Pediatric Ophthalmology

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All Cornea 36 Cataract 17 Glaucoma 14 Retina & Vitreous 72 Neurophthalmology 8 Oculoplasty 15 Uvea & Inflammatory Diseases 24 Miscellaneous 20 Oncology 9 Pediatric Ophthalmology 16

8 min read

Ten Caveats in Primary Posterior Capsulorhexis and Anterior Vitrectomy in Pediatric Cataracts

Unlike in adults , the risk of risk of developing visual axis opacification (VAO) after cataract surgery in children is nearly 100%.[1,2] Hence the need for primary posterior capsulotomy (PPC) and anterior vitrectomy (automated/manual) in pediatric cataract surgeries.Let us answer the few salient features of PPC and AV in following ten questions , 1. Why PPC is needed? The anterior hyaloid face in infants and young children is highly reactive and closely linked to the posterior capsule. It serves as a scaffold for the accumulation of lens epithelial cells and other inflammatory cells, resulting in VAO in almost all cases.[3,4] The VAO will continue to have the amblyogenic effect nullifying the purpose of cataract surgery in the child. Further the amblyogenic effect of VAO increases as the age of the child decreases. Therefore, PPC with/without anterior vitrectomy is necessary to determine the ultimate visual outcome of cataract surgery in young children. Further In addition, PPC may al

Dr. Disha Agarwal · Dr. Sowmya R
4 min read

Cyclic Esotropia

Cyclic esotropia is a rare form of non-accommodative convergent strabismus which present as 24-hour period of straight eye position followed by 24 hours of large-angle esotropia1. Burian in 1958 described Cyclic esotropia for the first time in English literature2. Duke-Elder3 described the “Cyclic Squint” as a “rare and curious condition which invariably takes the form of a temporary esotropia.” Etiopathogenesis/Theories The etiology of this rare form of convergent strabismus is unknown. Possible theories behind the evolution of such a strabismus include progressive loss of compensation of a latent strabismus, change of a central clock mechanism, and incomplete cerebral dominance, with interhemispheric conflict1 spontaneously or may be precipitated by a trigger. The trigger can be traumatic brain injury, strabismus surgery, extracapsular cataract surgery, retinal detachment with scleral buckling, orbital surgery and ocular trauma 4 . However, many cases have been associated with other

Dr. Sunanda Nandi · Dr. Manju Bhate
5 min read

Hess Chart: Postgraduate Students' Perspective

In Hess charting, one eye will see the red object on the screen and the other eye has to superimpose the green target ( maybe green torch) on the red target. This is called Haploscopic Principle. The dissociation of two eyes is achieved by the means of colors. In diplopia charting there is one object, the patient sees two images. We dissociate the eyes by means of complementary colors. Diplopia chart red glass always in front of the right eye. In the Hess chart, red if Infront of the right eye means, we are checking the position left eye ( behind the green glass ). If red is in Infront of the left eye means, the right eye position is checked (behind the green.) Always remember the eye behind the green glass is checked, about its positions, when the eye behind the red glass is fixing the red light of the screen The degree between two lines in the Hess chart is five ( 5 degrees ). Every 15 degrees, red lights are present: The inner nine lights represent the inner squares. Outer lights re

Dr. (Capt) V.R Vijayaraghavan
5 min read

Diplopia Charting: A Ready Reckoner for the Postgraduates

Diplopia charts are kept in postgraduate examinations during viva sessions. Even in theory examinations also, these topics may be asked. It is not difficult to interpret the charts and all PGs should practice recording the results of these charts. Principle: Dissociation of eyes by means of complementary colors. We use red and green goggles (Armstrong google). In diplopia charting, Red is always in the Right eye and patients perceive one object as two fused images. Let us see the method of interpretations of these charts See the chart Remember red and green goggles are used. Red in front of the right eye and Green in front of the left eye. To your right side (The right side of the picture). Version positions. Dextrum version. Elevation and Depressions are there. The left side of you is the left side positions like levoversion, elevation and levodepression are there Primary position elevation and depressions are noted. Totally we have nine quadrants Never forget to write the name of the

Dr. (Capt) V.R Vijayaraghavan
4 min read

Top-Ten-Must-Not-Forget-In-Strabismus-Evaluation

1. External face features affecting the eye position Facial asymmetry and palpebral fissure shape changes alter the ocular position, possibly due to extra-ocular muscle heterotopy The common extra-ocular features affecting ocular position are craniosynostosis, hydrocephalus, facial fracture, mongoloid and anti-mongoloid slant, telecanthus, congenital superior oblique palsy (face fuller on the affected side), facial nerve palsy. 2. Head posture Head does what eye cannot do Look for abnormal head posture when a patient is reading best-corrected visual acuity with proper refractive correction. The target should preferably be at the eye level of the patient in order to avoid a false chin-up position Head tilt, turn, chin-up/down Head turn is the opposite side of the ear seen Measure with a goniometer Look for incomitant strabismus and nystagmus Keep patient’s head straight throughout the examination – eg. In patients with Duane syndrome, small change in head posture can cause large ocular

Dr. Goura Chattannavar · Dr. Virangi Doshi · +1 other
10 min read

Diplopia and Hess Charting

Diplopia Charting Diplopia chart is the record of separation of the diplopic or double images in the nine positions of gaze. It can be plotted charted in patients who cooperate and can appreciate the double vision and with incomitant or comitant deviation. The method The patient should be comfortable with his head erect and should preferably be still throughout the examination. The test is preferably carried out in a dark room. Red glass is put in front of one of the eyes (red in front of right, R for R, is a convention). It is desirable to use Armstrong goggles since these are shaped to fit the orbital margin and therefore patient would be looking only through the colored medium. The examiner holds the torch (vertical source of light) at around ½ m or 1 m (It is important to mention the distance on the chart). This source of light could be horizontal if the complaint is of vertical separation of images The light is held directly in front of the patient at first. If the patient sees a

Dr. Jitendra Jethani · FNB
10 min read

Fun with Prisms in Ophthalmology

What are prisms? Prisms are nothing but a portion of a refracting medium bordered by two plane surfaces that are inclined at a finite angle. Prisms have a thicker portion called the base of the prism and a tapering portion called the apex of the prism. Prisms are oriented with their apex towards the direction of deviation. What happens to light when it enters a prism? Light has particle and wave characteristics. When it travels through the thicker base of the prism, the particle form of light has to travel a longer distance than at the apex of the prism, this difference causes light to bend towards the base of the prism. The power of a prism to bend light is measured in prism diopters (PD). One prism diopter will shift light by 1 cm at 1m distance. Calibration of Prism Prisms made of glass are calibrated in Prentice position. They should be held with the back surface perpendicular to the line of sight. Plastic prisms and prism bars are calibrated by the angle of minimum deviation. They

Dr. Manjula Jayakumar
12 min read

Duanes Retraction Syndrome Made Ridiculously Simple

Synonyms: Stilling–Turk–Duane syndrome. Duane Retraction Syndrome is a type of congenital cranial dysinnervation which occurs in 1-4% of strabismus cases. It has varied presentation mostly involving variable horizontal duction deficits, with narrowing of the palpebral fissure and globe retraction on attempted adduction, occasionally accompanied by upshoot or down shoots Etiopathogenesis Various theories have been proposed earlier for the cause of DRS but currently, the most accepted theory is that of innervational anomalies which leads to all the features of DRS. It is considered to be a part of congenital cranial dysinnervation syndrome as it’s a developmental anomaly of the 6th cranial nerve or its nucleus leading to innervational deficiency of lateral rectus muscle which might be associated with secondary innervational abnormality with Medial rectus. The lack of normal innervations of lateral rectus was proved by electromyographic studies. It is also associated with paradoxical inne

Dr. Prerana Tripathi · Dr. Sowmya R
9 min read

Esotropia Made Simple for the Postgraduates

As like other strabismus, esodeviation can be, True esodeviation Pseudo esodeviation A prominent epicanthic folds 1, 2 Negative angle kappa in high myopes. True esodeviation can be either comitant or incomitant 1,2 A. Comitant I. Accommodative esotropia. Refractive accommodative esotropia (normal AC/A ratio) Non Refractive accommodative esotropia (high AC/A ratio) Hypo accommodative esotropia (reduced NPA) Partially accommodative esotropia II. Non-accommodative esotropia Essential infantile esotropia Non-accommodative convergence excess Acquired esotropia Acute Onset esotropia Divergence insufficiency or paralysis Cyclic esotropia Recurrent esotropia III. Microtropia IV. Nystagmus blockade syndrome. B. Incomitant Paralytic - Neurogenic (VI nerve palsy) Nonparalytic- Myogenic (ocular myasthenia) A & V pattern syndromes Duane’s retraction syndrome Mechanical – restrictive esodeviation Congenital fibrosis syndrome Acquired Dysthyroid eye disease Trauma to the orbital wall Myositis (IOID)

Dr. Sowmya R
18 min read

Learn from the Masters Tips & Tricks in the Management of Pediatric Cataract 2

Read Learn from the Masters Tips & Tricks in the Management of Pediatric Cataract 1 After the discussion on the etiology of pediatric cataracts, and about when and how to operate we go further to know about choosing the IOL formulae, IOL material and power of IOL to be implanted in children. Also, an insight into the post-operative rehabilitation with follow up eOphtha: Considering the varied opinions in choosing the IOL formulae for pediatric cataracts , what’s the formulae used in your practice ? Do you use different formulae in microphthalmic eyes? Dr. Bharti Gangwani : I use Holladay 1 for young children and small eyes with AL < 22 mm and SRK/T for older children with AL > 22 mm. No I do not use different formula in microphthalmic eyes though many of these eyes are left aphakic if the eye is really small. Dr Kalpana Narendran : SRK - T formula is used. If Axial length 22 – SRK T. Dr. Sudarshan Khokhar: We use modified SRK 2 or SRK/T formula for IOL power correction for all eyes. We

Dr. Sowmya R