Part 29. Disorders of The Eye

CHAP 574. Disorders of Eye Movement and Alignment

Chapter 573. Abnormalities Of Pupuil And Iris

Leukocoria

; cats eye reflex

; ※슬 primary diagnostic consideration

    - cataract

    - persistent hyperplastic primary vitreous

    - cictricial retinopathy of prematurity

    - retinal detachment & retinoschisis

    - larval granulomatosis

    - retinoblastoma

    - others

           / endophthalmitis, organized vitreous hemorrhage, leukemic ophthalmopathy, exudative retinopathy

    - a few rare condition

           / medulloepithelioma, massive retinal gliosis, retinal pseudotumor of Norrie disease, pseudoglioma of the Bloch-Sulzberger syndrome, retinal dysplasia, retinal lesions of the phakomatoses

    - also maybe

           / fundus coloboma, large atrophic chorioretinal scrs, ectopic medullation of retinal nerve fibers

Chapter 574. Disorders Of Eye Movement And Alignment

Strabismus

Diagnosis

# corneal light reflex test

# cover test

    ; cover-uncover test & alternate cover test

97 MöBius Syndrome

    ; *congenital facial paresis, abduction weakness

           - facial palsy

                   / *bilateral

                   / often asymmetric, incomplete

                   / spare the lower face and platysma

           - abduction defect

                   / unilateral or bilateral

                   / *esotropia

    ; Associated Developmental Defect

           - ptosis, palatal and lingual palsy, hearing loss, pectorial and ligual muscle defects, micrognathia, syndactyly, supernumery diagnosis, abscence of hands, feet, fingers, or toes

nystagmus

Spasmus Nutans

    ; special type of acquired nystagmus

    ; Triad

           - *pendular nystagmus, head nodding, torticollis

    ; unknown causes

    ; asso. disease

           - *underlying brain tumor

                   / esp. *hypothalamus, chiasmal optic glioma

Chapter 576. Disorders Of The Lacrimal System

Dacryostenosis And Dacryocystitis

Treatment

    ; nasolacrimal massage

           - primary treatments

           - two to three times a day

    ; cleaning of the lids with warm water

    ; topical AB

    ; probing

           - after 1yr

           - mostly repeat procedures

    ; dacryocystorhinostomy

Chapter 577. Disorders Of The Conjunctiva

Conjunctivitis

Ophthalmia Neonatorum

Epidermiology

Clinical Manifestation

; *timing & character of signs

    - *somewhat typical for each cause

           --> but not rely solely on clinical findings

# inflammation by silver nitrate

    ; occurs within 6-12hr

           --> clearing by 24-48hr

# gonococcal conjunctivitis

    ; incubation periods

           - 2-5days

    ; serosanguineous discharge

           --> thick & purulent within 24hr discharge

    ; spread to deeper layer of conjunctivae, cornea

    ; Complication

           - corneal ulcertion & perforation, iridocyclitis, ant. synechiae, panophthalmitis

# inclusion blennorrhea

    ; incubation periods

           - 5-14days

    ; copious purulent discharge

    ; involved mainly tarsal conjunctivae

Treatment

# gonococcal conjunctivitis

    ; *ceftriaxone 25-50mg/kg/day for 7days

    ; saline irrigation every 10-30min, gradually increasing to 2hr interval

    ; single dose of kanamycin 75-150mg im with GM eye ointment for 3days

# inclusion blennorrhea

    ; *oral EM for 2wks

Acute Purulent Conjunctivitis

Viral Conjunctivitis

Epidemic Keratoconjunctivitis

Chapter 578. Abnormalities Of The Cornea

Dendritic Keratitis

; infection of herpes simplex

Treatment

; 5-iodo-2’-deoxyuridine(IDU)

Chapter 579. Abnormalities Of The Lens

Cataracts

★종류 Differential Diagnosis

Developmental Variants

Prematurity

Mendelian Inheritance

Congenital Infection Syndrome

Metablolic Disorders

    ; galactosemia

    ; juvenile-onset DM

    ; hypoglycemia in neonates

    ; hypocalcemia

    ; wilsons diseases

    ; sphingolipidoses, mucopolysaccharoidoses, mucolipidoses

           - esp. Niemann-Pick disease, mucosulfatidosis, Fabry disease, spartyl-glycosaminuria

Miscellaneous Disorders

Chromosomal Defects

    ; 13-, 18-, 21trisomy

    ; turner syndrome

    ; deletion syndrome - 11p13, 18p, 18q

    ; duplication syndrome - 3q, 20q, 10q

Drugs, Toxic Agents And Trauma

    ; corticosteroids

    ; child abuse

 

 

Chapter 581. Disorders Of The Retinal And Vitreous

Retinopathy Of Prematurity

Pathogenesis

# Injury to process(retinal angiogenesis from optic disk to periphery)

# 1st observation in acute phase

    ; *cessation of vasculogenesis(abrupt termination of the vessels)

           --> grow into ridge composed of mesenchymal & endothelial cells

           --> vascularization of retina

           --> *abnormal proliferation of vessels out of plaine of retina

           --> cicatrization & traction on retina

           --> detachment

# *Major factors

    ; *prematurity & retinal immaturity at birth

    ; hyperoxia

# other problems

    ; respiratory distress, apnea, brdycardia, heart disese, infection, hypoxia, hypercarbia, cidosis, nemia, need for transfusion

Classification

# Zone I ; twice disk-macular distance

# Zone II ; ora serrata nasally, anatomic equtor temporally

# Zone III

    ; residual crescent

    ; vasculized last

    ; *frequently involved with ROP

# Staging

    I ; demarcation line

    II ; ridge

           - grown demarcation line with height, width, volume

    III ; development of extraretinal fibrovascular tissue

    IV(1) ; subtotal retinal detachment not involving macula

    IV(2) ; subtotal retinal detachment involving macula

    V ; total retinal detachment

Clinical Course And Prognosis

; 90% - spontaneous arrest & regression

; left with demarcation line, undervascularization, abnormal branching, tortuosity or strightening of retinal vessels

; *Dragged Disk

    - arrest or regressed ROP

    - retinal pigmentry changes, dragging of retina

Diagnosis

# 82 Indication

    ; weighing less than 2000gm at birth(esp. less than 1500gm) : 한글판은 1800gm

    ; before 33wk gestational age

    ; supplemental oxygen more than 6hr

 --> *4-7wks 검사

# *ROP진단은 postconception 32-40wks 가장 흔하게 된다

Treatment

Prevention

Retinoblastoma

; *common primary malignant intraorbicular tumor

; hereditroy or nonhereditroy pattern

; bilateral case - 25-35%

; average age at diagnosis

    - 12mo in bilateral

    - 21mo in unilatera

Clinical Manifestation

    ; leukocoria

           - 1st sign

    ; strabismus

Chapter 582. Abnormalities Of Optic Nerve

# Ddx Of Papilledema From Optic Neuritis

 

Papilledema

Optic Neuritis

chronic vision loss

bilateral

blurring of optic disc

elevation of optic nerve head

engorgement of optic nerve veins

nerve fiber layer hemorrhage

acute or chronic vision loss

maybe unilateral

normal optic disc

normal appearing nerve head

 

 

pain on movement of globe

 

 

Chapter 584. Orbital Abnnormalities

Orbital Cellulitis

Etiology

    ; PNS infection

    ; H. influenzae, S. aureus, Group A β-hemolytic streptococci, S. pneumoniae