Chapter-25 Ophthalmology

BOOK TITLE: IAP Management Algorithms for Common Pediatric Illnesses

1. Srikanth R
2. Swaminathan Meenakshi
Publishing Year
Author Affiliations
1. Sankara Nethralaya, 18, College Road, Nungambakkam, Chennai, Tamil Nadu, India, Sankara Nethralaya, Chennai, Tamil Nadu, India, Medical Research Foundation, Chennai, Tamil Nadu, India, Medical Research Foundation, Chennai, Tamil Nadu, Sankara Nethralaya, Chennai, Tamil Nadu
2. Sankara Nethralaya, Chennai, Tamil Nadu, India, Strabismus Medical Research Foundation, Chennai, Tamil Nadu, Maharashtra, India, Mahatma Gandhi Memorial Hospital Parel, Mumbai, Maharashtra, India; Lokmanya Tilak Municipal Medical College and LTMG Hospital, Sion, Mumbai, Maharashtra, India, Medical Research Foundation, Chennai, Tamil Nadu, Sankara Nethralaya, Chennai, Tamil Nadu
Chapter keywords
leukocoria, white papillary reflex, developmental cataract, persistent fetal vasculature, retinal detachment, ocular coloboma, Retinoscopy, birth trauma, maternal infection, Neurodevelopmental strabismus, Refractive errors, retinoblastoma management, retinopathy of prematurity


This chapter provides an overview of leukocoria, strabismus and refractive errors. Leukocoria (white reflex in pupil) is the name given to the white papillary reflex on clinical examination. It can be caused by abnormalities in lens (cataract), vitreous (persistent fetal vasculature), or retina (retinoblastoma). Complete clinical and family history followed by a thorough ophthalmic examination is key to the diagnosis and management of leukocoria. The main causes of leukocoria include congenital and developmental cataract, retinal detachment (RD), retinopathy of prematurity (ROP), toxocariasis, persistent fetal vasculature (PFV), Coat\'s disease and ocular coloboma. It is important that all children with suspected leukocoria get a complete eye examination for early diagnosis and treatment. Persistent fetal vasculature is usually associated with micro cornea and congenital cataract. Management of congenital cataract along with tackling of the persistent hyaloids vasculature is essential to create a clear visual axis. Retinoblastoma management again varies according to the stage, laterality and position in eye. It consists of chemotherapy, radiotherapy, transpupillary thermotherapy or even enucleation in end stage. Strabismus is a common condition in childhood affecting 2. 1% of the population, with an increased prevalence associated with assisted delivery (forceps or cesarean section), low birth weight (including premature infants) and neurodevelopmental disorders. Neurodevelopmental strabismus (associated with a neurodevelopmental problem) is independently associated with maternal smoking later in pregnancy, maternal illnesses in pregnancy and low birth weight for gestational age. Strabismus may be the presenting symptom in children with a serious eye or brain condition. All professionals involved with the management of strabismus need to be able to recognize this, and either initiate onward referral or arrange for appropriate investigation and management. Birth history includes significant antenatal history, maternal infection and any drugs taken during pregnancy, any untoward event during delivery, birth trauma, forceps and birth asphyxia, gestational age or birth weight of the child. Sensory evaluation has to be done before motor evaluation. Retinoscopy is carried out in a semi-darkened room using hand-held lenses, or trial frame and to neutralize the retinoscopic reflex along the visual axis. It is important to maintain the child\'s attention and fixation should be on the retinoscope light. Refractive errors are probably the most common cause of vision impairment in children. They need to be recognized early and treated so that the child may have a trouble free schooling. Decision regarding whether to give spectacles should be left to the ophthalmologist. The decision depends on the refractive error if it is thought to be amblyogenic. Children also need to be screened for coexisting amblyopia and strabismus which need to be treated accordingly.

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