Questions and Answers
What is the recommended management for anterior blepharitis?
What complication is commonly associated with corneal ulcer due to bacterial keratoconjunctivitis in children?
What is a common systemic condition associated with Peters anomaly?
What treatment is recommended for managing chalazia?
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Which of the following is NOT a feature of aniridia?
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Which condition is primarily characterized by choristoma located inferotemporally?
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What is the significance of checking for lagophthalmos in children with superficial punctate keratitis?
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In the management of hordeola, which treatment option is typically indicated?
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What complication is often associated with congenital malformations that include defects in lens vesicle separation?
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In the treatment of superficial keratitis, which of the following is the preferred management?
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What is the common initial treatment recommended for Nasolacrimal Duct Obstruction that has bacterial conjunctivitis?
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Which complication is NOT typically associated with facial hemangiomas?
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What is the recommended management for Impetigo in children?
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Which of the following characteristics is true regarding Molluscum Contagiosum?
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What is a significant risk factor for developing facial hemangiomas?
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In the case of Nasolacrimal Duct Obstruction, what percentage of infants resolve without surgical intervention?
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What is the appearance of lesions caused by Molluscum Contagiosum?
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What conservative treatment can be initiated for Epiblepharon?
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What common risk factor is associated with developing Impetigo in children?
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Which treatment for Molluscum Contagiosum might be considered if lesions are bothersome?
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What is the appropriate initial action for a child under 5 exhibiting malaise and fatigue due to a bug bite near the eye?
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Which of the following symptoms is NOT characteristic of Orbital Cellulitis?
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What type of treatment is indicated for advanced cases of Orbital Cellulitis?
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What is the primary complication of Blepharo-Keratoconjunctivitis (BKC)?
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In a case of preseptal cellulitis, what characteristic symptom differentiates it from Orbital Cellulitis?
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Which of the following best describes the etiology of Blepharo-Keratoconjunctivitis?
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What risk factor is associated with an increased likelihood of Orbital Cellulitis in children?
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Which of the following is NOT a symptom of Orbital Cellulitis?
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What is most commonly associated with unilateral cases of leukocoria?
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Which of the following conditions is characterized by opacity of the lens at birth?
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Which condition is NOT typically found in the differential diagnosis of leukocoria?
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What treatment is recommended for congenital cataracts after diagnosis?
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Which symptom may indicate deprivation amblyopia if it exceeds a certain size?
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What is crucial in post-operative care after cataract extraction in infants?
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What is a common complication associated with both contact lens and IOL use in infants with unilateral cataracts?
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Which treatment for Persistent Hyperplastic Primary Vitreous (PHPV) has the lowest chance of achieving visual acuity of 20/50 or better?
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What is the most common presenting sign of Retinoblastoma?
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Which of the following conditions has the highest incidence of affecting boys and is associated with peripheral retinal telangiectasia?
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What characterizes the treatment of Toxocariasis?
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Myelinated nerve fibers are primarily characterized by which of the following attributes?
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In cases of coloboma, what is a significant risk associated with the condition?
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What is the primary etiology of Retinal Detachment in the pediatric population?
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Which form of treatment is generally preferred by surgeons for infants with unilateral cataracts?
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What common sign can indicate a child has Retinoblastoma?
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Study Notes
Pediatric Ocular Diseases Overview
- Focus areas include adnexa, lids, lashes, anterior segment, leukocoria, retinal diseases, systemic conditions affecting the retina, optic nerve abnormalities, and nystagmus in infancy.
Adnexa, Lids, and Lashes
Facial Hemangioma
- Benign vascular tumor; bright red, flat birthmark appearing at birth or within the first two weeks.
- Common locations: face, scalp, chest, back; typically fades by age 10.
- Risk factors include Caucasian ethnicity, female gender, and prematurity.
- Complications can involve bleeding, vision blockage, pain, and infections.
- Oral Propranolol can accelerate resolution.
Nasolacrimal Duct Obstruction (NLDO)
- Occurs in about 5% of infants; commonly at the valve of Hasner.
- Symptoms include epiphora (tear overflow), usually unilateral but can be bilateral.
- Non-surgical treatments: topical antibiotics for bacterial conjunctivitis, frequent eyelid massage.
- Observation shows 66% of infants resolve NLDO without surgery; 41% over the age of one may also resolve spontaneously.
Impetigo
- Bacterial skin infection characterized by "honey-colored crusts," most prevalent in children aged 2-5.
- Common skin sites include the face, neck, and trunk; often seen in daycare children and those with eczema.
- Treatment includes topical antibiotics like mupirocin or oral antibiotics; sanitation of fomites is crucial.
Molluscum Contagiosum
- Viral skin infection mostly affects children aged 1-4; presents as flesh-colored, dome-shaped lesions with umbilicated centers.
- Tends to resolve on its own over time; treatment may involve monitoring or curettage.
- Sanitation of fomites important due to its contagious nature.
Epiblepharon
- Congenital lid condition causing eyelashes to contact cornea, more common in lower lid.
- Characterized by tight skin around eyelashes leading to irritation; treatment may include conservative measures or surgery.
Anterior Segment Conditions
Ocular Dermoid
- A choristoma (normal tissue in an abnormal location); often located inferotemporally.
- Can induce astigmatism and may lead to amblyopia; treatment involves monitoring or surgery.
Aniridia
- Caused by a mutation in the PAX6 gene; results in iris hypoplasia and associated complications including glaucoma, cataract, and optic nerve hypoplasia.
- Nystagmus can also be observed.
Peters Anomaly
- Characterized by corneal opacities due to anterior segment dysgenesis.
- Features may include shallow anterior chamber, synechiae between iris and cornea, and central corneal leukoma.
- Often accompanied by systemic and ocular associations related to PAX6.
Orbital Conditions
Orbital Cellulitis
- Symptoms include proptosis, pain, limited extraocular movements, and potential vision loss.
- Associated with symptoms of sinusitis and fever; typically requires IV antibiotic treatment.
Blepharo-Keratoconjunctivitis (BKC)
- Involves chronic inflammatory disease of eyelid margins, leading to conjunctival and corneal involvement.
- Management strategies vary according to severity and may include lid hygiene, warm compresses, and topical/oral antibiotics.
Corneal Involvement in BKC
- Requires corneal staining for assessment; treatment may involve lubrication and topical steroids based on severity.
General Management Strategies
- Topical antibiotics for bacterial infections and supportive care for various conditions.
- Regular monitoring critical for congenital conditions and obstructive issues, as outcomes can vary widely.
Definition of Leukocoria
- White pupil appearance often noted in flash photography.
Differential Diagnoses of Leukocoria
- Strabismus
- Anisometropia
- Congenital Cataract
- Persistent Fetal Vasculature
- Retinoblastoma
- Retinal Detachment
- Coloboma
- Myelinated Nerve Fiber Layer (NFL)
- Retinopathy of Prematurity
- Coats disease
- Toxocariasis
- Toxoplasmosis
- Cytomegalovirus
- Norrie’s disease
- Morning glory disc anomaly
- Incontinentia Pigmenti
Etiology of Leukocoria
- Unknown prevalence, can be inherited or associated with syndromes.
- Unilateral cases primarily have unknown origins.
- Congenital cataracts are generally inherited and mostly bilateral, but can link to:
- Intrauterine infections
- Metabolic disorders
- Chromosome abnormalities and syndromes
- Trauma and medications.
Signs and Symptoms
- Opacity of the lens detected at birth.
- May present with leukocoria, nystagmus in one or both eyes, and strabismus.
- Can lead to deprivation amblyopia if greater than 3 mm.
- No relative afferent pupillary defect (APD) observed.
Treatment Options
- Cataract extraction recommended within days to weeks.
- Post-operative treatment for amblyopia.
- Use of SilSoft contact lenses or intraocular lenses (IOL).
- Investigate potential underlying disorders; treatment may be necessary.
- If cataract is not visually significant, monitoring may be sufficient.
Infant Aphakia Treatment Study (IATS)
- Compared outcomes of contact lens (CL) vs. IOL in unilateral cataract.
- No significant vision difference between CL and IOL groups at ages 1 and 4.5.
- Approximately half of participants achieved vision of 20/200 or better.
- Higher complication rates noted in IOL group; more surgeries required.
- Both groups showed about one-third developed glaucoma.
Persistent Hyperplastic Primary Vitreous (PHPV)
- Involves failure of primary vitreous regression, usually unilateral.
- Associated with fibrous tissue attaching to lens back.
- Possible complications: vascular traction, shallow anterior chamber, microphthalmos, cataract, persistent hyaloid artery.
PHPV Treatment and Visual Outcomes
- Surgical options include cataract extraction with IOL, vitrectomy, and removal of embryonic remnants.
- Visual outcomes vary based on the treatment, with successful vision (20/50 or better) in 12.6% of cases.
Retinoblastoma
- Most common pediatric neoplasm, hereditary in 25% of cases, often bilateral.
- Presenting signs include leukocoria (56%), strabismus (20%), painful red eye (7%), and poor vision (5%).
- Treatment methods include chemotherapy, radiation therapy, laser therapy, cryotherapy, and enucleation.
Retinal Detachment
- Most frequently occurs due to trauma in pediatric cases.
- Other causes include proliferative retinopathy, high myopia, aphakia, and retinopathy of prematurity (ROP).
Coats Disease
- Characterized by peripheral retinal telangiectasia and exudation; may cause serous retinal detachment.
- More prevalent in males, typically unilateral.
- Considered idiopathic.
Toxocariasis
- Infection caused by Toxocara canis/cati resulting in retinal granuloma and severe inflammation.
- Usually unilateral and without effective treatment.
Myelinated Nerve Fibers (NFL)
- Presents as superficial white retinal lesions with feathery borders, can be unilateral or bilateral.
- Vision loss is uncommon unless the macula is affected, often associated with high myopia.
Coloboma
- Results from incomplete closure of the embryonic optic fissure, often in the inferior nasal area of the optic disc.
- Vision loss severity depends on the size and location of the coloboma.
- Increased risk of retinal detachment associated with coloboma.
- Part of CHARGE syndrome, which includes coloboma, heart defects, atrial abnormalities, growth retardation, and ear development issues.
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Description
This quiz covers pediatric ocular diseases focusing on adnexa, lids, lashes, and various conditions affecting infant eyes. Key topics include facial hemangioma, nasolacrimal duct obstruction, and systemic complications impacting ocular health. Test your knowledge on these critical aspects of pediatric ophthalmology.
