why worry about strabismus?
DESCRIPTION
Why worry about strabismus?. [1,8]. Initial Presentation. Most (75%) PARENTS detect abnormality. http://shainazhope.com/. Retinoblastoma. Autosomal dominant (RB1) with incomplete penetrance Increased risk other cancers Only 5-10% of cases have family history. Retinoblastoma. Age - PowerPoint PPT PresentationTRANSCRIPT
Why worry about strabismus?
[1,8]
Vitreous Hemorrhage (dark reflex)Hypopyon (layering of WBCs in anterior chamber)
Initial Presentation
• Most (75%) PARENTS detect abnormality
http://shainazhope.com/
Retinoblastoma
• Autosomal dominant (RB1) with incomplete penetrance• Increased risk other cancers
– Only 5-10% of cases have family history
Retinoblastoma
• Age– 90% younger than 5 years at diagnosis– Average of 18 months– Rare cases in adults [1]
Morbidity/ Mortality
• 5 year survival 93%• If untreated: Metastatic spread within 6
months– 50% 1yr survival
• With early detection, among most curable childhood cancer
• Leukocoria is actually a late finding– Ocular survival 9% at 5 years
Red Reflex
http://www.daisyseyecancerfund.org
[9]
Red Reflex
• Screens all aspects of optical pathway– Tear film, cornea, aqueous and vitreous humor,
iris, lens, retina.– Over 30 Diseases:
• Cataracts, glaucoma, retinoblastoma, systemic disease [3].
White Reflex “White Pupil”
tapetum lucidum"bright tapestry"
White Reflex
• PCP first noted presenting signs in only 5%• Delayed PCP referral 21% (3.75 months)
– PCP reassured parents of normalcy or made wrong diagnosis– False reassurance with normal red reflex
[11]
AAP Policy (Dec 2008)
• Document Red Reflex:– In newborn nursery– ALL routine health supervision visits
• Previous Recs: within 2months; 6 months; 1,3,5,10yrs
• Refer to ophtho:– All high risk patients
• Fam Hx: RB, infantile cataracts, retinal dysplasia, glaucoma– Based on parental observation alone– Abnormal red reflex (urgent)– Contact ophthalmologist directly– Document confirmation of proper followup [3]
What’s your Dx
Retinoblastoma
Pseudostrabismus
Strabismus
www.kidsretina.blogspot.comPediatric retina blog
Persistent Fetal Vasculature
Congenital Cataracts
Congenital Glaucoma
Normal Retina
Take Home Points
• Screen in the nursery and at every checkup!• Take parental concerns seriously and refer!• Do not trust a normal red reflex if concerns
are present.• Call ophthalmologist directly, especially if
abnormal exam.• Close followup of high risk patients.