22 Ophthalmology

Ambylopia

• path: cortical blindness. Brain turns off one eye

  • cause: strabismus or cataracts

• treatment: no treatment

• prevention: prevent from happening.,

Strabismus

• path: "lazy eye"

• diagnosis: light not shining on middle of eye

• treatment:

  • Surgery if congenital. Fix by 6 mo

  • Acquired: patch good eye. Let bad eye catch up. Or give glasses if refractory problem

Cataracts

• path

  • congenital: TORCH

  • acquired: inborn error (galactosemia)

• symptoms: cloudy, milky white in front of eye

• diagnosis: clinical

• treatment: remove

Retinoblastoma

• path: rb gene

• symptoms: no red reflex. All white retina

• diagnosis: clinical

• treatment

  • surgical

  • don't use radiation: can induce retinoblastoma

• f/u: worry about osteosarcoma later on in life

Retinopathy of Prematurity

• pt: premature with no surfactant, FiO2

• symptoms: angiogenesis on retina

• diagnosis: clinical

• treatment: laser ablation

• f/u: worry about bronchopulmonary dysplasia, IVH (US, doppler), necrotizing enterocolitis

Neonatal Conjunctivitis

	Onset	Discharge	Treatment
Chemical	Within 24 hrs	bilateral, non purulent	Topical erythromycin prophylaxis
Gonorrhea	Day 2-7	bilateral, purulent	Treat with ceftriaxone, cultures, PCR
Chlamydia	Day 5 - 14	Unilateral turn purulent and bilateral. mucopurulent	No prophylaxis. Oral erythromycin treatment. Look for pneumonia. Culture, PCR
HSV			Acyclovir, galcyclovir
Bacterial	Day 5 -14		Treat as if chlamydia. Wait for culture

• Chemical: silver nitrate. Thought it prevented chlamydia vertical transmission (doesn't)