NR602: Pediatric Study Topics
Pediatric Study Topics
Eye Disorders- 616- 646
Strabismus- a defect in In ocular alignment, or the position of the eyes in relation to each other; It is commonly
called lazy eye. And strabismus, the visual axes are not parallel because the muscles of the eyes are not
coordinated; When one eye is directed straight ahead, the other deviates.
Retinoblastoma is an intraocular tumor that develops in the retina. Although it is rare, this malignant retinal
tumor is the most common tumor in childhood (some 4% of cancers in children younger than 15 years of age)
Clinical findings
strabismus is the most common finding
there is a decreased visual acuity uni- or bilateral white pupil (leukocoria), described often as an
intermittent “glow, glint, gleam, or glare” by parents, is usually seen in low light settings or
noted in photographs taken with a flash i.e. (cat's eye reflex)
other symptoms include an abnormal red reflex, nystagmus, glaucoma, orbital Cellulitis and
photophobia, hyphema, hypopyon (plus an anterior Chamber of eye); Signs of global rupture or
also possible
Bulbar or palpebral conjunctival injection is a common presentation, which can be unilateral or bilateral.
differential diagnosis should include allergy, conjunctivitis, infection, foreign body, chemical exposure, or
systemic inflammatory disease, irritation of the conjunctiva or cornea, and congenital glaucoma.
Watery discharge can occur with allergies, nasolacrimal obstruction, foreign bodies, viral infection, and iritis.
Purulent or mucoid discharge can be noted with chronic dacrocystitis or nasolacrimal obstruction.
Advanced allergic conjunctivitis can have some mucoid production.
To differentiate, microscopic investigation of discharge may lead to other clues.
Photophobia is a symptom common of trauma and in infants with glaucoma or retinal disease. Other non-eye
related causes of photophobia include migraines and meningitis.
A white pupil, or leukocoria is a serious finding and demands immediate referral to the pediatric
ophthalmologist.
Causes of leukocoria include retinal detachment, cataract, retinal dysplasia, retinopathy of prematurity, and in
newborns retinoblastoma.
All newborns should have a fundoscopic examination within 24 hours of birth and yearly on physical
examinations.
Conjunctivitis chart
,Chalazion vs Stye
,CHALAZIONS – Benign, chronic lipogranulomatous inflammation of the eyelid
Causes – blockage of the meibomian cyst
Risk – hordeolum or any condition which may impede flow through the meibomian gland. Also mite species that reside in
lash follicles
Assessment – PAINLESS, NOT INVOLVING LASHES
Lid edema, or palpable mass
Red or grey mass on the inner aspect of lid margin
Prevention – good eye hygiene
Treatment – warm, moist compresses 3x per day
Antibiotics not indicated because chalazion is granulomatous condition, if secondarily infected consider
SULFACETAMIDE, ERYTHROMYCIN
Follow up – 2-4 weeks, if still present after 6 weeks follow up with ophthalmologist
Blepharitis-
BLEPHARITIS – Inflamation/infection of the lid margins (chronic problem)
2 Types:
seborrheic (non ulcerative) : irritants (smoke, make up, chemicals)
s&s – chronic inflammation of the eyelid, erythema, greasy scaling of anterior eyelid, loss of eyelashes, seborrhea
dermatitis of eyebrows and scalp
, Ulcerative- infection with staphylococcus or streptococcus
s&s – itching, tearing, recurrent styes, chalazia, photophobia, small ulceration at eyelid margin, broken or absent
eyelashes
● the most frequent complaint is ongoing eye irritation and conjunctiva redness
Treatment – clean with baby shampoo 2-4 times a day, warm compresses, lid massage (right after warm compress)
For infected eyelids – antistaphyloccocal antibiotics BACITRACIN, ERYTHROMYCIN 0.05% for 1 week AND
QUIONOLONE OINTMENTS
For infection resistant to topical – TETRACYCLINE 250 MG PO X4
DOXYCYCLINE 100 MG PO X2
Dacryocystitis is an inflammation of the involved nasolacrimal duct; infection can result. Treatment: Gentle pressure
applied in a downward and medial direction transmits hydrostatic force through the nasolacrimal duct to the
obstruction. This technique should be performed two or three times a day. The eyelid should be cleaned with plain water
after massage. Treatment of dacryocystitis is warm compresses AND oral or parenteral antibiotics
For uncomplicated bacterial conjunctivitis, treatment includes the following:
• Sodium sulfacetamide 10% ophthalmic solution or ointment; not effective against H. influenzae; stings; can
cause allergic reactions (including Stevens-Johnson syndrome)
• Trimethoprim sulfate plus polymyxin B sulfate ophthalmic solution
• Erythromycin 0.5% ophthalmic ointment for patients with sulfa allergy and infants Azithromycin drops for
children older than 12 months
• Fluoroquinolone ophthalmic drops including besifloxacin, ciprofloxacin, gatifloxacin, levofloxacin,
moxifloxacin, or ofloxacin for children older than 12 months
The aminoglycosides (neomycin, tobramycin, and gentamicin) are to be avoided because of possible
hypersensitization, severe allergic reactions, and increasing resistance.
CONJUCTIVITIS – inflammation or irritation of conjuctiva
Bacterial (PINK EYE) – in peds bacteria is the mosts common cause, contact lens, rubbing eyes, trauma,
Pediatric Study Topics
Eye Disorders- 616- 646
Strabismus- a defect in In ocular alignment, or the position of the eyes in relation to each other; It is commonly
called lazy eye. And strabismus, the visual axes are not parallel because the muscles of the eyes are not
coordinated; When one eye is directed straight ahead, the other deviates.
Retinoblastoma is an intraocular tumor that develops in the retina. Although it is rare, this malignant retinal
tumor is the most common tumor in childhood (some 4% of cancers in children younger than 15 years of age)
Clinical findings
strabismus is the most common finding
there is a decreased visual acuity uni- or bilateral white pupil (leukocoria), described often as an
intermittent “glow, glint, gleam, or glare” by parents, is usually seen in low light settings or
noted in photographs taken with a flash i.e. (cat's eye reflex)
other symptoms include an abnormal red reflex, nystagmus, glaucoma, orbital Cellulitis and
photophobia, hyphema, hypopyon (plus an anterior Chamber of eye); Signs of global rupture or
also possible
Bulbar or palpebral conjunctival injection is a common presentation, which can be unilateral or bilateral.
differential diagnosis should include allergy, conjunctivitis, infection, foreign body, chemical exposure, or
systemic inflammatory disease, irritation of the conjunctiva or cornea, and congenital glaucoma.
Watery discharge can occur with allergies, nasolacrimal obstruction, foreign bodies, viral infection, and iritis.
Purulent or mucoid discharge can be noted with chronic dacrocystitis or nasolacrimal obstruction.
Advanced allergic conjunctivitis can have some mucoid production.
To differentiate, microscopic investigation of discharge may lead to other clues.
Photophobia is a symptom common of trauma and in infants with glaucoma or retinal disease. Other non-eye
related causes of photophobia include migraines and meningitis.
A white pupil, or leukocoria is a serious finding and demands immediate referral to the pediatric
ophthalmologist.
Causes of leukocoria include retinal detachment, cataract, retinal dysplasia, retinopathy of prematurity, and in
newborns retinoblastoma.
All newborns should have a fundoscopic examination within 24 hours of birth and yearly on physical
examinations.
Conjunctivitis chart
,Chalazion vs Stye
,CHALAZIONS – Benign, chronic lipogranulomatous inflammation of the eyelid
Causes – blockage of the meibomian cyst
Risk – hordeolum or any condition which may impede flow through the meibomian gland. Also mite species that reside in
lash follicles
Assessment – PAINLESS, NOT INVOLVING LASHES
Lid edema, or palpable mass
Red or grey mass on the inner aspect of lid margin
Prevention – good eye hygiene
Treatment – warm, moist compresses 3x per day
Antibiotics not indicated because chalazion is granulomatous condition, if secondarily infected consider
SULFACETAMIDE, ERYTHROMYCIN
Follow up – 2-4 weeks, if still present after 6 weeks follow up with ophthalmologist
Blepharitis-
BLEPHARITIS – Inflamation/infection of the lid margins (chronic problem)
2 Types:
seborrheic (non ulcerative) : irritants (smoke, make up, chemicals)
s&s – chronic inflammation of the eyelid, erythema, greasy scaling of anterior eyelid, loss of eyelashes, seborrhea
dermatitis of eyebrows and scalp
, Ulcerative- infection with staphylococcus or streptococcus
s&s – itching, tearing, recurrent styes, chalazia, photophobia, small ulceration at eyelid margin, broken or absent
eyelashes
● the most frequent complaint is ongoing eye irritation and conjunctiva redness
Treatment – clean with baby shampoo 2-4 times a day, warm compresses, lid massage (right after warm compress)
For infected eyelids – antistaphyloccocal antibiotics BACITRACIN, ERYTHROMYCIN 0.05% for 1 week AND
QUIONOLONE OINTMENTS
For infection resistant to topical – TETRACYCLINE 250 MG PO X4
DOXYCYCLINE 100 MG PO X2
Dacryocystitis is an inflammation of the involved nasolacrimal duct; infection can result. Treatment: Gentle pressure
applied in a downward and medial direction transmits hydrostatic force through the nasolacrimal duct to the
obstruction. This technique should be performed two or three times a day. The eyelid should be cleaned with plain water
after massage. Treatment of dacryocystitis is warm compresses AND oral or parenteral antibiotics
For uncomplicated bacterial conjunctivitis, treatment includes the following:
• Sodium sulfacetamide 10% ophthalmic solution or ointment; not effective against H. influenzae; stings; can
cause allergic reactions (including Stevens-Johnson syndrome)
• Trimethoprim sulfate plus polymyxin B sulfate ophthalmic solution
• Erythromycin 0.5% ophthalmic ointment for patients with sulfa allergy and infants Azithromycin drops for
children older than 12 months
• Fluoroquinolone ophthalmic drops including besifloxacin, ciprofloxacin, gatifloxacin, levofloxacin,
moxifloxacin, or ofloxacin for children older than 12 months
The aminoglycosides (neomycin, tobramycin, and gentamicin) are to be avoided because of possible
hypersensitization, severe allergic reactions, and increasing resistance.
CONJUCTIVITIS – inflammation or irritation of conjuctiva
Bacterial (PINK EYE) – in peds bacteria is the mosts common cause, contact lens, rubbing eyes, trauma,
