Babies!!
ED Presentations
🦓
A Picture is Worth A Thousand Words
Medications
100
We check for this in a newborn well child check!
What is Leukocoria? (absence of red reflex)
Concern for retinoblastoma, cataract, etc
Requires prompt evaluation. >95% chance of cure if tumor located within the eye. Potentially lethal if spreads past the eye
We also can look for asymmetric corneal reflexes!
100
This patient presenting with pain with extraocular eye movements will likely require admission for
What is orbital cellulitis?
100
Ectopia lentis in the upward direction is commonly seen in this connective tissue disorder
What is Marfan's Syndrome? Non-ocular manifestations include tall stature, pectus excavatum, MVP, aortic root dilation
Downward lens dislocation is commonly seen in Homocystinuria
100
What is strabismus? (mis-alignment)
100
This TB medication is well-known for turning all bodily fluids including tears orangey-red!
What is Rifampin?
The color of your tears turn back to normal after discontinuing the medication
200
Infants born at ≤28 weeks or with birth weight ≤1500g should have a dilated ophthalmoscopic examination at 4–6 weeks of age to screen for this
What is retinopathy of prematurity?
If severe, may require retinal cryotherapy or laser therapy to prevent blindness.
200
Colloquially known as "lazy eye", this condition is reduced vision in one eye caused by abnormal visual development early in life and leads to blindness if not corrected by age 7
What is amblyopia? Usually treated with an eye patch
Medicated (atropine) eye drops can be used instead of a patch. Drops are put in the “good” eye, blurring near vision in that eye... allows the eye that’s being ignored to start working with the brain
200
Eyelashes growing inwards toward the eye. The lashes rub against the cornea, the conjunctiva, and the inner surface of the eyelids.
What is Trichiasis?
More common in adults but can also be seen in kids!
200
Seen on flurorescein stain testing.
What is a corneal abrasion?
200
Accutane (isotretinoin) can cause this common eye side effect
What is dry eyes?
300
The recommended treatment for a baby presenting with this...
What is oral propanolol?
Infantile hemangioma is usually noticed within first 1-2 weeks of life. Most slowly regress over the years, but require treatment to prevent astigmatism or vision changes
300
Unilateral eye and ear infection together is concerning for...
What is Conjunctivitis-otitis syndrome?
Most often caused by nontypeable H. flu (usually beta-lactamase producers)
Systemic oral antibiotics are recommended
300
Patient with slight pupil size difference ~1mm but reactive to light
What is physiologic aniscoria? benign condition with a difference in pupil size of less than or equal to 1 mm
300
This retinal exam is concerning for this.
What is papilledema?
Can be seen in idiopathic intracranial hypertension (IIH), hypertensive crisis, intracranial tumor, etc
300
Yet another TB medication with vision side effects. Specifically, decreasing color vision.
What is ethambutol?
400
The most likely diagnosis in a 3 day old male infant with purulent eye discharge and swelling
What is conjunctivitis from Neisseria gonorrhoeae?
causes purulent, rapid onset conjunctivitis with lid swelling in infants between 2-4 days of
age
Chlamydia trachomatis causes serous or purulent conjunctivitis with variable lid swelling in infants
between 4-10 days of age
400
The most likely diagnosis for severe pain, photophobia, and tearing in a contact lens wearing patient
What is bacterial keratitis (most common organisms are gram negatives, especially pseudomonas)
Risk increased 10-fold is contact lenses are worn overnight!
400
Toddler presenting with rapid, painless proptosis is concerning for...
What is Rhabdomyosarcoma?
most common primary orbital tumor. Requires prompt evaluation
400
This painful inflammation around the eye
What is a stye?
Treat with Warm compresses. Chalazia look similar, and are caused by plugged oil ducts, but are usually painless.
Preseptal cellulitis meanwhile tends to have diffiuse inflammation, no nodule, may have fever, some history of sinusitis
400
Kids with seasonal allergies will thank you for this prescription! The 1st line for allergic conjunctivitis...
A. Timolol
B. Flonase
C. Claritin
D. Zyrtec
What is D, Zyrtec? Most beneficial for eye symptoms in environmental allergies. More effective than claritin!
500
The menace reflex is a reflex blinking that occurs in response to a rapid moving object and visual threat. This reflex typically develops by what age?
What is 5 months of age?
500
10 year old boy is brought to the ED after sustaining a baseball injury to the left eye. Which of the following is most consistent with suspected diagnosis of orbital floor fracture?
A. Glaucoma
B. Exophthalmos
C. Diplopia
D. Numbness of lower teeth/chin
What is, C, Diplopia?
Orbital floor fracture (or "blow out" fracture") is usually 2/2 blunt trauma to the orbit. Can lead to entrapment of orbital fat and inferior rectus muscle. Bc infraorbital nerve may be injured, can get numbness of the cheek and upper teeth.
500
9 month old presenting with a history of excessive tearing when eating
What is crocodile tear syndrome?
Extremely rare; when eating, lacrimal and parotid glands both get stimulated
Nasolacrimal duct obstruction = excessive tearing from birth
500
The name for the creases shown here...
What is a Dennie-Morgan Line? Often seen in patients with environmental allergies! (along with allergic shiners, pictured below)
500
This anti-seizure medication is also used to treat migraine headaches and mood disorders but can cause this very rare but dangerous side effect?
What is topamax (topiramate)? And acute angle closure glaucoma