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Book Details
Abstract
Pediatric Ophthalmology and Strabismus is your one-stop source for comprehensive coverage of all the pediatric ophthalmic conditions you are likely to encounter in practice. Extensively updated with expert contributions from leaders in the field and now featuring online instructional videos, this ophthalmology reference delivers all the state-of-the-art guidance you need to effectively diagnose and manage even the most challenging eye diseases and disorders seen in children.
- Take a holistic approach to patient management that considers the family and ensures optimal doctor-patient relationships.
- Get a balanced view of etiology, diagnosis, and management, and access unique guidance on the practical problems encountered in real-life clinical cases.
- Impresses the importance of systemic disease in diagnosis and management.
- Apply all the latest clinical advances through updated coverage of strabismus diagnosis, management and complications; retinal dystrophies; imaging & investigation; AIDS in children; developmental biology; cerebral visual impairment; child abuse; severe developmental glaucoma; and corneal dystrophies.
- Get rich visual guidance in diagnosis and management from over 1,700 full-color illustrations.
- Access advice from the experts with contributions from several new top researchers and clinicians.
- Find the answers you need quickly and easily through a consistent chapter organization and highly accessible clinical information.
- Browse the complete contents of Pediatric Ophthalmology and Strabismus online, download all the images, and watch brand-new procedural videos at www.expertconsult.com.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Pediatric Ophthalmology and Strabismus | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Video contents | viii | ||
| Foreword | x | ||
| Preface | xii | ||
| List of Contributors | xiv | ||
| 1 Epidemiology, growth and development | 1 | ||
| 1 Epidemiology and the world-wide impact of visual impairment in children | 1 | ||
| Chapter contents | 1 | ||
| Specific issues in the epidemiological study of visual impairment in childhood | 1 | ||
| Framing the question | 2 | ||
| Who is a visually impaired child? | 2 | ||
| Measuring the frequency and burden of childhood visual impairment | 2 | ||
| Sources of information on frequency and causes of visual impairment | 3 | ||
| Impact of visual impairment | 3 | ||
| Visual impairment in the broader context of childhood disability | 4 | ||
| Multiple impairments | 4 | ||
| Mortality | 4 | ||
| Groups at high risk of visual impairment | 4 | ||
| Frequency of childhood visual impairment and blindness | 4 | ||
| Prevalence | 4 | ||
| Incidence | 5 | ||
| “Causes” of visual impairment | 5 | ||
| Variation by region and over time | 5 | ||
| Other sources of variations in the pattern of causes | 6 | ||
| Prevention of visual impairment and blindness in childhood: “VISION 2020” | 7 | ||
| The role of ophthalmic professionals in prevention of childhood visual impairment | 8 | ||
| Selected further reading | 8 | ||
| References | 8 | ||
| 2 Clinical embryology and development of the eye | 9 | ||
| Chapter contents | 9 | ||
| Embryogenesis and eye development | 9 | ||
| Eye organogenesis (4th–8th week gestation human) | 9 | ||
| Fourth week | 9 | ||
| Fifth week | 9 | ||
| Sixth week | 10 | ||
| Seventh week | 10 | ||
| Eighth week | 10 | ||
| Differentiation and maturation of elements | 10 | ||
| Cornea | 10 | ||
| Anterior chamber structures | 12 | ||
| Iris | 12 | ||
| Ciliary body | 12 | ||
| Trabecular meshwork | 12 | ||
| Pupillary membrane | 12 | ||
| Lens | 13 | ||
| Vitreous and hyaloid system | 13 | ||
| Retina | 13 | ||
| Optic nerve | 14 | ||
| Extraocular muscles | 14 | ||
| Lacrimal system | 14 | ||
| Cranial nerves | 14 | ||
| Emmetropization | 15 | ||
| References | 15 | ||
| References | 15.e1 | ||
| 3 Developmental biology of the eye | 16 | ||
| Chapter contents | 16 | ||
| Introduction | 16 | ||
| Important concepts and processes in developmental biology | 16 | ||
| Differentiation | 16 | ||
| Cell migration | 16 | ||
| Programmed cell death | 17 | ||
| Signaling | 17 | ||
| Transcription factor codes | 17 | ||
| Specific developmental events in eye development | 17 | ||
| The eye field and the preplacodal region | 17 | ||
| The optic vesicle and optic stalk | 19 | ||
| Patterning of neural retina in the optic vesicle | 20 | ||
| Involvement and development of the RPE | 20 | ||
| Lens development | 21 | ||
| Differentiation of the neural retina | 21 | ||
| Closure of the optic fissure | 21 | ||
| Cornea and anterior segment development | 21 | ||
| Summary | 22 | ||
| References | 22 | ||
| 4 Normal and abnormal visual development | 23 | ||
| Chapter contents | 23 | ||
| Introduction | 23 | ||
| Visual acuity | 23 | ||
| Contrast sensitivity | 25 | ||
| Vernier acuity and stereoacuity | 25 | ||
| Vernier acuity | 25 | ||
| Stereoacuity | 26 | ||
| Dark adapted visual threshold | 26 | ||
| Visual fields | 27 | ||
| Delayed development of visual responsiveness | 28 | ||
| References | 29 | ||
| References | 30.e1 | ||
| 5 Emmetropization, refraction and refractive errors: | 31 | ||
| Chapter contents | 31 | ||
| Postnatal growth and emmetropization | 31 | ||
| Treatment of refractive errors | 33 | ||
| Myopia | 33 | ||
| Hyperopia | 33 | ||
| Astigmatism | 34 | ||
| Anisometropia | 34 | ||
| References | 34 | ||
| 6 Milestones and normative data | 36 | ||
| Chapter contents | 36 | ||
| Intercanthal distance and palpebra | 36 | ||
| Tear secretion | 37 | ||
| Cornea | 38 | ||
| Central corneal thickness | 38 | ||
| Pupil size and reaction to light | 38 | ||
| The crystalline lens | 39 | ||
| Pars plana and ora serrata | 39 | ||
| Optic disc parameters | 39 | ||
| Axial length | 39 | ||
| Extraocular muscles and sclera | 40 | ||
| Children’s visual function questionnaire | 40 | ||
| Visual acuity | 40 | ||
| Visual field | 42 | ||
| Refraction, corneal curvature, and astigmatism | 42 | ||
| Intraocular pressure | 44 | ||
| References | 44 | ||
| References | 44.e1 | ||
| 2 Core practice | 45 | ||
| 7 Examination, history and special tests in pediatric ophthalmology | 45 | ||
| Chapter contents | 45 | ||
| Assent and consent | 45 | ||
| It is all about the child | 45 | ||
| The equipment | 46 | ||
| History: include the children | 46 | ||
| A no-touch approach at first | 46 | ||
| Say “Hi”! | 46 | ||
| Observe | 46 | ||
| Head/body posture | 47 | ||
| Visual behavior | 47 | ||
| Where to sit for the examination | 47 | ||
| Parents as a resource | 47 | ||
| Targeted examination | 47 | ||
| Bruckner’s test | 48 | ||
| Binocularity: first no dissociation, no glasses | 48 | ||
| Vision assessment | 48 | ||
| Dynamic retinoscopy | 50 | ||
| Version, ductions, null position | 50 | ||
| Next step: touching and other methods of annoying the child – the second part of the examination | 51 | ||
| Use the company | 51 | ||
| Pupils and corneal diameter | 51 | ||
| Lids | 51 | ||
| Binocularity | 51 | ||
| Confrontation fields | 52 | ||
| Strabismus assessment | 52 | ||
| Slit-lamp examination | 52 | ||
| Refraction | 52 | ||
| Intraocular pressure measurement | 53 | ||
| Fundus examination | 53 | ||
| Finally: rewarding success | 54 | ||
| References | 54 | ||
| 8 Visual electrophysiology: | 55 | ||
| Chapter contents | 55 | ||
| Introduction | 55 | ||
| The tests | 55 | ||
| What do the responses tell us? An aide memoire for a busy clinician | 57 | ||
| The electro-oculogram | 57 | ||
| The electroretinogram | 57 | ||
| The visual evoked potential | 58 | ||
| Use of different types of stimulation: pattern reversal, pattern onset, and flash stimulation | 59 | ||
| Visual acuity and the VEP | 59 | ||
| Technical factors | 60 | ||
| Visual stimulators | 60 | ||
| Flash | 60 | ||
| Patterns | 60 | ||
| Field size | 60 | ||
| Check sizes | 60 | ||
| ERG electrodes | 61 | ||
| Refractive error | 61 | ||
| Dilation | 61 | ||
| Dark adaptation | 61 | ||
| Maturation | 61 | ||
| Summary | 61 | ||
| References | 61 | ||
| 9 Imaging the fundus | 63 | ||
| Chapter contents | 63 | ||
| Imaging dependent on the state of the media | 63 | ||
| Confocal scanning laser ophthalmoscopy | 63 | ||
| Autofluorescence | 63 | ||
| Fluorescein and indocyanine green angiography | 63 | ||
| Red-free and infrared imaging | 63 | ||
| Wide-field imaging | 64 | ||
| Ultra-wide-field confocal scanning laser | 64 | ||
| Time and Fourier domain optical coherence tomography: “in vivo histology” | 65 | ||
| Imaging independent of the state of the media | 67 | ||
| Ultrasound, computed tomography, and magnetic resonance imaging | 67 | ||
| References | 69 | ||
| 10 Genetics and pediatric ophthalmology | 71 | ||
| Chapter contents | 71 | ||
| Background | 71 | ||
| Mendelian inheritance | 71 | ||
| Autosomal dominant inheritance (Fig. 10.1) | 71 | ||
| Expressivity | 71 | ||
| Penetrance | 71 | ||
| New mutations | 72 | ||
| Autosomal recessive inheritance (Fig. 10.3) | 73 | ||
| X-linked inheritance (Fig. 10.4) | 73 | ||
| Female carriers | 73 | ||
| Mitochondrial, or maternal, inheritance | 75 | ||
| Genetic heterogeneity | 75 | ||
| Genetic counseling | 76 | ||
| Genetic testing | 76 | ||
| What is a mutation? | 76 | ||
| Chromosomal alterations | 76 | ||
| Submicroscopic genomic rearrangements | 76 | ||
| Single gene mutations | 77 | ||
| DNA sequencing | 77 | ||
| Conventional DNA sequencing | 77 | ||
| High-throughput DNA sequencing | 77 | ||
| Genetic testing: counseling and ethical issues | 77 | ||
| Predictive or presymptomatic testing | 78 | ||
| Carrier testing | 78 | ||
| Childhood testing | 78 | ||
| Prenatal testing | 78 | ||
| Clinical examination | 78 | ||
| References | 78 | ||
| 3 Infections, allergic and external eye disorders | 79 | ||
| 11 Ocular manifestations of intrauterine infections | 79 | ||
| Chapter contents | 79 | ||
| Congenital rubella | 79 | ||
| Toxoplasmosis | 80 | ||
| Cytomegalovirus | 81 | ||
| Herpes simplex virus | 81 | ||
| Intrauterine infection (5%) | 81 | ||
| Perinatal infections (85%) | 81 | ||
| Postnatal infection (10%) | 82 | ||
| Syphilis | 82 | ||
| Varicella zoster virus | 82 | ||
| Other intrauterine infections | 83 | ||
| References | 83 | ||
| References | 84.e1 | ||
| 12 Neonatal conjunctivitis (ophthalmia neonatorum) | 85 | ||
| Chapter contents | 85 | ||
| Prophylaxis | 85 | ||
| Chemical conjunctivitis | 85 | ||
| Chlamydial conjunctivitis | 85 | ||
| Gonococcal conjunctivitis | 86 | ||
| Bacterial (not chlamydial or gonococcal) conjunctivitis | 87 | ||
| Herpetic conjunctivitis | 87 | ||
| Neonatal conjunctivitis in hospitalized patients | 87 | ||
| Laboratory testing | 87 | ||
| References | 87 | ||
| 13 Preseptal and orbital cellulitis | 89 | ||
| Chapter contents | 89 | ||
| Anatomy and terminology | 89 | ||
| Classification | 89 | ||
| Preseptal cellulitis | 90 | ||
| Clinical assessment | 90 | ||
| History | 90 | ||
| Examination | 90 | ||
| Management | 91 | ||
| Orbital cellulitis | 92 | ||
| Etiology | 92 | ||
| History | 92 | ||
| Examination | 92 | ||
| Management | 92 | ||
| Orbital imaging | 93 | ||
| Microbiology of preseptal and orbital cellulitis | 95 | ||
| Subperiosteal and orbital abscess | 95 | ||
| Osteomyelitis of the superior maxilla | 96 | ||
| Cavernous sinus thrombosis | 96 | ||
| Fungal orbital cellulitis orbital mucormycosis | 97 | ||
| References | 99 | ||
| 14 Endophthalmitis | 100 | ||
| Chapter contents | 100 | ||
| Clinical presentation | 100 | ||
| Exogenous bacterial endophthalmitis | 100 | ||
| Cataract surgery | 100 | ||
| Trauma | 101 | ||
| Glaucoma filtration surgery | 101 | ||
| Strabismus surgery | 101 | ||
| Intravitreal injection | 101 | ||
| Prevention | 101 | ||
| Management | 102 | ||
| Endogenous bacterial endophthalmitis | 103 | ||
| Exogenous fungal endophthalmitis | 103 | ||
| Endogenous fungal endophthalmitis | 103 | ||
| References | 104 | ||
| 15 External eye disease and the oculocutaneous disorders | 105 | ||
| Chapter contents | 105 | ||
| Blepharokeratoconjunctivitis | 105 | ||
| Pathogenesis of blepharokeratoconjunctivitis | 105 | ||
| Treatment of blepharokeratoconjunctivitis | 107 | ||
| Other uncommon causes of chronic blepharokeratoconjunctivitis | 108 | ||
| Conjunctivitis | 109 | ||
| Acute conjunctivitis | 109 | ||
| Hyperpurulent conjunctivitis | 109 | ||
| Membranous conjunctivitis | 110 | ||
| Diagnosis and investigation of conjunctivitis | 110 | ||
| Systemic treatment for microbial conjunctivitis | 110 | ||
| Acute follicular conjunctivitis | 110 | ||
| Viral infectious keratoconjunctivitis | 110 | ||
| Adenoviral keratoconjunctivitis | 110 | ||
| Herpes simplex blepharoconjunctivitis | 111 | ||
| Acute hemorrhagic conjunctivitis | 112 | ||
| Chlamydia conjunctivitis | 112 | ||
| Trachoma | 112 | ||
| Chronic follicular conjunctivitis | 112 | ||
| Molluscum contagiosum | 113 | ||
| Parinaud’s oculoglandular syndrome | 113 | ||
| Ophthalmia nodosa | 113 | ||
| Conjunctival folliculosis | 113 | ||
| Chronic papillary conjunctivitis | 114 | ||
| Vernal keratoconjunctivitis | 114 | ||
| Clinical features | 114 | ||
| Corneal changes | 114 | ||
| Associated disease | 115 | ||
| Disease mechanisms | 116 | ||
| Management | 116 | ||
| Oculocutaneous conjunctivitis | 117 | ||
| Stevens-Johnson syndrome and toxic epidermal necrolysis | 118 | ||
| Management of SJS/TEN | 118 | ||
| Graft-versus-host disease | 120 | ||
| Corneal limbus stem cell failure (ocular surface failure) | 121 | ||
| Management of severe ocular surface disease | 122 | ||
| Toxic and hypersensitivity keratoconjunctivitis | 122 | ||
| Corneal or conjunctival artefacta | 123 | ||
| Ligneous conjunctivitis | 123 | ||
| Keratitis | 123 | ||
| Microbial keratitis | 123 | ||
| Initial examination | 124 | ||
| Investigation | 124 | ||
| Treatment | 125 | ||
| Choice of initial antibiotics | 125 | ||
| Sterilization phase | 125 | ||
| The healing phase | 125 | ||
| Use of topical corticosteroids | 125 | ||
| Progressive or indolent microbial keratitis | 126 | ||
| Herpes simplex virus keratitis | 127 | ||
| Management | 127 | ||
| Herpes zoster ophthalmicus | 128 | ||
| Interstitial keratitis | 129 | ||
| Thygeson’s superficial punctate keratitis | 130 | ||
| Ichthyosis | 130 | ||
| Hereditary benign intraepithelial dyskeratosis | 130 | ||
| References | 130 | ||
| References | 131.e1 | ||
| 16 Ocular manifestations of HIV/AIDS in children | 132 | ||
| Chapter contents | 132 | ||
| HIV/AIDS: global and regional epidemiology | 132 | ||
| Transmission of HIV in children | 132 | ||
| Diagnosis of HIV/AIDS in children | 133 | ||
| Ocular manifestations of HIV/AIDS in children | 134 | ||
| Ophthalmic screening and monitoring of HIV-infected children | 138 | ||
| References | 138 | ||
| 4 Systematic paediatric ophthalmology | 139 | ||
| 1 Disorders of the eye as a whole | 139 | ||
| 17 Disorders of the eye as a whole | 139 | ||
| Chapter contents | 139 | ||
| Anophthalmos and microphthalmos | 139 | ||
| Anophthalmos | 139 | ||
| Microphthalmos | 140 | ||
| Idiopathic isolated microphthalmos | 140 | ||
| Inherited isolated microphthalmos | 140 | ||
| Microphthalmos with orbital cyst | 140 | ||
| Microphthalmos with cryptophthalmos | 141 | ||
| Microphthalmos with ocular and systemic malformations | 142 | ||
| Microphthalmos with ocular abnormalities | 142 | ||
| Microphthalmos with systemic malformations | 142 | ||
| Gene mutations associated with anophthalmos and microphthalmos | 143 | ||
| SOX2 | 143 | ||
| PAX6 | 143 | ||
| PAX2 | 143 | ||
| CHX10 | 143 | ||
| FOXE3 | 143 | ||
| OTX2 | 143 | ||
| BMP4 | 143 | ||
| Other disorders of the eye as a whole | 144 | ||
| Nanophthalmos | 144 | ||
| Cyclopia and synophthalmos | 145 | ||
| Clinical evaluation and management of anophthalmos and microphthalmos | 145 | ||
| References | 146 | ||
| References | 146.e1 | ||
| 2 Lids, brows and oculoplastics | 147 | ||
| 18 Developmental anomalies of the lids | 147 | ||
| Chapter contents | 147 | ||
| Normal development and anatomy of the eyelids | 147 | ||
| Embryology of the eyelids | 147 | ||
| Initial development | 147 | ||
| Fusion | 148 | ||
| Final reopening | 148 | ||
| Morphology and anatomy of the eyelids | 148 | ||
| Clinical evaluation of the eyelids | 149 | ||
| Clinical landmarks | 149 | ||
| Eyelid developmental anomalies | 150 | ||
| Developmental anomalies of the periorbital region | 150 | ||
| Abnormal distances between the eyelids and orbits | 150 | ||
| Hypertelorism | 150 | ||
| Telecanthus and dystopia canthorum | 151 | ||
| Hypotelorism | 151 | ||
| Abnormal aspect of the inner canthus | 152 | ||
| Epicanthus palpebralis | 152 | ||
| Epicanthus inversus | 152 | ||
| Major malformations of the eyelids | 152 | ||
| Ablepharon | 152 | ||
| Cryptophthalmos (see Chapter 17) | 152 | ||
| Ankyloblepharon | 152 | ||
| Clefting or notching of the eyelids (“coloboma”) | 152 | ||
| Abnormal palpebral fissures | 155 | ||
| Orientation of the palpebral fissures | 155 | ||
| Long palpebral fissures | 155 | ||
| Short palpebral fissures | 156 | ||
| Abnormal position of the eyelids | 156 | ||
| Ectropion | 156 | ||
| Eversion | 157 | ||
| Epitarsus | 157 | ||
| Epiblepharon | 157 | ||
| Entropion | 157 | ||
| Lagophthalmos | 157 | ||
| Lid retraction in infancy | 157 | ||
| Ptosis (see Chapter 19) | 158 | ||
| Classification | 158 | ||
| Congenital ptosis | 158 | ||
| Neurogenic defects | 159 | ||
| Myogenic ptosis | 159 | ||
| Pseudoptosis | 160 | ||
| Syndromes with ptosis | 160 | ||
| Eyebrows and eyelashes | 160 | ||
| Prominent eyebrows and/or eyelashes | 160 | ||
| Distichiasis | 160 | ||
| Trichomegaly | 162 | ||
| Synophrys | 162 | ||
| Sparse or absent eyebrows and/or eyelashes | 163 | ||
| White brows or lashes | 163 | ||
| Dysmorphology databases and genes involved in syndromes with eyelid anomalies | 164 | ||
| References | 164 | ||
| References | 164.e1 | ||
| 19 Lids: Congenital and acquired abnormalities − practical management | 165 | ||
| Chapter contents | 165 | ||
| Management of congenital lid conditions | 165 | ||
| Lid coloboma | 165 | ||
| Cryptophthalmos | 165 | ||
| Ablepharon | 166 | ||
| Ankyloblepharon | 166 | ||
| Euryblepharon | 166 | ||
| Ectropion | 166 | ||
| Eversion | 166 | ||
| Epiblepharon | 166 | ||
| Entropion | 167 | ||
| Tarsal kink/upper lid entropion | 167 | ||
| Distichiasis | 167 | ||
| Epicanthal folds | 168 | ||
| Telecanthus | 168 | ||
| Blepharophimosis | 169 | ||
| Management of congenital and acquired ptosis | 169 | ||
| History and examination | 169 | ||
| Treatment | 169 | ||
| Specific conditions | 170 | ||
| Lid retraction in infancy | 171 | ||
| Seventh nerve palsy | 172 | ||
| Corneal exposure | 172 | ||
| Paralytic ectropion | 172 | ||
| Epiphora (see Chapter 21) | 172 | ||
| Cosmesis | 172 | ||
| Lid tumors | 172 | ||
| Nevi | 172 | ||
| Molluscum contagiosum | 172 | ||
| Juvenile xanthogranuloma (see Chapter 27) | 173 | ||
| Complex choristoma | 173 | ||
| Pilomatrixoma (calcifying epithelioma of Malherbe) | 173 | ||
| Lid hamartoma | 173 | ||
| Meibomian gland diseases | 173 | ||
| Chalazia (meibomian cysts) | 173 | ||
| Acute blepharitis (see Chapter 15) | 174 | ||
| Chronic blepharitis (see Chapter 15) | 174 | ||
| Lid lice (see Chapter 15) | 174 | ||
| Trichiasis | 174 | ||
| Socket management | 175 | ||
| Contracted socket | 175 | ||
| Orbital volume replacement | 175 | ||
| Discharging sockets | 175 | ||
| Lid and adnexal trauma (see Chapter 66) | 175 | ||
| Etiology | 175 | ||
| Immediate management | 175 | ||
| Traumatic ptosis | 176 | ||
| Lacrimal drainage injuries | 176 | ||
| Medial canthal tendon injuries | 176 | ||
| Burns | 177 | ||
| References | 177 | ||
| 20 Lid and orbital infantile peri-ocular hemangiomas (capillary hemangiomas) and other vascular disease | 178 | ||
| Chapter contents | 178 | ||
| Tumors | 178 | ||
| Infantile peri-ocular hemangioma (capillary hemangioma) | 178 | ||
| Clinical features | 179 | ||
| Investigation | 180 | ||
| Management | 180 | ||
| Hemangiopericytoma | 181 | ||
| Vascular malformations | 184 | ||
| Venous-lymphatic malformations (lymphangiomas) | 184 | ||
| Superficial | 184 | ||
| Deep | 184 | ||
| Combined lesions (lymphohemangiomas) | 184 | ||
| Investigation | 185 | ||
| Management | 185 | ||
| Congenital orbital varices | 185 | ||
| Arteriovenous malformations | 186 | ||
| Sturge–Weber syndrome (see Chapters 37 and 65) | 187 | ||
| Rare vascular lesions of the orbit | 188 | ||
| Klippel-Trenaunay-Weber syndrome (see Chapter 65) | 188 | ||
| Blue rubber bleb nevus syndrome | 188 | ||
| References | 189 | ||
| References | 189.e1 | ||
| 3 Orbit and lacrimal | 190 | ||
| 21 The lacrimal system | 190 | ||
| Chapter contents | 190 | ||
| Introduction | 190 | ||
| Lacrimal gland | 190 | ||
| Embryology | 190 | ||
| Anatomy | 190 | ||
| Congenital abnormalities | 190 | ||
| Dry eyes in children | 191 | ||
| Congenital causes | 191 | ||
| Acquired causes | 191 | ||
| Dacryoadenitis | 191 | ||
| Lacrimal tumors (see Chapter 26) | 191 | ||
| The lacrimal drainage system | 191 | ||
| Embryology | 191 | ||
| Anatomy | 191 | ||
| Physiology | 192 | ||
| Congenital abnormalities | 192 | ||
| Congenital dacryocystocele | 192 | ||
| Congenital nasolacrimal duct obstruction | 192 | ||
| Natural history | 193 | ||
| Conservative treatment | 193 | ||
| Syringing and probing | 193 | ||
| What to do if probing fails | 196 | ||
| Intubation | 196 | ||
| Dacryocystorhinostomy | 197 | ||
| Congenital fistulae of the lacrimal outflow system | 197 | ||
| Punctal and canalicular abnormalities | 197 | ||
| Acquired conditions of the lacrimal drainage apparatus | 197 | ||
| Canaliculitis | 197 | ||
| Acute dacryocystitis | 197 | ||
| Acquired nasolacrimal duct obstruction | 197 | ||
| References | 197 | ||
| References | 198.e1 | ||
| 22 The management of orbital disease in children | 199 | ||
| Chapter contents | 199 | ||
| Orbital disease and age | 199 | ||
| Clinical assessment | 200 | ||
| History | 200 | ||
| Examination | 202 | ||
| Enophthalmos | 202 | ||
| Investigations | 204 | ||
| Radiology | 204 | ||
| Plain X-rays | 204 | ||
| Computed tomography and magnetic resonance imaging | 204 | ||
| Surgery | 204 | ||
| References | 205 | ||
| 23 Neurogenic tumors | 206 | ||
| Chapter contents | 206 | ||
| Optic nerve tumors | 206 | ||
| Optic glioma | 206 | ||
| Visual pathway gliomas | 206 | ||
| Presentation | 206 | ||
| Radiographic features | 208 | ||
| Biological behavior and management | 208 | ||
| Screening for visual pathway gliomas | 211 | ||
| Meningiomas | 211 | ||
| Optic nerve sheath meningiomas | 211 | ||
| Investigation | 212 | ||
| Treatment | 212 | ||
| Rare optic nerve tumors in childhood | 214 | ||
| Schwannoma | 214 | ||
| References | 215 | ||
| References | 215.e1 | ||
| 24 Orbital rhabdomyosarcoma | 216 | ||
| Chapter contents | 216 | ||
| General considerations | 216 | ||
| Clinical features | 216 | ||
| Diagnostic approaches | 216 | ||
| Computed tomography | 216 | ||
| Magnetic resonance imaging | 217 | ||
| Biopsy | 219 | ||
| Pathology | 219 | ||
| Management | 219 | ||
| Historical aspects | 219 | ||
| Intergroup Rhabdomyosarcoma Study Group | 219 | ||
| Surgery | 219 | ||
| Chemotherapy | 219 | ||
| Irradiation | 220 | ||
| Prognosis | 220 | ||
| Summary | 220 | ||
| References | 220 | ||
| References | 221.e1 | ||
| 25 Other mesenchymal abnormalities | 222 | ||
| Chapter contents | 222 | ||
| Dysplasias | 222 | ||
| Fibrous dysplasia of the orbit | 222 | ||
| Clinical features | 222 | ||
| Management | 223 | ||
| Bone tumors | 224 | ||
| Reparative granuloma | 224 | ||
| Aneurysmal bone cyst | 225 | ||
| Neoplasias | 225 | ||
| Juvenile ossifying fibroma of the orbit | 225 | ||
| Other mesenchymal tumors | 226 | ||
| Osteoblastoma | 226 | ||
| Postirradiation osteosarcoma of the orbit (see Chapter 42) | 226 | ||
| Infantile cortical hyperostosis (Caffey’s disease) | 226 | ||
| Osteopetrosis | 227 | ||
| Other bone dysplasias | 227 | ||
| References | 228 | ||
| References | 228.e1 | ||
| 26 Metastatic, secondary and lacrimal gland tumors | 229 | ||
| Chapter contents | 229 | ||
| Metastatic disease | 229 | ||
| Neuroblastoma | 229 | ||
| Genetics | 229 | ||
| Clinical presentation | 229 | ||
| Ophthalmic and orbital features | 230 | ||
| Presentation | 230 | ||
| Treatment | 230 | ||
| Ewing’s sarcoma | 231 | ||
| Secondary disease | 231 | ||
| Retinoblastoma (see Chapter 42) | 231 | ||
| Malignant melanoma | 231 | ||
| Lacrimal gland tumors | 232 | ||
| References | 232 | ||
| References | 233.e1 | ||
| 27 Histiocytic, hematopoietic and lymphoproliferative disorders | 234 | ||
| Chapter contents | 234 | ||
| Langerhans’ cell histiocytosis (histiocytosis X) | 234 | ||
| Ophthalmic involvement | 235 | ||
| Orbital involvement | 235 | ||
| Clinical features | 235 | ||
| Investigation | 235 | ||
| Management and prognosis | 237 | ||
| Non-Langerhans’ cell histiocytosis | 237 | ||
| Juvenile xanthogranuloma | 237 | ||
| Histopathology | 237 | ||
| Ocular involvement | 238 | ||
| Management | 239 | ||
| Optic nerve and retinal involvement | 239 | ||
| Epibulbar lesions | 239 | ||
| Involvement of the ocular adnexae | 239 | ||
| Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) | 240 | ||
| Leukemia (see Chapter 64) | 240 | ||
| Lymphoma | 241 | ||
| References | 241 | ||
| References | 242.e1 | ||
| 28 Craniofacial abnormalities | 243 | ||
| Chapter contents | 243 | ||
| Introduction | 243 | ||
| Craniosynostosis | 243 | ||
| Pathophysiology | 243 | ||
| Pathogenesis and genetics | 243 | ||
| Effects on the skull | 243 | ||
| Effects on intracranial pressure, the brain, and optic nerve | 244 | ||
| Effects on the orbit | 244 | ||
| Management | 245 | ||
| Diagnosis | 245 | ||
| Ophthalmic management in craniosynostosis | 248 | ||
| Vision loss | 248 | ||
| Strabismus | 250 | ||
| Clefting syndromes | 250 | ||
| Treacher-Collins syndrome | 251 | ||
| General findings | 251 | ||
| Ocular findings | 251 | ||
| Management protocol | 258 | ||
| Goldenhar’s syndrome | 258 | ||
| General findings | 258 | ||
| Ocular findings | 258 | ||
| Frontoethmoidal meningoencephalocele | 258 | ||
| Management | 260 | ||
| Midline facial cleft | 260 | ||
| Amniotic bands | 260 | ||
| Craniofacial surgery | 260 | ||
| Neurosurgical complications | 262 | ||
| The ophthalmologist as an important member of the craniofacial team | 263 | ||
| Acknowledgment | 263 | ||
| References | 263 | ||
| 29 Cystic lesions and ectopias | 265 | ||
| Chapter contents | 265 | ||
| Cystic lesions | 265 | ||
| Lacrimal ductal cyst | 265 | ||
| Dermoid cyst | 265 | ||
| Superficial dermoids | 266 | ||
| Deep dermoids | 267 | ||
| Conjunctival dermoids | 267 | ||
| Orbital encephalocele (see Chapter 56) | 267 | ||
| Sinus mucocele | 268 | ||
| Congenital cystic eyeball (anophthalmos with cyst) (see Chapter 17) | 268 | ||
| Microphthalmos with cyst | 269 | ||
| Clinical presentation | 269 | ||
| Management | 270 | ||
| Orbital teratoma | 270 | ||
| Parasitic cysts | 271 | ||
| Echinococcosis (hydatid cyst) | 271 | ||
| Ectopias | 272 | ||
| Dermolipoma | 272 | ||
| Ectopic lacrimal gland | 272 | ||
| Conjunctival and inclusion cyst | 272 | ||
| Other cystic lesions | 273 | ||
| References | 273 | ||
| References | 274.e1 | ||
| 30 Inflammatory disorders | 275 | ||
| Chapter contents | 275 | ||
| Non-specific orbital inflammatory syndromes (pseudotumors) | 275 | ||
| Definition | 275 | ||
| Anterior idiopathic orbital inflammation: acute and subacute | 275 | ||
| Diffuse idiopathic orbital inflammation: acute and subacute | 276 | ||
| Anterior and diffuse non-specific orbital inflammatory syndromes: differential diagnoses and management | 276 | ||
| Idiopathic orbital myositis: acute and subacute | 277 | ||
| Idiopathic lacrimal inflammation: acute and subacute | 277 | ||
| Specific causes of orbital inflammation | 277 | ||
| Wegener’s granulomatosis | 278 | ||
| Clinical features | 278 | ||
| Sarcoidosis | 278 | ||
| Thyroid orbitopathy | 279 | ||
| References | 279 | ||
| 4 External Disease and Anterior Segment | 281 | ||
| 31 Conjunctiva and subconjunctival tissue | 281 | ||
| Chapter contents | 281 | ||
| Anatomy | 281 | ||
| Conjunctiva in systemic disease | 281 | ||
| Vitamin A deficiency | 281 | ||
| Xeroderma pigmentosa | 282 | ||
| Sturge-Weber syndrome | 283 | ||
| Icthyosis | 283 | ||
| Anemia | 283 | ||
| Leukemias | 283 | ||
| Measles keratoconjunctivitis | 283 | ||
| Alkaptonuria | 283 | ||
| Ataxia telangiectasia (Louis-Bar syndrome) | 283 | ||
| Fabry’s disease | 284 | ||
| Osler-Weber-Rendu syndrome | 284 | ||
| Sickle cell disease | 284 | ||
| Conjunctival tumors | 284 | ||
| Hamartomas | 284 | ||
| Choristomas | 284 | ||
| Epithelial tumors | 285 | ||
| Lymphangiectasia | 285 | ||
| Lymphangiomas | 285 | ||
| Rhabdomyosarcoma | 285 | ||
| Neurofibromas and neurilemmomas | 285 | ||
| Juvenile xanthogranuloma | 285 | ||
| Pigmented lesions of the conjunctiva | 285 | ||
| Conjunctival nevus | 285 | ||
| Melanocytic nevus | 286 | ||
| Nevus of Ota | 286 | ||
| Malignant melanoma | 286 | ||
| Miscellaneous disorders of conjunctiva | 286 | ||
| Pyogenic granuloma | 286 | ||
| Subconjunctival hemorrhage | 287 | ||
| Conjunctival granulomas | 287 | ||
| Parasitic infestation of the conjunctiva | 288 | ||
| Ophthalmomyiasis | 288 | ||
| Conjunctival trauma and foreign bodies | 288 | ||
| Symblepharon | 289 | ||
| References | 289 | ||
| 32 Anterior segment: | 290 | ||
| Chapter contents | 290 | ||
| Embryology of the anterior segment | 290 | ||
| Control of development: responsible genes | 290 | ||
| Gene mutations causing anterior segment developmental anomalies | 290 | ||
| Transcription factors and anterior segment development | 291 | ||
| Gene expression in the developing anterior segment: sites of gene action | 291 | ||
| Understanding gene function through study of animal models | 293 | ||
| Foxc1 and Pitx2 are essential for corneal development | 293 | ||
| Pax6 and other genes expressed in the developing lens cause ASDAs | 293 | ||
| Insights into the etiology of developmental glaucoma from mouse models of ASDA | 294 | ||
| Clinical conditions due to anterior segment developmental anomalies | 294 | ||
| Anterior segment developmental anomalies of neural crest cell origin | 294 | ||
| Posterior embryotoxon | 294 | ||
| Congenital iris ectropion | 296 | ||
| Congenital hereditary endothelial dystrophy | 296 | ||
| Posterior polymorphous dystrophy | 296 | ||
| Primary congenital glaucoma | 296 | ||
| ICE syndromes | 296 | ||
| Anterior segment developmental anomalies of ectodermal origin | 297 | ||
| Anterior segment developmental anomalies of a global origin | 297 | ||
| Congenital megalocornea | 297 | ||
| Microcornea | 298 | ||
| Peters’ anomaly | 298 | ||
| Sclerocornea | 302 | ||
| Cornea plana | 302 | ||
| Autosomal dominant keratitis | 303 | ||
| Aniridia | 304 | ||
| Penetrating keratoplasty for anterior segment developmental anomalies | 306 | ||
| References | 308 | ||
| References | 309.e1 | ||
| 33 Corneal abnormalities in childhood | 310 | ||
| Chapter contents | 310 | ||
| Developmental defects | 310 | ||
| Embryologic errors | 310 | ||
| Anterior segment dysgenesis (Chapter 32) | 310 | ||
| Genetic syndromes | 310 | ||
| Trisomy 18 and trisomy 8 mosaic | 310 | ||
| Ectodermal dysplasia | 311 | ||
| Corneal opacities associated with dermatologic conditions | 311 | ||
| Ichthyosis | 311 | ||
| Autoimmune blistering diseases | 312 | ||
| Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis | 312 | ||
| Epidermolysis bullosa | 312 | ||
| Reiter’s syndrome | 313 | ||
| Vitamin A deficiency and measles (see Chapter 31) | 313 | ||
| Infectious keratitis (see Chapter 15) | 313 | ||
| Herpetic keratitis (see Chapter 15) | 313 | ||
| Inflammatory keratitis: chronic blepharokeratoconjunctivitis (see Chapter 15) | 314 | ||
| Interstitial keratitis | 314 | ||
| Cogan’s syndrome | 314 | ||
| Corneal trauma | 314 | ||
| Exposure keratitis | 314 | ||
| Corneal anesthesia and hypoesthesia | 315 | ||
| Treatment in infancy | 316 | ||
| Treatment in childhood | 316 | ||
| Accidental and non-accidental injury | 316 | ||
| Hyphema and blood staining | 316 | ||
| Keratoconus (see Chapter 34) | 317 | ||
| Keratoglobus and blue sclerae | 317 | ||
| Dermoids | 318 | ||
| Amniotic bands | 319 | ||
| Corneal crystals | 319 | ||
| Cystinosis (see Chapter 62) | 320 | ||
| Schnyder’s corneal dystrophy | 320 | ||
| Bietti’s crystalline dystrophy | 320 | ||
| Band keratopathy | 320 | ||
| Corneal arcus | 321 | ||
| Corneal nerves | 321 | ||
| Multiple endocrine neoplasia | 322 | ||
| References | 322 | ||
| References | 322.e1 | ||
| 34 Corneal dystrophies | 323 | ||
| Chapter contents | 323 | ||
| Definition | 323 | ||
| Classification | 323 | ||
| Mutation rate | 323 | ||
| Dystrophies related to mutations in the TGFBI gene | 323 | ||
| Granular dystrophies | 324 | ||
| Granular corneal dystrophy, type 1 (a category 1 dystrophy) | 324 | ||
| Granular corneal dystrophy, type 2 (a category 1 dystrophy) | 324 | ||
| Lattice corneal dystrophy (a category 1 dystrophy) | 324 | ||
| Reis-Bücklers and Thiele-Behnke corneal dystrophies (category 1 dystrophies) | 324 | ||
| Dystrophy due to mutations in other genes | 325 | ||
| Macular corneal dystrophy (a category 1 dystrophy) | 325 | ||
| Posterior polymorphous corneal dystrophy (some subtypes are a category 1, some a category 2 dystrophy) | 325 | ||
| Meesmann’s corneal dystrophy (a category 1 dystrophy) | 326 | ||
| Schnyder’s corneal dystrophy (a category 1 dystrophy) | 326 | ||
| Congenital hereditary endothelial dystrophy (the autosomal dominant variety is a category 2 dystrophy; the autosomal recessive variety is a category 1 dystrophy) | 328 | ||
| Reference | 328 | ||
| 35 The lens | 329 | ||
| Chapter contents | 329 | ||
| Anatomy | 329 | ||
| Embryology | 329 | ||
| Developmental abnormalities of the lens | 330 | ||
| Ectopia lentis | 332 | ||
| Marfan’s syndrome and the type-1 fibrillinopathies | 332 | ||
| Homocystinuria | 334 | ||
| Weill-Marchesani syndrome | 334 | ||
| Ectopia lentis et pupillae | 335 | ||
| Aniridia (see Chapter 32) and congenital glaucoma (see Chapter 37) | 335 | ||
| Megalocornea | 335 | ||
| Ehlers-Danlos syndrome | 335 | ||
| Trauma | 336 | ||
| Sulfite oxidase deficiency and molybdenum cofactor deficiency | 336 | ||
| Xanthine oxidase deficiency | 336 | ||
| Management of ectopia lentis | 336 | ||
| References | 337 | ||
| 36 Childhood cataracts | 339 | ||
| Chapter contents | 339 | ||
| Incidence | 339 | ||
| Detection | 339 | ||
| Morphology | 339 | ||
| Persistent fetal vasculature | 341 | ||
| Etiology | 342 | ||
| Bilateral | 342 | ||
| Unilateral | 342 | ||
| History | 342 | ||
| Ocular examination | 343 | ||
| Laboratory work-up | 343 | ||
| Management | 347 | ||
| Non-surgical: patching, dilation | 347 | ||
| Surgical | 347 | ||
| Surgical techniques | 347 | ||
| Optical correction | 347 | ||
| Contact lenses | 347 | ||
| Spectacles | 347 | ||
| Intraocular lenses | 347 | ||
| Management of amblyopia | 348 | ||
| Unilateral cataract | 349 | ||
| Bilateral and traumatic cataracts | 349 | ||
| Postoperative complications | 349 | ||
| Visual axis opacities | 349 | ||
| Amblyopia (see Chapter 70) | 349 | ||
| Glaucoma (see Chapter 37) | 350 | ||
| Strabismus | 350 | ||
| Irregular pupil | 350 | ||
| Heterochromia iridis | 350 | ||
| Endophthalmitis | 350 | ||
| Retinal hemorrhages and detachments | 350 | ||
| Cystoid macular edema | 351 | ||
| Corneal edema | 351 | ||
| Visual outcomes | 351 | ||
| References | 351 | ||
| 37 Childhood glaucoma | 353 | ||
| Chapter contents | 353 | ||
| Introduction | 353 | ||
| Classification | 353 | ||
| Clinical findings | 353 | ||
| Unique features of glaucoma in infancy | 353 | ||
| Generalized ocular enlargement | 353 | ||
| Reversible optic nerve cupping | 353 | ||
| Differential diagnosis | 355 | ||
| Classification | 355 | ||
| Primary childhood glaucoma | 355 | ||
| Primary congenital glaucoma | 355 | ||
| Demographics | 355 | ||
| Genetics | 356 | ||
| Pathogenesis | 356 | ||
| Gonioscopic findings | 356 | ||
| Treatment | 356 | ||
| Juvenile open angle glaucoma | 356 | ||
| Secondary childhood glaucoma | 356 | ||
| Anterior segment developmental anomalies (see Chapter 32) | 356 | ||
| Aniridia | 358 | ||
| Phakomatoses | 358 | ||
| Aphakic glaucoma | 358 | ||
| Inflammatory glaucoma | 359 | ||
| Miscellaneous conditions | 359 | ||
| Management | 359 | ||
| Assessment | 359 | ||
| History | 359 | ||
| Examination | 359 | ||
| Intraocular pressure measurement | 359 | ||
| Anterior segment examination | 360 | ||
| Corneal diameter measurement | 360 | ||
| Corneal thickness | 360 | ||
| Gonioscopy | 360 | ||
| Posterior segment examination | 360 | ||
| Refraction | 360 | ||
| Examination under anesthesia | 361 | ||
| Anesthesia | 361 | ||
| Examination findings | 361 | ||
| Investigations | 361 | ||
| Ultrasound | 361 | ||
| A-scan | 361 | ||
| B-scan | 361 | ||
| Visual fields | 361 | ||
| Optic disk and nerve fiber layer analysis | 361 | ||
| Interpretation of findings | 361 | ||
| Treatment | 361 | ||
| Medical therapy | 361 | ||
| Beta-blockers | 361 | ||
| Prostaglandin analogs | 362 | ||
| Carbonic anhydrase inhibitors | 362 | ||
| Sympathomimetics | 362 | ||
| Parasympathomimetics | 362 | ||
| Surgical therapy | 362 | ||
| Angle surgery | 362 | ||
| Goniotomy | 362 | ||
| Trabeculotomy | 363 | ||
| Trabeculotomy combined with trabeculectomy | 363 | ||
| Filtering surgery | 363 | ||
| Trabeculectomy | 363 | ||
| Antimetabolite treatment | 364 | ||
| Tube drainage surgery | 365 | ||
| Cyclodestruction | 365 | ||
| Refractive correction and amblyopia therapy | 366 | ||
| The role of penetrating keratoplasty | 366 | ||
| Prognosis | 366 | ||
| Acknowledgments | 366 | ||
| References | 366 | ||
| References | 367.e1 | ||
| 5 The uvea | 368 | ||
| 38 The uveal tract | 368 | ||
| Chapter contents | 368 | ||
| Anatomy | 368 | ||
| Embryology | 368 | ||
| Symptoms of uveal disease | 369 | ||
| Persistent pupillary membranes | 370 | ||
| Congenital iris and stromal cysts | 370 | ||
| Iris ectropion or ectropion uveae | 371 | ||
| Heterochromia iridis | 371 | ||
| Juvenile xanthogranuloma | 372 | ||
| Brushfield’s spots | 372 | ||
| Colobomas | 372 | ||
| Iris melanosis and iris mammillations | 373 | ||
| Tumors of the uveal tract (Box 38.5) | 373 | ||
| Iris hemangioma | 373 | ||
| Choroidal melanomas | 374 | ||
| Spontaneous hyphemas | 375 | ||
| References | 375 | ||
| References | 376.e1 | ||
| 39 Uveitis | 377 | ||
| Chapter contents | 377 | ||
| Introduction | 377 | ||
| General considerations | 377 | ||
| Organization of service | 378 | ||
| Evaluation for systemic disease | 379 | ||
| Epidemiology of pediatric uveitis | 379 | ||
| Epidemiology of vasculitis | 379 | ||
| Clinical types of uveitis | 380 | ||
| Idiopathic uveitis | 380 | ||
| Painful anterior uveitis | 380 | ||
| Painless anterior uveitis | 380 | ||
| Intermediate uveitis | 380 | ||
| Panuveitis and multifocal choroiditis | 380 | ||
| Retinitis | 381 | ||
| Neuroretinitis | 381 | ||
| Post-traumatic uveitis | 382 | ||
| Sympathetic ophthalmia | 382 | ||
| Lens-induced uveitis | 382 | ||
| Parainfectious uveitis | 382 | ||
| Localized autoinflammatory diseases | 382 | ||
| Juvenile idiopathic arthritis | 382 | ||
| Epidemiology | 382 | ||
| JIA types associated with CAU | 382 | ||
| Investigation of CAU | 382 | ||
| Other JIA types | 382 | ||
| Screening | 383 | ||
| Monitoring | 383 | ||
| Clinical signs | 383 | ||
| Course | 384 | ||
| Indications for treatment | 384 | ||
| Alternative treatments to topical steroids | 385 | ||
| Alternatives to methotrexate | 385 | ||
| Glaucoma | 385 | ||
| Other localized autoinflammatory diseases | 385 | ||
| Behçet’s disease | 385 | ||
| 5 Selected topics in pediatric ophthalmology | 616 | ||
| 58 Ethics, morality and consent in pediatric ophthalmology | 616 | ||
| Chapter contents | 616 | ||
| Informed consent | 616 | ||
| Capacity to give consent (Box 58.1) | 616 | ||
| Points for giving informed consent (Box 58.2) | 617 | ||
| If the child patient refuses the procedure | 617 | ||
| If the parent refuses the procedure | 617 | ||
| Consent to research | 617 | ||
| Confidentiality | 618 | ||
| Access to medical records by children, young people, and parents | 618 | ||
| Child protection | 618 | ||
| References | 618 | ||
| Further reading | 618 | ||
| 59 How to help the visually disabled child and family | 619 | ||
| Chapter contents | 619 | ||
| Telling the family | 619 | ||
| The family | 619 | ||
| Early interventions | 620 | ||
| The multidisciplinary team | 620 | ||
| Development of the child | 620 | ||
| Motor development | 620 | ||
| Conceptual development | 620 | ||
| Language development | 620 | ||
| Social and emotional development | 620 | ||
| Neurodevelopmental issues and the visually impaired child | 620 | ||
| Blind mannerisms | 621 | ||
| Possible behavioral problems? | 621 | ||
| Promotion of vision development | 621 | ||
| Education | 621 | ||
| Orientation and mobility | 622 | ||
| Assistive technology | 622 | ||
| References | 622 | ||
| 60 Visual conversion disorder: | 624 | ||
| Chapter contents | 624 | ||
| Features and definitions | 624 | ||
| Conversion disorder | 625 | ||
| Clinical presentation and symptoms | 625 | ||
| Depression | 625 | ||
| Association with organic disease | 625 | ||
| Psychologic background | 626 | ||
| Detection of functional ocular disorders in children | 626 | ||
| Clinical examination in visual conversion disorders | 626 | ||
| Total blindness | 626 | ||
| Bilateral | 626 | ||
| Unilateral | 626 | ||
| Partial acuity loss | 628 | ||
| Unilateral | 628 | ||
| Bilateral | 628 | ||
| Visual field defects | 628 | ||
| Confirmatory studies | 629 | ||
| Management | 630 | ||
| Prognosis | 630 | ||
| References | 630 | ||
| 61 Vision, reading and dyslexia | 631 | ||
| Chapter contents | 631 | ||
| Reading | 631 | ||
| Dyslexia | 631 | ||
| Reading assessment | 632 | ||
| Dyslexia management | 632 | ||
| The visual system | 632 | ||
| The clinical work-up | 633 | ||
| History | 633 | ||
| Examination | 633 | ||
| Refraction | 633 | ||
| Near visual acuity | 633 | ||
| Accommodation | 633 | ||
| Near point accommodation | 633 | ||
| Dynamic refraction | 634 | ||
| Accommodative facility | 634 | ||
| Convergence | 635 | ||
| Binocular function | 635 | ||
| Saccadic function | 635 | ||
| Suggested management | 635 | ||
| Controversial theories and treatments | 635 | ||
| Magnocellular theory | 635 | ||
| Meares Irlen syndrome | 635 | ||
| Ocular motor dysfunction | 635 | ||
| Accommodation exercises and low plus glasses | 636 | ||
| Summary | 636 | ||
| Acknowledgment | 636 | ||
| References | 636 | ||
| 62 Neurometabolic disease and the eye | 638 | ||
| Chapter contents | 638 | ||
| Lysosomal disorders | 638 | ||
| Mucopolysaccharidoses | 639 | ||
| Corneal clouding in MPS | 639 | ||
| Hypermetropia and strabismus in MPS | 640 | ||
| Retinopathy in MPS | 640 | ||
| Optic disk swelling and atrophy | 640 | ||
| Glaucoma | 641 | ||
| Systemic manifestations in MPS | 641 | ||
| Prognosis and treatment of MPS | 641 | ||
| Neuronal ceroid lipofuscinosis | 642 | ||
| Infantile neuronal ceroid lipofuscinosis (CLN1, Haltia-Santavuori disease) | 642 | ||
| Classical late infantile neuronal ceroid lipofuscinosis (CLN2, Jansky-Bielschowsky disease) | 642 | ||
| Juvenile neuronal ceroid lipofuscinosis (CLN3, Batten’s disease) | 642 | ||
| Glycoprotein disorders | 643 | ||
| α-Mannosidosis (α-mannosidase deficiency) | 643 | ||
| Fucosidosis | 643 | ||
| Sialidosis (mucolipidosis type I) | 643 | ||
| Sialic acid storage diseases | 643 | ||
| Mucolipidoses | 644 | ||
| Sphingolipidoses | 645 | ||
| GM2 gangliosidosis | 645 | ||
| Metachromatic leukodystrophy (arylsulfatase deficiency) | 645 | ||
| Krabbe’s disease (galactocerebrosidase deficiency) | 645 | ||
| GM1 gangliosidosis | 645 | ||
| Niemann-Pick disease | 645 | ||
| Niemann-Pick disease types A and B (sphingomyelinase deficiency) | 645 | ||
| Niemann-Pick types C and D | 646 | ||
| Fabry’s disease (α-galactosidase deficiency) | 646 | ||
| Farber’s disease | 647 | ||
| Cystinosis | 647 | ||
| Gaucher’s disease (glucocerebrosidase deficiency) | 647 | ||
| Gaucher’s type 1 (non-neurologic) | 647 | ||
| Gaucher’s type 2 (infantile) | 647 | ||
| Gaucher’s type 3 (Norrbottnian or chronic neuronopathic) | 647 | ||
| Mitochondrial disorders | 648 | ||
| Leber’s hereditary optic neuropathy | 648 | ||
| Kearns-Sayre syndrome | 648 | ||
| MELAS syndrome | 648 | ||
| NARP syndrome | 648 | ||
| Leigh’s disease | 648 | ||
| Alpers’ syndrome | 649 | ||
| Sengers’ syndrome | 649 | ||
| Autosomal dominant optic atrophy | 649 | ||
| Peroxisomal diseases | 649 | ||
| Peroxisomal biogenesis disorders | 649 | ||
| Zellweger’s spectrum (Zellweger’s syndrome, neonatal adrenoleukodystrophy, infantile Refsum’s disease) | 649 | ||
| Rhizomelic chondrodysplasia punctata | 649 | ||
| Refsum’s disease | 649 | ||
| X-linked adrenoleukodystrophy | 649 | ||
| Primary hyperoxaluria type I | 650 | ||
| Congenital defects of glycosylation | 650 | ||
| Disorders of N-linked glycosylation | 650 | ||
| Walker-Warburg syndrome and muscle–eye–brain disease | 650 | ||
| Inborn errors of carbohydrate metabolism | 650 | ||
| Galactosemia and galactokinase deficiency | 650 | ||
| Inborn errors of amino acid metabolism | 651 | ||
| Homocystinuria | 651 | ||
| Propionic and methylmalonic acidemias | 651 | ||
| CblC (cobalamin C) disease | 651 | ||
| Maple syrup urine disease | 651 | ||
| Molybdenum cofactor deficiency and isolated sulfite oxidase deficiency | 651 | ||
| Gyrate atrophy | 651 | ||
| Tyrosinemia type 2 (Richner-Hanhart syndrome) | 651 | ||
| Oculocutaneous albinism | 652 | ||
| Aromatic L-amino acid decarboxylase deficiency | 652 | ||
| Canavan’s disease | 652 | ||
| Disorders of fatty acid and fatty alcohol metabolism | 652 | ||
| Long chain 3-hydroxyacyl-CoA dehydrogenase deficiency | 652 | ||
| Sjögren-Larsson syndrome | 653 | ||
| Disorders of sterol metabolism | 653 | ||
| Smith-Lemli-Opitz syndrome | 653 | ||
| Mevalonic aciduria and hyperimmunoglobulinemia D syndrome | 653 | ||
| X-linked dominant chondrodysplasia punctata 2 (CDPX2, Conradi-Hünermann syndrome) | 654 | ||
| Cerebrotendinous xanthomatosis | 654 | ||
| X-linked ichthyosis (steroid sulfatase deficiency) | 654 | ||
| Lipoprotein disorders | 654 | ||
| Abetalipoproteinemia (Bassen-Kornzweig syndrome) | 654 | ||
| Lecithin : cholesterol acyltransferase (LCAT) deficiency and “fish eye” disease (partial LCAT deficiency) | 654 | ||
| Apo A-I deficiency | 654 | ||
| Copper transport disorders | 654 | ||
| Wilson’s disease | 654 | ||
| Menkes’ disease | 654 | ||
| References | 655 | ||
| References | 655.e1 | ||
| 63 Pupil anomalies and reactions | 656 | ||
| Chapter contents | 656 | ||
| Development (see Chapter 2) | 656 | ||
| The near synkinesis | 656 | ||
| Congenital and structural abnormalities | 656 | ||
| Afferent abnormalities of pupil reactivity | 657 | ||
| Afferent pupil defects | 657 | ||
| Amaurotic pupils | 657 | ||
| Relative afferent pupil defect | 658 | ||
| Testing for a RAPD | 658 | ||
| Light–near dissociation | 658 | ||
| Efferent pupillomotor defects | 658 | ||
| Argyll Robertson pupils | 658 | ||
| Sylvian aqueduct syndrome (Parinaud’s dorsal midbrain syndrome) | 658 | ||
| Adie’s syndrome (tonic pupil syndrome) | 658 | ||
| Other causes of tonic pupils | 659 | ||
| Iris abnormalities | 659 | ||
| Benign episodic unilateral mydriasis (“springing pupil”) | 660 | ||
| Midbrain corectopia | 660 | ||
| Third nerve palsy (see Chapter 82) | 660 | ||
| Riley-Day syndrome | 660 | ||
| Iris sphincter or dilator muscle spasms | 660 | ||
| Paradoxical pupils | 660 | ||
| Horner’s syndrome | 661 | ||
| Clinical characteristics | 661 | ||
| Miosis | 661 | ||
| Ptosis | 661 | ||
| Ipsilateral anhidrosis | 661 | ||
| Heterochromia | 662 | ||
| Pharmacological responses | 662 | ||
| Other characteristics | 662 | ||
| Congenital Horner’s syndrome (Fig. 63.10) | 662 | ||
| Postnatally acquired Horner’s syndrome | 663 | ||
| Management | 663 | ||
| Congenital Horner’s syndrome | 663 | ||
| Acquired Horner’s syndrome | 663 | ||
| Pupil changes from high sympathetic “tone” | 664 | ||
| Pupil changes from damage to the parasympathetic system (see Chapter 82) | 664 | ||
| Pharmacological agents | 664 | ||
| Pupil-dilating agents | 664 | ||
| Parasympatholytic agents | 664 | ||
| Sympathomimetics | 664 | ||
| Pupil-constricting agents | 664 | ||
| Cholinergic drugs | 664 | ||
| Anticholinesterases | 664 | ||
| Sympatholytic agents | 664 | ||
| Systemic agents | 664 | ||
| Abnormalities of the near reflex | 664 | ||
| Congenital absence | 664 | ||
| Acquired defects | 664 | ||
| Sylvian aqueduct (Parinaud’s) syndrome | 664 | ||
| Systemic disease | 665 | ||
| Pharmacological agents | 665 | ||
| Eye disease | 665 | ||
| Other neurological causes | 665 | ||
| Accommodation in school children | 665 | ||
| Spasm of the near reflex | 665 | ||
| References | 665 | ||
| 64 Leukemia | 667 | ||
| Chapter contents | 667 | ||
| Introduction | 667 | ||
| Lids | 668 | ||
| Conjunctiva | 668 | ||
| Cornea and sclera | 668 | ||
| Lens | 668 | ||
| Anterior chamber, iris and intraocular pressure | 668 | ||
| Choroid | 669 | ||
| Retina and vitreous | 669 | ||
| Hyperviscosity changes | 669 | ||
| Retinal hemorrhages | 670 | ||
| Retinal infiltrates and white patches | 670 | ||
| Retinal infarction | 671 | ||
| Vitreous cells | 671 | ||
| Other retinal manifestations | 671 | ||
| Optic nerve | 671 | ||
| Other neuro-ophthalmic involvement | 671 | ||
| Complications of treatment | 672 | ||
| Drugs | 672 | ||
| Stem cell transplantation | 673 | ||
| References | 674 | ||
| 65 Phakomatoses | 675 | ||
| Chapter contents | 675 | ||
| Definition | 675 | ||
| Neurofibromatoses | 675 | ||
| Neurofibromatosis type 1 | 675 | ||
| Genetics | 675 | ||
| Clinical presentation | 675 | ||
| Lisch nodules | 675 | ||
| Anterior segment and uvea | 676 | ||
| Skin, lids and orbits | 676 | ||
| Skeletal anomalies | 676 | ||
| Optic disk and central nervous system | 677 | ||
| Other systems | 677 | ||
| Neurofibromatosis type 2 | 678 | ||
| Genetics | 678 | ||
| Systemic findings | 678 | ||
| Ocular findings | 678 | ||
| Anterior segment | 678 | ||
| Posterior segment | 678 | ||
| Prognosis | 679 | ||
| Tuberous sclerosis | 680 | ||
| Diagnostic criteria | 680 | ||
| Genetics | 680 | ||
| Neurologic features | 680 | ||
| Dermatologic manifestations | 682 | ||
| Visceral features | 682 | ||
| Ocular features | 682 | ||
| Ocular management | 682 | ||
| Vigabatrin monitoring | 684 | ||
| von Hippel-Lindau disease | 684 | ||
| Genetics | 684 | ||
| Diagnostic criteria and screening | 685 | ||
| CNS and visceral features | 685 | ||
| Ophthalmic features | 685 | ||
| Sturge-Weber syndrome | 685 | ||
| Pathogenesis | 686 | ||
| Neurologic features | 686 | ||
| Ophthalmic features and management issues | 686 | ||
| Dermatologic features and management issues | 687 | ||
| Other conditions sometimes grouped with phakomatoses | 688 | ||
| Klippel-Trénaunay-Weber syndrome (Fig. 65.24) | 688 | ||
| Ataxia telangiectasia (Louis-Bar syndrome) | 688 | ||
| Wyburn-Mason syndrome | 688 | ||
| References | 688 | ||
| 66 Accidental trauma in children | 690 | ||
| Chapter contents | 690 | ||
| Introduction | 690 | ||
| Epidemiology | 690 | ||
| Self-inflicted injury | 690 | ||
| Ophthalmic trauma caused by amniocentesis and birth injury | 690 | ||
| Eyelid and lacrimal system trauma | 690 | ||
| Anterior segment trauma | 691 | ||
| Subconjunctival hemorrhage (see Chapter 31) | 691 | ||
| Corneal abrasion | 691 | ||
| Corneal foreign body | 691 | ||
| Eye wall injuries | 692 | ||
| Etiology | 692 | ||
| Predisposition (“brittle corneas”) | 692 | ||
| Globe rupture | 693 | ||
| Anterior versus posterior laceration | 693 | ||
| Diagnosis | 693 | ||
| Management | 693 | ||
| Prevention | 693 | ||
| Treatment | 693 | ||
| Imaging | 693 | ||
| Anesthesia | 694 | ||
| Surgery | 694 | ||
| Prognosis | 694 | ||
| Traumatic cataracts | 694 | ||
| Hyphema | 694 | ||
| Posterior segment trauma | 695 | ||
| Commotio retinae | 695 | ||
| Purtscher’s retinopathy | 695 | ||
| Whiplash injury | 696 | ||
| Choroidal rupture | 696 | ||
| Retinal hemorrhages | 696 | ||
| Traumatic retinal detachment | 696 | ||
| Orbit trauma | 696 | ||
| Orbital bone fractures | 696 | ||
| General | 696 | ||
| Blow-out fractures | 696 | ||
| Etiology | 696 | ||
| Complications | 697 | ||
| Traumatic optic neuropathy (see Chapter 53) | 697 | ||
| Etiology | 697 | ||
| Diagnosis and treatment | 697 | ||
| Traumatic retrobulbar hemorrhage | 697 | ||
| Central nervous system trauma (see Chapter 56) | 697 | ||
| Prolonged cortical visual impairment following trauma | 697 | ||
| Post-traumatic transient cortical visual impairment | 698 | ||
| Traumatic cranial neuropathy (see Chapter 83) | 698 | ||
| Diagnosis | 698 | ||
| Management | 698 | ||
| Disorders following concussion | 698 | ||
| References | 698 | ||
| 67 Child maltreatment, abusive head injury and the eye | 700 | ||
| Chapter contents | 700 | ||
| Definitions | 700 | ||
| Epidemiology | 700 | ||
| Risk factors for child maltreatment | 700 | ||
| Presentation of child abuse victims to the ophthalmologist | 701 | ||
| Management | 701 | ||
| Clinical records | 702 | ||
| History | 703 | ||
| Examination | 703 | ||
| Medico-legal issues | 703 | ||
| Expert witness | 703 | ||
| Evaluation of child maltreatment literature | 703 | ||
| Ophthalmic features of physical abuse | 704 | ||
| Direct injury | 704 | ||
| Indirect injury | 704 | ||
| Ophthalmology outcome on follow-up of abusive head injury | 706 | ||
| Differential diagnosis of retinal hemorrhages | 707 | ||
| Clinical entities or disease states | 708 | ||
| Pre-existing eye disease | 708 | ||
| Confounding conditions | 708 | ||
| Systemic features of abusive head injury | 709 | ||
| Neurological | 709 | ||
| Fractures | 709 | ||
| Bites | 709 | ||
| Burns and scalds | 709 | ||
| Bruises | 710 | ||
| Biomechanics of retinal hemorrhages | 711 | ||
| Prevention | 711 | ||
| Munchausen’s syndrome by proxy | 711 | ||
| The ophthalmologist and child maltreatment | 712 | ||
| References | 712 | ||
| References | 713.e1 | ||
| 68 Refractive surgery in children | 714 | ||
| Chapter contents | 714 | ||
| Introduction | 714 | ||
| Types of refractive surgery used in children | 715 | ||
| Safety of ASA versus LASIK | 715 | ||
| Phakic intraocular lens safety | 715 | ||
| Refractive lens exchange and clear lens extraction safety | 716 | ||
| Strategy for pediatric refractive surgery | 716 | ||
| Improvements in visual acuity and visual function | 716 | ||
| Controversies in pediatric refractive surgery | 716 | ||
| Summary | 716 | ||
| References | 720 | ||
| References | 720.e1 | ||
| 6 Amblyopia, strabismus and eye movements | 721 | ||
| 1 The fundamentals of strabismus and amblyopia | 721 | ||
| 69 A vision of the present and future of strabismus | 721 | ||
| Chapter contents | 721 | ||
| Pharmacologic treatment of strabismus | 721 | ||
| Pharmacologic treatment of the deviation | 721 | ||
| Botulinum toxin A | 721 | ||
| Crotoxin | 721 | ||
| Bupivacaine | 721 | ||
| Pharmacologic treatment of amblyopia | 722 | ||
| Surgical treatment of strabismus | 722 | ||
| Strabismus surgery | 722 | ||
| Chemical or biologic adhesives | 723 | ||
| Implantable functional electrical stimulation devices to correct strabismus and nystagmus | 723 | ||
| Replacement of lost ocular rotational forces | 723 | ||
| A new method for treating nystagmus | 723 | ||
| The genetics of strabismus | 724 | ||
| Comitant strabismus | 724 | ||
| Incomitant strabismus | 724 | ||
| The congenital cranial dysinnervation disorders | 724 | ||
| The CFEOMs | 724 | ||
| Duane’s syndrome | 724 | ||
| Stem cells and strabismus | 725 | ||
| References | 725 | ||
| References | 725.e1 | ||
| 70 Amblyopia management | 726 | ||
| Chapter contents | 726 | ||
| Methods of detection | 726 | ||
| Methods of treatment | 727 | ||
| Refractive correction | 727 | ||
| Occlusion therapy | 727 | ||
| “Penalization” therapy | 729 | ||
| Occlusion compared to penalization | 729 | ||
| Fogging | 729 | ||
| Active therapy | 730 | ||
| Systemic therapy | 730 | ||
| Combined therapies | 730 | ||
| Discontinuation of treatment/maintenance therapy | 731 | ||
| Compliance | 731 | ||
| Reverse amblyopia | 731 | ||
| Treatment of adults | 731 | ||
| References | 731 | ||
| References | 732.e1 | ||
| 71 The physiologic anatomy of eye muscles and the surgical anatomy of strabismus | 733 | ||
| Chapter contents | 733 | ||
| Introduction | 733 | ||
| The extraocular muscles | 733 | ||
| Medial rectus muscle | 736 | ||
| Lateral rectus muscle | 736 | ||
| Superior rectus muscle | 736 | ||
| Inferior rectus muscle | 737 | ||
| Superior oblique muscle | 737 | ||
| Inferior oblique muscle | 737 | ||
| Orbital connective tissue | 738 | ||
| The pulley theory | 739 | ||
| Anatomic variations | 740 | ||
| References | 740 | ||
| 72 The clinical approach to strabismus | 742 | ||
| Chapter contents | 742 | ||
| Introduction | 742 | ||
| The clinical setting | 742 | ||
| Room layout | 742 | ||
| Distance fixation and acuity targets | 742 | ||
| Tools of the trade | 742 | ||
| Interaction with the child and parents | 744 | ||
| First meeting | 744 | ||
| Role of the orthoptist | 744 | ||
| Practical history taking: extracting clinically relevant details | 744 | ||
| Examination | 744 | ||
| Sensory examination | 744 | ||
| Acuity | 744 | ||
| Preferential looking techniques | 745 | ||
| Kay pictures | 745 | ||
| logMAR-based matching tests | 745 | ||
| logMAR | 745 | ||
| Fixation preference | 745 | ||
| Binocular single vision, fusion and stereopsis | 745 | ||
| Retinal correspondence | 745 | ||
| Motor and sensory fusion | 745 | ||
| Central (bifoveal) and peripheral fusion | 745 | ||
| Fusion range (fusion amplitudes) | 745 | ||
| Binocular vision | 746 | ||
| Stereopsis | 746 | ||
| Measuring retinal correspondence binocular vision, and fusion | 746 | ||
| Tests of retinal correspondence | 746 | ||
| Bagolini glasses | 746 | ||
| Tests of fusion potential | 746 | ||
| Worth four-dot test | 746 | ||
| Testing fusion range (amplitude) | 746 | ||
| Tests of stereopsis | 746 | ||
| Accommodation and convergence | 747 | ||
| Motor examination | 747 | ||
| Basic deviation | 747 | ||
| Prism cover tests in nine positions of gaze | 747 | ||
| Versions and ductions | 747 | ||
| Head tilts | 747 | ||
| Torsion measurement | 747 | ||
| Maddox rods | 747 | ||
| Bagolini lenses | 749 | ||
| Indirect ophthalmoscopy | 749 | ||
| Forced duction and forced generation tests | 749 | ||
| Abnormal head postures (see Chapter 81) | 749 | ||
| Ocular examination in strabismus patients | 749 | ||
| Documentation of strabismus findings | 751 | ||
| Sensory documentation | 751 | ||
| Motor documentation | 751 | ||
| Prism cover tests | 751 | ||
| Versions | 751 | ||
| Characteristics of abnormal ocular movements | 751 | ||
| Electronic patient records and audit in strabismus management | 752 | ||
| References | 755 | ||
| 73 Why do humans develop strabismus? | 756 | ||
| Chapter contents | 756 | ||
| Developmental non-paralytic strabismus | 756 | ||
| Early-onset (infantile) esotropia | 756 | ||
| Early cerebral damage as the major risk factor | 756 | ||
| Cytotoxic insults to cerebral fibers | 757 | ||
| Genetic influences on formation of cerebral connections | 757 | ||
| Development of binocular visuomotor behavior in normal infants | 757 | ||
| Development of sensorial fusion and stereopsis | 758 | ||
| Development of fusional vergence and an innate convergence bias | 758 | ||
| Development of motion sensitivity and conjugate eye tracking (pursuit/optokinetic nystagmus) | 758 | ||
| Development and maldevelopment of cortical binocular connections | 758 | ||
| Persistent nasalward visuomotor biases in strabismic primate | 758 | ||
| Repair of strabismic human infants: the historical controversy | 758 | ||
| Repair of high-grade fusion is possible | 759 | ||
| Timely restoration of correlated binocular input: the key to repair | 760 | ||
| Visual cortex mechanisms in microesotropia (monofixation syndrome) | 760 | ||
| Neuroanatomic findings in area V1 of microesotropic primates | 761 | ||
| Extrastriate cortex in microesotropia | 761 | ||
| Acquired (non-infantile) esotropia | 762 | ||
| Exotropia | 762 | ||
| Summary of strabismus neuroscience knowledge | 762 | ||
| References | 763 | ||
| References | 763.e1 | ||
| 2 Esotropias | 764 | ||
| 74 Infantile esotropias | 764 | ||
| Chapter contents | 764 | ||
| History | 764 | ||
| Epidemiology | 765 | ||
| The natural history of the development of ocular alignment | 765 | ||
| Clinical patterns | 765 | ||
| Dissociated vertical deviation (alternating sursumduction, occlusion hyperphoria) | 765 | ||
| Inferior oblique muscle overaction | 765 | ||
| Dissociated horizontal deviation | 766 | ||
| Latent nystagmus | 766 | ||
| Optokinetic asymmetry | 766 | ||
| Differential diagnosis | 766 | ||
| Ciancia syndrome | 767 | ||
| Nystagmus blockage syndrome | 767 | ||
| Does stability of preoperative alignment affect outcomes? | 768 | ||
| Measurement uncertainty | 768 | ||
| Non-surgical management | 768 | ||
| Timing of surgery: why early surgery? | 769 | ||
| Why delay primary surgery? | 771 | ||
| Surgical management | 771 | ||
| Review of botulinum and the rationale of its use | 772 | ||
| Postsurgical management | 772 | ||
| Conclusion | 773 | ||
| Acknowledgment | 773 | ||
| References | 773 | ||
| References | 774.e1 | ||
| 75 The accommodative esotropias | 775 | ||
| Chapter contents | 775 | ||
| Characteristics | 775 | ||
| Classification | 775 | ||
| The accommodative convergence/accommodation ratio | 776 | ||
| Risk factors for accommodative esotropia | 776 | ||
| Clinical evaluation | 776 | ||
| Non-surgical treatment | 776 | ||
| Surgical treatment | 777 | ||
| Long-term prognosis | 777 | ||
| References | 778 | ||
| 76 Special esotropias (acute comitant, sensory deprivation, myopia associated and microtropia) | 779 | ||
| Chapter contents | 779 | ||
| Acute comitant esotropia | 779 | ||
| Sensory deprivation esotropia | 780 | ||
| Myopia-associated esotropia | 780 | ||
| Microtropia | 781 | ||
| Synthesis | 781 | ||
| References | 782 | ||
| 3 Exotropias | 783 | ||
| 77 Intermittent exotropia | 783 | ||
| Chapter contents | 783 | ||
| Definition | 783 | ||
| Cause | 783 | ||
| Epidemiology | 784 | ||
| Clinical features | 784 | ||
| Quality of life in intermittent exotropia | 784 | ||
| Clinical evaluation | 784 | ||
| Assessing the control of intermittent exotropia | 785 | ||
| Measuring the deviation | 785 | ||
| Stereoacuity in intermittent exotropia | 786 | ||
| Differential diagnosis | 786 | ||
| Management of intermittent exotropia | 786 | ||
| Overminus lenses | 786 | ||
| Orthoptic/occlusion treatment | 786 | ||
| Chemodenervation | 786 | ||
| Surgical management | 786 | ||
| Surgical procedures | 788 | ||
| Desired early postoperative alignment | 788 | ||
| Other associations | 788 | ||
| Pattern deviations (see Chapter 80) | 788 | ||
| Lateral or horizontal incomitance | 788 | ||
| High AC/A ratio | 789 | ||
| Concomitant vertical deviations | 789 | ||
| Postoperative undercorrection | 789 | ||
| Postoperative overcorrection | 789 | ||
| References | 791 | ||
| References | 791.e1 | ||
| 78 Special forms of comitant exotropia | 792 | ||
| Chapter contents | 792 | ||
| 7 Common Practical Problems in a Paediatric Ophthalmology and Strabismus Practice | 944 | ||
| 91 I think my baby can’t see! | 944 | ||
| History | 944 | ||
| Examination | 944 | ||
| References | 947 | ||
| 92 My baby’s got a red eye, doctor! | 948 | ||
| The baby with a red and discharging eye | 948 | ||
| The baby with a painless red eye | 948 | ||
| The baby with a watery red eye | 948 | ||
| The baby with photophobia or blepharospasm and a red eye | 948 | ||
| References | 949 | ||
| 93 The sticky eye in infancy | 950 | ||
| Ophthalmia neonatorum | 950 | ||
| Bacterial conjunctivitis | 950 | ||
| Viral and allergic conjunctivitis | 950 | ||
| Nasolacrimal duct obstruction | 950 | ||
| Lashes and lids | 950 | ||
| Malnutrition and other causes | 950 | ||
| References | 951 | ||
| 94 Doctor, my baby’s eye looks strange | 953 | ||
| 95 My baby has a lump in the lid | 954 | ||
| Rhabdomyosarcoma (see Chapter 24) | 954 | ||
| Dermoid (see Chapter 29) | 954 | ||
| Capillary hemangioma (see Chapter 20) | 955 | ||
| Chalazion (see Chapter 15) | 956 | ||
| Molluscum contagiosum and warts (see Chapter 19) | 956 | ||
| Stye/abscess | 956 | ||
| Other less common causes of lumps in the lid | 956 | ||
| Malignancies | 956 | ||
| Nevi (see Chapter 18) | 956 | ||
| Inflammatory lesions | 956 | ||
| Neural (see Chapter 65) | 956 | ||
| Other vascular lesions (see Chapter 20) | 956 | ||
| Miscellaneous | 956 | ||
| References | 956 | ||
| 96 My child keeps blinking and closing his eye | 957 | ||
| Introduction | 957 | ||
| History | 957 | ||
| Examination | 957 | ||
| Tic disorder | 957 | ||
| Management | 958 | ||
| Ocular surface disorders | 958 | ||
| Ocular alignment/movement/refraction | 958 | ||
| Photoreceptor dystrophy | 958 | ||
| Other possibilities | 958 | ||
| 97 My baby keeps closing one eye | 959 | ||
| Introduction | 959 | ||
| The approach to a case | 959 | ||
| Acute presentation | 959 | ||
| Sub-acute or chronic presentation | 959 | ||
| Unilateral or bilateral asymmetric eye closure | 960 | ||
| References | 960 | ||
| 98 My child’s eyes are dry and sore | 961 | ||
| Introduction | 961 | ||
| Presentation and symptoms | 961 | ||
| History | 961 | ||
| Examination | 962 | ||
| Assessment | 962 | ||
| Visual acuity | 963 | ||
| External inspection | 963 | ||
| Ocular surface examination and staining patterns | 963 | ||
| Other tests | 963 | ||
| Schirmer’s test | 963 | ||
| Tear osmolarity | 963 | ||
| Impression cytology | 963 | ||
| Corneal sensation | 964 | ||
| Causes of dry eye | 965 | ||
| Management | 965 | ||
| General advice | 965 | ||
| Protection | 965 | ||
| Lubrication | 965 | ||
| Allergic eye disease | 965 | ||
| Cyclosporine A | 965 | ||
| Acetyl cysteine drops | 966 | ||
| Lid margin disease | 966 | ||
| Punctal occlusion: temporary or permanent | 966 | ||
| Glasses and moisture-retaining goggles | 966 | ||
| Contact lenses | 966 | ||
| Tarsorrhaphy: temporary, permanent | 966 | ||
| Salivary gland transplant | 966 | ||
| References | 967 | ||
| 99 My child seems to hate the bright light | 968 | ||
| Presentation | 968 | ||
| The approach to a photophobic child | 968 | ||
| The pathophysiology of photophobia | 968 | ||
| Diseases causing photophobia | 969 | ||
| Conjunctivitis | 969 | ||
| Corneal disorders | 969 | ||
| Glaucoma | 969 | ||
| Uvea | 969 | ||
| Lens | 970 | ||
| Retina | 970 | ||
| Central nervous system | 970 | ||
| Strabismus | 970 | ||
| Physiological and functional | 970 | ||
| Management | 970 | ||
| References | 970 | ||
| 100 My child’s eyes keep watering! | 971 | ||
| Signs and symptoms | 971 | ||
| History | 971 | ||
| Examination | 971 | ||
| External inspection | 971 | ||
| Slit-lamp examination | 971 | ||
| Fluorescein testing | 971 | ||
| Intraocular pressure | 971 | ||
| Cycloplegic refraction, fundus examination | 972 | ||
| Causes and treatment | 972 | ||
| Non-patent nasolacrimal drainage system (see Chapter 21) | 972 | ||
| Treatment | 972 | ||
| Foreign body/corneal abrasion | 972 | ||
| Keratitis and conjunctivitis (see Chapter 15) | 972 | ||
| Contact lens-related epiphora | 972 | ||
| Congenital glaucoma | 972 | ||
| Crocodile tears | 973 | ||
| References | 973 | ||
| 101 Proptosis at different ages | 974 | ||
| 102 My child seems to have a pain in the eye | 975 | ||
| Pain systems | 975 | ||
| Classification of eye pains | 975 | ||
| History | 975 | ||
| Examination | 975 | ||
| Other investigations | 976 | ||
| Headache | 976 | ||
| Refraction | 977 | ||
| Visual symptoms | 977 | ||
| Ocular symptoms | 977 | ||
| Referred symptoms | 977 | ||
| References | 977 | ||
| 103 My child’s teacher says she can’t see properly! | 978 | ||
| Mode of presentation | 978 | ||
| Diagnosis | 978 | ||
| History | 978 | ||
| Examination | 978 | ||
| Ocular examination | 978 | ||
| Neurological examination | 978 | ||
| Causes and treatment | 979 | ||
| Amblyopia | 979 | ||
| Refractive errors | 979 | ||
| Accommodative anomalies | 979 | ||
| Orbital disease (see Chapter 22) | 979 | ||
| Media opacities | 979 | ||
| Corneal diseases (see Chapter 33) | 979 | ||
| Anterior chamber anomalies | 979 | ||
| Lens anomalies (see Chapter 35) | 979 | ||
| Vitreous disorders | 980 | ||
| Retinal disorders | 980 | ||
| Congenital vascular disorders (see Chapter 47) | 980 | ||
| Retinal dystrophies (see Chapter 44) | 980 | ||
| Systemic disease | 980 | ||
| Optic nerve diseases | 980 | ||
| Central nervous system diseases | 980 | ||
| Non-organic visual disorders | 980 | ||
| 104 My child could see perfectly but now the vision is weak | 981 | ||
| Examination | 981 | ||
| Anterior segment | 981 | ||
| Cornea | 981 | ||
| Iris | 981 | ||
| Lens | 981 | ||
| Posterior segment | 981 | ||
| Vitreous | 981 | ||
| Retina/choroid | 981 | ||
| Optic nerve, chiasm, and optic tract | 982 | ||
| Central nervous system and cortical visual impairment | 982 | ||
| What if the eye exam is normal? | 982 | ||
| Electrophysiological tests (see Chapter 8) | 983 | ||
| Neuroimaging studies | 983 | ||
| 105 The deaf-blind child | 984 | ||
| Background | 984 | ||
| Communication with dual sensory impaired | 984 | ||
| Neuroadaptation | 984 | ||
| Causes of deaf-blindness | 984 | ||
| Management | 984 | ||
| Resources | 986 | ||
| Deafblind UK | 986 | ||
| Sense | 986 | ||
| National Consortium on Deaf-Blindness | 986 | ||
| American Association of the Deaf-Blind | 986 | ||
| Organizations for Deafblind People Throughout the World | 987 | ||
| References | 987 | ||
| 106 Optic atrophy in infancy and childhood | 988 | ||
| Presentation | 988 | ||
| Causes (Fig. 106.3) | 988 | ||
| History and examination | 990 | ||
| Further investigations | 990 | ||
| Prognosis | 991 | ||
| References | 991 | ||
| 107 The swollen optic disc | 992 | ||
| 108 Headache in children | 1004 | ||
| Introduction | 1004 | ||
| Classification and etiology | 1004 | ||
| When is a headache worrying? | 1004 | ||
| Chronic daily headaches | 1005 | ||
| Tension-type headaches | 1005 | ||
| Cluster headache and paroxysmal hemicrania | 1005 | ||
| Migraine | 1005 | ||
| Etiology and genetics of migraine | 1006 | ||
| Management of pediatric migraine | 1007 | ||
| Bio-behavioral strategies | 1007 | ||
| Acute therapies | 1007 | ||
| Preventative therapies | 1007 | ||
| Secondary headaches | 1007 | ||
| Epilepsy | 1007 | ||
| Preictal headaches | 1007 | ||
| Postictal headaches | 1008 | ||
| Raised intracranial pressure and idiopathic intracranial hypertension | 1008 | ||
| Brain tumor | 1008 | ||
| Infections | 1008 | ||
| Structural abnormalities | 1008 | ||
| Vascular abnormalities | 1008 | ||
| Summary | 1008 | ||
| References | 1009 | ||
| 109 My little girl tells me she sees strange things | 1010 | ||
| Introduction | 1010 | ||
| Entoptic phenomena | 1011 | ||
| Photopsia and phosphenes | 1011 | ||
| Floaters (myodesopsia, mouches volantes) | 1012 | ||
| Benign blurred (“fuzzy”) vision | 1012 | ||
| Transient loss of vision | 1012 | ||
| Movement illusions (oscillopsia and Pulfrich phenomenon) | 1012 | ||
| Color (dyschromatopsia) | 1012 | ||
| Seeing multiples (monocular diplopia, triplopia, and polyopia) | 1013 | ||
| Size (micropsia, macropsia, teleopsia, lilliputianism) | 1013 | ||
| Distortion (dysmetropsia, metamorphopsia and “Alice in Wonderland syndrome”) | 1013 | ||
| Bradyopsia | 1014 | ||
| Visual perseveration and other rare cerebral visual disturbances | 1014 | ||
| Visual disturbances associated with migraine | 1014 | ||
| Hallucinations | 1014 | ||
| Hallucinations in darkness and with social deprivation | 1014 | ||
| Charles Bonnet syndrome (visual release phenomenon) | 1014 | ||
| Hypnagogic and hypnopompic hallucinations | 1015 | ||
| Occipital and temporal lobe epilepsy | 1015 | ||
| Peduncular hallucinosis | 1015 | ||
| Drug-induced hallucinations | 1015 | ||
| Psychogenic (“functional”) visual loss | 1015 | ||
| Medical conditions | 1017 | ||
| Psychiatric dis ease | 1017 | ||
| References | 1017 | ||
| 110 My little boy isn’t doing as well as he should at school | 1018 | ||
| Possible reasons for poor school progress | 1018 | ||
| Global learning difficulty | 1018 | ||
| Specific learning difficulty | 1018 | ||
| Other developmental disorders | 1018 | ||
| Assessment and intervention | 1019 | ||
| The role of the ophthalmologist | 1019 | ||
| School difficulty in a child with visual impairment | 1019 | ||
| Distance access | 1019 | ||
| Near access | 1019 | ||
| 111 My child’s pupils look odd! | 1021 | ||
| References | 1023 | ||
| 112 Unequal pupils | 1024 | ||
| Horner’s syndrome | 1024 | ||
| Oculomotor palsy | 1024 | ||
| Structural anomalies | 1024 | ||
| Physiological anisocoria | 1024 | ||
| Pharmacological testing | 1024 | ||
| Slit-lamp examination | 1024 | ||
| Light and near reactions | 1024 | ||
| Refraction | 1025 | ||
| When to investigate Horner’s syndrome | 1025 | ||
| References | 1025 | ||
| 113 Wobbly eyes in infancy | 1026 | ||
| Clinical “wave forms” | 1026 | ||
| Vision | 1029 | ||
| Further reading | 1029 | ||
| 114 Practical problems: | 1030 | ||
| Introduction | 1030 | ||
| Nomenclature | 1030 | ||
| Patient history | 1030 | ||
| Characterization of the head position | 1030 | ||
| Examination | 1031 | ||
| Visual acuity/refraction | 1031 | ||
| External examination | 1031 | ||
| Ocular motility | 1031 | ||
| Other aspects of the examination | 1031 | ||
| Treatment | 1032 | ||
| Summary | 1032 | ||
| References | 1032 | ||
| 115 Vital communication issues: | 1033 | ||
| Before the consultation | 1033 | ||
| During the consultation | 1033 | ||
| After the consultation | 1034 | ||
| Complaints and litigation | 1035 | ||
| Poor attendance | 1035 | ||
| Summary | 1035 | ||
| References | 1035 | ||
| 116 Vital communication issues: | 1036 | ||
| Infants | 1036 | ||
| School-age children | 1036 | ||
| If all else fails | 1037 | ||
| Summary | 1037 | ||
| References | 1037 | ||
| 117 My child just will not let me put the eye drops in! | 1038 | ||
| Introduction | 1038 | ||
| Causes of poor compliance | 1038 | ||
| Formulating a strategy | 1038 | ||
| Conclusions | 1039 | ||
| 118 Hand defects and the eye | 1040 | ||
| Embryology | 1040 | ||
| Etiology | 1040 | ||
| References | 1044 | ||
| 119 Contact lenses for children | 1045 | ||
| Lens insertion for a child | 1045 | ||
| Types of lenses | 1045 | ||
| Hygiene | 1045 | ||
| High prescriptions and aphakia | 1045 | ||
| High myopia | 1045 | ||
| What lens to fit? | 1045 | ||
| Unilateral ametropia | 1045 | ||
| Aphakia | 1045 | ||
| Congenital cataracts | 1045 | ||
| Procedure for lens fitting | 1045 | ||
| Index | 1068 | ||
| A | 1068 | ||
| B | 1070 | ||
| C | 1072 | ||
| D | 1076 | ||
| E | 1077 | ||
| F | 1079 | ||
| G | 1080 | ||
| H | 1081 | ||
| I | 1082 | ||
| J | 1084 | ||
| K | 1084 | ||
| L | 1084 | ||
| M | 1085 | ||
| N | 1087 | ||
| O | 1089 | ||
| P | 1090 | ||
| Q | 1093 | ||
| R | 1093 | ||
| S | 1095 | ||
| T | 1098 | ||
| U | 1099 | ||
| V | 1099 | ||
| W | 1101 | ||
| X | 1101 | ||
| Y | 1101 | ||
| Z | 1101 |