Daniel M Laby, MD
David G Kirschen, OD, PhD
Minefields in Pediatric Eye Care
drlaby@drlaby.com
“Minefields (Life and Sight issues) in Pediatric Eye Care” – Outline
(How to avoid a mine when walking through Pediatric Eye Care)
Drs. Laby and Kirschen have no financial interests to disclose.
Basic assumption: Cycloplegic refraction and dilated evaluation of posterior
segment integral portion of Pediatric Exam
This course will introduce the listener to the many potential minefields in the
vision care of children. Specific clinical examples will be presented in a question
and answer format, allowing the participant to test their own knowledge before
reviewing the clinical pearls of each situation.
A. Visual Acuity
1. Amblyopia – the ATS series of studies
2. Cataract
3. ROP
B. Color Vision Testing
1. Optic nerve abnormalities
2. Congenital red/green deficiency
3. Photoreceptor abnormalities
C. Ocular Alignment
1. Abduction/Adduction abnormality
a. Cranial motor nerve abnormality
1. Nerve palsy - viral
2. Compressive lesions – tumors
b. Duane Syndrome
c. Fibrosis syndrome
d. Pediatric myasthenia Gravis
1. Other associated abnormalities
2. Ptosis/Pupil changes – CNIII damage
D. Abnormal innovational patterns
1. Marcus Gunn jaw winking – a mine that isn’t
E. Nystagmus
1. Significant neurological insult vs. benign etiology
F. Trauma
1. Workup
a. hyphema
b. iritis
c. diplopia
1. muscle entrapment
2. enophthalmos
Daniel M Laby, MD
David G Kirschen, OD, PhD
Minefields in Pediatric Eye Care
drlaby@drlaby.com
a. Orbital fracture
b. legal issues
2. Pupils
a. Afferent papillary defect
b. Heterochromia – Congenital Horners syndrome
c. Horners syndrome
3. Anterior Segment
a. Iris Nevi – document for possible future malignant
transformation
b. Congenital glaucoma
4. Tearing
a. Differential
1. NLDO
2. Congenital Glaucoma
3. Allergy
4. Foreign Body/lashes
5. Corneal abnormalities
5. Posterior Segment
a. Retinoblastoma
b. Disc Edema
1. Papilledema vs. Pseudopapilledema
c. Shaken baby syndrome
6. Special Clinical Situations
a. Red Eye
b. Trauma
c. Tearing
d. Photophobia
e. Abnormal red reflex
f. Malingering