11

22

MR SHOJA.MR SHOJA.MDMD

Shahid sadoughi Shahid sadoughi Medical SchoolMedical School

33

. Causes of Childhood Blindness

INTERNATIONAL CENTRE FOR EYE HEALTH TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS

44

Cloudy Cloudy Cornea in Cornea in infancyinfancy

Gonococcal keratitis.Gonococcal keratitis.

Congenital Corneal Diseases.Congenital Corneal Diseases.

Obstetrical Forceps Trauma.Obstetrical Forceps Trauma.

Congenital Gluacoma.Congenital Gluacoma.

55

Birth TraumaBirth Trauma : : ((Forceps Forceps injuryinjury ) )

66

Horizontal Tear in Descemet M in Congenital Glaucoma

77

Sclero CorneaSclero Cornea

Corneal DermoidCorneal Dermoid

AniridiaAniridia

CongenitalCongenital RubellaRubella

88

MUCOPOLYSACCHARIDOSE

99

CYSTINOSIS

KAYSER FLEISHERRING

1010

Peter,s anomalyPeter,s anomaly

1111

Congenital Hereditary Congenital Hereditary Endothelial Dystrophy Endothelial Dystrophy

(CHED(CHED))

Endothelial dysfunction .Endothelial dysfunction .

Increased cornea thickness.Increased cornea thickness.

Cornea is edematous & bluish.Cornea is edematous & bluish.

IOP is normal .IOP is normal .

Primary treatment isPrimary treatment is keratoplastykeratoplasty

1212

Macro Macro CorneaCornea

13 mm horizontal diameter 13 mm horizontal diameter

X-linked reccessive patternX-linked reccessive pattern

90% patients are male 90% patients are male

No Cornea clouding , photophobiaNo Cornea clouding , photophobia

MicrocorneaMicrocornea

1313

KeratoglobusKeratoglobus

Cornea is thinnerCornea is thinner

Deep anterior chamberDeep anterior chamber

Spontaneous break in descemetSpontaneous break in descemet,,s s MM

Cornea easily ruptured by truma.Cornea easily ruptured by truma.

Part of Ehlers-Danols type 6 Part of Ehlers-Danols type 6 syndrome Paitient should wear syndrome Paitient should wear protective lens.protective lens.

1414

KeratoconuKeratoconuss

Bilateral , twice in femaleBilateral , twice in female

Central , paracentral thining.Central , paracentral thining.

Irregular myopic astigmatism.Irregular myopic astigmatism.

Chronic eye rubbing is a factorChronic eye rubbing is a factor

VKC is a risk factor . VKC is a risk factor .

Common in Down ,Osteogenesis Common in Down ,Osteogenesis imperfecta imperfecta

Rapid progression occur in teanagerRapid progression occur in teanager

1515

Acute keratoconusAcute keratoconus ((Hydrops)Hydrops)

Common in DownCommon in Down, , s syndromes syndrome Result from ocular messageResult from ocular message

Often at night,extremely painful Often at night,extremely painful

Rupture in DescemetRupture in Descemet,,s membrane s membrane

Deep opacity at apex of coneDeep opacity at apex of cone

If hydrops happens, don’t lose If hydrops happens, don’t lose heartheart

1616

Cloboma Cloboma of Irisof Iris

Occur in inferonasal Iris.Occur in inferonasal Iris.

Microphthalmia is common.Microphthalmia is common.

Cloboma of retina & choroid .Cloboma of retina & choroid .

VA ranges is low.VA ranges is low.

1717

Stromal DystrophiesStromal Dystrophies

GranularGranular

MacularMacular

LatticeLattice

1818

Primary Congenital Primary Congenital GlaucomaGlaucoma

Incidence in USA is 1:10000Incidence in USA is 1:10000

Incidence in Saudia Arabic is 1:2500Incidence in Saudia Arabic is 1:2500

75% have bilateral involvement75% have bilateral involvement

Occurs in 65% of male ,reccessive Occurs in 65% of male ,reccessive patternpattern

60% occur before 6 months60% occur before 6 months

80% by 1 year of age80% by 1 year of age

1919

Congenital Glaucoma

INTERNATIONAL CENTRE FOR EYE HEALTH TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS

2020

Clinical TriadClinical Triad

11 -- EpiphoraEpiphora

22 - - PhotophobiaPhotophobia

3 3 –– Blepharospasm Blepharospasm

2121

SignsSigns :: Elevated IOPElevated IOP Cloudy cornealCloudy corneal Buphthalmos Buphthalmos Optic nerve cupping Optic nerve cupping Descemet,s membrane tear Descemet,s membrane tear Increased axial length Increased axial length

blunt trauma . hyphemablunt trauma . hyphema

Rupture of globeRupture of globe

2222

All infants with cloudy corneas must All infants with cloudy corneas must be evaluated for Congenital be evaluated for Congenital Glaucoma . Glaucoma . General practitioners especially General practitioners especially obstetricians and paediatricians obstetricians and paediatricians should know importance of early should know importance of early referral and intervention of referral and intervention of congenital glaucoma.congenital glaucoma.Sporadic but mutation found in the Sporadic but mutation found in the CYPIBI gene on chromosome 2 p 21. CYPIBI gene on chromosome 2 p 21.

Congenital

Glaucoma.

2323

Systemic conditions Systemic conditions with Glaucomawith Glaucoma

AniridiaAniridia

Retinopathy of prematurityRetinopathy of prematurity

Neuro fibromatosis Neuro fibromatosis

Sturge weber syndromeSturge weber syndrome Congenital RubellaCongenital Rubella

2424

CongenitalCongenital Rubella Rubella SyndromeSyndrome

Invasion of lens by virus Invasion of lens by virus (( f first trimisterirst trimister))

Dense bilateralDense bilateral nuclearnuclear CataractCataract

PDA,deafness & mental retardationPDA,deafness & mental retardation

Immature & poorly dilated Iris ,MicrocorneaImmature & poorly dilated Iris ,Microcornea..

1/31/3 hazy cornea due to Keratitis & Glaucomahazy cornea due to Keratitis & Glaucoma

Elevated infant IgM antibody against rubellaElevated infant IgM antibody against rubella..

Extreme inflammation post-opExtreme inflammation post-op

Complete removal of lens materialComplete removal of lens material..

2525

TreatmentTreatment

Poor if present at birth Poor if present at birth

Poor if corneal diameter is> 14 mm Poor if corneal diameter is> 14 mm

50% becomes legally blind50% becomes legally blind

favourable prognositic group favourable prognositic group

onset 3-12 monthsonset 3-12 months

Amblyopia is major problems Amblyopia is major problems Treatment is not sought until considerable damage has already occurred.

2626

How Is Glaucoma How Is Glaucoma TreatedTreated??

MedicationsMedications– Prostaglandin analogsProstaglandin analogs– Beta blockersBeta blockers– Alpha agonistsAlpha agonists– Carbonic anhydrase inhibitorsCarbonic anhydrase inhibitors– Cholinergic agentsCholinergic agents

Laser therapyLaser therapy SurgerySurgery

2727

Optic never damageOptic never damage

Corneal opacitiesCorneal opacities

Corneal astigmatism Corneal astigmatism

Surface irregularitisSurface irregularitis

AmblyopiaAmblyopia

Causes of Visual Loss in Congenital Glaucoma

2828Anti Glaucoma Drops

2929TRABECULOTOMY-GONIOTOMY

3030

Axial myopiaAxial myopia primary megalocorneaprimary megalocornea CORNEAL FINDINGSCORNEAL FINDINGS slerocornea slerocornea congenital hereditary endothelial congenital hereditary endothelial dystrophy dystrophy Keratitis Keratitis cystinosiscystinosis birth traumabirth trauma EPIPHORAEPIPHORA Nasolacrimal duct obstructionNasolacrimal duct obstruction

Differential DiagnosisDifferential Diagnosis ofof

Congenital GlaucomaCongenital Glaucoma

3131

3232

Clinical Clinical

presentationpresentation

Rapid onset of painRapid onset of pain Conjunctival injection (Conjunctival injection (RednessRedness)) PhotophobiaPhotophobia Decreased visionDecreased vision Discharge and lid edemaDischarge and lid edema

3333

Ocular infections

3434

Corneal Dismeters and Axial Lengths for Corneal Dismeters and Axial Lengths for GlaucomaGlaucoma

Corneal Diameters Axial Length (mm)

Age Normal Possible Glaucoma normal Glaucoma

Newborns 9.5-10.5 11.5-12.5 16-17 >20

1year 10-11.5 12.0-12.5 20.1 >22.5

2year 11.5-12 12.5-13.0 21.3 >23

3535

THANKS FOR YOUR ATTENTION

3636

Complete Ocular ExaminationComplete Ocular Examination

Slit lamp ExamSlit lamp Exam

RetinoscopyRetinoscopy

GonioscopyGonioscopy

TonometryTonometry

Measurment of corneal diameterMeasurment of corneal diameter

Optic Never evaluationOptic Never evaluation

Follow -up Evaluation (4-6 weeks)Follow -up Evaluation (4-6 weeks)

3737

Aqueous Outflow Pathway