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Clinical Color Atlas & Manual of Pediatric Ophthalmology, Strabismus & Neuro-Ophthalmology (2 Volumes)
Karthikeyan Arcot Sadagopan
SECTION 1: PEDIATRIC EYE EXAMINATION, OCULOPLASTY AND ANTERIOR SEGMENT ABNORMALITIES
CHAPTER 1:
History Taking and Pediatric Eye Examination
HISTORY TAKING
Informant
Reliability
Referral Details
Chief Complaint
Other Complaints Pertaining to Eye
Elaborating the History of Complaints
Birth History
Vaccination Status and Vaccination History
Antenatal History
Developmental History
Glasses
Patching
Medical History
Some Important Questions
History of Allergy
History of Prior Surgeries
Treatment History
Family History
Pedigree
Rapport
Department (Figures 1.4A to F)
Examiner
Safety
Rapport with the children (Figures 1.3A to E)
Rapport and Trust of the Parents
PEDIATRIC EYE EXAMINATION
Basic Instruments for Examination (Figure 1.5A)
Instruments for Neuro-ophthalmological Examination (Figure 1.5B)
Some Valuable Sterile Surgical Instrumentsat the Outpatient Department
Eye Examination
Making a Routine Examination Technique
Scan the Face
Conditions that can be Better Appreciated/Diagnosed Best in Natural/Daylight
Examining the Glasses
Examination of the Head
Shape of the Head
Dysmorphic Features
Anterior Fontanelle
Head Nodding
Head Posture
Anomalous Head Posture (Figures 1.27 to 1.31)
History
Examination
Causes of Abnormal Head Posture
Ocular
Subtarsal Foreign Body
Mechanism for Adopted Head Posture
Nonocular Causes
Practical Points
Facial Asymmetry
Examine for Specific Behavior
Bruckner Test
Sequence of Examination
Examination: Practical Tips
Some Practical Tips
Sleeping Child
Crying Child (Figures 1.50 and 1.51)
Injured Child
Feeding the Child
Examination with Restraint
Indications
Contraindications
Glance from Distance
Examining a Dummy
Getting Assistance from the Parents
Patching
Examining Old Photographs
Tips
Importance of Taking Photographs in Clinical Practice
Scanning the Patient
CHAPTER 2:
Pediatric Oculoplasty and Lacrimal Disorders
INTRODUCTION
Pediatric Oculoplasty: Perspective from a Pediatric Ophthalmologist
ABNORMALITIES OF PALPEBRAL APERTURE
Ephiblepharon
Euryblepharon
Lid Retraction (Figures 2.3 to 2.5)
Eye Popping Reflex
Widening of Palpebral Fissure
Mongoloid Slant
Anti-Mongoloid Slant
Nanophthalmos
Epicanthus (Figures 2.9A to D)
Epicanthus Supraciliaris
Epicanthus Tarsalis
Epicanthus Palpebralis
Epicanthus Inversus
Blepharophimosis Syndrome
ABNORMALITY OF THE EYEBROWS AND EYELASHES
Synophrys
Sparse Eyebrows
Telecanthus
Hypertelorism
Hypotelorism
Lid Coloboma
Congenital Entropion
Congenital Tarsal Kink
Congenital Ectropion
Lagophthalmos and Bell's Phenomenon
Technique of Examination
Guidelines for Treatment
Lid Lag
PTOSIS EVALUATION
History
Examination
Surgical Planning Based on Examination Findings
Sling Procedure
Levator Resection
ETIOLOGY OF PTOSIS
Neurogenic
Myogenic
Aponeurotic
Mechanical
Others
SEVERITY OF PTOSIS
PTOSIS WITH PUPIL ANOMALIES
Horner's Syndrome
Congenital Third Cranial Nerve Palsy
Acquired Third Cranial Nerve Palsy
Trauma
VARIABLE PTOSIS
Myasthenia Gravis (Figures 2.52A to D)
Marcus Jaw-Winking Ptosis
Phenomenon of Marin Amat
Third Cranial Nerve Palsy with Aberrant Regeneration (Congenital and Acquired)
FAMILIAL PTOSIS
Visually Significant Ptosis
Visual Rescue (Figures 2.59C to E)
OCULAR MOTILITY
Conditions that Cause Limitation of Motility and Ptosis
STRABISMUS WITH PTOSIS
Exotropia
Hypotropia
Esotropia
Esotropia and Hypotropia
Hypertropia
PSEUDOPTOSIS
Ipsilateral Ocular Causes
Ipsilateral Lid Causes
Contralateral Lid Causes
LID TUMORS
Chalazion
Symptoms
Signs
Management
Molluscum Contagiosum
Symptoms
Signs
Management
Nevi
Symptoms
Signs
Management
Viral Wart
Symptoms
Signs
Management
Dermoid (Figure 2.72)
Symptoms
Signs
Management
Ocular Dermal Melanocytosis Nevus of Ota
Symptoms
Signs
Management
Hemangioma
Symptoms
Signs
Management
Port-wine Stain (Nevus Flammeus)
Symptoms
Signs
Management
Vascular Malformations
Lymphangioma (Figure 2.78)
Symptoms
Signs
Management
Neurofibroma of the Lid
Symptoms
Signs
Management
MALIGNANT LID TUMORS IN CHILDREN
Xeroderma Pigmentosa
Basal Cell Nevus Syndrome
False Lid Tumors
LID INFECTION AND INFLAMMATION
Blepharitis
Anterior Marginal Blepharitis
Posterior Blepharitis
Phthiriasis Palpebrum
Symptoms
Signs
Management
Distichiasis
Symptom
Signs
Management
Trichiasis
Symptoms
Signs
Management
Blepharochalasis
Symptoms
Signs
Management
Preseptal Cellulitis (Figures 2.92 to 2.96)
Introduction
Symptoms
Signs
Workup
Management
Preference of Antibiotics
Viral Infection
Practical Points
PEDIATRIC LACRIMAL DISORDERS
Congenital Nasolacrimal Duct Obstruction
History
Examination
Management
Acquired Nasolacrimal Duct Obstruction
Congenital Dacryocele (Amniotocele)
Symptoms
Signs
Management
Lacrimal Abscess
Lacrimal Fistula
Symptoms
Signs
Management
Fluorescein Dye Disappearance Test
Acute Dacrocystitis
Symptoms
Signs
Management
Lacrimal Gland Enlargement and Inflammation
Facial Clefting Syndrome (Figure 2.109)
PRACTICAL TIPS IN EVALUATING THE LACRIMAL SYSTEM
DISORDERS OF THE GLOBE
Anophthalmos (Figures 2.111 to 2.113)
Microphthalmos (Figures 2.113 to 2.120)
Nanophthalmos (Pure Microphthalmos) (Figures 2.114 to 2.117)
Microphthalmos with Ocular Anomalies
Microphthalmia with Cyst (Figures 2.118 and 2.119)
Colobomatous Microphthalmos
Cryptophthalmos
Fraser Syndrome (Figures 2.121 to 2.125)
Cyclophthalmos
Anterior Megalophthalmos
High Myopia with Posterior Staphyloma (Figure 2.127)
CHAPTER 3:
Pediatric Corneal Disorders
CORNEA AND OCULAR SURFACE DISORDERS
ANTERIOR SEGMENT EXAMINATION
SLIT LAMP EXAMINATION
Preparing the Slit Lamp (Figures 3.1A to G)
Preparing the Patient (Figures 3.2A to D)
Examination Sequence
Handheld Slit Lamp
Special Maneuvers
Diffuse Illumination (Figures 3.4A to H)
Direct Focal Illumination (Figures 3.7A and B)
Sclerotic Scatter (Figures 3.8A to F)
Retroillumination (Figures 3.9H, I, N and O)
Transillumination (Figures 3.9A to O)
Specular Reflection
CONJUNCTIVITIS
Ophthalmia Neonatorum
History
Examination
Bacterial Conjunctivitis
Purulent Conjunctivitis
Membranous/Pseudomembranous Conjunctivitis
Acute Catarrhal Conjunctivitis
Chronic Catarrhal Conjunctivitis
Granulomatous Conjunctivitis
Causes
Membranous Conjunctivitis
Causes
Pseudomembranous Conjunctivitis
Adenoviral Keratoconjunctivitis (Figure 3.15)
Symptoms
Signs
Management
Other Viral Causes of Conjunctivitis
Molluscum Contagiosum Induced Conjunctivitis
Phlyctenular Conjunctivitis (Figures 3.18A to C)
Symptoms
Signs
Management
Vernal Keratoconjunctivitis
Giant Papillary Conjunctivitis
Symptoms
Signs
Management
Atopic Keratoconjunctivitis
Symptoms
Signs
Management
Allergic Rhinoconjunctivitis
Symptoms
Signs
Management
Floppy Eyelid Syndrome
Symptoms
Signs
Management
Drug-Induced Allergic Contact Dermatitis (Figures 3.22A and B)
Symptoms
Signs
Management
Trachoma
Signs
Scarring
Corneal Opacity (Designated Corneal Opacity in the World Health Organization Simplified Trachoma)
Other Findings
Management
DEVELOPMENTAL ANOMALIES OF CORNEA AND ANTERIOR SEGMENT
Embryology of the Anterior Segment
Megalocornea (Figure 3.23)
Symptoms and Signs
Management
Microcornea
Ocular Associations
Systemic Associations
Sclerocornea
Management
Peter's Anomaly
Ocular Associations
Systemic Associations: Peter's Plus Anomaly
Management
Congenital Hereditary Endothelial Dystrophy
Management
Congenital Hereditary Stromal Dystrophy
Aniridia
Ocular Findings
Systemic Associations
Iridocorneal Endothelial Syndrome
Essential Iris Atrophy
Iris Nevus Syndrome
Chandler's Syndrome
Anterior Segment Dysgenesis Syndrome (Figure 3.34B)
Axenfeld-Rieger Spectrum
Axenfeld Anomaly
Axenfeld-Rieger Anomaly
Axenfeld-Rieger Syndrome
Keratoconus
Ocular Findings: Slit Lamp Signs
Other Signs
Ocular Associations
Systemic Associations
Management
Recent Advanced Options
Congenital Anterior Staphyloma
CONGENITAL CORNEAL OPACITY
Approach to a Child with Corneal Opacity
Examination
Causes (Tables 3.3 to 3.6)
GROWTHS
Limbal Dermoid
Symptoms
Signs
Management
Dermolipoma
Symblepharon
Causes of Symblepharon
Pigmented Lesions of Conjunctiva
Nevi
Ocular Melanosis
Oculodermal Melanocytosis (Nevus of Ota) (Figure 3.40D)
False Pigmentation
Pterygium and Pseudopterygium
Pinguecula
Malignancy
Episcleritis
Cysts
False Growths
KERATITIS
Evaluation of Keratitis
Symptoms
History
Examination
Management
Treatment
Bacterial Keratitis
Presentation
Morphological Clues to Etiology
Management
Viral Keratitis (Herpetic Eye Disease)
Herpes Simplex Keratitis
Herpes Zoster Keratitis (Figures 3.54A and B, 3.55A and B)
Pseudodendrites (Figure 3.53B)
Varicella Zoster Keratitis (Figures 3.56A to E)
Disciform Keratitis
Management of Viral Keratitis
Fungal Keratitis
Symptoms and Signs
Management
Acanthamoeba Keratitis
Symptoms and Signs
Management
Acne Rosacea Keratitis
Dermatological Findings
Ocular Findings
Management
Phlyctenular Keratitis (Figures 3.61A to E)
Interstitial Keratitis
Causes
Evaluation of Interstitial Keratitis
Management
Vernal Keratoconjunctivitis
Symptoms and Signs
Management
Exposure Keratopathy (Figures 3.66A to C)
Causes
Coexistent Factors which Influence the Severity
Morphology and Description
Xerophthalmia (Figures 3.67 to 3.70)
Vitamin A Deficiency (Primary Xerophthalmia)
Secondary Xerophthalmia (Figures 3.68 to 3.70)
Filamentary Keratitis
Causes
Management (Treatment)
Neurotrophic Keratopathy
Causes
Lesions
Marginal Keratitis
Symptoms
Signs
Management
MISCELLANEOUS CORNEAL CONDITIONS
Band Shaped Keratopathy (Figures 3.71A to F)
Causes
Corneal Graft (Figures 3.72A to E, 3.73A to C)
Dellen
Prominent Corneal Nerves
Vortex Keratopathy (Cornea Verticillata)
Corneal Rings and Lines
Lines
Corneal Hypoesthesia
Causes
Corneal Crystals
Causes
Contact Lens (Figure 3.74)
Amniotic Membrane Transplantation(Figures 3.75A to C)
Source/Harvesting and Storage of Membrane
Properties of Amniotic Membrane
Indications
Keratoprosthesis (Figures 3.76A and B)
Types
Indications
Complications
CHAPTER 4:
Iris and Anterior Chamber Abnormalities
INTRODUCTION
ANTERIOR CHAMBER ABNORMALITIES
Hypopyon
Causes
Clues to Etiology of Hypopyon
Management
Pseudohypopyon
Hyperolean
Introduction
Complications
Management
Hyphema
Introduction
Causes
Candy Stripe Sign
Corneal Blood Staining
IRIS
Heterochromia Iridis
Causes
Iris Freckle
Iris Mamillations
Lisch Nodules
Brushfield Spots
Juvenile Xanthogranuloma
Iris Transillumination Defect
Location of Iris Transillumination
Prominent Iris Vessels
Neovascularization of Iris
Ectropion Uvea
Iris Cyst
Anterior Chamber Intraocular Lens
Introduction
Complications
Iris-supported Intraocular Lens
Peripheral Anterior Synechiae
Introduction
Causes
Iris Atrophy
Keratic Precipitates
CHAPTER 5:
Pediatric Cataract and Lens Abnormalities
INTRODUCTION
Symptoms of Pediatric Cataract
Signs of Poor Vision
PEDIATRIC CATARACT EVALUATION
History
Examination
Pediatrician Referral
Referral to Pediatrician for Screening
Investigations
Treatment Options
MORPHOLOGY OF PEDIATRIC CATARACTS
Importance of Recognizing Morphology
Total Cataracts
Congenital Morgagnian Cataract
Membranous Cataracts
Anterior Polar Cataracts
Anterior Pyramidal Cataracts
Anterior Subcapsular Cataracts
Anterior Lenticonus
Vossius Ring
Zonular Cataracts
Ant-Egg Cataracts
Central Pulverulent Cataracts
Nuclear Cataracts
Coralliform Cataracts
Sutural Cataracts
Coronary Cataracts
Crystalline Cataracts
Floriform Cataracts
Posterior Cataracts
Mittendorf's Dot
Posterior Lenticonus and Posterior Lentiglobus
Posterior Subcapsular
Posterior Capsular
Posterior Polar Cataract
Punctate Cataracts
Sectoral Cataracts
Sunflower Cataract
Complicated Cataract
Persistent Fetal Vasculature
Special Morphological Forms of Cataracts in Metabolic and Systemic Disorders
ETIOLOGY OF PEDIATRIC CATARACTS
OCULAR ASSOCIATIONS OF CONGENITAL CATARACT
Anterior Segment
Posterior Segment
SYSTEMIC ASSOCIATIONS OF CONGENITAL CATARACT
VISUALLY SIGNIFICANT CATARACT
POOR PROGNOSTIC INDICATORS
ECTOPIA LENTIS
Causes
History
Clinical Evaluation
Systematic Systemic Evaluation
Examination of other Family Members
Marfan Syndrome (Figures 5.53 to 5.56)
Risk Factor
Ocular Features
Systemic Features
Revised Ghent Criteria is Used for Diagnosis of Marfan Syndrome
Homocystinuria
Ocular Features
Systemic Features
Ehler-Danlos Syndrome
Weill-Marchesani Syndrome
Ocular Features
Systemic Features
Microspherophakia Hernia Syndrome
Hyperlysinemia
Sulfite Oxidase Deficiency
Ectopia Lentis et Pupillae
Megalophthalmos
Trauma
Management
Options
Lensectomy
Contact Lenses
Scleral Fixation Lenses
Iris-supported Lenses
Intraocular Lens
PEDIATRIC CATARACT SURGERY
Indications for Surgery
Contraindications for Intraocular Lens/Secondary Intraocular Lens
Time of Surgery
Time Interval between Surgeries
Time Interval between Pediatric Cataract Surgeries
Bilateral Simultaneous Cataract Surgery
Timing of Secondary Posterior Chamber Intraocular Lens Implantation
Surgical Options
Conventional Limbal Section
Choice of Intraocular Lens
Choice of optic size
Intraocular Lens
Anterior Chamber Intraocular Lenses are Contraindicated in Children
GUIDELINES FOR INTRAOCULAR LENS POWER CALCULATIONS
COMPLICATIONS OF PEDIATRIC CATARACT SURGERY
Per-operative Complications
Postoperative Complications
Postoperative Iritis
Postoperative Iritis and Fibrin Membrane Formation
Endophthalmitis
Iris Prolapse
Pupil Peaking
Decentration of Intraocular Lens
Refractive Surprises
Prevention
Management
Hyphema
Glaucoma
Posterior Capsule Opacification
Guidelines for YAG Capsulotomy
Pupillary Capture
Capsular Phimosis
Cystoids Macular Edema
After Cataract Formation
Iridocapsular Adhesions
Corneal Decompensation
Pediatric Cataract Surgery
Surgical Steps
Transition from Adult Cataract Surgery to Pediatric Cataract Surgery
Intraocular Lens Materials
Acrylic Intraocular Lens
Hydrogel lenses
Silicone Lenses
VISUAL REHABILITATION
Aphakic Glasses
Contact Lens
Pseudophakia
Bifocals
CHAPTER 6:
Pediatric Glaucoma
INTRODUCTION
CHILDHOOD GLAUCOMAS
Primary Glaucomas
TONOMETRY
Recording Intraocular Pressure
Tonometry
Contact Tonometry
Noncontact Tonometry
Applanation Tonometer
Slit Lamp Adjustments
Patient Preparation
Measuring the Reading
GONIOSCOPY
Technique of Gonioscopy
Preparation of Patient
Preparation of the Slit Lamp
Preparation of the Goniolens
Procedures
Documentation of Gonioscopy Findings
Angle Findings in Newborn
Indications for Gonioscopy
Diagnostic
Therapeutic
Contraindications for Gonioscopy
SYMPTOMS AND SIGNS
OCULAR ASSOCIATIONS
Clinical Conditions Associated with Glaucoma
Axenfeld-Rieger Syndrome
Aniridia
Peter's Anomaly
Neurofibromatosis
Sturge-Weber Syndrome
Oculodermal Melanocytosis (Nevus of Ota)
Tuberous Sclerosis
EXAMINATION UNDER ANESTHESIA
Equipments (Figures 6.31A to H)
Sequence of Examination Under Anesthesia
Intraocular Pressure
Anterior Segment Examination
Anterior Chamber Depth
Disc Evaluation
Refraction
Axial Length
Pachymetry
Practical Tips
Corroborating the Findings of the Examination
DIFFERENTIAL DIAGNOSIS
SECONDARY GLAUCOMAS
Glaucoma Related to Uveitis (Acute and Chronic)
Malignant Glaucoma
Glaucoma Associated with Increased Episcleral Venous Pressure
Glaucoma Related to Intraocular Infection
Secondary Glaucomas Associated with Hereditary Ocular Conditions
Silicone oil
Trauma
Angle Recession Glaucoma
Hyphema
Ghost Cell Glaucoma
Lens-Related Glaucoma
Intraocular Neoplasm
Retinoblastoma
Iris cyst
Steroid Induced Glaucoma
Neovascular Glaucoma
Angle-Closure Glaucoma
Angle-Closure Glaucoma in Children
Glaucoma in Coats’ Disease
DISC EVALUATION
Normal Disc Appearance
Effect of Same Cup Size in Different Sized Discs (Figure 6.60)
Normal Appearance of Different Sized Disc and a CD Ratio of 0.35 in Each (Figure 6.61)
Normal Shape of Disc and their Corresponding Cup (Figure 6.62)
Significance of Comparing Disc Shape and Cup Shape (Figure 6.63)
Disc Asymmetry (Figures 6.65A and B)
True CD Asymmetry (Figure 6.67)
Size of the Disc
Megalopapilla
Color and Contour of the Neuroretinal Rim
Nerve Fiber Layer
Nerve Fiber Layer Defects
Peripapillary Atrophy
Differentiating Neuro-ophthalmological and Glaucomatous Disc
Myopia and Glaucoma
Myopic Disc and Glaucomatous Disc
Advanced Glaucomatous Cupping
Differential Diagnosis of the Glaucomatous Disc
MEDICAL MANAGEMENT
SURGICAL OPTIONS
Goniotomy
Complications of Goniotomy
Trabeculotomy
Complications of Trabeculotomy-Trabeculectomy
Complications of Trabeculectomy
Shunt Procedures
Complications of Shunt Procedures
SECTION 2: PEDIATRIC POSTERIOR SEGMENT ABNORMALITIES AND TRAUMA
CHAPTER 7:
Pediatric Retinal Disorders and Uveitis
INTRODUCTION
EXAMINING TECHNIQUE
Direct Ophthalmoscope
Documentation
Bruckner's Test
Important Applications of Direct Ophthalmoscope
Slit Lamp Fundus Biomicroscopy (Figures 7.3 to 7.5)
Initial Adjustments
Procedures
Lens Choice
Indirect Ophthalmoscopy in Children
SEQUENCE OF FUNDUS EXAMINATION
PRACTICAL EXAMINATION TIPS FOR RETINOPATHY OF PREMATURITY
Requirements
Examination Technique
Choice of Lens/Sequence of Lens
Examining Sequence
RETINITIS PIGMENTOSA
Typical Retinitis Pigmentosa
Clinical Triad
Fundus Triad (Figures 7.11A to C)
Inheritance Triad
Other Inheritance Patterns
Ocular Associations
Anterior Segment
Posterior Segment
Atypical Retinitis Pigmentosa
Systemic Associations
SYSTEMIC EVALUATION OF PIGMENTARY RETINOPATHY
History
Examination
Ethnicity
Age at Presentation
Examination
Classic Facial Appearances
Ocular Findings
Pattern of Pigmentary Retinopathy
System Wise
PSEUDORETINITIS PIGMENTOSA
CONGENITAL STATIONARY NIGHT BLINDNESS
CSNB with Abnormal Fundus
Oguchi's Disease (Figures 7.16A to C)
Fundus Albipunctatus
CSNB with Myopia, Nystagmus and Reduced Visual Acuity (X-Linked Recessive)
INHERITED CHOROIDAL DYSTROPHIES
Gyrate Atrophy of Choroid (Ornithine Delta Aminotransferase Deficiency)
Clinical Presentation
Fundus Findings (Figures 7.17 to 7.19)
Differential Diagnosis
Treatment Options
Choroideremia
Presentation
Fundus Findings (Figures 7.20A and B,7.21A and B)
Differential Diagnosis
FLECKED RETINA
Stargardt's Disease and Fundus Flavimaculatus (Figures 7.24 to 7.26)
Classification
Differential Diagnosis
Cone Dystrophy
Retinitis Punctata Albescens
Flecked Retina of Kandori (Night Blindness)
Benign Familial Fleck
Kyamura Fundus (Xerophthalmic Fundus)
Bietti's Cornea Retinal Dystrophy
Dominant Drusen (Figure 7.27)
Fundus Findings
INHERITED MACULAR DYSTROPHIES
Rod Monochromatism (Congenital Achromatopsia)
Symptoms
Criteria for Diagnosis
Clinical Findings
Fundus
Blue Cone Monochromatism
Symptoms
Signs
Workup
Electroretinogram
Progressive Cone Dystrophy
Symptoms
Signs
Workup
Associated Systemic Conditions
Treatment
Pattern Dystrophy (Figures 7.29A and B)
Clinical Features
Types
Best Vitelliform Macular Dystrophy
Clinical Features
Symptoms
Signs
Stages
Workup
LEBER's CONGENITAL AMAUROSIS (FIGURES 7.31A AND B)
HEREDITARY VITREORETINOPATHIES
Congenital Retinoschisis (X-Linked Juvenile Retinoschisis)
Goldmann-Favre Syndrome
Stickler Syndrome
Ocular Manifestations
Systemic Findings
Wagner Syndrome
Kniest Syndrome
Familial Exudative Vitreoretinopathy
Autosomal Dominant Vitreoretinochoroidopathy
Autosomal Dominant Neovascular Inflammatory Vitreoretinopathy
Snowflake Degeneration (Hirose)
NIGHT BLINDNESS IN CHILDREN
History
Clinical Examination and Workup
Clinical Conditions Causing Night Blindness
Steps in the Diagnosis
Progressive
Nonprogressive (Stationary)
VASCULAR ABNORMALITIES
Coats’ Disease
Clinical Features
Fundus Fluorescein Angiography
Treatment
Capillary Hemangioma
Retinal Cavernous Hemangioma
Racemose Hemangioma
Congenital Vascular Tortuosity
Diabetic Retinopathy
Radiation Retinopathy
Malignant Hypertension
Retinal Vasculitis
Dragged Disc
Causes
CHORIORETINITIS AND RETINOCHOROIDITIS
Toxocariasis
Presentation
Ocular Larva Migrans
Visceral Larva Migrans
Toxoplasmosis (Figure 7.39)
Clinical Features
Workup
Investigations
Treatment
Medications
Serpiginous Choroiditis (Geographical Helicoid Peripapillary Choroidopathy)
Ocular Features
Sympathetic Ophthalmia
Vogt-Koyanagi-Harada Syndrome
Diagnostic Criteria
Phases
Prodrome
Skin Findings
Ocular Findings
Treatment
RETINAL DETACHMENT IN CHILDREN
Retinal Detachment (Figures 7.46A to D)
Non-Rhegmatogenous
Rhegmatogenous Detachment
PIGMENTED LESIONS AND BACKGROUND ALTERATIONS IN SPECIFIC CLINICAL CONDITIONS
Choroidal Nevus (Figure 7.47)
Bear Track Lesions
Sturge-Weber Syndrome
Nevus of Ota
Choroidal Tear
CHAPTER 8:
Retinopathy of Prematurity
RETINAL VASCULARIZATION
PATHOGENESIS OF RETINOPATHY OF PREMATURITY
CLASSIFICATION OF RETINOPATHY OF PREMATURITY
Location
Extent
Staging
Stage 1: Demarcation Line
Stage 2: The Ridge
Stage 3
Stage 4: Partial Retinal Detachment
Stage 5: Total Retinal Detachment
Plus Disease
REGRESSION OF RETINOPATHY OF PREMATURITY
SCREENING CRITERIA
Screening Protocol
TREATMENT
Criteria
NEW CONCEPTS
RETINOPATHY OF PREMATURITY, PREMATURITY AND VISUAL PROBLEMS
CHAPTER 9:
Pediatric Ocular Trauma
INTRODUCTION
OCULAR TRAUMA TERMINOLOGY
BIRMINGHAM EYE TRAUMA—CLASSIFICATION
Type
Open Globe Injury
Closed Globe Injury
Grading
Zone (Closed Globe Injury)
Zone (Open Globe injury)
LESIONS OF BLUNT OCULAR TRAUMA
Blunt Trauma
Concussions and Contusions
Lesions of the Conjunctiva
Lesions of the Cornea
Corneal Lacerations
Lesions of the Iris and Ciliary Body
Vascular Changes
Hemorrhages
Lacerations of the Iris and Ciliary Body
Inflammatory and Atrophic Changes
Lesions of the Lens and Zonule
Lenticular Opacities
Subluxation and Dislocation of the Lens (Figures 9.8A and B,9.9)
Lesions of the Choroid
Lesions of the Retina
Vascular changes in the Retina
Lesions of the Optic Disc
Effects on the Vitreous
Ruptures of Sclera
Changes in Refraction
Changes in Ocular Tension
BLUNT ORBITAL TRAUMA
Campbell's Seven Rings of Blunt Trauma
EYELID LACERATION
VALSALVA INDUCED INJURY
CHEMICAL INJURIES
Management
THERMAL INJURY
ELECTRICAL INJURY
FOREIGN BODY
INTRAOCULAR FOREIGN BODY
Imaging Modalities
Plain Radiographs
Computerized Tomography
Ultrasonography
Ultrasound Biomicroscopy
Magnetic Resonance Imaging
Characteristics of Foreign Body
Technique of Removal
OPEN GLOBE INJURY
Penetrating Injury
Sympathetic Ophthalmia
Clinical Features
CHILD ABUSE
Ophthalmic Findings in Child Abuse
Iatrogenic/Whiplash Injury
PEDIATRIC EYE TRAUMA EVALUATION
History
Examination
PLANNING AND PREPARATION OF EYE TRAUMA PATIENT FOR SURGERY
Minimize Further Injury
Improving Surgical Objectives
Minimize Risk of Infection
Reduce Risk to Patient's General Health
Reduce Medicolegal Risk
CHAPTER 10:
Ultrasonography in Children
INTRODUCTION
Indications
Contraindications
Practical Difficulties in Children
Some Practical Tips
AXIAL LENGTH
Myopia
Nanophthalmos
Silicone Oil
EXCAVATED LESIONS
Posterior Staphyloma
Retinochoroidal Coloboma
Morning Glory Disc
Disc Coloboma
Cupping of Disc
POINT OR DOT-LIKE ECHOES
Endophthalmitis
Vitreous Hemorrhage
Posterior Capsule Rent with Cortex in Vitreous
MEMBRANOUS ECHOES
Posterior Vitreous Detachment
Retinal Detachment
Tractional Retinal Detachment
Choroidal Detachment
Persistent Fetal Vasculature
TRAUMA AND INTRAOCULAR FOREIGN BODY
Penetrating Injury
Optic Nerve Avulsion
Intraocular Lens
INTRAOCULAR AND ORBITAL MASS LESIONS
Retinoblastoma
Choroidal Melanoma
Choroidal Hemangioma
Orbital Cyst
Orbital Hemorrhage
INFLAMMATORY LESIONS
Posterior Scleritis
Elevated Lesions
EXTRAOCULAR MUSCLE EXAMINATION
Slipped Muscle: Lost/Slipped Muscle
Enlarged Rectus Muscle
SECTION 3: VISUAL ACUITY, REFRACTION AND AMBLYOPIA
CHAPTER 11:
Visual Acuity Assessment and Amblyopia Management
INTRODUCTION
STANDARD VISION AND NORMAL VISION
DIFFERENCE IN VISUAL ACUITY
PREVERBAL CHILDREN
Infants
Visual Evoked Potential
Toddlers
Forced Choice Preferential Looking Tests
Kay's Picture Tests
Allen Picture Tests
Lea Symbols
Sheridan-Gardiner Test (Matching Optotype)
Sonsken Silver Test
Cambridge Crowding Cards
Illiterate E or Tumbling E Test/Landolt C/Fooke's Symbol
HOTV Test
Snellen Chart
Rosenbaum Card
NEAR VISION TESTING
Near Visual Acuity Charts
VISUAL BEHAVIOR
PRACTICAL TIPS IN RECORDING VISUAL ACUITY IN CHILDREN
IMPORTANT CLINICAL CONSIDERATIONS
AMBLYOPIA
Definition
Causes
Types
Risk Factors for Amblyopia
Diagnosis
Severity
Workup
History
Examination
Treatment
Patching Schedule
Important Practical Points
Duration of Patching and Follow-up (Early Recommendations)
CLINICAL CLUES FOR JUDGING THE PRESENCE AND, IN SOME INSTANCES, THE SEVERITY OF AMBLYOPIA IN DIFFERENT CLINICAL SITUATIONS
Refractive Error
Ptosis
Severity of Ptosis and Risk for Amblyopia (In the Absence of other Amblyopic Factors Like Anisometropia)
Cataract (Figures 11.20 to 11.22)
Judging the Cause of Visual Loss (Post-Traumatic Corneal Scarring with Traumatic Cataract)
Cornea
Strabismus
Glaucoma
Congenital Optic Nerve and Retinal Abnormalities
Nystagmus
Neuro-ophthalmology
Minimal Face Turn
Large Face Turn
Opposite Face Turn
PEDIATRIC EYE DISEASE INVESTIGATOR GROUP STUDIES
Congenital Esotropia Observation Study
Objective
Conclusion
Randomized Trial Comparing Part-Time Versus Minimal-Time Patching for Moderate Amblyopia
Objective
Conclusion
A Randomized Trial Comparing Part-Time Versus Full-Time Patching for Severe Amblyopia
Objective
Conclusion
An Observational Study on Recurrence of Amblyopia after Discontinuation of Treatment
Conclusion
A Randomized Trial Comparing Daily Atropine Versus Weekend Atropine for Moderate Amblyopia
Objective
Conclusion
An Evaluation of Treatment of Amblyopia in 7 Years to Less than 18 Years Old
Objectives
Conclusion
A Randomized Trial to Evaluate 2 Hours of Daily Patching for Amblyopia in Children 3 Years to Less than 7 Years Old
Objective and Rationale
Conclusions
A Randomized Trial Comparing Atropine to Atropine Plus a Plano Lens for the Sound Eye as Prescribed Treatments for Amblyopia in Children 3 Years to Less than 7 Years Old
Objectives
Conclusion
A Randomized Trial of Near Versus Distance Activities while Patching for Amblyopia in Children 3 years to Less than 7 Years Old
Objective
Conclusion
A Randomized Trial Comparing Patching to Atropine for Amblyopia in Children 7 Years to Less than 13 Years Old
Objectives
Conclusion
Clinical Relevance
Risk Factors for Recurrence of Amblyopia after Stopping Patching
Effect of Amblyopia Treatment on Ocular Alignment
PATCHING THERAPY
Questions to be Asked During Follow-up of Patching Therapy
About the Eye
About Patching
Behavior of Child
Questions Regarding Glasses
Ask the Parents for the Following
Judge the Ability of the Parents in the Following Areas
Other Applications of Patching (Other than Amblyopia)
CHAPTER 12:
Pediatric Refractive Errors, Contact Lens and Low-Vision Rehabilitation
PEDIATRIC REFRACTION
Myopia
Clinical Types
Types Based on Etiology
Symptoms
Ocular Findings of Axial Myopia
Systemic Associations
Ocular Associations
Causes of Visual Loss in Myopias
Workup
Practical Pearls
Corneal Cause
Index Myopia
Hyperopia
Astigmatism
Anisometropia
Definition
Types
Symptoms
Causes
Clinical Conditions with Increased Incidence of Anisometropia
Workup
Management
Practical Tips
Important Practical Steps and Tips for Pediatric Refraction
Steps in Refraction
Practical Tips and Tricks in Glasses
PEDIATRIC CONTACT LENSES
Indications
Pediatric Aphakia Management
Aphakic Spectacles
Intraocular Lenses
Mensuration of the Infant Eye
Contact Lenses
Contact Lens for Pediatric Aphakia
Soft Contact Lenses (Hydrogel) (Figures 12.9A to C)
Silicone Hydrogel Lenses
Rigid Contact Lenses (Figures 12.12A to C)
Silicone Elastomer Lenses
Scleral Lenses
Daily Wear Versus Extended Wear
Contact Lens Back Vertex Power
Summary
Binocular Vision of Aphakic Eye Corrected by Contact Lens
PEDIATRIC LOW VISION
Referral to Low-Vision Services
Pediatric Eye Disorders that Might Require Low-Vision Evaluation
Children 0–3 Years of Age
Children 4 Years Onward
Skills Required for Low-Vision Service Delivery
Assessment of Magnification Needed
Equipment Needed for Low-Vision Services
Guidelines for Referral to Education by Eye Care
The Following Guidelines Should be Followed
These Children Should Receive Following Support at School
Assessment of Low-Vision
Clinical Assessment
Functional Assessment
Nonoptical Devices
Optical Devices
Spectacle Magnifiers (Figure 12.16A)
Handheld Magnifiers (Figures 12.16B and C,12.17A and B)
Stand Magnifiers (Figure 12.16D)
Telescopes
Functional Low-Vision
SECTION 4: STRABISMUS
CHAPTER 13:
Strabismus
INTRODUCTION
STRABISMUS EVALUATION
History
Etiology
Family History
Birth, Antenatal and Developmental History
Systemic Diagnosis and Management Purposes
Equipments Required for an Examination
Stereopsis
Lang Two-Pencil Test
Titmus Test
TNO Test
Frisby Test
Lang Test
Randot Stereo Test
Anomalous Head Posture
Facial Asymmetry
Pseudostrabismus
Cover Test/Uncover Test and Alternate Cover Test
Requirements
Procedures
Interpretation
Clinical Applications
Cover Test/Uncover Test and Alternate Cover Test
OCULAR MOTILITY EXAMINATION
Requirements
Technique
Postrotatory Nystagmus
Action of Extraocular Muscles
Both Superiors Incyclotort and Both Obliques Abduct
Terminology (Figures 13.24A to C, 13.25A to I)
Grading of Overaction and Underaction of Muscles
Muscle Sequel
Parks’ Three-Step Test
Procedures
Contraindications/Not Valuable
Interpretation
Torsion
PRISMS
Principle of Prism
Parts of a Prism
Angle of Deviation Depends on
Nature of Image
Material of Prism
Clinical Availability
Based on the Mechanism of Action
Power of a Prism
Placing the Prism for Examination
Position of Prism
Prism Placement (Figures 13.36 to 13.40)
Splitting the Prism
Stacking of Prisms (Figures 13.38A to C)
Technique of Using Prisms When There is Both Horizontal and Vertical Deviation
Holding the Prism for Checking in Lateral Gaze Positions
Holding the Prism in Head Tilt Test
Fixing Right Eye and Fixing Left Eye
Effect of Spectacle Lens Power on Measurement of Deviation
Minus Measures More
Activity
Tests Involving Prisms
MEASUREMENT OF DEVIATION
Pitfalls in Measuring the Deviation
Position of Head
Position of the Eye
Position of Prism
Preference of Eye
Presence of High Power Glasses
Picking the Wrong Test
Selecting the Prism
Prism Bar
Trial Frame Prism
Fresnel Trial Lens Prism
Avoiding Bias
TESTS WITH PRISMS
Krimsky test (Krimsky I) (Figures 13.42A to F)
Indications
Procedures
Modified Krimsky (Krimsky II)
Procedures
Simultaneous Prism Cover Test
Alternate Prism Cover Test
Four Prism Diopter Test
To Find Fixation Preference
ASSESSMENT OF TORSION
Subjective Test
Double Maddox Rod Test (Figures 13.44A and B)
Objective Assessment
Indirect Ophthalmoscope View
FIXATION PATTERN
Binocular Fixation Pattern: Grading
CSM Notation
FORCE DUCTION TEST
Requirements
Procedure and Interpretation
SENSORY ASPECTS OF STRABISMUS
Worth Four-Dot Test
Interpretation
Bagolini Striated Glasses
Interpretation
Fusion
Monocular Clues for Depth Perception
Confusion
Diplopia
Eccentric Fixation
Eccentric Viewing
Anomalous Retinal Correspondence
Suppression
ACCOMMODATIVE CONVERGENCE/ACCOMMODATION RATIO
Methods of Detection
Gradient Method
Heterophoria Method
Clinical Accommodative Convergence/Accommodation (AC/A Ratio)
Clinical Applications
MYOPIA AND STRABISMUS
Squint Assessment
Management
Surgical Considerations
HYPERMETROPIC EYE
Squint Assessment
Management
Surgical Considerations
EVALUATION OF ASTHENOPIA IN CHILDREN
Symptoms
History
Examination
Patient Counseling
Normal Fusional Amplitude Range
ESODEVIATIONS
Classification
Concomitant Esodeviations
Nonconcomitant Esodeviations
Approach to a Child with Esotropia
History
Examination
Essential Infantile Esotropia (Figures 13.55A to J)
Introduction
History
Examination
Management
Acquired Esotropia
Accommodative Esotropia
History
Recent Classification
Examination
Treatment Principles
Method of Weaning Glasses
Prescribing the Bifocals
Indication for Contact Lenses
Surgery
Partial Accommodative Esotropia
Decompensated Accommodative Esotropia
BASIC ESOTROPIA
Microtropia or Monofixational Esotropia
SENSORY ESOTROPIA
EXODEVIATIONS
Classification of Exodeviations
Concomitant Exodeviations
Nonconcomitant Exodeviations
Infantile Exotropia
Clinical Features
Evaluation
Management
Intermittent Exotropia
Clinical Features (Figures 13.63A and B)
Evaluation
Important Clinical Points to Remember
Assessment of Control
Office Control
Surgery Guidelines
Constant Exotropia
Classification
Treatment
Sensory Exotropia
VERTICAL DEVIATIONS
Dissociated Strabismus Complex
Introduction
Symptoms
Examination
Important Clinical Points
Differentiating Features of Dissociated Horizontal Deviation and Intermittent Exotropia
Management
Horizontal and Vertical Strabismus
PATTERN STRABISMUS
Head Posture
Workup
CYCLOVERTICAL HETEROTROPIAS
Apparent Oblique Muscle Dysfunction
INFERIOR OBLIQUE OVERACTION
Clinical Features
Workup
Management
INFERIOR OBLIQUE PALSY
SUPERIOR OBLIQUE UNDERACTION
SUPERIOR OBLIQUE OVERACTION
COMMON CONDITIONS WITH DIFFERENT PATTERN DEVIATIONS
V-Esotropia
V-Exotropia
A-Esotropia
A-Exotropia
Management
PALPEBRAL FISSURE IN STRABISMUS PATIENT
Ptosis
Lid Retraction
Cogan's Lid Twitch and Lid Hop
Narrowing of Lid Fissure
Widening of Lid Fissure
Higher Position of Lower Lid
Lower Lid Retraction
Mongoloid and Anti-Mongoloid Slant
Epicanthic Folds
Iatrogenic
Mongoloid Slant and Anti-Mongoloid Slant (Figures 13.81 to 13.84)
RESTRICTIVE STRABISMUS
Dysthyroid Ophthalmopathy
Symptoms
Important Points to Remember
Phases
Clinical Features
Extraocular Motility
Workup
Management
Principles of Strabismus Management
Buckle Related Strabismus
Introduction
History
Double Vision Following Retinal Detachment Surgery
Examination and Workup
Management
Dragged Fovea Diplopia Syndrome
Muscle Entrapment
Introduction
Symptoms
Clinical Findings
Glaucoma Drainage Implant Related Strabismus
Risk Factors
Mechanism
Management Options
Prevention
Complications
Strabismus Fixus (Figures 13.93A to D)
Myopic Restrictive Strabismus (Heavy Eye Phenomenon)
Etiology Postulated
Clinical Features
Differential Diagnosis
Management
MONOCULAR ELEVATION DEFICIT (OLD TERMINOLOGY—DOUBLE ELEVATOR PALSY)
Clinical Features
Types
Differentiating the Three Types
Congenital and Acquired Monocular Elevation Deficit
Causes of Acquired Monocular Elevation Deficit
Workup
Differential Diagnosis
Management (Figures 13.99A to D)
PARALYTIC STRABISMUS
Oculomotor Nerve Palsy (Figures 13.100 to 13.109)
Introduction
Isolated Oculomotor Nerve Palsy
Causes
History
Terminology
Clinical Features
Clinical Evaluation
Pupil and Accommodation
Indications for Neuroimaging
Management
Surgical Options
Congenital Third Nerve Palsy
Clinical Evaluation
Trochlear Nerve Palsy (Superior Oblique Palsy) (Figures 13.110 to 13.116)
Causes
Clinical Evaluation
Surgery
Head Posture in Superior Oblique Palsy
Superior Oblique Palsy with Superior Rectus Contracture
Presentation of Fixing with the Paretic Eye
Bilateral Superior Oblique Palsy
Clinical Features
Abducens Nerve Palsy (Figures 13.117 to 13.119)
Introduction
Causes
Clinical Evaluation
Workup
Management
Surgery
MULTIPLE CRANIAL NERVE PALSY (Figures 13.120 to 13.124)
Cavernous Sinus Thrombosis
Superior Orbital Fissuritis
Orbital Apex Syndrome
Carotid-Cavernous Fistula
STRABISMUS SYNDROMES
Duane Retraction Syndrome
Clinical Features
Types
Workup
Forceps Test
Management
Indications for Surgery
Duane Retraction Syndrome with Abduction Splits
Inverse Duane Retraction Syndrome
Brown Syndrome
Introduction
Symptoms (Figures 13.137 to 13.141)
Clinical Features
Clinical Evaluation
Confirmation
Management
Möbius Syndrome
Lid Retraction
OCULAR MOTILITY IN NEURO-OPHTHALMOLOGICAL DISORDERS
Internuclear Ophthalmoplegia
Convergence
Differential Diagnosis
Wall-Eyed Bilateral Internuclear Ophthalmoplegia
Differential Diagnosis
One-and-Half Syndrome
Paralytic Pontine Exotropia (Figures 13.148A and B)
Gaze Palsy
Horizontal Gaze Palsy (Figures 13.149 to 13.151)
Down Gaze Palsy
Up Gaze Palsy
Dorsal Midbrain Syndrome (Parinaud Syndrome)
Oculogyric Crisis
Skew Deviation (Figures 13.146 to 13.152)
Wernicke's Encephalopathy
Clinical Features
Convergence Insufficiency
Myasthenia Gravis (Figures 13.153 to13.155)
Clinical Features
Investigations
Differential Diagnosis
Management
Tensilon Test (Edrophonium Test)
Physostigmine Test
Myasthenic Crisis
Cholinergic Crisis
Myotonic Dystrophy (Figures 13.156A to E)
Ocular Features
Systemic Features (Figures 13.156A to E)
Chronic Progressive External Ophthalmoplegia
Clinical Features
Muscle Biopsy
Differential Diagnosis
Diagnostic Tests
Refsum's Disease
Abetalipoproteinemia
MELAS
Progressive Supranuclear Palsy (Steele-Richardson Olszewski syndrome) (Figures 13.158 A to J)
Criteria
Clinical Features
Ocular
Neurological
Management
Congenital Fibrosis of the Extraocular Muscles (CFEOM)
History
Clinical Features (Figures 13.159A to C)
Ocular Associations
Workup
Differential Diagnosis
Management
Strabismus in Other Neurological Disorders
Dorsal Midbrain Syndrome (Parinaud Syndrome)
Causes
Clinical Findings
ORBITAL CAUSE OF STRABISMUS
Blowout Fracture (Inferior Rectus Entrapment)
Introduction
History
Examination and Workup
Management
Investigations
Causes of Limitation
Orbital Floor Fracture Repair
Indications
Complications
Strabismus Management
Orbital Tumors
Glioma (Figures 13.165A and B)
Meningioma (Figures 13.166A to C)
Post-surgery for Orbital Tumor
Postorbitotomy—Inferior Rectus Weakness i
Strabismus in Craniosynostosis
Craniosynostosis
Clinical Features
Workup
Management
MISCELLANEOUS
Lost Muscle/Slipped Muscle (Figures 13.175 and 13.176)
History
Lost Muscle
Slipped Muscle
Clinical Features
Prevention/Precautions
Imaging
Management
Surgery
Lost Inferior Rectus
Re-Surgeries (Figures 13.177A to E)
Squints Requiring Reoperations
Evaluation
History—Prior Surgery
Clinical Evaluation
On the Table
Abnormal Angle Kappa
Complications of Strabismus Surgery (Figures 13.179A to C)
Complications
Anti-elevation Syndrome
Clinical Findings (Figure 13.180)
Mechanism and Risk Factors
SECTION 5: ORBIT AND PEDIATRIC OCULAR ONCOLOGY
CHAPTER 14:
Pediatric Orbital Disorders
INTRODUCTION
PROPTOSIS EVALUATION
History
CLINICAL EXAMINATION
Requirements
Technique of Examination
Measurement of Proptosis
Palpation
Auscultation
Ocular Motility
Intraocular Pressure Assessment
Corneal Sensation
Facial Sensation
Dilated Fundus Examination
ENT Examination
Examine the Neck
Do a Systemic Examination
Record and Document Vital Signs
BENIGN ORBITAL TUMORS
Dermoid (Figures 14.16A to E)
Epidermoid Cysts
Lipodermoids
Lymphangioma
Presentation
Symptoms
Signs
Imaging
Management
Orbital Venous Malformation
Imaging
Cavernous Hemangioma
Symptoms
Signs
Management
Optic Nerve Tumor
Optic Nerve Glioma
Presentation
Neurofibromatosis and Optic Nerve Glioma
Signs and Symptoms
Follow-up
Imaging
Treatment
TRAUMATIC PROPTOSIS
Retrobulbar Hemorrhage
Presentation
Symptoms
Signs
Differential Diagnosis
Management
Follow-up
INFECTION AND INFLAMMATION
Orbital Cellulitis
Presentation
Etiology
Symptoms
Signs
Workup
Management
Parasitic Infection
Idiopathic Orbital Inflammation (Pseudotumor of Orbit)
Definition
Presentation
Symptoms
Signs
Workup
Imaging
Treatment
CONGENITAL LESIONS
SYSTEMIC DISORDERS
Dysthyroid Ophthalmopathy
Craniosynostosis
MALIGNANT TUMORS
Leukemia (Figures 14.37 to 14.39)
Proptosis
Rhabdomyosarcoma
Presentation
Classification
Symptoms
Signs
Imaging
Workup
Differential Diagnosis
Management
INTRAOCULAR TUMOR PRESENTING AS PROPTOSIS
SINUS DISEASE PRESENTING AS PROPTOSIS
NASOPHARYNGEAL TUMORS
INTRACRANIAL LESIONS PRESENTING AS PROPTOSIS
SYSTEMIC MALIGNANCY PRESENTING AS PROPTOSIS
Metastatic Neuroblastoma
Presentation
Symptoms
Signs
Metastasis
Workup
Orbital Procedures and Surgery for the Pediatric Ophthalmologist
Dermoid Surgery
RARE CAUSES OF PROPTOSIS AND ORBITAL TUMORS IN CHILDREN
Congenital Teratoma of the Orbit
Aneurysmal Bone Cyst
Introduction
Presentation
Pathology
Imaging
Management
Fibrous Dysplasia of Orbit
Introduction
Presentation
Symptoms and Signs
Complications
Systemic Associations
Diagnosis
Differential Diagnosis
Management
Ossifying Fibroma
Ewing's Sarcoma
Introduction
Presentation
Imaging
Pathology
Management
CHAPTER 15:
Pediatric Ocular Oncology: Retinoblastoma and Leukemia
INTRODUCTION
ROLE OF PEDIATRIC OPHTHALMOLOGIST
CLINICAL PRESENTATIONS
Symptoms
Signs
Atypical Presentations
LEUKOCORIA
History
Examination
Investigations
Leukocoria: Differential Diagnosis
INTERNATIONAL INTRAOCULAR RETINOBLASTOMA CLASSIFICATION
INTERNATIONAL STAGING OF RETINOBLASTOMA (Figures 15.7A TO E)
13Q DELETION SYNDROME
MANAGEMENT
Chemotherapy
Indications
Intraocular Retinoblastoma
Vitreous Seeds
Chemotherapy Protocols
Investigations Prior to Commencing Chemotherapy
Side Effects of Chemotherapy
B-scan
Management of Intraocular Relapses Following Prior Treatment with Standard First-Line Chemotherapy
PERIOCULAR CHEMOTHERAPY
Indications
Technique
Dose
Advantages
Side Effects and Complications
Alternatives
INTRA-ARTERIAL CHEMOTHERAPY (Figures 15.11A TO E)
Indications
Primary
Secondary
Technique
Advantages
Disadvantages and Complications
CRYOTHERAPY
Indications
Technique
First Treatment
Second Treatment
Limitations
LASER PHOTOCOAGULATION
Transpupillary Thermotherapy
Limitations
BRACHYTHERAPY (PLAQUE RADIOTHERAPY)
Indications
Primary Treatment Modality
Secondary Treatment Option
Types of Plaque
Dosage
Placement of the Plaque
Advantages of Plaque
Disadvantages
ENUCLEATION
Indication
Important Points to be Considered Prior Enucleation
Practical Tips
Technique
Important Differences Between Enucleation for Retinoblastoma and other Clinical Indications
The Following Findings should be Noted and Documented During Enucleation
Orbital Implants
Materials
Advantages of Implants
Contraindications
Complications
Artificial Eye (Figures 15.15A To K,15.16A and B)
DERMIS FAT GRAFT (FIGURES 15.18A TO F)
Indications
Contraindications
Complications
EXTERNAL BEAM RADIOTHERAPY
Indications
SCHIPPER TECHNIQUE
Whole Eye
Risks
Side Effects of Treatment
Other Primary Tumor Formation
OTHER NEW TECHNOLOGIES
Proton Beam Radiation Therapy
Conformal Radiation
PATHOLOGY OF RETINOBLASTOMA
Examination of Enucleation Specimens for Retinoblastoma (Figures 15.19 to 15.26)
Molecular Genetic Studies
Risk of Metastasis
Prognostic Indicators
Optic Nerve Involvement
Flexner-Wintersteiner Rosettes
Homer-Wright Rosettes
Fleurettes
Retinocytoma
Histopathology of Conditions that Clinically Mimic Retinoblastoma
GENETICS OF RETINOBLASTOMA
The Retinoblastoma Gene
Importance of Genetic Testing
Algorithm
Unilateral
Bilateral
RISK ASSESSMENT
Sporadic Somatic
13q Deletion
Bilateral/Hereditary
FOLLOW-UP PROTOCOLS WHERE GENETIC TESTING IS CURRENTLY NOT AVAILABLE
INTRODUCTION
CLASSIFICATION
OPHTHALMOLOGICAL MANIFESTATIONS
Anterior Segment
Orbit Involvement
Posterior Segment Involvement
Retina
Vascular
Choroid
Optic Nerve Involvement
Systemic Manifestations
Practical Pearls
ACKNOWLEDGMENT
SECTION 6: NEURO-OPHTHALMOLOGY
CHAPTER 16:
Neuro- Ophthalmology (Pediatric and Adult)
PUPIL EXAMINATION
Requirements
Technique
Swinging Flash Light Test
Testing for Relative Afferent Pupillary Defect
Total Afferent Pupil Defect
Relative and Total Afferent Pupil Defect
Light Near Dissociation
Argyll Robertson Pupil
Tonic Pupil
Special Techniques
Special Situations
Horner Syndrome
Oculomotor Nerve Palsy
Pupil Gaze Dyskinesis
Uveitis
Pupil Response in the Presence of Posterior Synechiae
Paradoxical Pupil Response
Technique of Examining the Fundus in Undilated Pupil
Anisocoria
CORNEAL SENSATION
Requirements
Practical Tips
CONFRONTATION FIELDS (FIGURES 16.15 TO 16.16A AND B)
Some Clues from History
Importance of Confrontation Visual Fields
Test Requirements
Procedure
Color Desaturation Test
Blind Spot
Periphery Testing
Normal Values (TINS)
Homonymous Hemianopia/Quadrantic Field Defects
Bitemporal Hemianopia
Optic Tract Lesion
OKN Tape in Detecting the OKN Response in a Patient with Field Defect (Figures 16.17A and B and 16.18A and B)
Effect of Strabismus Surgery on Visual Fields (Figures 16.19A to C to 16.22A and B)
NEUROLOGICAL EXAMINATION
Higher Functions
Pupil
Corneal Sensation and Cranial Nerves
Motor System
Sensory System
Cerebellar System
Gait
Vital signs:
Auscultation
Testing the Integrity of the Neurological System (Different Areas)
Lobe Functions and Symptoms During Malfunction
Diagnosis
Anatomical
Pathological and Etiological
Radiological (Discussed in Some of the Following Chapters)
Pupil
Field Defects: Significance in Localization
Fields
Cranial Nerves
Level of Involvement
CONGENITAL OPTIC DISC ANOMALIES
Retinochoroidal Coloboma
Dysplastic Disc
Optic Disc Pit
Coloboma of the Optic Disc
Morning Glory Disc
Peripapillary Staphyloma
Papillorenal Syndrome (Vacant Disc Syndrome)
Optic Disc Drusen
Pseudodrusen
Myelinated Nerve Fibers
Bergmeister's Papilla
Optic Nerve Hypoplasia
History
Examination
De Morsier Syndrome: (Septo-Optic Dysplasia)
Megalopapilla
Tilted Disc Syndrome (Fuchs’ Coloboma)
Situs Inversus
The Disc in Albinism
Disc in Myopia
Dragged Disc (Falciform Fold of the Retina)
Disc in Down Syndrome
Vascular Anomalies
Congenital Vascular Tortuosity
Cilioretinal Artery
Tumors
Astrocytic Hamartoma
Retinoblastoma
Capillary Hemangioma of the Optic Disc
Cavernous Hemangioma
Combined Hamartoma of the Retina and Retinal Pigment Epithelium
Melanocytoma of the Optic Nerve Head
Choroidal Osteoma
Angioid Streaks
PAPILLEDEMA
Symptoms
Causes of Increased ICT
Fundus Signs
Mechanical Signs
Vascular Signs
Stages of Papilledema
Workup
Differential Diagnosis
Causes of Pseudopapilledema
Unilateral Papilledema
Management
PAPILLEDEMA IN CHILDREN
Evaluation
History (Conditions that Need to be Considered are Given in Parenthesis)
Examination
Rule Out Pseudopapilledema (Table 16.3)
Ocular Examination
Examination
Special Points to Remember
Pseudotumor Cerebri
Management
INTRACRANIAL TUMORS
Introduction
Frontal Lobe
Parietal Lobe
Temporal Lobe
Occipital Lobe
Meningioma
Olfactory Groove Meningioma
Origin of Tumor
Types Based on Location (Figures 16.56A to D)
Symptoms
Signs
Field Defect
Localizing Value of Ocular Symptoms
Imaging
Management
Prognosis
Recurrence
Sphenoid Wing Meningioma
Origin of Tumor
Location
Symptoms
Clinoid Type
Symptoms
Signs
Fundus
Field Defect
En Plaque Meningioma
Symptoms
Signs
Localizing Value of Ocular Symptoms
Imaging
Management
Prognosis
Recurrence
Parasagittal Meningiomas
Origin of Tumor
Location
Symptoms
Signs
Fundus
Field Defect
Localizing Value of Ocular Symptoms
Imaging (Figures 16.59A to F)
Management
Prognosis
Recurrence
Suprasellar Mass
Endocrinology Symptoms
Skin Lesions
Gliomas
Craniopharyngioma
Suprasellar Germinoma
Pituitary Adenoma
Meningioma
Langerhans Cell Histiocytosis
Compressive Aneurysms and Suprasellar Arachnoid Cysts
Pituitary Tumors
Origin of Tumor
Location
Types (CAB)
Symptoms
Signs
Fundus
Systemic
Localizing Value of Ocular Symptoms
Imaging (Figure 16.63A to C)
Management
Prognosis
Recurrence
The Pituitary Tumor in Women
Craniopharyngioma
Origin of Tumor
Location
Children
Adults
Field Defect
Localizing Value of Ocular Symptoms
Imaging
Management
Prognosis
Recurrence
Cavernous Sinus Tumors
Origin of Tumor
Location
Causes
Symptoms
Signs
Fundus
Field Defect
Localizing Value of Ocular Symptoms
Imaging
Management
Prognosis
Recurrence
Cerebellar Tumors
Origin of Tumor
Types
Symptoms
Signs
Fundus
Field Defect
Imaging (Figures 16.68A to C)
Management
Prognosis
Cerebellopontine Angle Tumors
Origin of Tumor
Causes
Symptoms
Signs
Fundus
Field Defect
Localizing Value of Ocular Symptoms
Imaging
Management
Prognosis
Recurrence
Midbrain and Pineal Gland Tumors
Origin of Tumor
Location
Symptoms
Signs
Fundus
Field Defect
Localizing Value of Ocular Symptoms
Management
Pontine Tumors
Causes
Location
Symptoms
Signs
Fundus
Field Defect
Localizing Value of Ocular Symptoms
Prognosis and Recurrence
Imaging (Figures 16.78A to D)
Management
Prognosis
Tumors of the Third Ventricle
Origin of Tumor
Location
Symptoms
Signs
Fundus
Field Defect
Localizing Value of Ocular Symptoms
Imaging (Figures 16.79 and 16.80)
Management
Prognosis and Recurrence
Tumors of the Ventricle System
Choroid Plexus Papilloma
Management
Prognosis
Recurrence
Intraocular Tumor Presenting with Intracranial Manifestation/Extension
Tumors Arising from Olfactory Tract
Central Nervous System Lymphoma
Origin of Tumor
Location
Symptoms
Signs
Fundus
Field Defect
Localizing Value of Ocular Symptoms
Management
Prognosis
Recurrence
Multiple Intracranial Tumors
Optociliary Shunt Vessels
DISC EDEMA DIFFERNTIAL DIAGNOSIS
HYDROCEPHALUS
Types
Causes of Hydrocephalus
History
Macrocephaly
Examination
Investigations
Follow-up
Practical Tips
OPTIC NEURITIS
Symptoms
Signs
Workup
Typical Optic Neuritis/Atypical Optic Neuritis
Atypical Optic Neuritis
Multiple Sclerosis
High-Risk Factors for Multiple Sclerosis
Features of Multiple Sclerosis
Devic's Disease (Neuromyelitis Optica)
Summary of Findings of the Optic Neuritis Treatment Trial
Treatment
NEURORETINITIS
Symptoms
Signs
Workup
Management
ANTERIOR ISCHEMIC OPTIC NEUROPATHY
Decision Making
NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY
Symptoms
Signs
Risk Factors
Systemic
Ocular (Disc at Risk)
Differential Diagnosis
Optic Neuritis
Arteritic Anterior Ischemic Optic Neuropathy
Atypical Features (Suspect Other Causes)
Workup
Management
Practical Tips
ARNTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY—GIANT CELL ARTERITIS
Presentation
History
Symptoms
Signs
Workup
Management
Practical Pearls
DISC PALLOR
Decisions to Arrive
History
Examination
Hereditary Optic Atrophy
Autosomal Dominant Pattern
Autosomal Recessive Pattern
Mitochondrial
Management
LEBER'S HEREDITARY OPTIC NEUROPATHY, NUTRITIONAL, TOXIC, COMPRESSIVE AND INFILTRATIVE OPTIC NEUROPATHY
Leber's Hereditary Optic Neuropathy
Signs
Treatment
Nutritional and Toxic
Signs
Treatment
Compressive Optic Neuropathy
Signs
Causes
Treatment
Infiltrative Optic Neuropathy
Symptoms
Causes
Workup
TRAUMATIC OPTIC NEUROPATHY
History
Symptoms
Signs
Workup
Management
Practical Points
OCULAR FINDINGS OF HEAD INJURY
OCULAR FINDINGS IN A COMATOSE PATIENT
NYSTAGMUS
History
Examination
Workup
Neurological Nystagmus
Practical Clinical Points
Typical Congenital Nystagmus
Periodic Alternating Nystagmus
Dissociated Nystagmus
Seesaw Nystagmus
Upbeat Nystagmus
Downbeat Nystagmus
Features of Nystagmus
Workup
Convergence Retraction Nystagmus
Superior Oblique Myokymia
Management
Typical Congenital Nystagmus
Surgery
Nystagmus with Adapted Head Posture
Surgery Guidelines
No Face Turn and No Strabismus, Only Nystagmus
Nystagmus with Esotropia
Management
Nystagmus Blockage Syndrome
Nystagmus with Esotropia and Face Turn
Face Turn is Ipsilateral to the Fixating Eye
Face Turn is Ipsilateral to the Deviating Eye
Face Turn, Nystagmus and Exotropia
Face Turn Ipsilateral to Deviating Eye
Face Turn Ipsilateral to the Fixating Eye
Neurological
Sensory Nystagmus
Albinism
Blue Cone Monochromatism
Cataract
HEADACHE IN CHILDREN
Important Decision Making
History
Headache
Associated Complains
Examination
Referrals
Vision-threatening
Life-threatening
THE NEUROLOGICALLY IMPAIRED CHILD
Causes
Decision Making
Workup
History
Examination
Management
Cerebral Palsy
Causes and Risk Factors
Symptoms and Signs
Cortical Visual Impairment
Periventricular Leukomalacia
Risk Factors
Mechanism
Clinical Findings
Diagnosis
Delayed Visual Maturation
Metabolic Encephalopathy
MALINGERING AND HYSTERIA
Symptoms
Tests for Malingering
Visual Acuity
Tests Involving Binocularity
Tests Based on Use of Complementary Colors
Pupil Reaction
Optokinetic Nystagmus
Other Methods
Menace Reflex
Mirror Test
Magic Drops
Observation of the Patient
Workup
Conditions that could be Misdiagnosed as Malingering
Practical Pearls
FACIAL NERVE PALSY
Symptoms
Signs
Decision Making
Workup
Imaging
Referrals
Treatment (Also Referred Under Lagophthalmos)
ESSENTIAL BLEPHAROSPASM AND HEMIFACIAL SPASM
Benign Essential Blepharospasm
Presentation
Symptoms
Triggering Factors
Relieving/Reducing Factors
Signs
Differential Diagnosis
Management
Hemifacial Spasm
Meige's Syndrome
BOTULINUM TOXIN
Properties
Mechanism of Action
Indications in Ophthalmology
Strabismus
Indications in Neuro-Ophthalmology
Cosmetic
Contraindications
Complications
Toxin
Technique
Dosage
TEMPORAL ARTERY BIOPSY
Indications
Biopsy
Technique
Complications
Biopsy Findings
OPTIC NERVE SHEATH FENESTRATION/OPTIC NERVE SHEATH DECOMPRESSION
Pseudotumor Cerebri (Figures 16.129A to F)
Medical Management
Surgical Management
Indications
Contraindications
Complications
SECTION 7: RADIOLOGY
CHAPTER 17:
Radiology for the Ophthalmologist
INTRODUCTION
INDICATIONS FOR IMAGING
When to Image?
Pediatric Ophthalmology
Neuro-Ophthalmology
Strabismus and Ocular Motility
What to Image?
What Modality of Imaging to Order?
What to Tell the Radiologist?
What to Ask the Radiologist?
Can this Patient Afford for the Imaging Modality?
What to Tell the Patient?
APPROACH TO CT SCAN OF ORBIT
Common Things to Know About a CT Scan
Scan Orientation
Scout Film
Slice Thickness and Interslice Gap
Imaging Plane
Contrast Medium
Tissue Window
Points for Evaluating an Orbital Scan
Bones
Soft Tissues
Some Points for MRI
NORMAL IMAGING
Computed Tomography
Orbital Imaging
Magnetic Resonance Imaging
Brain Imaging
CAVERNOUS HEMANGIOMA
LYMPHANGIOMA
RHABDOMYOSARCOMA
RETINOBLASTOMA
ORBITAL LYMPHOMA
ORBITAL CELLULITIS
ORBITAL CYSTICERCOSIS
OPTIC NEURITIS
DYSTHYROID OPHTHALMOPATHY
IDIOPATHIC ORBITAL INFLAMMATION
BLOWOUT FRACTURE
OPTIC DISC DRUSEN
INTRAOCULAR FOREIGN BODY
CONGENITAL MALFORMATIONS OF THE BRAIN
CENTRAL NERVOUS SYSTEM INFECTIONS AND SEQUEL OF INFECTIONS
HYPOXIA
HYPOGLYCEMIA
CAVERNOUS ANGIOMA
BASILAR ARTERY ANEURYSM
INTERNAL CAROTID ARTERY ANEURYSM
SUBARACHNOID HEMORRHAGE
CAROTID CAVERNOUS FISTULA
CRANIOSYNOSTOSIS
SUMMARY FOR INTERPRETATION
Some Practical Tips in Competitive Examinations
Some Practical Tips in Clinical Setting
SECTION 8: THE EYE IN SYSTEMIC DISORDERS
CHAPTER 18:
Systemic Disorders
INTRODUCTION
EYE AND SKIN DISORDERS
Introduction
Classification of Skin Diseases
Oculocutaneous Albinism (Figures 18.1A to H)
Ocular Features
Systemic Features
Clinical Practical Points
Xeroderma Pigmentosa
Ocular Manifestations
Dermatologic Manifestations
Systemic Manifestations (Less Common and Less Specific)
Practical Points
Organoid Nevus Syndrome and Nevus of Jadassohn
Ocular Features
Systemic Features
Incontinentia Pigmenti
Ocular Features
Cutaneous Features
Neurological
Dental Anomalies
Developmental Abnormalities
Sturge-Weber Syndrome
Ocular Findings (Figures 18.5A to E)
Systemic Findings
Clinical Tips
Nevus of Ota (Oculodermal Melanocytosis)
Tuberous Sclerosis (EPILOIA) Bourneville Disease
Ocular Features
Systemic Features
Genetics
Special Clinical Tips
Neurofibromatosis
Diagnostic Criteria
Ocular Findings
Systemic Findings
Genetics
Varicella
Herpes-Zoster Ophthalmicus
Steven-Johnson Syndrome (Erythema Multiforme Major)
Ocular Features (Figures 18.11 and 18.12)
Systemic Features
Practical Points
Ocular
Staphylococcal Impetigo
Ophthalmological Findings
Dermatological Features
Practical Point
Vitiligo
Ocular Conditions
Human Papilloma Virus
Hypohidrotic/Anhidrotic Ectodermal Dysplasia
Ocular Manifestations
Systemic Manifestations
Management
Nance-Horan Syndrome
Facial Features (Figure 18.17A)
Ocular Findings
Systemic Findings
Congenital Syphilis
Facial Features (Figure 18.18A)
Systemic Features
Ocular Features
Dermatological
Practical Points
Ocular Side Effects of Treatment for Skin Diseases
EYE FINDINGS IN METABOLIC DISORDERS
Introduction
Suspecting a Metabolic Disorder
Mucopolysaccharidosis
Types
Clinical Features
Systemic Features
Practical Points
Management
Fabry Disease
Sphingolipidoses
Ophthalmological Manifestations
Systemic Manifestations
Renal
Cardiac
Central Nervous System
Practical Point
Gaucher's Disease
Types
Ophthalmological Features
Systemic Features
Management
Practical Clinical Tips
Tay-Sachs Disease
Ophthalmological Features
Systemic Features
Practical Pearls
Other Causes of Cherry-Red Spot
X-linked Adrenoleukodystrophy and Schilder's Disease
Systemic Features
Ocular Features
Wilson's Disease
Ocular Features
Systemic Features
Practical Points
Niemann-Pick Disease
Types
Ophthalmological Features
Systemic Features
Practical Points
Leigh's Disease
Ophthalmological Features
Systemic Features
Neuronal Ceroid Lipofuscinosis
Types
Ophthalmological Manifestations
Systemic Manifestations
Adult Neuronal Ceroid Lipofuscinosis (Kufs Disease)
Mitochondrial Myopathy Kearn-Sayre Syndrome
SYNDROMES
Introduction
Down Syndrome (Figures 18.30A to J)
Ocular Manifestations
Systemic Manifestations
Clinical Pearls
Treacher Collins Syndrome (Mandibulofacial Dysostosis)
Ophthalmological Features
Facial Features (Figures 18.31A and B)
Systemic Features
Turner Syndrome
Ocular Findings
Systemic Findings
Clinical Points
Parry-Romberg Syndrome (Progressive Hemifacial Atrophy)
Ophthalmological Features
Systemic Features
Clinical Pearls
Hemifacial Microsomia (Oculo-Auriculo-Vertebral Spectrum)
Ophthalmological Features
Systemic Features
Wildervanck Syndrome (Cervico-Oculo-Acoustic Syndrome)
Facial Features
Ophthalmological Features
Systemic Features
Practical Pearls
Möbius Syndrome
Possible Etiologies
Ophthalmological Features
Systemic Features
Waardenburg Syndrome (Figures 18.37A to E)
Ophthalmological Features
Facial Features
Systemic Features
Diagnostic Criteria
CHARGE Syndrome
Diagnostic Criteria
Ophthalmological Features
Systemic Features
Minor Criteria
Other Findings
Fraser Syndrome
Ophthalmological Features (Figure 18.39A)
Systemic Features
Practical Clinical Pearls
Branchio-Oculo-Facial Syndrome
Ophthalmological Features (Figure 18.40A)
Systemic Features
Practical Pearls
Branchio-Oto-Renal Syndrome(Melnick Fraser Syndrome)
Facial Features
Ophthalmological Findings
Systemic Findings
Other Abnormalities
THE EYE IN ENDOCRINOLOGICAL DISORDERS
Introduction
Hypothyroidism
Congenital Hypothyroidism
Systemic Findings
Investigations
Treatment
Hyperthyroidism
Ocular Findings
Investigations
Treatment
Pituitary Abnormalities
Ocular Findings
Systemic Findings
Evaluation
Treatment
Nelson Syndrome
Wolfram Syndrome (DIDMOAD Syndrome)
Adrenal Diseases: Pheochromocytoma
Ten Percent Tumor
Clinical Presentation
Investigation
Ocular Findings
Treatment
Cushing's Syndrome/Iatrogenic Cushing's Syndrome
Systemic Features
Ocular Features
Addison's Disease
Ocular Findings
Systemic Findings
Multiple Endocrine Neoplasia Syndrome
Multiple Endocrine Neoplasia Type 1
Multiple Endocrine Neoplasia Type 2A
Multiple Endocrine Neoplasia Type 2B
Diabetes Mellitus
Obesity
Pinealoma (Melatonin)
Parathyroid Disorders
Hyperparathyroidism
Hypoparathyroidism
Thymus
EYE FINDINGS IN RENAL DISEASE
Introduction
Renal Lesions and Eye Disease
General Ocular Features of Renal Failure or Renal Disease
Eye Findings that need to be Looked for, Based on Specific Renal Diagnosis
Urine Tests Used to Diagnose Ophthalmological Conditions
Properties
Clinical Conditions
Drugs to be used with Caution/Contra-indicated in Renal Impairment
THE EYE IN CARDIAC DISEASES
Introduction
The Oculo-Cardiac Connection
Some Ocular Findings Associated/Related with Cardiac Abnormalities
Strabismus
Cornea
Lens and Cataract
Pupil
Horner Syndrome
Retinal Dystrophy
Glaucoma
Specific Cardiac Abnormality and Ocular Conditions to Look for
Valvular Lesions
Septal Defects
Major Blood Vessels
Cardiomyopathy
Infective Endocarditis
Arrhythmias
Cardiac Tumors
Some Syndromes with Cardiac Abnormalities
Medications
Congenital Rubella Syndrome
Ophthalmological Features
Systemic Features
Postnatal Rubella
Practical Clinical Points
RESPIRATORY SYSTEM
Introduction
THE EYE IN GASTROINTESTINAL DISORDERS
Blindness and Deafness (Eye and Ear)
Introduction
Infection
Retinal Dystrophy
Syndromes
Metabolic Disorders
CRANIOSYNOSTOSIS
Introduction
Clinical Types
Crouzon Syndrome
Ocular Manifestations
Systemic Features
Apert Syndrome
Ocular Manifestations
Ocular Associations
Systemic Features
APPENDICES:
APPENDIX I:
Protocols for Cross Referral in Pediatric Eye Care Followed at Lumbini Eye Institute
INTRODUCTION
GUIDELINES FOR CROSS REFERRAL
PEDIATRIC OCULOPLASTY
Guidelines for Cross Referral
Palpebral Fissure Anomalies
Congenital Ptosis
Ectropion and Entropion
Epiblepharon
Epicanthus and Telecanthus
Lid Coloboma
Lagophthalmos
Lid Tumors
Pediatric Lacrimal Disorders
Congenital Nasolacrimal Duct Obstruction
Pediatric Oculoplasty and Orbital Trauma
Lid Tear
Blowout Fracture
Preseptal Cellulitis
Orbital Cellulitis
Pediatric Proptosis
Enucleation
Evisceration
Dysthyroid Ophthalmopathy
PEDIATRIC CORNEAL DISORDERS
Introduction
Guidelines for Cross Referral
Pediatric Corneal Trauma
Infection
Congenital Corneal Disorders
Degenerations and Dystrophies
Ocular Surface Disorders
Contact Lens Evaluation
Surgeries
Ocular Surface Growths
GUIDELINES FOR CROSS REFERRAL BETWEEN GLAUCOMA DEPARTMENT AND PEDIATRIC EYE CARE DEPARTMENT
Clinical Evaluation
Intervention
PEDIATRIC EYE CARE DEPARTMENT AND VITREORETINA DEPARTMENT
Guidelines for Cross Referral
Myopia
Trauma
Heredity Retinal Dystrophies
Retinal Detachment
Retinochoroidal Coloboma
Retinoblastoma
Retinopathy of Prematurity
Postoperative
Second Opinion
Interventions
Examination Under Anesthesia
Follow-up Patients
GUIDELINES FOR CROSS REFERRAL IN UVEA DEPARTMENT
Clinical Evaluation
Interventions
Investigations
GUIDELINES FOR REFERRAL BETWEEN GENERAL OPHTHALMOLOGY, STRABISMUS AND NEURO-OPHTHALMOLOGY
Guidelines for Referral
APPENDIX II:
Scope of Work and Career Opportunities for the Pediatric Ophthalmologist
APPENDIX III:
Pediatric Antibiotic Doses
AMOXICILLIN
ERYTHROMYCIN
AZITHROMYCIN
CEFTRIAXONE
GENTAMICIN
CEFOTAXIME
VANCOMYCIN
METRONIDAZOLE
MEBENDAZOLE
ACYCLOVIR
ITRACONAZOLE
AMPHOTERICIN B
ACETAZOLAMIDE
APPENDIX IV:
Fortified Antibiotics
FORTIFIED GENTAMICIN/TOBRAMYCIN
FORTIFIED CEFAZOLIN
FORTIFIED VANCOMYCIN
APPENDIX V:
Intravitreal Antibiotics
AMIKACIN
VANCOMYCIN
APPENDIX VI:
Suggested Reading and Internet Resources
CHAPTER 1: HISTORY TAKING AND PEDIATRIC EYE EXAMINATION
CHAPTER 2: PEDIATRIC OCULOPLASTY AND LACRIMAL DISORDERS
CHAPTER 3: PEDIATRIC CORNEAL DISORDERS
CHAPTER 4: IRIS AND ANTERIOR CHAMBER ABNORMALITIES
CHAPTER 5: PEDIATRIC CATARACTS AND LENS ABNORMALITIES
CHAPTER 6: PEDIATRIC GLAUCOMA
CHAPTER 7: PEDIATRIC RETINAL DISORDERS AND UVEITIS
CHAPTER 8: RETINOPATHY OF PREMATURITY
CHAPTER 9: PEDIATRIC OCULAR TRAUMA
CHAPTER 10: ULTRASONOGRAPHY IN CHILDREN
CHAPTER 11: VISUAL ACUITY ASSESSMENT AND AMBLYOPIA MANAGEMENT
CHAPTER 12: PEDIATRIC REFRACTIVE ERRORS, CONTACT LENS AND LOW-VISION REHABILITATION
CHAPTER 13: STRABISMUS
CHAPTER 14: PEDIATRIC ORBITAL DISORDERS
CHAPTER 15: PEDIATRIC OCULAR ONCOLOGY: RETINOBLASTOMA AND LEUKEMIA
CHAPTER 16: NEURO-OPHTHALMOLOGY (PEDIATRIC AND ADULT)
CHAPTER 17: RADIOLOGY FOR THE OPHTHALMOLOGIST
CHAPTER 18: SYSTEMIC DISORDERS
PEDIATRIC OPHTHALMOLOGY
COLOR ATLAS
GENERAL TOPICS
SOME USEFUL WEBSITES
INDEX
TOC
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