Eye disorders in Children - Paediatric Neurology

Eye disorders in Children

·        Routine eye checks for infants:

o   Fixing and following: ophthalmology referral if not doing this by 4 months

o   Pupillary red reflexes: view from about 50 cm. Leukocornea (white pupil) Þ ?retinoblastoma. Other irregularities Þ ?congenital cataract

o   Ocular alignment: symmetrical corneal light reflex (don‟t have to be exactly central).  Strabismus

o   (misalignment of visual axis) ® amblyopia. May be intermittent. Test with cover test. Accommodative Esotropia = convergent strabismus related to accommodation

o   Eye movements: if not following then test vestibulo-ocular reflexes using dolls eye

o   Adnexa Oculi: Eyelids. Check for Congenital Naso-Lacrimal Duct Obstruction (tears, puss or mucus discharged by pushing on lacrimal duct) due to incomplete canalisation. Most resolve by age 1 (Þ usually managed conservatively by twice daily lacrimal sac massage)

o   Globes and cornea: of equal size

·        Serious disorders in the neonate (® urgent referral):

o   Congenital Glaucoma: photophobia, corneal haze/opacity, corneal enlargement or asymmetry 

o   Ophthalmia Neonatorum: conjunctivitis with infection and inflammation of the conjunctiva in first month of life. Urgent microbiology and iv antibiotics for chlamydia and/or N Gonorrhoeae

·        Red Eye in Children

o   Conjunctivitis:

§  Common in newborns – may be serious

§  Bacterial: rapid onset, usually spills from one eye to the other.  Puss. 

·        Neonatal often Neisseria gonorrhoea (prevented with silver nitrate drops in new born if high risk). Can lead to perforation of orbit. If systemic spread then septic arthritis. Treatment: B Penicillin 25 mg/kg/12hr iv + 3 hourly 0.5% chloramphenicol drops for 7 days 

·    3 – 5 days post delivery: Chlamydia.  Can progress to rhinitis and pneumonitis.  Diagnosis 

§  requires special chlamydia swab. Treatment: Erythromycin 10mg/kg/6hr po for 21 days to eliminate lung organisms + 1% tetracycline drops 

·   Acute causes often Staph aureus, S pneumoniae, H influenzae or S pyogenes. Treatment: drops up to hourly (eg chloramphenicol)

·        Chronic: usually toxins or immune (eg Kawasaki, Erythema Multiforme, Reiter‟s  Syndrome) 

§  Viral: acute onset, often bilateral, minimal pain, thin watery discharge, photophobia. Adenovirus, Herpes Simplex, measles, etc. Generally clears spontaneously. If Herpes suspected (eg eyelid vesicles), start 4 hourly acyclovir and immediate referral 

§  Allergic: history of atopy and itchy eyes. If mild then use astringent, topical anti-histamine or cromoglycate

o   Subconjunctival haemorrhage: common after blunt trauma (eg birth), coughing (eg whooping cough) and vomiting.

o   Corneal abrasions: trauma or infection (esp HSV) 

o   Iritis/Uveitis: uncommon in children. May have no pain but strabismus or visual loss. Cornea red near iris (unlike conjunctivitis). Look for white cells in anterior chamber.