kpa t pfizer education grant
TRANSCRIPT
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KPA – PFIZER EDUCATION GRANT
What every Paediatrician needs to know in
Paediatric Ophthalmology
Dr. Njambi Ombaba
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Paediatricians knowledge in ophthalmology
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OUTLINE
Visual development in a child
Amblyopia
Pointers to poor vision
Childhood eye conditions
Vision screening
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NORMAL VISUAL DEVELOPMENT
Pupillary reflex 30 weeks gestation
Blink reflex Birth
Fixation 2 months
Pursuit movements 2 -3 months
Accommodation 4 months
Stereopsis ( depth perception) 3-7 months
Fovea maturation 4 months
Contrast sensitivity / color vision 4 months
Central visual system maturation 7-8 years
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AMBLYOPIA – LAZY EYE
Physiological central visual loss due to stimulus suppression
During riti al period of visual development
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AMBLYOPIA TREATMENT
Must e done within riti al period
Treat the amblyogenic factor
Penalize the better eye
Patch
Atropine
Fogging
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POINTERS TO POOR VISION IN A CHILD
Squinting
Holding objects close to face
Moving close to screens/ TV
Blurry vision, tired eyes, headache
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SUBTLE SIGNS OF POOR VISION
Poor attention span
Avoiding near tasks
Losing track while reading
Turning face sideways
Closing one eye to read
Sensitivity to light, tearing
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REFRACTIVE ERRORS
Commonest cause of visual impairment
May cause amblyopia
Corrected with spectacles and contact lenses
Myopia
Hyperopia
Astigmatism
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ALLERGIC CONJUNCTIVITIS
Types Treatment Complications
Acute
Seasonal Perennial
Atopic
Vernal
Artificial tears
Antihistamines
Mast cell stabilizers
Steroids
Refractive errors
Corneal ulcers
Scarring
Viral keratitis
Keratoconus
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STRABISMUS- CROSSED EYES
Normal ocular alignment Esotropia –
convergent squint
Exotropia- divergent
squint Hypertropia
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STRABISMUS
Causes Congenital – motor, sensory
imbalance
Sensory deprivation e.g cataracts
Refractive errors
Traumatic
Nerve palsies III, IV, VI
Neuromuscular diseases
Retinoblastoma
Consequences Amblyopia
Loss of depth perception/
Stereopsis
Refractive errors
Cosmetic and psychological effects
Treatment Treat cause
Amblyopia therapy
Spectacle correction
Surgery
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LEUKOCORIA (WHITE REFLEX) CATARACTS
Causes Treatment
Cataracts -Congenital Developmental
-Hereditary
-Infections (TORCHES)
-Metabolic disorders
-Trauma
Prompt surgery to
prevent amblyopia
Spectacle correction
Amblyopia therapy
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LEUKOCORIA- Retinoblastoma Treatment
Childhood eye cancer
Usually < 5yrs
RB- 1 gene mutation
Somatic or germline
+/_Family history
Prompt referral to safe life
Risk of second cancers
-Enucleation
-Chemotherapy
Radiotherapy
-Focal laser / cryotherapy
-Regular EUAs
-Genetic counseling
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LEUKOCORIA ROP
Abnormal retinal Vascularization in
premature babies
Risk factors
Birth weight < 1500g
GA < 32 weeks
Supplemental oxygen
Neonatal complications
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LEUKOCORIA - ROP
Prevention/ Treatment
Eye screening starting 3-4 weeks after birth
Early stages
Laser / cryotherapy/ Anti VEGF
Late stage
Retinal detachment
Variable outcome
Ocular complications in preterms
Strabismus
Refractive errors
Glaucoma
Cataract
Nystagmus
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GLAUCOMA IN CHILDREN High pressure in the eye
causing optic nerve damage
and irreversible blindness
Urgent surgery to lower
pressure and prevent visual
loss
Presentation : At birth or later
Triad: Photophobia
Tearing
Blepharospasms
Others: Bull s eye Big orneas/ eye
Cornea haziness/ scarring
Myopia
Lens dislocation
Ddx: Nasolacrimal duct obstruction
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XEROPHTHALMIA- VIT A DEFICIENCY Causes / Risk factors Treatment / Prevention
Xerophthalmia – dryness
of conjunctiva and
cornea
Early: Night blindness
Late: corneal ulcer,
melting and later scarring
Vitamin A deficiency
Risk factors
Measles
Malnutrition
Mal absorption
Vitamin A supplements
Food rich in vitamin A
Immunization
Reversible in early stages
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OPHTHALMIA NEONATORUM
Causes Treatment
Conjunctivitis of the
newborn occurring
within 30 days of life
Eye discharge +/-
swollen eyelids
-Neisseria gonorrhea
-Chlamydia
-Viruses
-Traditional eye
medicine
Frequent eye irrigation
Antibiotic eye drops
Systemic antibiotics
Risk factors
-Untreated STDs in
pregnancy
-Premature /
prolonged labour
-Contamination at
delivery
Prevention
ANC screening
Tetracycline eye
ointment
Good labour
management
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CEREBRAL VISUAL IMPAIRMENT- CVI Visual loss resulting from organic
brain damage
Other ocular complications
Strabismus
Refractive errors
Nystagmus
Causes Hypoxia- birth asphyxia
Infections- meningitis,
encephalitis, neonatal sepsis/
jaundice
Neurological disorders
Hydrocephalus
Trauma
Metabolic disorders
Treatment
Underlying cause
Visual stimulation
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Visual screening
Neonates
Infant (6-12 months)
Preschoolers( 3 years)
School going (annually)
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THANK YOU