2. PEDIATRIC EYE EXAMINATION
Overall examination – indirectly during
communication
Appearance of the external eye– lid abnormality,
eye lashes, eyeglobe, cornea and conjunctiva
Compare both eyes
Pupil reaction – direct and indirect
Internal examination – if needed
5. NASOLACRIMAL DUCT
OBSTRUCTION
30% infants at birth
Relative narrowing of the distal nasolacrimal
system
Resulting in decreased tear outflow
Causes: congenital dacryostenosis. Secondary to
trauma, orbital tumours, various dev anomalies
ie craniofacial clefts
7. TREATMENT –
CONG DACRYOSTENOSIS-
spontaneously open by 1 year of age.
Lacrimal sac massage
Instillation of broadspectrum ab drops or
ointment.
Over 1 year old; probing and irrigation of the
nasolac system
Fail to probe – silicone tubing
9. TREATMENT
ACUTE DACRYOCYSTITIS
purulent material - gently compress
Obtain a Gram stain and culture and ab
sensitivity testing
Pain control
Warm compression
Neonates and infants – IV ab
10. EPIPHORA
5% obstruction to the nasolac duct.
Diff Diag:- glaucoma, corneal abrasion, conjunctivitis,
keratitis, allergy and foreign body.
T(x) – massage, after 1 year old - probing
11. PSEDOSTRABISMUS
Epicanthus
Common sign in babies
Extra folds at the upper and the lower medial
canthus.
Esotropic appearance, Hirscberg’s Test to confirm.
Typical in Down Syndrom Children.
13. PTOSIS
Drooping of the upper eyelid
Dystrophy of the levator muscles
Cong ptosis - unilat. or bilat.
Mild – cover more than 2 mm of the cornea
Moderate - 3 mm
Severe - 4 mm or more
Effect on the vision and cosmesis value
14. BLEPHARITIS
inflammation at the lid margin.
red, swollen, with debris.
2 types; Squamos & Ulcerative
Staphylococcal blepharitis; common
irritation, red, warm & photophobic
secondary infection ie conjunctivitis, stye and
chalazion.
15. STYE (EXTERNAL HORDEOLUM)
Acute Bacterial infection at the eyelash follicle.
Sometimes it involves the Moll and Zeiss gland.
Causes; hygiene and chronic blepharitis.
T(x): Hot compress, a/biotik topikal/sistemik,
excision
17. INTERNAL HORDEOLUM
Acute staphyloccal infection at the meibomian
gland.
Advancement from meibomianitis & chronic
blepharitis
Redness, swollen at the tarsal plate.
T(x): same as stye
18. CHALAZION
Chronic inflammation
of the meibomian
gland causes slogged
ductus
Initiate pressure to
the cornea and causes
irregular astigmatism.
T(x): Incision, steroid
injections
21. ALLERGIC CONJUNCTIVITIS
Epiphora, itchiness, redness, photophobic, chemosis.
Allergy to pollen, animals and food.
Children with hay fever, eczema or asthmatic
T(x) topical antihistamine & allergen disinfectant
22. INFECTIOUS CONJUNCTIVITIS
< 28 days from birth– Ophthalmia neonatarum
Caused by gonorrhoea, staphylococcus,
streptococcus, haemophilus, pneumococcus,
chlamydia, herpes simplex
Can penetrate the cornea and cause blindness
23. CONGENITAL CATARAT
Matured catarct > 3mm at central, need to be
reffered
If bilateral, surgery need to be done within 2 weeks
of birth
Small opacity– monitor
Traumatic cataract ( 8 – 10 yrs) need urgent surgery
26. CONGENITAL GLAUCOMA
Present at birth
Manifest differently compared to adults
Children’s eye more elastic, so it will
stretch with pressure.
Signs-Buphthalmos,corneal edema,
lacrimation, photophobia, diameter cornea
12- 13mm, endothelial breaks, usually
unilateral, elevated IOP, cupping
28. CONGENITAL GLAUCOMA
M(x) surgeri; goniotomy or trabeculotomy,
medical T(x), lens extraction
VA less then 6/15 due to damage optic nerve
and corneal opacification.
Secondary Glaucoma– hyphema(trauma),
Retinopathy of prematurity, retinoblastoma,
post cataract surgery, rubella syndrome
29. RETINOBLASTOMA
Retinal cancer – detected at early birth,
heriditary (need to do the Genetic Test)
Need early diagnosis, can be fatal.
Nystagmus dan leucocoria (white pupil)
T(x) – enucleation, chemotheraphy (93% success)
30. RETINOPATHY OF PREMATURITY
(ROP)
Depends on the immaturity level or birth
weight
If >2000g ROP infrequent
<1500g ROP
<1250g @ <28 wks – vulnerable
Ophthalmology assessment for <1500g
Severe ROP – complications; changes at
peripheral and posterior retina, Stretching of
the vitroretinal causing detachment and,
retinal folds