E2: peds - ophtho & dental disorders

what age do you start testing for visual acuity?

age 3 → younger than 3, test for visual behavior

what is the visual fixation test?

a colorful object/sticker on the end of a tongue depressor is moved side to side

what is the Sheridan Gardiner test?

aka visual acuity test

- letters of ↓ size are shown to child and they match the letter to one on a card

- good for children who haven't mastered reading the alphabet yet

light is focused in front of the retina

myopia

light is focused behind the retina

hyperopia

light in different meridians is brought to focus either in front or behind the retina

astigmatism

light is focused on the retina

emmetropic (aka normal)

inward convergence to the eye for a prolonged period seen in < 6 months of age

infantile esotropia

treatment for infantile esotropia?

surgery → weaken the medial rectus muscle

botox can also be used

what condition has features:

- acquired strabismus at age 2-5

- hyperopia

- eyes straight with glasses on and esotropic with glasses off

- MCC of esotropia in children

Accommodative esotropia

what condition has feature:

- esodeviation that is present with & w/o glasses

nonaccommodative esotropia

what conditions have features:

- white of the scleral is between the cornea and inner canthus is obscured (gives appearance of esotropia)

- worsens with gaze to the right or left

- prominent epicanthal folds

- closely spaced eyes

- flat nasal bridge

- asymmetry of lids or nasal bridge

pseudostrabismus

how is pseduostrabismus differentiated from true strabismus?

pseduostrabismus has symmetrical corneal light reflex & cover/uncover test is normal

what condition has features:

- form of pseduostrabismus

- appearance of exotropia

- caused by cicatricial changes of retina after retinopathy of prematurity or the eyes rotating outward to focus light on the fovea (bc fovea is displaced)

positive angle kappa → no tx required

which condition has features:

- esotropia that ↑ with gaze directed toward the side of the palsy

- esodeviation

- can be caused by pathological (trauma, tumor, ↑ ICP) or post-viral illness

6th CN palsy

if 6th CN palsy is idiopathic, what should you suspect?

pontine glioma

what causes Duane syndrome?

- failure of normal development of CN VI followed by anomalous innervation of lateral rectus muscle by CN III

- malformation of CN nuclei producing co-innervation of the medial & lateral rectus muscles

what syndrome has features:

- esotropia or exotropia

- unilateral or bilateral congenital defect

- up or down shoot of the eye & narrowing of the lid tissue on attempted adduction

Duane Syndrome

what condition has features:

- caused by vision loss in one eye or CN III paralysis

- affected eye deviates laterally

- pt squints one eye in bright light or complain of discomfort at night when tired

exodeviation

what condition has features:

- MC form of exodeviation in children

- eye "floats" or drifts when child is tired or inattentive

- child blinks repeatedly to reestablish fusion and realign their eyes

intermittent exotropia

what condition has features:

- down and outward position (inability to elevate & adduct eye)

- eyelid ptosis

- pupil enlargement

- caused by congenital defects, trauma, tumor or CN III paralysis

CN III palsy

a form of strabismus that causes the eyes to deviate upward and has features:

- diploplia

- HA

- blurred vision

- eye strain/fatigue

- head tilt or head posture

hypertropia

what condition has features:

- head is tilted to the shoulder opposite the side of the affected eye

- upward deviation of the eye and difficulty depressing the eye on adduction

- diplopia in the contralateral field of gaze

- caused by congenital defect or due to trauma

CN IV palsy

overreaction of the inferior oblique muscle, whose action is elevation and adduction

inferior oblique overaction

an uncommon form of vertical strabismus that may be congenital or acquired and caused by trauma, inflammatory disorders, or congenital abnormality of the superior oblique tendon

brown syndrome → inability to elevate eye in adduction

what are some causes of vertical deviations?

myasthenia gravis

thyroid ophthalmopathy

chronic progressive external ophthalmoplegia

orbital fxs w muscle entrapment

orbital disease w intraorbital masses

what are the special tests for strabismus?

light reflex test → norm = reflex symmetrical in both eyes

cover test → norm = no mvmt of uncovered eye

cover/uncover test → norm = covered eye has no mvmt

functional reduction in VA caused by abnormal visual development in early life caused by strabismus, refractive error or deprivation

amblyopia → refer ophtho, patch unaffected eye

which type of amblyopia:

misalignment of eyes results in visual cortex suppression of the visual input of the deviating eye

strabismic

which type of amblyopia:

difference of VA between eyes leads to visual blurring of one eye and visual cortex suppression of the visual input of the blurred eye

anisometropic

which type of amblyopia:

eye misalignment and refractive error leads to visual cortex suppression of the chronically blurred image

combined strabismic and anisometropic

which type of amblyopia:

bilateral, symmetric high refractive error resulting in blurred vision in both eyes and inadequate development of the visual cortex

ametropic

which type of amblyopia:

obstruction of the visual axis results in suppression of the visual cortex

deprivation

a bluish mass below the medial canthal tendon caused by proximal obstruction of the nasolacrimal system

congenital dacryocystocele/mucocele → refer ophtho

!

swelling and inflammation of the lacrimal gland visible beneath the lateral aspect of the upper eyelid accompanied by symptoms of pain and tenderness

dacryoadenitis

neuronal dendrite seen with fluorescein staining

herpes simplex keratitis

congenital anomaly caused by genetic mutation that presents with partial or complete absence of the iris

- associated with WAGR syndrome and ↑ risk of glaucoma

aniridia

what condition has features:

- leukocoria (white reflex)

- poor vision (partial or total vision loss)

- strabismus

- photophobia

- due to congenital, disease or idiopathic causes

cataracts

what condition has features:

- iris heterchromia

- anisocoria

Horner syndrome

tooth eruption chart

changes in the bite often occur as a result of?

prolonged thumbsucking

small, white cystic lesions seen along the midpalantine raphe

gingival cyst → epstein pearls

firm, grayish-white mucous gland cysts on the buccal aspect of the alveolar ridges

gingival cysts → bohn nodules

benign tumor in newborns that arises from the mucosa of the gingiva

congenital epulis

benign, but locally aggressive, tumor of the anterior maxilla that produces elevation of the lip and displaced primary teeth

melanotic neuroectodermal tumor

chronic and recurring condition affecting the filiform papillae of the tongue. lesions are red, slightly depressed and bordered by a whitish band

benign migratory glossitis (geographic tongue)

bluish, opalescent sheen on several teeth resulting from genetically defective dentin and is associated with osteogenesis imperfecta

dentinogenesis

white spots on the tooth which represent demineralization of the enamel are precursors to this condition

dental caries (aka cavities)

ulceration on the labial mucosa surrounded by a erythematous halo

recurrent aphthous ulcers

this condition is associated with an abscessed maxillary tooth

facial cellulitis → hospitalized w IV ABX, I&D and tooth extraction

food particles and bacteria that become trapped under the residual overlying gingiva resulting in inflammation and abscess formation, most commonly affecting partially erupted third molars (wisdom teeth)

pericoronitis

localized necrosis and hemorrhage covered with pseudomembranes

acute necrotizing ulcerative gingivitis

bluish, fluctuant swelling in the floor of the mouth (retention cyst) associated with trauma to a salivary duct

ranula