Congenital, developmental and neoplastic conditions

13.2 Congenital, developmental and neoplastic conditions



Greg Stevens




Essentials



1 These conditions are most likely to present with a concern from a parent or caregiver who has noted that there has been a change in the appearance of their child’s eyes, or that they are not responding to visual cues in an expected way.

A detailed examination will help to further define the abnormalities or deficits noted. These conditions require specialised investigations and management, and as such consultation with a paediatric ophthalmologist is advised.



Deficits in visual acuity


This may reflect a deficit anywhere from the visual cortex to the cornea and a careful examination including pinhole testing in children old enough to co-operate will help localise this and guide appropriate referral.



Strabismus


Abnormalities of the binocular alignment of the eyes, strabismus, may present with a concern from a parent that their child has a squint, and this may be confirmed by careful examination of the corneal reflex and use of the cover-uncover test.


Strabismus may be convergent (esotropia), divergent (exotropia), upwards (hypertropia) or downwards (hypotropia).


Strabismus may be a dynamic process, occurring in relation to alterations in the accommodative reflex with refractive errors.


The importance of strabismus lies in the development of amblyopia, which is the decrease in visual acuity occurring in visually immature children due to the lack of a clear image provided to the retina. It is usually unilateral. Strabismus may also be an early sign of significant visual pathology, e.g. retinoblastoma, retinitis of prematurity and Coats’ disease.

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Sep 7, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Congenital, developmental and neoplastic conditions

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