Topic

#Pediatric Ophthalmology

19 articles
  1. Articles 28 Sep 2021 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
  3. Students Gallery 2 Apr 2021 13 min read

    How to examine a case of strabismus ?

    There is no substitute to good history obtained at the start of the examination As history gives us a direction to look for, and find pertinent signs aiding in diagnosis and management. The various presenting complaints could range from abnormal head posture, deviation noticed by parents or friends, intermittent eye closure, double vision and so on. Some important points to be noted in patients with squint include, Family history of squint and wear of glasses (amongst parents, siblings and distant relatives) Personal history starting from birth history- Factors such as prematurity and birth weight, nature of delivery (normal/forceps/cesarean) Deviation – the age at which it was noticed, the direction of deviation (inward/ outward/ other) the eye deviated, constant or intermittent nature of deviation. Further, if deviation becomes more obvious when the child is inattentive, tired or ill. The diurnal or cyclic pattern if any also has to be noted. Any history of convulsion, illness or tra

    Dr. Sowmya R, MS,FMRF, FAICO · Dr. Prerana Tripathi, DO, DNB, FICO
  4. Articles 2 Apr 2021 9 min read

    Persistent Fetal Vasculature Syndrome

    It is a congenital ocular disorder where fetal vasculature persists. It can be either subtle (no disturbance in vision) or severe (profound visual loss) Anatomy The fetal vasculature is composed of two parts: Tunica vasculosa lentis: It is situated anteriorly encircling the lens. It has anterior and posterior divisions. Anteri­or division has additional attachments to the pupillary frill of the iris. Posterior division has additional attachments to the cil­iary process and continues with the hyaloid artery posteriorly. Hyaloid artery: It is situated porteriorly behind the lens. It is also called primary vitreous. The hyaloid vessel extends from posterior surface of lens to the disc. The vasculature fills the vitreous cavity & has many attachments to the retinal surface Normal regression of embryonic vascular system1 During development blood flow to the eye is through hyaloid artery. At the 240-mm stage (seventh month), blood flow in the hyaloid artery ceases. Hyaloid vascular regressio

    Parag K. Shah, DNB
  5. Articles 2 Apr 2021 11 min read

    Retinopathy of Prematurity

    Introduction Retinopathy of Prematurity (ROP) is a fibrovascular proliferative disorder, which affects the developing peripheral retinal vasculature of premature infants. It is an avoidable cause of blindness in children. The initial signs of ROP are detectable by a few weeks after birth, and the condition progresses rapidly thereafter. This means that screening has to be timely, and there is only a very narrow window of opportunity for treating. If not treated, the condition progresses rapidly to Stage 4 or 5 in approximately 50% of babies. The visual prognosis for babies with Stage 5 disease (total retinal detachment) is very poor, even after complex vitreoretinal surgery. The primary goal of screening is to detect all babies with treatable disease in time for treatment to be effective. Pathogenesis In the normal foetus, vascular development of the retina occurs in two phases. Phase 1 (True vasculogenesis): It occurs from 8-21 weeks of foetal development. Spindle cells (mesenchymal p

    Parag K. Shah, DNB · Dr. V. Narendran, DNB · +1 other
  6. Interesting Reads 2 Apr 2021 4 min read

    Ten Tips and Tricks to Examine a child in Your Practice

    1. Choosing the best time: Train your clinic receptionist to ask the parents when the child is likely to be cooperative and/or awake. It is not uncommon for infants to sleep a lot during the day. It is also not uncommon for children on anti-seizure medication to be sleepy, thereby making examination difficult. 2. Child-friendly atmosphere: Train your staff to speak to the child and address the child by name and smile and make the family feel welcome. The décor in the waiting area and in the examination room should be colorful with pictures and cut outs appropriate for a child. Furniture chosen should be non-impact and the flooring safe for children, if they fall. It should also be easy to maintain by wiping down frequently to prevent spread of infection. Using many colorful toys during examination takes away the fear of the experience to some extent for the child. 3.White coats: A child often associates white coats with doctors and hospitals. Hence it is best to avoid wearing one. If c

    Dr. Meenakshi Swaminathan
  7. Articles 2 Apr 2021 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
  8. Articles 1 Apr 2021 42 min read

    Retinopathy of Prematurity

    Introduction First described in 1942, retinopathy of prematurity (ROP) is a vasoproliferative retinopathy affecting premature infants of low birth weight. As per the original description by Terry et al, this disease was labelled as retrolental fibroplasia (RLF) based on the hypothesis that it involved the proliferation of the embryonic hyaloid system[1] But Owens and Owens later described that in these infants, the hyaloid system was normal at birth and the RLF developed postnatally.[2] The term “retinopathy of prematurity” was coined later as the disease pathogenesis and clinical presentation got better understood. [3]In the 1950s, the association between supplemental oxygen and ROP pathogenesis was first established by controlled studies done in the neonatal intensive care units. {4,5] The spectrum of ROP ranges from mild cases that may resolve spontaneously with no visual impairment to advanced cases with bilateral irreversible blindness within the first few months of life. Epidemio

    Dr. Parveen Sen · Dr. Aditya Maitray
  9. Students Gallery 1 Apr 2021 7 min read

    Ten Pearls in the Management of Paralytic Strabismus

    Paralytic strabismus is an incomitant strabismus resulting from complete (paralysis) or partial (paresis) motor deficiency of one or a group of extraocular muscles, which are supplied by the third, fourth or sixth cranial nerve. 1 History and basic examination Paralytic strabismus may be congenital or acquired. Careful history-taking will rule out an antecedent fever, trauma, neurological symptoms, or systemic illness in acquired cases. Patients complain of ocular deviation, limitation of ocular movements or abnormal head posture. Diplopia is usually a feature of recent-onset strabismus but congenital cases with spontaneous decompensation may also present with diplopia. Facial asymmetry can be noted in some congenital superior oblique palsy(SOP) with a head tilt. Visual acuity is usually preserved in isolated acquired paralytic strabismus. Amblyopia develops only in patients in whom paralysis occurs early and when the patient is unable to maintain binocular single vision in any gaze. F

    Dr. Karthika Bhaskaran · Dr. Pradeep Sharma
  10. Articles 1 Apr 2021 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, DO, DNB, FICO · Dr. Sowmya R, MS,FMRF, FAICO

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