DIAGNOSIS AND MANAGEMENT OF CHILD WITH OPHTHALMOLOGY DISORDER

Dr. Sunerti, SpM

ANATOMI

Equipment for Ophthalmologic Examination

Flash light Loupe Ophthalmoscopy (Direct, Indirect) Slit lamp Tonometry (Schiotz Tonometry) Snellen chart

Eye Examination
Anterior Segment Eyelid, Eye brow Conjunctiva Sclera Cornea Anterior Chamber Pupil Posterior Segment Lens Vitreus Body Retina

Vision Examination
Any ocular examination must include assessment of vision Measurement of visual acuity is subjective recuire respon from the patient Examines with Snellen chart, children can be tested at about age 3 years Normal visual Acuity 6/6 (20/20) Poor vision 3/60, HM, LP Totally blind NLP

ILLiterate eye chart

Slit Lamp Examination

The patient is seated, the head is stabilized by an adjustable chinrest and Fore head strap We can be visualized the anterior segment

Direct Ophthalmoscopy
Is a standard part of the ophthalmologic examination Need dark room to allow evaluation of the central fundus

Normal Fundus

It is practical device, who might use it to screen patient for glaucoma. Patient is placed supine and topical anasthetic is instilled into each eye Normal intra ocular pressure 15 20 mmHg

Congenital Ptosis
Is commonly due to dytrophy of the levator muscle of the upper lid Other causes are congenital third nerve palsy

Congenital Palpebra Coloboma

Is a cleft of ussually the upper lid due to incomplete fusion of fetal maxilary processes Large defects require early repair to avoid corneal ulceration

MEGALOCORNEA
Is an enlarged cornea with normal clarity and function It must be differentiated from congenital glaucoma In new born the corneal diameter is 9.5 to 10.5 mm

CONGENITAL GLAUCOMA
Early sign : Corneal Hase/opacity, Increased corneal diamter, increased intra ocular pressure The most striking symptom is extreme photophobia Early Recognation is essential to prevent permanent blindness

COLOBOMA OF THE IRIS

Indicates incomplete closure of fetal ocular cleft Usually occurs inferiorly and nasally It may be associated with coloboma of the lens, choroid and optic nerve

ANIRIDIA
Absence of the iris Frequently associated with secondary glaucoma and wilms tumor

STRABISMUS
Any deviation from perfect ocular alignment Misalignment my be any direction inward, outward up or down Treatment should be started as soon as a diagnosis is made

CONGENITAL CATARACT
A Cataract is any opacity in the lens Congenital cataract are common and often visually insignificant If cataract are dense, central and larger than 2 mm in diameter, require surgical management with in the first 2 months of life

RETINOBLASTOMA
Malignant tumor of childhood 90 % of cases the diagnosis is made before the end of the third year Infants and children with presenting symptom of Strabismus should be examined carefully to role out Retinoblastoma

Gonococcal Conjuntivitis
Inflamation of the conjunctiva cause by Neisseria gonorrhoeal, present between the second and fifth days after birth Marked by a profuse purulent exsudat Profusely exsudative demands immediate laboratore and immediate treatment