COMMON EYE DISEASES IN CHILDHOOD

Dr Elizabeth Joseph Magnitude of visual impairment in children-  1.5million blind or severely visually impaired children in the world  1 million blind children live in Asia  50,000 new cases are added every year  Prevalence of low vision is likely to be 5-10times the figure for blindness. Causes of visual loss in children  Marked variation among various regions of the world  Vitamin A deficiency in association with measles and diarrhea  Congenital cataract and glaucoma  R O P is increasing as neonatal services improve.  Optic atrophy and lesions of higher visual pathways to perinatal cerebral hypoxia  Genetic causes. Role of pediatricians-  Examination of newborn-external eye, pupillary reflex, red reflex, - exclude cataract, buphthalmos, microphthalmos  Screening of low birth weight babies for ROP  Examination of high risk groups-children born to families with genetic diseases  All children should be examined for vision, clarity of media, evidence of conjunctivitis, squint, cataract, other abnormalities Assessment of vision  Fixation and Following of light should be looked for and documented before 4 months of age  Fixation should be Central, Steady and Maintained Optokinetic nystagmus  Presence or absence of nystagmus on gentle rotation of OKN drum quantifies visual acuity in babies Vision testing - 3-5 years of age  Matching optotypes Screening the red reflex- Bruckners test  The quality of red reflex should be assessed by pediatricians before discharging newborn babies. Assessment of Red Reflex  Gross difference in the quality of red reflex of both eyes is indicative of refractive errors and strabismus Assessment of Red Reflex-  Opacities of the media like Cataract,  P H P V , Retinoblastoma, Endophthalmitis etc can be detected on assessment of red reflex Retinoblastoma CONGENITAL CATARACT Important Causes- Intrauterine infections like, rubella, toxoplasmosis, Metabolic diseases like galactosemia, Inherited-autosomal dominant/recessive Management of congenital cataract  Total cataracts are to be operated as early as one month of age  Delayed surgery can result in amblyopia  Optical correction with intraocular lens, contact lens or spectacle  Intraocular lens implantation is safe after 2 years of age Subluxated cataract  Partially displaced lens  Marfans syndrome, Homocystinuria,  Weill Marchesani syndrome Surgical incisions for Cataract Modern Cataract Surgery  Pediatric Cataract Surgery is more difficult than in adult and should be done only by very experienced surgeons  Lens matter is aspirated through a small anterior capsular rexis[ opening]  IOL is implanted inside the capsular bag [between the anterior and posterior layers of the capsule]  Foldable IOL can be inserted through a 3 mm incision and Rigid IOL needs 5 mm incision Congenital Nasolacrimal duct obstruction  Isolated defect or associated with other anomalies  Infant develops watering from the eye, recurrent conjunctivitis  Discharge Management Antibiotic drops and lacrimal massage in the early months  Nasolacrimal Probing at the age of 10 months to 1 year DACRYOCYSTITIS  Frequently accompanies nasolacrimal duct obstruction  Prompt treatment with systemic antibiotic is mandatory as an abscess formation is most likely NEONATAL CONJUNCTIVITIS- Can lead to keratitis and visual loss  Cause- gonococcal, chlamydial [infection from mother]  Cross infection from neonatal nurseries and labour rooms- Staphylococcus aureus, staphyloccus epidermidis, streptococcus viridans, streptococcus pn, pseudomonas Management of neonatal conjunctivitis.  Better to establish a lab diagnosis by gram staining and culture  Intense topical and systemic antibiotic therapy  Look for corneal involvement  Lid hygiene Viral conjunctivitis  Redness and watering without much discharge  Purulent discharge indicates secondary bacterial infection Allergic conjunctivitis/Vernal Catarrh  Common in children  Itching is the symptom  Seasonal  Cobble stone Pappillae in the palpebral Conjunctiva  Can lead to corneal ulcer  Requires prolonged treatment BLEPHARITIS  Eye lids are swollen Eye lids are swollen and scaly, Lashes appear matted.  Treatment - Lid hygiene, Antibiotic cream  Buphthalmos[Congenital Glaucoma and scaly,Lashes matted.  Treatment- Lid hygiene, Antibiotic cream Buphthalmos[Cong. Glaucoma  Eye lids are swollen and scaly,Lashes matted.  Treatment- Lid hygiene, Antibiotic cream BUPHTHALMOS [Cong. Glaucoma]  Watering, Photophobia  Megalocornea.  Corneal haze and edema  Treatment- Surgery as early as the first week of life Kiran- had cong. Glaucoma, operated at 2 weeks of age- RETINOBLASTOMA-  Commonest malignant ocular tumour  50% of cases are heritable due to genetic mutation- autosomal dominant Retinoblastoma  Yellow reflex at the pupil  Gross defective vision depending on the location and extent of the tumour Globe with tumour inside Malignant neuroblastic cells  Flexener-Wintersenier rosettes VITAMIN A DEFICIENCY  Xerophthalmia  Bitots spots  Night blindness  Corneal Xerosos  Corneal ulcer[Keratomalacia] Treatment of Keratomalacia  For children older than 1 year- oral vit A 200,000 IU on day one, 200,000 IU on second day and additional dose repeated 2-4 weeks later  Less than 1 year – Half the above dose CHALAZION-  Inflammation of the meibomian glands  Local antibiotic ointment, Anti inflammatory agents  Incision and curettage if not responding ORBITAL CELLULITIS  Painful red eye with lid oedema  Ocular movements restricted  May be associated with fever, resp. infection, sinusitis etc  Visual loss can occur due to optic neuritis or exposure keratitis STRABISMUS  Strabismus or squint leads to loss of binocular vision and amblyopia if not corrected in time.  Strabismus surgery as early as 6-8 months of age will help the child to develop normal vision and steriopsis Treatment of Amblyopia Left con. squint with I O OA Strabismus surgery- Lt. Convergent