Part 29. Disorders of The Eye
Chapter 573. Abnormalities Of Pupuil And Iris
Leukocoria
; cat¡¯s eye reflex
; ¡Ø½½ primary diagnostic consideration
- cataract
- persistent hyperplastic primary vitreous
- cictricial retinopathy of prematurity
- retinal detachment & retinoschisis
- larval granulomatosis
- retinoblastoma
- others
/ endophthalmitis, organized vitreous hemorrhage, leukemic ophthalmopathy, exudative retinopathy
- a few rare condition
/ medulloepithelioma, massive retinal gliosis, retinal pseudotumor of Norrie disease, pseudoglioma of the Bloch-Sulzberger syndrome, retinal dysplasia, retinal lesions of the phakomatoses
- also maybe
/ fundus coloboma, large atrophic chorioretinal scrs, ectopic medullation of retinal nerve fibers
Chapter 574. Disorders Of Eye Movement And Alignment
Strabismus
Diagnosis
# corneal light reflex test
# cover test
; cover-uncover test & alternate cover test
¡Ø97 MöBius
Syndrome
;
*congenital facial paresis,
abduction weakness
- facial palsy
/
*bilateral
/ often asymmetric, incomplete
/ spare the lower face and platysma
- abduction defect
/ unilateral or bilateral
/
*esotropia
;
¡ÚAssociated Developmental Defect
- ptosis, palatal and lingual palsy, hearing loss, pectorial and ligual muscle defects, micrognathia, syndactyly, supernumery diagnosis, abscence of hands, feet, fingers, or toes
nystagmus
Spasmus Nutans
; special type of acquired nystagmus
;
¡ÚTriad
-
*pendular nystagmus, head nodding,
torticollis
; unknown causes
; asso. disease
-
*underlying brain tumor
/
esp. *hypothalamus, chiasmal optic
glioma
Chapter 576. Disorders Of The Lacrimal System
Dacryostenosis And Dacryocystitis
Treatment
; ¡Únasolacrimal
massage
-
primary treatments
-
two to three times a day
; cleaning of the lids with
warm water
; topical AB
; probing
-
¡Úafter 1yr
-
mostly repeat procedures
; dacryocystorhinostomy
Chapter 577. Disorders Of The Conjunctiva
Conjunctivitis
Ophthalmia Neonatorum
Epidermiology
Clinical Manifestation
; *timing
& character of signs
-
*somewhat typical for each cause
--> but not rely solely on clinical findings
# inflammation by silver nitrate
; occurs within 6-12hr
--> clearing by 24-48hr
# gonococcal conjunctivitis
; incubation periods
-
¡Ú2-5days
; serosanguineous discharge
--> thick & purulent within 24hr discharge
; spread to deeper layer of conjunctivae, cornea
; Complication
- corneal ulcertion & perforation, iridocyclitis, ant. synechiae, panophthalmitis
# inclusion blennorrhea
; incubation periods
-
¡Ú5-14days
; copious purulent discharge
; involved mainly tarsal conjunctivae
¡ÚTreatment
# gonococcal conjunctivitis
;
*ceftriaxone 25-50mg/kg/day for
7days
; saline irrigation every 10-30min, gradually increasing to 2hr interval
; single dose of kanamycin 75-150mg im with GM eye ointment for 3days
# inclusion blennorrhea
;
*oral EM for 2wks
Acute Purulent Conjunctivitis
Viral Conjunctivitis
Epidemic Keratoconjunctivitis
Chapter 578. Abnormalities Of The Cornea
Dendritic Keratitis
; infection of herpes simplex
Treatment
; ¡Ú5-iodo-2¡¯-deoxyuridine(IDU)
Chapter 579. Abnormalities Of The Lens
Cataracts
¡ÚÁ¾·ù Differential Diagnosis
Developmental Variants
Prematurity
Mendelian Inheritance
Congenital Infection Syndrome
Metablolic Disorders
; galactosemia
; juvenile-onset DM
; hypoglycemia in neonates
; hypocalcemia
; wilson¡¯s diseases
; sphingolipidoses, mucopolysaccharoidoses, mucolipidoses
- esp. Niemann-Pick disease, mucosulfatidosis, Fabry disease, spartyl-glycosaminuria
Miscellaneous Disorders
Chromosomal Defects
; 13-, 18-, 21trisomy
; turner syndrome
; deletion syndrome - 11p13, 18p, 18q
; duplication syndrome - 3q, 20q, 10q
Drugs, Toxic Agents And Trauma
; corticosteroids
; child abuse
Chapter 581. Disorders Of The Retinal And Vitreous
Retinopathy Of Prematurity
Pathogenesis
# Injury to process(retinal angiogenesis from optic disk to periphery)
# 1st observation in acute phase
;
*cessation of
vasculogenesis(abrupt termination of the vessels)
--> grow into ridge composed of mesenchymal & endothelial cells
--> vascularization of retina
-->
*abnormal proliferation of vessels
out of plaine of retina
--> cicatrization & traction on retina
--> detachment
# *Major
factors
;
*prematurity & retinal
immaturity at birth
; hyperoxia
# other problems
; respiratory distress, apnea, brdycardia, heart disese, infection, hypoxia, hypercarbia, cidosis, nemia, need for transfusion
Classification
# Zone I ; twice disk-macular distance
# Zone II ; ora serrata nasally, anatomic equtor temporally
# Zone III
; residual crescent
; vasculized last
;
*¡ãfrequently involved with ROP
# Staging
I ; demarcation line
II ; ridge
- grown demarcation line with height, width, volume
III ; development of extraretinal fibrovascular tissue
IV(1) ; subtotal retinal detachment not involving macula
IV(2) ; subtotal retinal detachment involving macula
V ; total retinal detachment
Clinical Course And Prognosis
; 90% - spontaneous arrest & regression
; left with demarcation line, undervascularization, abnormal branching, tortuosity or strightening of retinal vessels
; *Dragged
Disk
- arrest or regressed ROP
- retinal pigmentry changes, dragging of retina
Diagnosis
# ¡Ø82 Indication
; weighing less than 2000gm at birth(esp. less than 1500gm) : ÇÑ±ÛÆÇÀº 1800gm
; before 33wk gestational age
; supplemental oxygen more than 6hr
--> *4-7wks¿¡
°Ë»ç
# *ROPÁø´ÜÀº postconception 32-40wks¿¡ °¡Àå
ÈçÇÏ°Ô µÈ´Ù
Treatment
Prevention
Retinoblastoma
; *¡ãcommon primary malignant intraorbicular tumor
; hereditroy or nonhereditroy pattern
; bilateral case - 25-35%
; average age at diagnosis
- 12mo in bilateral
- 21mo in unilatera
Clinical Manifestation
; leukocoria
- 1st sign
; strabismus
Chapter 582. Abnormalities Of Optic Nerve
# ¡ÚDdx Of
Papilledema From Optic Neuritis
Papilledema |
Optic Neuritis |
chronic vision loss bilateral blurring of optic disc elevation of optic nerve head engorgement of optic nerve veins nerve fiber layer hemorrhage |
acute or chronic vision loss maybe unilateral normal optic disc normal appearing nerve head pain on movement of globe |
Chapter 584. Orbital Abnnormalities
Orbital Cellulitis
Etiology
; PNS infection
;
¢¾H. influenzae, S. aureus, Group A ¥â-hemolytic streptococci, S. pneumoniae