disorders of the nasolacrimal duct in infants?

Issues with eye growth and maturation

What neutralizes the axial hypermetropia in a newborn eye?

Physiological increase in axial length

When does the normal eye at birth develop full length, focusing on the retina without accommodation?

By 14 years of age

Which term describes the condition where an infant's eye focuses behind the retina without accommodation?

Hyperopia

During which period is the development of visual acuity considered critical according to the text?

First 3-4 months of life

What is the primary period during which deprivation can cause amblyopia?

A few months to 7 or 8 years of age

At what age does depth perception begin to develop rapidly according to the text?

5 months

What is the common cause of subconjunctival hemorrhages in newborns as explained in the text?

Pressure during delivery

What do dysconjugate eye movements in infants look like when considered normal?

Eyes move independently

What is the critical timeframe within which emergency referral should be made for a newborn with Neisseria gonorrhoeae conjunctivitis?

2-48 hours

Which of the following is the most dangerous infection in neonates as it can lead to corneal ulceration or perforation?

Gonococcal Conjunctivitis

What is the most sensitive test for diagnosing Chlamydia Conjunctivitis in newborns?

Direct culture of the conjunctiva

Which drug is used topically in addition to systemic antibiotics to treat herpes keratitis in neonates?

Trifluridine (trifluorothymidine)

What is the primary method of prophylaxis used for Ophthalmia Neonatorum according to the Canadian Pediatric Society policy statement?

Prenatal screening and treatment for chlamydia and gonorrhea

What feature on the cornea is characteristic of a herpesvirus infection in neonates?

Dendritic ulcer

What is the primary cause of primary congenital glaucoma as mentioned in the text?

Flat iris insertion

Which of the following is a common clinical feature of primary congenital glaucoma?

Buphthalmos if IOP is elevated after age 3

What is the primary method of treatment for glaucoma according to the text?

Placing a needle through the cornea to the trabecular meshwork

What does a lack of reflex in the left eye during a red reflex test indicate according to the text?

Cataract may be present

Which structure provides efferent pupillary motor output from the pretectal nucleus and controls the ciliary sphincter muscle in the iris?

Ciliary body

What does parallax in a red reflex examination indicate according to the text?

Corneal defects

What is the significance of a white pupil in one or both eyes in infants?

May suggest child abuse

What visual acuity is expected in a 4-year-old according to the text?

20/30

In children who are victims of nonaccidental injury, what other findings are retinal hemorrhages frequently associated with?

Intracranial hemorrhage

What does an infant's ability to watch and copy hand movements at 5 months indicate?

Good hand-eye coordination

What developmental milestone is expected at 9 months of age?

Recognition of faces

What is the primary cause of retinal hemorrhages in infants?

Child abuse

What does the Krimsky Light Reflex measure using prisms?

Angle of deviation from the center of reflex

What is the expected visual acuity for a 3-year-old according to the text?

20/30

Study Notes

Nasolacrimal Duct Obstruction in Newborns

  • A sign of Nasolacrimal Duct Obstruction in newborns is dacryocele.
  • The initial conservative measure for treating Nasolacrimal Duct Obstruction is massage and antibiotic ointment.
  • The most common risk factor associated with Nasolacrimal Duct Obstruction is maternal vaginal colonization with Chlamydia trachomatis.

Eye Development in Newborns

  • The normal axial length of a newborn eye is 17-18 mm.
  • The normal developmental status of an infant's eye is hypermetropic, with an axial hypermetropia of 3-4 D.
  • Axial hypermetropia is neutralized by the eye's growth and development.
  • The eye develops full length and focuses on the retina without accommodation by 12-14 months.
  • Depth perception starts to develop at 4-6 months.

Visual Acuity and Development

  • The critical period for development of visual acuity is from birth to 3-4 years.
  • The primary period during which deprivation can cause amblyopia is from birth to 6-7 years.
  • Visual acuity is expected to be 20/400 at birth and 20/20 at 4-5 years.
  • At 3 months, infants typically have a visual acuity of 20/400 and focus at 10 inches.
  • At 5 months, infants can watch and copy hand movements.
  • At 9 months, infants can follow moving objects with their eyes.

Eye Infections in Newborns

  • The primary cause of Ophthalmia Neonatorum is Neisseria gonorrhoeae.
  • The most common infectious cause of conjunctivitis in newborns during their first week of life is Chlamydia trachomatis.
  • The immediate danger associated with Neisseria gonorrhoeae causing conjunctivitis is corneal ulceration or perforation.
  • The recommended treatment for Herpes Simplex Conjunctivitis in neonates is topical and systemic antibiotics.
  • The primary method of prophylaxis used for Ophthalmia Neonatorum is erythromycin ointment.

Other Eye Conditions

  • Primary congenital glaucoma is a condition that affects 1 in 10,000 births.
  • The primary cause of primary congenital glaucoma is a trabeculodysgenesis.
  • The primary method of treatment for glaucoma is surgical intervention.
  • A white pupil in one or both eyes may indicate a serious condition such as retinoblastoma.
  • Retinal hemorrhages in infants are associated with bruises and fractures.
  • The primary cause of retinal hemorrhages in infants is nonaccidental injury.

Eye Examinations

  • The red reflex examination is significant in detecting abnormalities in the eye.
  • A lack of reflex in the left eye during a red reflex test indicates a possible abnormality.
  • The Krimsky Light Reflex measures the angle of deviation from the center of the light reflex using prisms.
  • Parallax in a red reflex examination indicates a possible refractive error.

This quiz covers the characteristics and management of Ophthalmia Neonatorum, toxic conjunctivitis in neonates, and Congenital Glaucoma. Topics include infectious causes, emergency referral criteria, and distinguishing features of Congenital Glaucoma.

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