Answer Sheet | Guaranteed High Marks!
astigmatism - defective curvature of the cornea or lens of the eye vision is blurry both
dose up and far away
nystagmus - Involuntary hythmic movements of one or both eyes
Classes of nystagmus - -Congential- 6 weeks-3 months
-Acquired- Concerning!
Causes of acquired nystagmus - Tumors, Albinism, CNS abnormalities, ear trauma, post-
infection of inner ear. hydrocephalus
Prematurity and IVH and drug exposure linked with - Acquired Nystagmus
Classification of Nystagmus - hyper=up, Hypo=down Exo=outward Eso=inward
Frequency, distance of eye movements, head of neck posturing, how many fields of gaze
affected?
Opsocolus - Involuntary oscillation of eye that persists of occurs beyond the first few
weeks of life= pathological condition
myopia - nearsightedness=distant objects blurry
Light from distant object focused IN FRONT of Retina
hyperopia - farsightedness=close objects are blurry
Visual image focused BEHIND retina
Cataracts - Cloudy lens. Most commonly caused by abnormal pupillary reflex. Congential
or Acquired
congenital cataracts - Infants should be able to follow moving objects by 3 months of
age- absence of the red reflex.
congenital cataracts causes - Trisomy 21, albinism, family history, Marfan, Diabetes,
Ataxia Telangiectasia, demyelinating sclerosis, prematurity, nystagmus,
Infection that cause cataracts - congenital rubella, CMV, toxoplasmosis,
,strabismus - muscle weakness causing crossed eyes
Types of strabismus - esotropia (eyes turn in) and exotropia (eyes turn out),
hypertrophic one eye higher than the other
Strabismus= estropia causes - LBW, prematurity, CP, Hydrocephalus, drug exposure
when is strabismus most visible - when the child is looking at near object
What age does strabismus commonly occur? - ages 1-8
-phoria - intermittent deviation occurs when one eye is closed, Will not disrupt everyday
life
-tropia - constant deviation. cannot keep alignment on fixated object. cover uncover test
"common with "tired" eyes
*tropia is NOT NORMAL and can lead to double vision since the misaligned eye won't correct
itself*
strabismus defined on video - Ocular misalignment
Intermittent Esotropia - Normal in ages 6 months to 4 year when tired, exposed to bright
light or sudden movement from near to far vision.
S/S persistent squinting, head tilting, face turning, over pointing, or even nystagmus -
strabismus
Tests to screen for strabismus - corneal light reflection, cover-uncover test, alternating
cover tests. Asymmetry of light reflex on cornea. Photoscreener.
Test for strabismus phorias - alternating cover test
test for strabismus tropias - cover-uncover test
iritis - form of uveitis affecting structures in the front of the eye
What diseases are associated with iritis /uveitis? - Crohn's, JIA, Psoriatic arthritis, Reiter
syndrome, Ankylosing spondylitis, juvenile spondyloarthropies
What infections can cause iritis? - Syphlilis, TB, sarcoidosis, Lyme disease
Clinical findings of iritis - Injected sclera, photophobia, pain, blurred vision, conjunctivitis,
sterile corneal infiltrates.
, strabismus - •"Crossed Eyes" (Strabismus)
-Most often noticed by mothers when child is an infant
-Is often "pseudo-strabismus" from a wide nasal bridge and will resolve as the child's face grows
-The key to diagnosis is the corneal light reflex
•If centered and the same in both eyes, then likely pseudostrabismus
•If not centered or not the same in both eyes, refer to pediatric optometry/ophthalmology
-Can lead to poor development of vision if not treated early
Viral Conjunctivitis - -Watery, red eye with excessive tearing and photophobia
-Tender preauricular nodes!
-Treatment is supportive with artificial tears, cool compresses, and frequent handwashing
-1-2 week course and should be out of school
-Refer only in severe cases
Bacterial conjunctivitis - -Purulent discharge with crusty eyelids
-In children less than 1 year old, most commonly Nasolacrimal duct obstruction
-Treat with 4th generation fluoroquinolone drops and refer to ophthalmology
-In older children, most commonly associated with URI
-Treat underlying infection with oral antibiotics
-Refer if significant pain or poor response to treatment
Primary care photo screener - -Many Pediatric Ophthalmic Disorders are easiest
diagnosed with flash photography
•Leukocoria =Will see white in the pupil instead of red and often unilateral
•Strabismus= Will only see 1 red reflex
-In older children, the red eye is usually the normal eye
Photoscreener shows white out in one eye could be - _Leukocoria
-Cataract
-Retinal Disease